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ANESTHESIOLOGY ACADEMIC PERFORMANCE POLICY

Background Information

• Besides learning the art and science of clinical care, one of the primary educational objectives of
anesthesiology residency is to prepare for the primary certification examinations: ABA Basic Exam, ABA
Advanced Exam, ABA Structured Oral Exam, and ABA OSCE. This policy specifically outlines the minimal
performance standards for the ABA Basic Exam and the ABA In-training Exam (ITE).

• At the end of each six-month period of clinical anesthesia training, we must report each individual resident’s
performance to the ABA. The ratings reported to the ABA are: “S” for satisfactory performance, which means
that full credit for that six-month period is given; “U” for unsatisfactory performance, the result of which is
described below. The ratings are based on the ACGME sub-competency milestones, derived from the six core
competencies, as well as the Essential Attributes.
 Essential Attributes: The physician who lacks one or more of the following attributes is not considered
qualified to practice anesthesiology safely.
o Demonstrates high standards of ethical and moral behavior.
o Demonstrates honesty, integrity, reliability, and responsibility.
o Learns from experience; knows limits.
o Reacts to stressful situations in an appropriate manner.
o Has no documented current abuse of alcohol, or illegal use of drugs.
o Has no cognitive, physical, sensory or motor impairment that precludes acquiring and processing
information in an independent and timely manner.
o Demonstrates respect for the dignity of patients and colleagues, and sensitivity to a diverse
patient population.

• If a “U”, for unsatisfactory, is reported to the ABA for a six-month period, conditional credit is given for that
period unless it is the last six-month period of training. A “U” designation received for the final six months of
residency leads to a six-month extension of training (according to ABA policies). Conditional credit is converted
to full credit if the next (or subsequent) six-month period is deemed an “S” by the program’s Clinical
Competence Committee. Two consecutive “U”s any time during the clinical anesthesia years require extension
of training by six months.

The Policy
ABA Basic Examination
• All residents are required to take the ABA Basic examination in June of the CA-1 year. Failure to register or
take the examination will be considered a failure in all but the most extreme circumstances, as determined by
the Chair of the Department in consultation with the Program Director (PD) and the Chair of the Clinical
Competence Committee.

• Should the resident receive a failing grade on the exam, an unsatisfactory report will be sent to the ABA for the
six month period to capture the time during which the examination score was released (corresponding to the
first 6 months of the CA2 year).

• The resident will be placed in an “individualized educational plan (IEP)”. The resident will meet with a Test
Taking Specialist at UAMS, will have focused and frequent Mentor sessions with their faculty mentor, will
complete all assigned learning activities (e.g., TruLearn quizzes), and must attend all required educational
conferences (e.g., Grand Rounds, review sessions, case conferences, Journal clubs, PBLDs).
• The resident must retake the examination at the next offering. Failure to register or retake the examination
will be considered a failure in all but the most extreme circumstances, as determined by the Chair of the
Department in consultation with the Program Director and the Chair of the Clinical Competence Committee.

• Should the resident receive a second failing grade on the Basic ABA exam, an unsatisfactory report will be sent
to the ABA for the six month period to capture the time during which the examination score was released. Two
failing grades on the Basic ABA exam shall constitute grounds for dismissal from the program. A committee
made up of the Clinical Competence Committee Chair, Department Chair, and Program Director will meet to see
if there are extenuating circumstances that preclude this action. The decision of the committee will be final.

ABA In-Training Examination

≤10th percentile:
An In-Training Examination (ITE) score at or below the 10th percentile will lead to a “U” (unsatisfactory) report
being sent to the ABA for the six-month period that the score was reported (January to June).

 The Clinical Competence Committee will meet after the ITE scores are reported in April to determine a
focused performance improvement plan that will include academic remediation (described below) plus
any additional competencies and attributes that must be addressed for the resident to successfully
progress in the residency program.
 The Clinical Competence Committee will review resident progress in October (6 months after the initial
review). Mentor reports, faculty evaluations, evidence of progression in clinical and non-clinical
competencies, and attendance at required learning activities will serve the basis for a decision about
extension of residency training (i.e., repeating the full residency year), non-renewal, and/or dismissal
from the residency program. The determination for continuation or dismissal will be made by a
committee comprised of the Chair of the Clinical Competence Committee, the Program Director, and the
Department Chair. The determination will be final.

≤30th percentile:
An ITE score at or below the 30th percentile at any point during the residency (including those with a
score ≤10th percentile) will lead to an academic remediation plan.

 The resident will be placed in an “individualized educational plan (IEP)”. The resident will meet with a
Test Taking Specialist at UAMS, will have focused monthly structured sessions with their faculty mentor,
and must attend all required educational conferences (e.g., Grand Rounds, review sessions, case
conferences, Journal clubs, PBLDs) with >90% attendance until the next ITE offering.
 The resident will be required to record arrival and departure time from the hospital. This data will be
linked to OR reports from EPIC to correlate the amount of in-hospital non-OR time.
 Faculty mentors will receive comprehensive reports to include: TruLearn activity, Anki Deck activity, and
in-hospital OR time and non-OR time, and will complete a structured report that addresses 1)
engagement with learning activities (as evidenced by TruLearn and Anki Deck activity reports,
attendance), 2) in-hospital OR and non-OR time.

Academic remediation begins in April when the ITE scores are released, and continues through the
following April for the first 3 years of residency. During the CA3 year, academic remediation continues
through graduation from residency.
Scaled score ≤30 on the CA3 ITE:
In addition, for the CA3 ITE, a scaled score ≤30 (which corresponds approximately to the 10th
percentile) will result in a “U” or “Unsatisfactory” report to the ABA for the final six-month period of
training.
 A “U” in the final six-month reporting period automatically triggers a six-month extension of
residency training (July – December).
 Midyear review (in October) by the Clinical Competency Committee will determine whether the
resident may graduate in December, or will be required to complete the full year of additional
residency training.
 A resident completing extended training will remain in academic remediation until graduation.

Opportunities tied to ITE performance:

Chief Resident:
 Chief residents will be selected from among those residents who score above the 30th percentile on
the ITE during the CA1 year AND pass the ABA Basic Exam on first attempt.

Research Elective Month:


 A score above the 50th percentile on the ITE during the CA1 year qualifies the resident for a research
month during the first half of the CA2 year.
 A score above the 50th percentile on the ITE during the CA2 year qualifies the resident for a research
month during the second half of the CA3 year.

CA3 Chronic Pain Elective Month:


 A score above the 30th percentile on the ITE during the CA2 year AND positive clinical reviews during
the CA2 chronic pain rotation will qualify the resident for a CA3 elective month in chronic pain, and
departmental support to apply for a Chronic Pain fellowship.

CA3 Health Policy, International, or other Away Electives:


 A score above the 30th percentile on the ITE during the CA2 year will qualify the resident to pursue
external elective opportunities (e.g., health policy, international).

Financial benefits tied to Examination performance:

ABA Basic Examination Fee:


• The Department shall pay the initial ABA fee towards the Basic examination but shall not pay any
subsequent fees for retaking a previously failed examination.

ABA Advanced Examination Fee:


• The resident must pay for the ABA Advanced exam fee from personal funds and submit receipts for
reimbursement. Reimbursement for the ABA Advanced exam fee, at the level of the first deadline submission
fee, will be after the CA-3 ITE scores are announced.
The following pertains to reimbursement for the ABA Advanced Exam fee :
 If a resident scores at or above the 30th percentile on both the CA-2 and the CA-3 ITEs, then the
resident receives full reimbursement.
 If a resident scores below the 30th percentile on either the CA-2 ITE or the CA-3 ITE, then the resident
receives half reimbursement.
 If a resident scores below the 30th percentile on both the CA-2 and the CA-3 ITEs, then the resident
will not be eligible for reimbursement for any portion of the ABA Advanced exam fee.

USMLE Examination:
It is strongly recommended that residents take the USMLE Step 3 as early in residency as possible. Successful
completion of USMLE Step 3 is required no later than December 31st of the CA-3 year. A resident who fails to
pass USMLE Step 3 by December 31st of their CA-3 year will receive a “U” or “Unsatisfactory” report to the
ABA for the final six-month period of their training. A “U” in the final six-month reporting period automatically
triggers a six-month extension of residency training. Failure to pass the USMLE Step 3 examination within the
six month extended training period will result in termination from the program.

Case logs:
In order to receive a satisfactory grade for the final six months, every resident needs to have completed his or
her case logs and must meet the minimum case numbers as required by the ACGME; case logs will be
reviewed quarterly by the Program Director or the PD’s designee(s).

Implementation Timeline:
2018-2019
o Basic Exam Retake Failure (for the November test) results in an unsatisfactory report
to the ABA for the six-month period to capture the time during which the examination
score was released (i.e., July to January CA-2). The CCC will determine whether
residents will be dismissed from the program or will be re-classified as CA1 residents
starting January 1, and will progress with the following class. Subsequent Basic Exam
Retake Failure will result in dismissal from the residency program.
o ITE 2018 results:
 ≤30th percentile results in implementation of the academic remediation plan
starting August 1, 2018.
o ITE 2019 results:
 ≥50th percentile for extended research time in 2019-2020;
 ≥30th percentile for CA-2 Chief eligibility, CA-3 Chronic Pain elective, and any
away rotations;
2019-2020
o Basic Exam Failure results in an unsatisfactory report to the ABA for the six-month
period to capture the time during which the examination was taken (i.e., January to
July of CA1 year). Basic Exam Retake Failure results in a second unsatisfactory report
to the ABA with dismissal from the program (both those making a third attempt in
June and those making a 2nd attempt in November).
o ITE 2020 results:
 ≤10th percentile results in an unsatisfactory report to the ABA for the six
month period to capture the time during which the examination score was
released
 CA3 scaled score ≤30 results in an unsatisfactory report to the ABA for the six
month period to capture the time during which the examination score was
released

2020-2021
o Full implementation of The Policy as written