Flexible Rotations During General Surgery Residency
Please note that approval must be obtained for each individual resident, regardless if the program received approval in the past for the same arrangement. The ABS approval letter should be submitted with the resident's application to the General Surgery Qualifying Exam.
The program will receive separate approval letters from the ABS and RRC-Surgery; both must be received prior to implementation of flexible rotations.
Example of Block Diagram
See also: ABS-RRC Flexible Rotations Policy (pdf).
- The American Board of Surgery approved in 2011 a new policy to permit greater flexibility in the structure of general surgery residency training.
- With advance approval, program directors may customize up to 12 months of a resident's rotations in the last 36 months of general surgery residency to allow for "early tracking" into the resident's chosen specialty. No more than six months of flexible rotations are allowed in any one year. This is an entirely voluntary option for program directors and may be done on a selective, case-by-case basis.
- Requests for ABS approval should be made in advance by letter (see next section). The requirement that no more than four months in the chief year be devoted to one area will be extended to six months, if necessary, upon approval. This policy does not affect any of the ABS' other requirements for certification.
Requesting Flexible Rotations
- To request flexible rotations for a resident, a letter should be mailed (no e-mails or faxes) to both the ABS (addressed to Dr. Jo Buyske, ABS associate executive director) and the executive director of the RRC-Surgery. The letter must be signed by both the program director and the designated institutional official (DIO) and be accompanied by:
- A block diagram (see example below) outlining the specific resident's individualized rotations
- A request to assign up to six months of chief experience in PGY-4, if necessary (RRC approval only)
|Resident, PGY Level, Specialty of Interest||Flexible Rotations||In lieu of:|
|Jane Smith, PGY-4, Transplant||Transplant Surgery (3 months)||Thoracic (1 month)|
Endocrine/Oncology (2 months)
|Aaron Jones, PGY-5, Surgical Oncology||Colorectal Surgery (2 months)||MIS (1 month)|
Trauma Surgery (1 month)
|Kate Walsh, PGY-5, Pediatric Surgery||HPB Surgery (1 month)|
Neonatal ICU (1 month)
|Critical Care (1 month)|
VA Surgery (1 month)
- The guidelines below are not intended to be prescriptive. They were created by the ABS to assist program directors in the design of flexible rotations for residents interested in a specific specialty. However, regardless of a resident's future specialty, the development of leadership skills and the ability to make independent decisions are critical for all residents and should be the hallmark of the surgical chief resident year.
- Flexible Rotations vs. ESPs: While the guidelines below mention the curricula of early specialization programs (ESPs) as a reference, ABS approval is not required for ACGME-accredited ESPs. The approval process above relates solely to flexible rotations within a five-year general surgery residency.
|Specialty Area||Recommended Training/Rotations|
|Acute Care Surgery / Surgical Critical Care||Exposure in senior residency years to vascular surgery, cardiothoracic surgery and open abdominal surgery is recommended.|
|Cardiothoracic Surgery||An elective PGY-3 rotation in cardiothoracic surgery is recommended. Program directors may also refer to the early specialization program curriculum for guidance on suggested rotations.|
|Colorectal Surgery||Specific training in all aspects of abdominal surgery, including open and advanced minimal invasive surgery, should be emphasized. Proficiency in open colon resection, laparoscopic colon resection and endoscopy are essential to the entering colorectal fellow.|
|Surgical Oncology||Senior-level experience in the six areas of the surgical oncology curriculum (upper GI, hepatobiliary, colorectal, endocrine, breast, and melanoma/sarcoma) is recommended.|
|Vascular Surgery||Program directors should refer to the early specialization program curriculum for guidance on suggested rotations.|
For questions regarding this policy, please contact the ABS coordinator.
Updated: September 2014