The exact role that the American Board of Surgery In-Training Examination plays in resident evaluation remains poorly defined. All residents must take the In-Training Examination annually. An analysis was performed of the results of the In-Training Examination and the Qualifying Examination of the American Board of Surgery for 16 residents who completed their residencies between July 1976 and July 1981. Twelve graduates passed their initial Qualifying Examinations with a mean .+-. 1 SEM [standard error of the mean] score of 81 .+-. 2. Four graduates failed with a score of 70 .+-. 0.3. Corresponding scores on their final In-Training Examinations were 42 .+-. 9 and 11 .+-. 6 (P < 0.001). Each year the In-Training Examination Scores obtained by the residents who passed the Qualifying Examination were significantly higher than were those scores obtained by the graduates who failed. Linear regression analysis identified a significant correlation between the graduates'' initial (r = 0.676) and final (r = 0.760) In-Training Examination scores and the Qualifying Examination score. In the resident training program, In-Training Examination results correlated well with Qualifying Examination results and may be used as an objective determinant for remedial measures and resident retentions. These data should be developed on a national level. While Board certification was or likely will be accomplished by all the residents studied, the goal is to strengthen the academic characteristics of the training program to produce uniform success on the initial Qualifying Examination.