VOLUME 37, ISSUE 1

Residency   training processes frequently change over time and it can be challenging to track all of the changes reliably.  Engagement with organizations that regulate residency training is an important aspect of staying up to date with changes that occur.  However, many who educate residents in training program may be unaware of changes as they occur unless they are actively engaged and able to attend numerous education society meetings.  My goal is to highlight important changes periodically so that we can all stay aware of the most current policies and procedures within the education of our future colleagues.  On that note, the American Board of Anesthesiology (ABA) has announced several policy changes and updates relevant for consideration by residents, training programs, and faculty members.  I would like to highlight aspects of the new ABA policies and how they may impact our trainees.

1. 1. The BASIC exam is the first part of the ABA staged examination series and was first required for those completing PGY-2 in 2014 and is offered twice each year. Up to this point, board policy has stated that an automatic “unsatisfactory” should result from a second and each subsequent failure on the exam for the Certificate of Clinical Competence (CCC) reporting period during which the examination was taken.  Also, board policy states that the failure to pass the BASIC exam three or more times will result in prolonged residency training.  The ABA is removing these two requirements as of January 1, 2025, and, instead, recommends each program establish its specific requirements for promotion and graduation.    Importantly, residency programs should expect that the Accreditation Council for Graduate Medical Education (ACGME) will continue to consider graduate board certification rate as a part of the overall program review.  Since passing the BASIC exam is required for board certification, residency training programs should consider their response to potential exam failure in advance of such an occurrence.  Guidance from the Association of Anesthesiology Core Program Directors (AACPD) may assist programs in development of the individual program’s local policy.  This is notable as the pass rate for repeat examinees declined for both the BASIC and ADVANCED exams in 2024. This data set demonstrates a repeat examinee pass rate that is approximately 20% and 30% lower than first time takers for the BASIC and ADVANCED exams, respectively.
   2. Examinee information regarding performance on the separate portions of the APPLIED exam, the Standardized Oral Examination (SOE) & Objective Structured Clinical Examination (OSCE), will be available to programs in the Record of Training Information Database (RTID), though candidates may opt out of making this available to their former programs.
   3. For training away requests, program directors must presently inform and receive approval from the ABA. Beginning January 1, 2025, there will now be certain circumstances for rotations of four weeks or less where the ABA will no longer require advanced notice.
   4. Demonstration of point of care ultrasound examination of the abdomen for free fluid and gastric volume/content assessment will additionally be included in the OSCE examination starting in 2025. For 2026, additional OSCE content includes interpretation of abdominal ultrasound images, qualitative and quantitative neuromuscular blockade assessment, and fetal heart rate monitor waveform and value.
   5. The ABA is developing a formative assessment tool for residents which is currently being piloted by several residency programs across the country. During this pilot phase, residents will receive questions covering BASIC and ADVANCED content in a variety of formats by email.  This educational effort is meant to provide supplemental instruction and spark conversation, and it is reported to be the first step in an evolving, long-term project being led by the ABA.
   6. Fellows will now be allowed to take the APPLIED exam and subspecialty exam in the same year, and fellows will not be required to pass the APPLIED before taking the subspecialty exam. Certain fellows may have multiple exams to coordinate during the fellowship year.  For example, an adult cardiac anesthesiology fellow may be trying to organize a schedule that includes the ADVANCED exam, the APPLIED exam (with its 2 components of the SOE and the OSCE), the adult cardiac anesthesia subspecialty exam and the Examination of Special Competence in Advanced Perioperative Transesophageal Echocardiography (Advanced PTEeXAM) all within a brief period of time.  Allowing flexibility in the sequence of the APPLIED exam and the subspecialty exam creates a better ability to coordinate a busy exam schedule.

As policy is changed and content outlines are updated, it will be important for training programs to be adaptable in their approach towards ensuring that high quality resident education leading to board certification is afforded to our trainees.  Program directors and faculty members will be key mentors for our trainees to ensure that they have the most up to date information regarding ABA policies and procedures surrounding the examination process.