General Surgery Readmissibility to 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 General Surgery Qualifying Examination (GSQE) and/or the General Surgery Certifying Examination (GSCE)

The pathways include:

• Independent Study/Assessment Pathway requires passing of a specific examination for readmissibility
• Two Clinical pathway options (individuals may pursue only one)
  • Formal Training pathway: Requires two years of formal training in an approved general surgery residency program
  • Proctored Practice Pathway: Requires one year of full-time proctored clinical experience

Individuals who wish to pursue readmissibility should begin the process by contacting the appropriate ABS exam manager.

II. Time Limits

This policy applies only to individuals who have never been certified by the ABS and have lost their admissibility to the initial certification process. Any candidate who completed training seven or more years ago will be required to re-enter formal training and complete a five-year 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 who have not pursued admissibility are required to complete and submit the GSQE application and meet those requirements.

Individuals who were previously certified by the ABS but allowed that certificate to lapse fall under other ABS policies and should contact the ABS regarding their specific situation. Please see our Lapsed Certificates Policy for additional information.

III. 7-Year Readmissibility Period

Individuals who lose admissibility have no more than seven years to successfully regain admissibility to the general surgery certification process.

The seven-year period begins immediately once admissibility has been lost, either by exhausting the time limits or exam opportunities granted. Delays in pursuing readmissibility will count against the seven-year readmissibility period.

During this period, if unsuccessful in regaining admissibility to the GSQE or GSCE through one pathway, the individual may pursue the other pathway. Individuals may pursue only one of the two Clinical Pathway options. No pathway may be repeated. There is a three-year limit on the Independent Study/Assessment Pathway Pathway and an absolute seven-year limit on the total readmissibility process.

Once the seven-year period has been exhausted, unsuccessful individuals will be required to re-enter formal training and complete a five-year general surgery residency program accredited by the ACGME or RCPSC to regain admissibility to the certification process.

IV. Readmissibility Pathways

A. Independent Study/Assessment Pathway

1. Overview

This Independent Study/Assessment 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 they wish to take the required examination. Individuals who have not actively pursued admissibility are required to complete and submit the GSQE application meeting those requirements. This application must also be received by February 1. Note that those who have not actively pursued admissibility are not required to complete SESAP or provide references.

2. Application

Pathway applicants who are submitting a readmissibility application will be required to submit the following items. If these items have already been submitted for one of the other pathways, they do not need to be resubmitted.

1. A completed application form (Note: Application required will vary on a case-by-case basis; all requirements for initial certification must be met to pursue readmissibility.)
2. Documentation of completion of the most recent version of SESAP (for-credit version)
3. Application fee of $550 paid by credit card through the ABS portal
4. Names of and contact information for the chair of surgery and chair of credentials at the hospital where the majority of the surgeon’s work is performed (Note: 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.)

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 this pathway. Note that approval of the application for the Independent Study/Assessment Pathway Pathway does not grant any official ABS status to the applicant.

Pathway applicants who are submitting a GSQE application will be required to submit the following items. If these items have already been submitted for one of the other pathways, they do not need to be resubmitted.

1. Operative Experience Report from general surgery residency meeting the ABS case requirements. The ABS will accept the ACGME General Surgery Defined Category and Minimum Report.
   • Case requirements are: 850 total cases, 200 chief cases, 40 surgical critical care patient management cases, and 25 teaching assistant cases
2. Documentation of ACLS, ATLS, FLS and FES certification
3. Attestation signed electronically by the candidate and the individual who was the general surgery program director during the candidate’s chief year
4. Application fee paid by credit card through the ABS portal

Note that approval of the GSQE application for Independent Study/Assessment Pathway Pathway does not grant any official ABS status to the applicant.

3. Requirements

Upon application approval, the individual will be 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 nationwide. Applicants may select their exam date, time, and location within the designated exam window.

4. Admissibility and Exam Opportunities

Upon successful completion of the readmissibility exam, the applicant will be admissible to the GSQE for four opportunities within four years or to the GSCE for three opportunities within three years and will be considered “in the examination process” during this time.

B. Clinical Pathways

1. Overview

The ABS recognizes that surgeons seeking readmissibility to certification examinations benefit from structured mentorship and clinical experience.

These guidelines apply to individuals pursuing readmissibility through either the Formal Training Pathway or the Proctored Practice Pathway. They do not apply to examination-based readmissibility pathways unless specifically required by the relevant specialty board of the ABS.

• Formal Training Pathway: Requires completion of both the PGY-4 and PGY-5 years in an accredited resident position in an ACGME-accredited general surgery residency training program
• Proctored Practice Pathway: Requires completion of a 12-month full-time proctored clinical experience at an institution with an ACGME-accredited general surgery program. (Note: Does not need to be completed in an accredited resident position within a surgery program. The ABS does not match candidates to program and/or mentors.)

The application of these guidelines, including final determinations of requirements regarding eligibility, required activities, entrustability expectations, successful completion, and specialty-specific requirements rests with each of the ABS’s specialty boards.

These guidelines outline key components of both the Formal Training Pathway and the Proctored Practice  Pathway. While the 12-month proctoring experience does not need to be completed in an accredited position within a surgery program for those who are pursuing the Proctored Practice Pathway, it must be a full-time clinical experience that is completed in an institution with an ACGME-accredited general surgery program. The guidelines provide a flexible framework that can be adapted to specialty-specific needs and individual requirements while upholding core standards for readmissibility to board certification examinations.

All Clinical Pathway plans require approval from the ABS three months before the proposed start date. The ABS maintains final authority on approval of both the proposed program and documentation of successful completion.

Candidates may complete either the Formal Training Pathway or the Proctored Practice Pathway but not both.

2. Core Requirements

1. 1. Program Administration
      Successful plans require strong leadership and institutional support. A surgeon certified by the ABS who is active in clinical practice must provide a letter of commitment to serve as a mentor. For the Standard Clinical Pathway, program directors are expected to identify a mentor who meets the requirements as outlined.
      1. Mentor Qualifications
         1. Current board certification and completion of a minimum of five years of post-certification clinical practice
         2. Valid medical license and active surgical practice
         3. Documented experience in surgical education and the use of Entrustable Professional Activities (EPAs)
      2. Institutional Requirements
         1. Hospital privileges for mentor and candidate
         2. Comprehensive malpractice coverage
         3. Educational resources and adequate case volume to support proctoring
         4. Experience with implementation of EPAs
         5. Support for assessment and documentation
         6. If there is an existing onsite ACGME-accredited training program, verification that this additional surgeon will not negatively impact the program is required
2. Core Competency Focus
   The program must demonstrate that the candidate achieves entrustability. Specific EPA requirements for each individual will be determined by the ABS in consultation with the relevant specialty or subspecialty board.
3. Assessment Structure
   Regular evaluations ensure progress and address deficiencies promptly. The assessment plan includes:
   1. Required Evaluations to be Submitted to the ABS
      1. Initial baseline assessment, gap analysis, and learning plan
      2. Quarterly written competency evaluations
      3. Midpoint formal assessment
      4. Final comprehensive evaluation
   2. Documentation Portfolio to be Submitted to the ABS
      1. Detailed case logs, including an overview of the outcomes
      2. Assessment results and evaluations including EPA-based assessments as  required by the Specialty Board.
      3. Conference participation records
      4. Quality improvement activities
4. Additional Requirements
   Specialty boards may add requirements unique to their specialty, such as simulation-based training, participation in specialty-specific learning activities, or CME courses.
5. Submission Process
   The path to approval and completion involves several key steps:
   1. Identification of a mentor
   2. Initial plan submission with mentor credentials
   3. Quarterly progress reports
   4. Final documentation package with mentor endorsement
6. Remediation
   In case of deficiencies, a written remediation plan must be submitted within two weeks, with monthly reassessment and possible program extension (maximum three months).

The current posted version of this policy supersedes all prior versions.