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2021 Hardship Modifications to General Surgery Training Requirements

Please see below for a list of hardship modifications and accompanying FAQs for 2021 graduating general surgery residents. Unless noted otherwise, these hardship modifications apply to individuals completing training in 2021 only.

Hardship Modifications

  • Non-voluntary offsite time that is used for clinical or educational purposes can be counted as clinical time. The types of activities done in this time should be documented by the program.
  • The General Surgery Board of the ABS (GSB) will accept 46 weeks of clinical time (including the non-voluntary time) for the 2020-21 academic year, without the need for pre-approval, permission or explanation.
  • Any resident completing training in 2021 who fails to meet 100% of ABS minimum case number requirements must provide written justification to the ABS as to why the numbers weren’t met.

    - Those who fall short of the ABS-required case minimums but have at least 80% of the traditionally required cases (680 total procedures; 20 cases as teaching assistant; 32 critical care cases; 160 chief year procedures) may petition the GSB to grant credit for their chief year.

    - Chief residents who do not log at least 680 procedures in total throughout their residency training period and at least 160 cases during their chief year will be required to extend their training no matter the circumstance.

  • Program directors are entrusted, as they always are, to make a decision about the readiness of the resident for independent practice. If a resident fails to meet 100% of case number requirements or falls below the 46-week mark for training time for the 2020-2021 academic year, and the program director nevertheless endorses them as ready for independent practice, the GSB will seek a catalog list of "out of hospital" learning activities, as well as a more detailed supporting statement from the program director. This might include information from the CCC, milestones achievements, entrustment through EPAs, evidence of leadership during this crisis, or other information.
  • The GSB will permit those who have been affected by the cancellation of FLS and/or FES exams to apply for and take the GQE and/or GCE without these certifications by the posted deadlines. Any candidate who does not obtain one or both of these certifications before applying for the GQE must obtain these certifications within one year following graduation.

    - A candidate will not be considered certified by the ABS and will not receive their certificate until proof of certification in these courses is provided.

In addition, the GSB will accept a 10% decrease in total cases, or 225 cases, for residents entering their PGY-3 year who have not met the minimum threshold of 250 procedures. These trainees will be permitted to progress into their PGY-3 experience with the expectation that they will have logged a minimum of 250 procedures within 6 months of starting the PGY-3 program.


FAQs

While residents are encouraged to strive to meet 100% of current training expectations with respect to length of training time, the General Surgery Board (GSB) understands the nature of the impact that the COVID-19 pandemic has had on surgical training. To this effect, any non-voluntary offsite time that is used for clinical or educational purposes can be counted as clinical time. The types of activities done in this time should be documented.

In addition, the GSB will accept 46 weeks of clinical time (including the non-voluntary time) for the 2020-21 academic year, without the need for pre-approval, permission or explanation.

Residents in extremely extenuating circumstances who do not complete 46 weeks of training may petition the GSB to grant credit for the academic year, provided that they have letters of support from their program director and chair of their clinical competency committee citing an achievement of sufficient milestones and other hallmarks of adequate preparedness despite these limitations. Additionally, the GSB will seek will seek a catalog list of "out of hospital" learning activities.

Those whose requests are granted will receive credit for the affected academic year. Those whose requests are not granted for any reason will not receive credit and must extend their training.

The General Surgery Board (GSB) will consider special requests for excused absences on a case-by-case basis from residents who contract COVID-19 and miss training for an extended period due to severe coronavirus-related illness. Similarly, special requests for residents who are excused from clinical care due to pregnancies and/or immunocompromised states will also be evaluated on a case-by-case basis.

These requests should be accompanied by an attestation of competence from the program director and the local Clinical Competency Committee. In some cases where competency is not clear, the resident will not be eligible for graduation or registration for the General Surgery Qualifying Exam (GQE) and will be required to extend their training.

Graduating residents are encouraged to make their best attempt to meet 100% of ABS case volume requirements (850 total cases, including 25 cases as teaching assistant, 40 critical care cases, and 200 chief year cases). Any resident completing training in 2021 who fails to meet 100% of the minimum case number requirements must provide written justification to the ABS as to why the numbers weren’t met. Anything below 100% will require this written justification. In order to petition for this exception, the candidate must have met a minimum of 80% of required numbers (680 total procedures; 20 cases as teaching assistant; 32 critical care cases; 160 chief year procedures).

Those whose requests are granted will receive credit for their accrued cases and be advanced to graduation and registration for the General Surgery Qualifying Exam (GQE). Those whose requests are not granted for any reason will not receive credit and must extend their training.

Chief residents who do not log at least 680 procedures in total throughout their residency training period and 160 cases in their chief year will not be eligible for graduation or registration for the GQE and will be required to extend their training no matter the circumstance.

Applicants are still required to have had at least 6 operative performance assessments and 6 clinical performance assessments conducted by their program director or other faculty members, as outlined in our Training Requirements. As a reminder, these assessments will not be collected; when approving an individual's application, the program director will be asked to attest that these 12 assessments have been completed.

The General Surgery Board (GSB) encourages residents to collect the required 250 case experience before beginning the PGY-3 level of training whenever possible. However, understanding the nature of the impact that the COVID-19 pandemic is having on surgical training, the GSB will accept a 10% decrease in total cases, or 225 cases, for residents entering their PGY-3 year who have not met the minimum threshold of 250 procedures. Residents who fall short of the 250 required case volume may progress into their PGY-3 experience with the expectation that they will have logged a minimum of 250 procedures within 6 months of starting the PGY-3 program.

Residents affected by this circumstance must review the trajectory of their operative experience with the program director and propose a plan to reach the intended case volume target of 250 procedures. Those who do not meet this flexible allowance in the required number of cases by this time will be required to complete an additional year of training.

With the exception of the 250-case requirement for residents beginning PGY-3 as outlined in FAQ #3 above, these hardship modifications apply to general surgery residents graduating in 2021 only.

The General Surgery Board (GSB) will permit those who have been affected by the cancellation of FLS and FES exams to apply for and take the GQE and/or the General Surgery Certifying Exam (GCE) without these certifications by the posted deadlines. Any candidate who does not obtain one or both of these certifications before applying for the GQE must obtain these certifications within one year following graduation. A candidate will not be considered certified by the ABS and will not receive their certificate until proof of certification in these courses is provided to ABS.

No, the decoupling of the GQE and GCE was a unique modification that was made for the graduating class of 2020 due to the examination administration issues brought about COVID. Residents completing training in 2021 must complete and pass the GQE before they are able to apply for the GCE.


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