Carlos Gomez-Garibello¹
Maryam Wagner² and Paola Fata²
1 Institute of Health Sciences Education - McGill University
2 McGill University

Background:
The Canadian Association of General Surgeons (CAGS) is a mandatory surgical knowledge exam for general surgery residents in Canada. This formative exam assesses the core knowledge required by trainees across different domains of surgery. The purposes of this study were to evaluate: i) the differences in surgical knowledge of residents across training years; and ii) longitudinal trends and development of knowledge over time. 

Summary of the Work
Residents’ performance data were analyzed both cross-sectionally and longitudinally, and across different surgical domains. Participants’ perceptions of the exam are collected using a post-exam survey. Exam results are used to foster residents’ learning through: 1) provision of a ‘report card’ detailing individualized learner’ exam performance, and program directors (who receive aggregated, anonymized data); and 2) delivery of a series of online interactive sessions between test-takers and expert surgeons reviewing test items. 

Results
The analyses revealed that the test successfully measures the progression of surgical knowledge and differentiates performance between junior and senior residents. The longitudinal analyses revealed that for learners who have taken the exam during the last five years, their overall performance improved progressively. In addition, the test also provided domain-specific information about residents’ strengths and areas for improvement across specific domains of surgery. Finally, residents perceived the exam as a positive resource to prepare for their certification examination. 

Discussion and Conclusion
These findings reveal that the CAGS exam has great potential to advance residency education by allowing residents to monitor their knowledge development and providing program directors information about their residents’ progress across specific domains, so they can make adjustments to their curricula.


Take home messages:

The CAGS exam exemplifies the ways in which learners can benefit from a formative exam. Additionally, this exam may serve as a model to integrate nation-wide formative examinations into program curricula. 

References (maximum three) 

Wrigley W, Van Der Vleuten CP, Freeman A, Muijtjens A. A systemic framework for the progress test: strengths, constraints and issues: AMEE Guide No. 71. Medical teacher. 2012 Sep 1;34(9):683-97. 

Fulcher G, Davidson F. Language testing and assessment. London and New York: Routledge; 2007 Jan.