Regaining admissibility

Regaining Admissibility to General Surgery Examinations

I. Introduction

Individuals may lose admissibility to the initial certification process for general surgery of the American Board of Surgery (ABS) if they exhaust the time limits or exam opportunities granted to them per ABS policies.

Pathways have been established to provide these individuals with the opportunity to regain admissibility to the following examinations:

  • General Surgery Qualifying Examination (QE)
  • General Surgery Certifying Examination (CE)
  • Three pathways are now available for regaining admissibility to either of these examinations. The Standard Pathway requires a year of formal training in an approved residency or fellowship program. The Alternative Pathway I requires passing of a specific examination for readmissibility. The Alternative Pathway II requires completion of educational materials developed by the American College of Surgeons (ACS).
  • This policy has been revised as of May 1, 2017, and supersedes all previous policies of the ABS governing re-entry to the general surgery certification process. The revised policy applies to all individuals — past, present and future — who seek readmissibility, including those currently in the readmissibility process.

II. Time Limitations

  • This policy applies only to individuals who have never become certified by the ABS and have lost their admissibility to the initial certification process. If these individuals have not actively pursued admissibility or readmissibility to the certification process within 10 years after completion of residency, they will be required to re-enter formal training for PGY-4 and PGY-5 level training in a surgery residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or Royal College of Physicians and Surgeons of Canada (RCPSC) to regain admissibility to the certification process.
  • Individuals previously certified by the ABS fall under other ABS policies and should contact the ABS office regarding their specific situation.

III. 7-Year Readmissibility Period

  • Individuals who lose admissibility to the general surgery certification process have no more than seven years following this event to regain admissibility.
  • The seven-year period begins immediately once admissibility has been lost, either by exhausting the time limits or exam opportunities granted. If an individual decides to delay in pursuing readmissibility, this will count against the seven-year readmissibility period.
  • During this period, if unsuccessful in regaining admissibility to the QE or CE through one pathway, the individual may pursue another pathway(s). There is a three-year limit on Alternative Pathway I, a three-year limit on Alternative Pathway II, and an overall absolute seven-year limit on the total readmissibility process.
  • No pathway may be repeated. Once the seven-year period has been exhausted, unsuccessful individuals will be required to re-enter formal training for PGY-4 and PGY-5 level training in a surgery residency program accredited by the ACGME or RCPSC to regain admissibility to the certification process.

IV. Applying for Readmissibility

To begin the readmissibility process, individuals must first contact the ABS coordinator to gain access to the online application process. All readmissibility applicants will be required to submit the following items:

  1. A completed application form
  2. Documentation of 60 credits of Category 1 CME completed within the last 24 months
  3. Application fee of $200 paid by credit card through the ABS website
  4. Reference forms completed by the chair of surgery and chair of credentials at the hospital where the majority of the surgeon's work is performed
    If these are not available due to the surgeon's type or location of practice, two reference letters from peers or referring doctors may be accepted. These reference letters must describe the applicant's practice and attest to the applicant's performance, ethics and professionalism.
  5. An operative case log for the most recent 12-month period. If the applicant has not been actively practicing surgery, the requirement for an operative log may be waived; however an explanatory letter must be included with the application for review.
  • Applicants must also possess a current full and unrestricted medical license to practice in the U.S. or Canada.
  • Once all application items have been received and the application for readmissibility approved, individuals will be permitted to pursue the following pathways. Note that approval of a readmissibilty application does not grant any official ABS status to the applicant.

V. Readmissibility Pathways

A. Standard Pathway
  • 1. Overview
  • The Standard Pathway requires completion of 12 months of senior-level clinical experience, including broad general surgery experience and a teaching environment with attending oversight and mentoring.
  • 2. Requirements
  • The applicant must complete 12 months of structured education in surgery in either an ACGME-accredited general surgery residency program or an approved fellowship program, in which the program director has agreed to provide an educational program that meets ABS guidelines. For fellowships, the ABS will accept completion of a 12-month training program in surgical critical care or acute care surgery, or an ACS Transition to Practice (TTP) fellowship toward this pathway. Other types of fellowships may be approved on an individual basis, if they provide broad general surgery experience and an appropriate teaching environment.
  • The structured educational program must be submitted to the ABS in advance for approval and must be a full-time activity. The program director must also submit quarterly summaries to the ABS of the individual's progress. Upon completion of the year, the program director must provide written attestation that the surgeon has successfully completed all requirements.
  • 3. Admissibility and Exam Opportunities
  • Upon completion of the required training, the applicant will be admissible to the QE for four opportunities within four years or to the CE for three opportunities within three years and will be considered "in the examination process" during this time.
B. Alternative Pathway I
  • 1. Overview
  • This alternative pathway allows individuals to study independently by their own methods and then demonstrate the acquisition of adequate surgical knowledge through the completion of a specific examination for readmissibility. If the individual does not already have an approved application for readmissibility, the application must be received by February 1 in the year he or she wishes to take the required examination.
  • 2. Requirements
  • The individual is granted three opportunities within three years to pass a secure examination of approximately 175-200 multiple-choice questions relevant to general surgery practice.
  • The exam is offered annually from mid-March through mid-May at computer-testing centers (see exam dates). Applicants may select their exam date, time and location within the designated exam window.
  • 3. Admissibility and Exam Opportunities
  • Upon successful completion of the readmissibility exam, the applicant will be admissible to the QE for four opportunities within four years or to the CE for three opportunities within three years and will be considered "in the examination process" during this time.
  • 4. Current Pathway Applicants
  • Individuals who entered this pathway in early 2017 fall under this revised policy, and will be granted three opportunities within three years to pass the readmissibility exam. If successful, they will then be admissible to the QE for four opportunities within four years or to the CE for three opportunities within three years.
C. Alternative Pathway II
  • 1. Overview
  • The ABS has designed a second alternative pathway to provide a more structured learning environment with completion of designated educational materials developed by the American College of Surgeons. This pathway also offers the option for receiving one-on-one mentoring from senior surgeons at the ACS. This new pathway is being introduced on a pilot basis, and may be modified periodically as experience is gained with it.
  • Enrollment of new candidates into this pathway will begin each year in mid-July immediately following the QE. Once enrolled, individuals may participate in this pathway for up to 36 months.
  • 2. Requirements
  • This pathway requires participation in three ACS programs:
  • Individuals enrolled in this pathway will be required to complete a minimum of one SRGS module per month. They will also be required to complete all modules in the current version of SESAP within a 12-month period. The General Surgery Review Course is offered once yearly in late July; candidates will be expected to attend this course and complete all required activities for CME credit.
  • 3. Admissibility and Exam Opportunities
  • Upon completion of the first 12 months in this program, including satisfactory completion of at least 12 SRGS modules, SESAP, and the review course, the applicant will be considered "in the examination process" and will be granted one opportunity to take the QE or CE, as applicable. The ACS will track the individual's participation in the pathway and inform the ABS as to his or her progress.
  • If unsuccessful in passing the QE or CE after completion of the first year, the applicant may continue for up to two additional years with the same yearly requirements to receive up to two more exam opportunities. If an applicant for any reason fails to complete the required material for a three-month period, they will be considered to have resigned from this pathway. If applicants are unsuccessful in passing the QE or CE after 36 months of participation, they will not be eligible for further continuation in this pathway.
  • 4. Fees
  • Applicants will be required to purchase these three educational resources from the ACS, and will be offered a reduced rate from standard fees. In addition, candidates will be financially responsible for any costs assessed by the ACS for the optional mentoring program (details below).
  • All financial arrangements for these programs will be directly between the candidate and the ACS, without ABS involvement. The ABS has no financial relationship with the ACS in regard to this pathway, and will in no way profit from the participation of candidates in this program. If candidates find at any time that they do not wish to continue or that the program is not useful to them, they may for any reason resign their participation in this pathway and will not be obligated for further charges.
  • Additional one-on-one mentoring by experienced surgeons selected by the ACS is available if desired by the participant. At a minimum, the mentoring component of this pathway will require participants to meet initially with ACS surgeons who will discuss their study habits and learning issues and help them establish a plan as to how the educational materials can best be used. Fees for all of these mentoring interventions will be disclosed upon entry to the program.
  • 5. Further Information
  • Individuals who enter this pathway acknowledge that neither the ACS nor ABS is offering any guarantees or assurances of success from this program. Rather, it should be regarded by all participants as a pilot effort to define a more effective way of remediating candidates who have been unsuccessful in passing the QE or CE through their own efforts. This pathway has been created to provide candidates with structured learning materials related to general surgery that have been validated over decades, and to accompany this by a direct mentoring relationship with an experienced surgical educator who can provide advice and feedback regarding effective methods of studying and learning the necessary material.

Updated: May 2017

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