The Thoracic Surgery Directors Association In-Training Exam: Development, Implementation, and 6-Year Trends.

Abstract

The Thoracic Surgery Directors Association In-Training Exam (TSITE) provides an annual, formative standardized assessment for cardiothoracic surgery trainees. This report outlines its historical development, governance, administration, and performance data from exams delivered from 2020 to 2025. The TSITE is administered annually by the Thoracic Surgery Directors Association to assess trainee knowledge by using a structured taxonomy aligned with American Board of Thoracic Surgery qualification content. The multiple-choice question exam comprises 160 questions (80 cardiac, 80 thoracic) derived through a rigorous question-writing and vetting process. Annual metrics included exam completion time, average scores, performance distribution, and Cronbach alpha. Examinee numbers increased from 437 in 2020 to 567 in 2025. Cronbach alpha ranged from 0.80 to 0.86, reflecting high reliability. A shift from 4 options with 3 distractors to 3 options and 2 distractors in 2025 decreased average exam time. Score distributions demonstrated stable performance trends, with most trainees scoring between 50% and 69%. The TSITE is a valid, reliable, and evolving personalized learning tool that supports both trainee self-assessment and programmatic benchmarking. Its iterative refinement reflects ongoing efforts to align with evolving clinical practice, American Board of Thoracic Surgery expectations, and user feedback.