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 different 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.
• Individuals who wish to pursue readmissibility should begin the process by contacting the ABS coordinator.

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. If these individuals have not actively pursued admissibility or readmissibility to the certification process within 7 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 who were previously certified by the ABS but allowed that certificate to lapse fall under other ABS policies and should contact the ABS office regarding their specific situation.

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. 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. 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 in a teaching environment with attending oversight and mentoring. Interested individuals should contact the ABS office to make sure the proposed training will meet ABS requirements.

• 2. Requirements
• The individual must complete 12 months of structured education in surgery in either a general surgery residency program accredited by the ACGME or RCPSC, or an approved fellowship program that provides broad general surgery experience in an academic setting. For fellowships, the ABS will accept completion of a 12-month training program in surgical critical care or acute care surgery, or the ACS Mastery in General Surgery (Mastery) Program, 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 fellowship or residency experience 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 to document the individual's satisfactory progress. Upon completion of the year, the program director must provide written attestation that the surgeon has successfully completed all requirements.
• The program director should identify a member of the faculty to serve as a mentor/preceptor for the surgeon. The preceptor should be interested in this educational activity and available to act as a mentor to the individual. The presence of the surgeon should not impact adversely upon the education of regularly appointed residents or fellows in the program.
• Active participation in all formal and informal departmental teaching activities (teaching conferences, daily ward rounds, journal club, basic science lectures, and selected readings) should be mandatory. The surgeon should take the ABS In-Training Examination and the American College of Surgeons' Surgical Education and Self-Assessment Program (SESAP^®) during the year with critique by a preceptor. Mock oral examinations should also be arranged monthly.

• 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 they wish to take the required examination.

2. Application

Pathway applicants 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 $450 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 this pathway. Note that approval of a readmissibilty application 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 (see exam dates). 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 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.

C. Alternative Pathway II

• 1. Overview
• This pathway provides a more structured learning environment, with completion of designated educational materials developed by the American College of Surgeons. The pathway offers one-on-one mentoring from senior surgeons through the ACS. This new pathway may be modified periodically.
• Enrollment of new candidates into this pathway will begin each year on July 1. Once enrolled, individuals may participate in this pathway for up to 36 months.

2. Application

Pathway applicants 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. Application fee of $450 paid by credit card through the ABS website
3. 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.
4. 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 this pathway. Note that approval of a readmissibilty application does not grant any official ABS status to the applicant.

• 3. Requirements
• This 12-month program requires successful completion of a personalized study program developed by the participant with the guidance of an assigned mentor. The program will include personal coaching, SRGS, SESAP, didactic course work, and other resources chosen to provide the best chance for success during the examination process.
• In addition, the ACS will require participants to meet at least once with experienced surgeons selected by the ACS who will discuss the participants' learning programs and help them establish a plan as to how the educational materials can be used. Further mentoring is available to participants if desired, but is not required for successful completion of this pathway.

• 4. 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 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. 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, applicants have the option of continuing for up to two additional years in this pathway, with the same yearly requirements to assist them in their examination efforts. 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 the pathway.

• 5. Fees
• 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. Additional one-on-one mentoring by experienced surgeons selected by the ACS is available if desired by the participant. Fees for mentoring interventions will be disclosed upon entry to the program.
• There is a separate fee for this program which will be billed directly to the candidate by ACS.
• 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. Refunds will not be provided for the educational materials or the course program fee.

• 6. 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 surgeon educator who can provide advice and feedback regarding effective methods of studying and learning the necessary material.

Updated: July 2021