Invited Commentary for “Multi-Institutional Study of Self-Reported Attitudes and Behaviors of General Surgery Residents About Ethical Academic Practices in Test-Taking”

The first American Board of Surgery In-Training Examination (ABSITE) was given in 1975 at the urging of resident program directors who wanted a tool to measure resident’s knowledge. The introduction of testing had arisen after a joint effort by the Mayo Clinic and National Board of Medical Examiners in 1967. By the time I took my first ABSITE in January 1980, the examination had already struck fear into the hearts of surgical residents. As a postgraduate year (PGY)-1 resident, I took my 2 weeks of annual vacation reading a surgical textbook in the weeks prior to the ABSITE. Reading the Surgical Education and Self-Assessment Program questions was also recommended and demonstrated the value of studying questions, a practice now extending to medical students reviewing 5000 questions prior to their United States Medical Licensing Examinations. During my PGY-2 year, my program’s pyramidal system required a manpower reduction from 9 to 4 categorical residents. Those of us with the top 4 ABSITE scores were chosen to become PGY-3 residents. The other 5 residents were left with an uncertain future and livelihood. Fortunately, for the most part, the pyramid is gone. What is the reader to make of the assessment of theoretical unethical, and perhaps illegal, ABSITE behavior derived from the paper, Multi-Institutional Study of SelfReported Attitudes and Behaviors of General Surgery Residents about Ethical Academic Practices in Test-Taking by Grignol VP, Grannan K, Sabra J, et al? In an attempt to measure the ethical behavior of general surgery residents pertaining to their use of ABSITE questions for personal benefit, a variety of hypothetical scenarios are posed for their responses. Buying and selling ABSITE questions were clearly