American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

These Three Practical Tips Can Help You Use the Neuroscience of Learning to Successfully Prepare for the ABSITE Exam

Carl Gustaf S. Axelsson, MD, MPhil, MMScMichael G. Healy, EdDRoy Phitayakorn, MD, MHP

Introduction

The American Board of Surgery In-Training Examination (ABSITE) was originally created to be an assessment tool of a resident’s knowledge, as well as to formatively identify individual and programmatic deficiencies.1,2 Over time, the ABSITE has been increasingly used as a data point to assess residents for remediation as well as for fellowship applications due to the observed correlation between ABSITE scores and the subsequent American Board of Surgery qualifying examination.2 However, residents have limited time to prepare for the ABSITE, and previously published recommendations to maximize ABSITE scores have intermittent success.3 In addition to these recommendations, we feel that a better understanding of how to apply the neuroscience of learning principles may provide insight into how to learn most effectively and help residents when preparing for the ABSITE. These principles include three key concepts:  the testing effect, retrieval practice, and interleaving.4 In this article, we review these key concepts and suggest available resources that residents can use to leverage their effects.

The Testing Effect

The testing effect is the concept that retrieving information from memory during a simulated exam or practice test can increase the long-term retention of that material or information.4 In practice, this concept implies that being tested on information, rather than merely reading it, is critical for knowledge mastery.5 To fully leverage the testing effect, learners must engage in the retrieval of information through answering recall-type or recognition-type multiple-choice questions and completing short-answer questions on the same knowledge topics.6 In addition, learners need to receive timely feedback on whether or not their answer is correct, along with rationale, in order to maximize this effect.6

There are many testing resources available for residents to prepare for ABSITE, including books, review courses, and various e-learning platforms, such as question banks.7,8 To apply the testing effect to books, a resident can create questions on specific topics covered in the text and return to these questions after reading that chapter. PeerWise is a free collaborative question writing application where groups of learners can create multiple choice question banks and then revise and choose the best questions for testing practice. There are also paid subscription question banks that give residents direct access to multiple-choice questions and practice exams. Table 1 illustrates a sampling of paid subscription question banks for ABSITE preparation and Table 2 a sampling of educational programs that can aid in ABSITE preparation.

Table 1. Paid Subscription Question Banks for ABSITE Preparation

Product

Selected Features

Subscription Information

Website

ABSITE Quest: Powered by Qstream

  • Over 1,000 ABSITE practice questions
  • 3 ABSITE review questions sent daily to complete
  • Spaced delivery of questions is utilized
  • Subscription Type:
    • Individual
  • Pricing:
    • 12 Months: $99

https://absitequest.com

Decker Surgery: BRe Surgery (Board Review)

  • Featuring ASBITE review exercises (Part 1), mock exam and qualifying exam prep (Part 2), and a question bank with over 3,500 questions (Part 3)

 

  • Subscription Type:
    • Individual
    • Institutional
  • Pricing:
    • 1 Year (Individual): $471
    • Residency Program: $1,500 and $125 per trainee/faculty

https://www.deckerip.com/products/surgery/

National Surgery Review: ABSITE/In Training Review Course Online

  • Over 40 hours of lectures
  • Over 140 ABSITE practice questions
  • Subscription Type:
    •  Individual
  • Pricing (Examples):
    • 1 Month: $399
    • 12 Months: $999

 

https://www.nationalsurgeryreview.com

TrueLearn: ABSITE SmartBank + Assessment Exam

  • 1,000 ABSITE practice questions
  • 250 question assessment exam
  • Elements of cognition science
  • National Real-Time Benchmarking
  • Subscription Type:
    • Individual
  • Pricing (Examples):
    • 1 Month: $220
    • 12 Months: $330

https://truelearn.com/general-surgery/absite-exam/

Table 2: Educational Programs Aiding in ABSITE Preparation

Product

Selected Features

Subscription Information

Website

American College of Surgeons: SESAP 17

  • 650 case-based, multiple-choice questions
  • Reset options allowing for focused reuse

 

  • Subscription Type:
    • Individual
  • Pricing (Examples):
    • Resident Member (NonCME Package):  $263
    • Resident Non-Member (NonCME Package): $357

https://www.facs.org/education/program/sesap

SCORE

  • Access to 700+ modules, 12 leading textbooks, and hundreds of surgical videos
  • This Week in Score
  • More than 1,500+ multiple-choice questions, which can be used to create custom quizzes
  • Subscription Type:
    • Individual
    • Institutional
  • Pricing:
    • 1 Year (Individual): $325
    • Residency Program: $500 annual license and $175 per trainee

https://www.surgicalcore.org

Retrieval Practice

Retrieval practice, which is closely related to the testing effect, implies that frequent retrieval of information from memory, preferably in a spaced manner, enhances learning and long-term retention.6 The frequent retrieval of information from memory appears to be superior when compared to repeated studying or re-reading of material.4,9 Similar to the testing effect, feedback is important to allow for correct knowledge to be transferred between different contexts (e.g., the ABSITE examination versus real-life clinical context) and retained.4 There is no specific literature on the optimal spacing to maximize retention, and it likely varies with the learner’s overall comfort and experience with a given topic. Well-established topics can be spaced at greater and greater intervals compared to new knowledge or knowledge that is difficult for the learner to retain.

Applying Retrieval Practice to ABSITE Preparation

Residents can apply retrieval practice to their ABSITE preparation in a variety of ways. First, residents can develop flashcards (e.g., Anki flashcards) on topics that occur in the clinical context, didactic teaching sessions, or the OR and revisit them regularly (e.g., once per week). Additionally, residents can collaborate by sharing their flashcards on various ABSITE topics. Please see Table 3 for a sampling of flashcard creation applications. Of note, some online question banks also apply retrieval practice by allowing flagged questions to be repeated at a specified time interval.

Table 3: Flashcard Creation Applications


Product

Features

Website

AnkiApp Flashcards

  • Free and iOS, Android, Windows and Linux compatible
  • The app tracks your knowledge
  • Create and easily share your flashcards
  • Pre-made flashcards are accessible

 

         https://www.ankiapp.com

Brainscape

  • Free and iOS and Android compatible
  • Create your own flashcards
  • User generated flashcard sets available

https://www.brainscape.com

Quizlet

  • Free and iOS and Android compatible
  • Create your own flashcards
  • Online database of previously generated flashcards

        https://quizlet.com

Firecracker

  • Desktop accessible and iOS and Android compatible app available
  • Subscription-based model
  • Pre-made flashcards on various medical topics
  • Accompanying question bank
  • Features include progress tracking, spaced assigned tasks and diagnostic tests

https://firecracker.lww.com/

Interleaving

Interleaving, which is the shifting and revisiting of topics, can lead to improved learning and retention in comparison to blocked learning, which is attempting to master a topic in isolation before moving on to the next topic.10 The frequent interleaving of various topics may seem both arduous and counterintuitive, but it results in greater retention likely by stimulating more effortful recall and by avoiding mistaking familiarity and fluency for retention and comprehension. In addition to facilitating long term recall,11 interleaving also enables superior discrimination of different topics, as shown throughout the educational landscape within and beyond medical and surgical education.12 For example, an interleaved approach to learning EKGs has been shown to be superior in medical students. Students who practiced using different categories of EKGs throughout their practice, as opposed to blocked learning, performed significantly better in the final assessment of knowledge.13

Applying Interleaving to ABSITE Preparation

Similar to the testing effect and retrieval practice, interleaving can be applied to dedicated individual studying and/or facilitated by faculty within a program’s curriculum. For example, on the individual level, residents should aim to cover a different topic each time they read, review flashcards, or use question banks and systematically revisit each topic. Practically, residents should try to review at least one old topic each time they study before they move on to a new topic. Another example of interleaving would be if a resident wants to create a block of 100 ABSITE practice questions to test their knowledge.  Instead of doing many questions on just a few topics, they should create a practice exam that follows the ABSITE test blueprint. Furthermore, programs should institute weekly didactic teaching in conjunction with asynchronous methods, including video-based education and online journal clubs, that can be scheduled in a fashion that collectively varies and revisits relevant ABSITE topics.

Conclusion

In summary, by actively engaging in self-directed learning and utilizing key neuroscience of learning principles, residents will be more effective in their ABSITE preparation. Importantly, the key neuroscience of learning principles described above are universal and can be applied in a variety of situations, regardless of the learning environment or setting, and can help our residents prepare to be true lifelong learners.

Summary of Learning Points

  • The testing effect describes the concept that retrieving information from memory during a simulated exam or practice test can increase the long-term retention of that material or information.
  • Retrieval practice, which is closely related to the testing effect, implies that frequent retrieval of information from memory, preferably in a spaced manner, enhances learning and long-term retention.
  • Interleaving, which is the shifting and revisiting of topics, can lead to improved learning and retention in comparison to blocking, which is attempting to master a topic in isolation before moving on to the next topic
  • By actively engaging in self-directed learning and utilizing key neuroscience of learning principles, our residents will be more effective in their ABSITE preparation and can help them prepare to be true life-long learners.

Carl Gustaf S. Axelsson, MD, MPhil, MMSc., is a Post-Doctoral Medical Education Researcher at Massachusetts General Hospital, Harvard Medical School in Boston, MA.

Michael G. Healy, EdD, is a Research Fellow at Massachusetts General Hospital, Harvard Medical School in Boston, MA.

Roy Phitayakorn, MD, MHP, is a General and Endocrine Surgeon and Director of Medical Student Education & Surgery Education Research at Massachusetts General Hospital in Boston, MA and an Associate Professor of Surgery at Harvard Medical School in Boston, MA.