The American Board of Surgery approved in 2003 the Early Specialization Program (ESP), a new pathway leading to certification in both surgery (general surgery) and vascular surgery, to be accomplished in a combined training program of four years of surgery followed by two years of vascular surgery at the same institution. Any proposed ESP must be approved by the Residency Review Committee for Surgery (RRC-Surgery) of the ACGME before implementation.
ESP does not result in a shortening of requirements for surgery certification. Sixty months of residency are still required prior to surgery certification and the requirements of the RRC-Surgery continue to apply. The difference is that 12 months of experience in a content area of surgery, i.e., vascular surgery, that normally occurs in PGY-5, will count toward both general surgery and vascular surgery certification.
The RRC-Surgery administratively manages the ESP, receives all applications, and reviews and approves such programs as part of its oversight process.
ACGME-accredited residency programs in surgery and vascular surgery that elect to participate in ESP must continue to meet all requirements of the RRC-Surgery in effect for those programs. In particular, both programs' passing rates on the ABS qualifying and certifying examinations in those specialties must meet or exceed RRC-Surgery requirements.
Please see the document below for RRC-Surgery application requirements for new programs and for established programs requesting additional trainees:
1. The principal content areas of general surgery have been defined by the ABS as the following:
Alimentary tract (including bariatric surgery)
Abdomen and its contents
Breast, skin and soft tissue
Solid organ transplantation
Surgical critical care
Surgical oncology (including head and neck surgery)
Trauma/burns and emergency surgery
2. Secondary areas/rotations are the following:
Plastic and reconstructive surgery
3. Additional technical experience which is separately evaluated by the RRC as defined categories, but which generally involve one of the content areas, are:
4. Other specialty areas which have been previously defined are:
Thirty-six of the first 48 months of surgery residency must be spent in areas 1, 2, or 3 above. In general, no more than four months of the 36 may be spent in vascular surgery.
Requirements in PGY-4 and PGY-5
The requirements for the PGY-4 and PGY-5 years are as follows:
During the 24 months of PGY-4 and PGY-5, a minimum of 12 months must be spent as chief resident in surgery. Chief resident rotations are defined as rotations in which the resident is the most senior resident on the service, is directly responsible for overseeing all patients on the service, and reports directly to the responsible attending physician.
A maximum of 12 months of the 24 months of PGY-4 and PGY-5 may be devoted to training in vascular surgery. This would normally be the 12 months of PGY-5.
It is highly desirable that the 12 months in the other content areas or thoracic surgery occur in PGY-4. Exceptions will be considered on a case-by-case basis and requests for such exceptions must include justification that such arrangements will not compromise broad experience in surgery.
It is desirable that the 12 months as chief resident in surgery be in the other content areas or thoracic surgery. Exceptions, which would allow up to four months of experience in vascular surgery to be considered part of the chief resident experience, will be considered on a case-by-case basis. Requests for such exceptions must also include justification that such arrangements will not compromise broad experience in surgery.
No more than four months as chief resident in surgery may be devoted to any single content area or thoracic surgery.
In situations where part of PGY-4 is spent on vascular surgery rotations, an equivalent amount of time must be spent as chief resident during PGY-5 in the other content areas/thoracic surgery.
The 12 months devoted to vascular surgery credited toward training in surgery must be spent entirely in clinical rotations and cannot include research rotations. Nonoperative rotations (e.g. interventional radiology) during PGY-5 are also not creditable toward the certification requirements in surgery. In such situations, individuals will not be admissible to the certification process in surgery until completion of acceptable operative rotations in PGY-6 that are of at least equal length to the non-creditable rotations.
Residents participating in ESP will not be considered for certification in surgery until they have completed 24 months of acceptable clinical rotations beyond PGY-3.
Eligibility for Certification
Residents who successfully complete an ESP will be eligible for certification in surgery at the end of PGY-5 and for certification in vascular surgery at the end of PGY-6. Application to enter the surgery certification process may be made in PGY-5, and the applicant may take the General Surgery Qualifying Examination (QE) during PGY-6 or afterwards. The General Surgery Certifying Examination (CE) may be taken following successful completion of the General Surgery QE. All rules and procedures governing the QE and CE processes for general surgery residents also apply to graduates of an ESP.
ESP graduates should refer to the Training Pathways page for further information. All rules and procedures for vascular surgery certification that apply to other graduates also apply to graduates of an ESP.