In 2003 the American Board of Surgery approved the Early Specialization Program (ESP), a new pathway leading to certification in both general surgery and vascular surgery. This is to be accomplished through a combined training program including four years of general surgery and two years of vascular surgery training to be completed in the same institution. Any proposed ESP must be approved by the Review Committee for Surgery (RC-Surgery) of the ACGME before implementation.
ESP does not result in a shortening of the requirements for board certification in surgery. Specifically, 60 months of residency are still required for board certification in surgery, and the requirements of the RC-Surgery still apply. However, 12 months in the content area of vascular surgery training experience that will occur in either the PGY-5 year, or divided between the PGY-4 and PGY-5 years (see below), will count towards both general surgery and vascular surgery certification requirements.
The RC-Surgery administratively manages the ESP, receives all applications, and reviews and approves such programs as part of its oversight process.
The ESP is a special and unique combined general and vascular surgery training paradigm reserved for exceptional residents who in the collective judgment of the General Surgery Program Director and the Vascular Surgery Program Director have exhibited the maturity, skill and judgment to enter this special program.
Resident Rotation Definitions
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
- Endocrine system
- Solid organ transplantation
- Pediatric surgery
- Surgical critical care
- Surgical oncology (including head and neck surgery)
- Trauma/burns and emergency surgery
- Vascular surgery
Secondary areas/rotations are the following:
- Plastic and reconstructive surgery
- Thoracic surgery
Additional technical experience which is separately evaluated by the RC as defined categories, but which generally involve one of the content areas, are:
- Advanced laparoscopy
Other specialty areas which have been previously defined are:
- Orthopedic surgery
ESP Program Requirements
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.
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 by the resident serving as 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.
The ESP in Vascular Surgery allows flexibility in program structure such that the 12 months of chief resident rotations may be distributed throughout the 24 months of the PGY4 and PGY5 years.
The chief resident rotations must be in the other (non-vascular) content areas/thoracic surgery. An exception may be made on a case-by-case basis to allow up to four months of vascular surgery rotations as chief resident.
No more than 12 months of chief resident rotations will be permitted during the PGY4 and PGY5 years.
No more than four months of the chief resident experience may be in any single content area.
12 months of vascular surgery training must be spent within the 24 months of PGY-4 and PGY-5.
PGY-6 must consist entirely of 12 months of vascular surgery training.
The 12 months of vascular surgery training credited toward training in surgery must all be spent entirely in clinical rotations and cannot include research rotations. Similarly, nonoperative rotations, such as interventional radiology or cardiology/vascular medicine, will not be credited toward the certification requirements in surgery.
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.
All rules and procedures for vascular surgery certification that apply to graduates of the other training pathways (0+5 and 5+2) also apply to graduates of an ESP.