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FAQs - 2020 Virtual General Surgery Qualifying Exam

ABS moved to a web-based, remote-proctored delivery for the July 2020 Surgery Qualifying Examination (QE), in hopes of minimizing unnecessary public exposure of our candidates during the ongoing COVID-19 pandemic, and to lessen the likelihood of disruption of the exam due to testing center closures and cutbacks at local levels. On the first day of the exam, the remote-proctoring service collapsed, causing delays, interruptions, and ultimately, a break down of the entire exam. They were not able to repair the problems in time to deliver the exam on Friday.

ABS contracted with our long-term trusted partner, Internet Testing Systems (ITS). ITS has delivered the in-training exam through a secure browser for the ABS for 10 years, and the Continuous Certification Assessment for the last two years. They have a superb track record. They do not offer remote proctoring, but subcontracted with a remote proctoring company with experience in the area, Verificient. Verificient is a certified SOC 2 organization, which is a high standard of security. SOC 2 certification requires companies to establish and follow strict information security policies and procedures encompassing the security, availability, processing, integrity, and confidentiality of customer data.

Although we were able to preserve 50% of the content by not delivering the exam on the second day, a new test draft will need to be developed. This process is usually an 18-month cycle, but can clearly be shortened with this large backbone of items. Nevertheless, putting together the right mix of questions across the curriculum content and reviewing the test draft will take several weeks at a minimum. Exam delivery services (Pearson VUE and ITS) require the items between 60 and 90 days before exam delivery, to convert them to the delivery platform, Q/A, and publish. It is possible that this timeline can be shortened, but it may be a process that can’t be changed. We are actively working with our partners to find out what our options are to redeliver this exam in a timely fashion.

Chief residents did not take the in-training exam with the expectation that it was a high-stakes exam, and some may not have fully prepared or performed as well as they would have. Not all candidates were chief residents this year, and will not have a recent in-training score. Most importantly, the in-training exam is not designed or scored for high-stakes assessment, and could not be considered a valid high-stakes assessment tool.

Our recent paper in JAMA Surgery demonstrated that both exams that are offered as part of the initial certification process are independently correlated with the risk of severe actions against medical licenses. Those who pass both the QE and CE on the first try are at the lowest risk, and the risk increases with each additional attempt for each exam. Both parts of certification are necessary to maintain our standards.

See our recent study, Association Between American Board of Surgery Initial Certification and Risk of Receiving Severe Disciplinary Actions Against Medical Licenses, published March 2020 in JAMA Surgery.

We have not had a complete cancellation, but we have had regional or exam center disruptions that made it impossible for some groups of people to take it in a given year. Exam centers have been affected by construction, area traffic, hurricanes, floods, and power outrages, causing same day or near time cancellations.

Exam delivery platforms need 60-90 days to prepare an exam for administration. Decisions about the July exam had to be made in April and May to be implemented in July. The ABS had a principle that we would not expose our volunteers, candidates, diplomates, or staff to COVID-19 by requiring them to be in public spaces during the pandemic. That, coupled with the fact that in April Pearson centers were closed or restricted across the country, dictated the decision to move away from Pearson testing centers for this exam.

We have asked all candidates to email us directly to report any suspicions of hacking, theft, or stalking. We are working with ITS and other cybersecurity experts to obtain videos, audit trails, and all other available information on these events.

The ABS is not adding to its coffers with exam fees. Between September 2018 and July 2020, ABS has invested approximately $5,000,000 of reserves in improving the quality, relevance, validity, and delivery of exams. Current exam fees do not cover expenses.

ABS announced on Friday, July 17, 2020, that we would be providing Qualifying Exam fee refunds to all candidates registered for the exam. Refunds began to process on Tuesday, July 21. We appreciate your patience as we individually process these refunds, a process that could take up to two weeks. Additionally, the credit card processing firm has confirmed that it takes seven to ten days from the settlement date (typically the day after the refund is processed) for the credit to show on the card holder's account.

The application fee for the 2020 Qualifying Exam was not included in the automatic refund. The application fee, paid by the applicant upon submission of the application materials when entering the certification process, is a fee that covers the processing of applications for both the Qualifying and Certifying Exams. By virtue of having an accepted, completed application, you are considered to be "in the examination process."

We will refund application fees upon request. If you choose to have your application fee refunded, you will be removed from the certification process for the 2020-2021 academic year. If you would like to re-enter the certification process in the 2021-2022 academic year or beyond, you can do so by reapplying at that time.

ABS posted updates on our website as they became available. Twitter was used to widely disseminate information and point to the website. Mass emails on our current service can take 90-120 minutes to be delivered. Since we were updating in real time, emails might have been outdated before arrival. The final cancellation email was irreversible, so we did not post on Twitter until after we knew that all emails had been sent. The emails went out late in the evening because ABS and ITS staff were working and testing patches from Verificent until nearly midnight before a final fatal error was identified.

We considered local proctoring, but quickly realized that many candidates have left their home institution, and many are not near academic medical centers. We were concerned that hospitals would not allow unaffiliated physicians in the doors to test during a pandemic. We decided that this was not a solution that could be implemented broadly and fairly enough for all candidates. Logistics of matching candidates with proctors and subsequently training the proctors were overwhelming in a short timeline. That being said, it does seem worth exploring for the 2021 QE, and perhaps even for 2020 with enough lead time.

The ABS is committed to including both candidates and program directors in the process. As of Monday, July 20, the General Surgery Board is in the midst of initial discussions to achieve this. ABS will host online discussions, webinars, and townhalls in upcoming weeks.

ABS as a whole cannot stress enough how deeply apologetic we are for this unfortunate situation. It will take us some time to resolve, but please know that we are sparing no effort in doing so. Please see the announcement posted on our website Friday, July 17.
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