Background: Common measures of evaluating surgical resident progression include American Board of Surgery In-Training Exam scores and Accreditation Council for Graduate Medical Education operative case logs. This study evaluates the relationship between operative cases performed and American Board of Surgery In-Training Exam scores in general surgery residents. Methods: A retrospective review of American Board of Surgery In-Training Exam scores and operative case logs was performed for postgraduate year 1–5 general surgery residents at a single academic institution (2008–2017). For each resident, the total number of operative cases logged from the start of their postgraduate year 1 until the end of each academic year was calculated and compared to their American Board of Surgery In-Training Exam scores for that corresponding year. Results: At all postgraduate-year levels, there was a positive linear relationship between the number of cases logged and American Board of Surgery In-Training Exam percentile (slope, m = 0.23–5.2, R2.01–.17) and scaled (m = 0.29–5.3, R2.13–.37) scores. At the postgraduate year 1, 2, 3, and 5 levels, and with all residents combined, residents in the top quartile of cases logged performed significantly better on the American Board of Surgery In-Training Exam than those in the bottom quartile (P <.05). Conclusion: Surgical residents who perform more operative cases do significantly better on the American Board of Surgery In-Training Exam than their peers. This association may be due to increased clinical experience, exposure to pathology, and/or individual resident motivation.
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