American Board of Surgery examination performance represents an important residency metric. The hypothesis is that demographic differences exist between the most and least successful programs.

This was a retrospective fifteen-year study. Data focused on program Examination Index (EI). The first and tenth decile programs were compared across demographics, using an α = 0.05.

The first decile had a higher EI than the tenth decile (91.0% ± 2 .6% vs 51.4% ± 5.4% [p < 0.001]). The first decile programs were larger (p = 0.001). The first decile had more military and academic programs, with fewer community programs (p = 0.01). More first decile programs were in the West with fewer in the Northeast (p = 0.02).

There are clear differences in ABS examination performance based on program size, type, and location. These results essentially perform a national needs-assessment, and may evoke a spirit of competition and collaboration.

In this study, the long-term performance on the American Board of Surgery examinations was examined for established residency programs, focusing on the first and tenth decile of residency program performance. First decile programs were more likely to be larger programs, have a higher percentage of military distinction, more likely to be in the West, and had a lower percentage of international medical graduates. Demographic differences were also seen nationally. This study essentially performed a national needs-assessment, and the results could potentially evoke a competitive spirt of the “gamification” of examination performance, as well as a collaborative spirit with regard to these high-stakes examinations.