I. Introduction
Individuals may lose admissibility to the initial certification process for complex general surgical oncology (CGSO) 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:
- Complex General Surgical Oncology Qualifying Examination (CGSO QE)
- Complex General Surgical Oncology Certifying Examination (CGSO CE)
Two different pathways are available for regaining admissibility to either of these examinations.
- The Standard Pathway requires a year of formal training in an approved CGSO fellowship program.
- The Alternative Pathway requires completion of educational materials developed in conjunction with Society of Surgical Oncology (SSO) and/or other educational materials considered acceptable to the Complex General Surgical Oncology Board of the ABS (CGSOB-ABS) and the ABS, as outlined below.
Individuals who wish to pursue readmissibility should begin the process by contacting the appropriate ABS examination manager.
II. Time Limitations
If an individual has not actively pursued admissibility or readmissibility to the certification process within seven years after completion of a CGSO fellowship program, they will be required to re-enter formal training in a CGSO program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the 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 have allowed that certificate to lapse fall under other ABS policies and should contact the ABS office regarding their specific situation.
III. Seven-Year Readmissibility Period
Individuals who lose admissibility have no more than seven years to successfully regain admissibility to the CGSO certification process.
The seven-year period begins immediately after admissibility has been lost, either by exhausting the time limits or exam opportunities granted. If an individual delays in pursuing readmissibility, this will count against the seven-year readmissibility period.
During this period, if unsuccessful in regaining admissibility to the CGSO QE or CGSO CE through one pathway, the individual may pursue the second pathway. There is a three-year limit on the Standard Pathway and a three-year limit on the Alternative pathway with an overall absolute seven-year limit on the total readmissibility process.
The Standard Pathway and the Alternative Pathway are available to regain admissibility to both the CGSO QE and CGSO CE examinations. No pathway may be repeated. Once the seven-year period has been exhausted, unsuccessful individuals will be required to re-enter formal training in a two-year CGSO program accredited by the ACGME or RCPSC to regain admissibility to the certification process.
IV. Readmissibility Pathways
Standard Pathway
1. Overview
The Standard Pathway requires completion of 12 months of fellow-level clinical experience, including broad CGSO experience in a teaching environment with attending oversight and mentoring. Interested individuals should contact the ABS office to ensure that the proposed training will meet ABS requirements.
2. Application & Requirements
The individual must complete 12 months of structured education in a complex general surgical oncology program accredited by the ACGME or RCPSC.
The fellowship experience must be a full-time activity and must be submitted to the ABS in advance for approval. 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 applicant has participated in full-time clinical training and has met the fellowship program’s operative case number requirements in place at the time.
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 adversely impact 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 complete work through the SCORE Complex General Surgical Oncology curriculum during the year with critique by their designated preceptor. Mock oral examinations should also be arranged monthly.
After completing all pathway requirements, the candidate must take and pass the CGSO QE (even if they had passed it previously) in order to become admissible to the CGSO CE.
The CGSO QE is administered once annually at computer testing centers on a specific date in the fall.
3. Admissibility and Exam Opportunities
Upon completion of the required training, the applicant will be admissible to the CGSO QE for four opportunities within four years or to the CGSO CE for three opportunities within three years and will be considered “in the examination process” during this time.
Alternative Pathway
1. Overview
The CGSOB has designed an Alternative Pathway to provide a more structured learning environment with completion of designated educational materials developed in conjunction with the Society of Surgical Oncology (SSO). This pathway also offers one-on-one mentoring from senior surgeons through the SSO. This new pathway is being introduced on a pilot basis and may be modified periodically as the experience matures.
Enrollment of new candidates into this pathway will begin each year on August 1. Once enrolled, individuals may participate in this pathway for 12 months.
2. Application
Pathway applicants who are submitting a readmissibility application will be required to submit the following items:
- 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.)
- Application fee paid by credit card through the ABS website
- 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.
- 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 an application does not grant any official ABS status to the applicant.
3. Requirements
This pathway requires participation in three educational programs, bi-weekly Multidisciplinary Tumor Board discussions, and passing a summative Mock Oral Exam over a 12-month period:
- SSO CGSO eLearning Curriculum – DeckerMed
- SCORE Curriculum for Complex General Surgical Oncology (CGSO-SCORE)
- SSO CGSO Board Review Course
- Participants will be required to show proof of attendance in bi-weekly Multidisciplinary Tumor Board discussions.
- Participants will be required to meet at least quarterly with experienced surgeons selected by the SSO who will discuss the participants’ learning programs and help them establish a plan for how the educational materials are utilized.
Further mentoring is available to participants if desired but is not required for successful completion of this pathway. Participants must successfully complete a mock Oral Examination with the mentor(s) to complete the program.
The SSO will track the individual’s participation in the pathway and inform the ABS as to the applicant’s progress.
For requirements 1-3 listed above, individuals enrolled in this pathway will be required to complete a minimum of one CGSO-SCORE module per week and the entire curriculum within the year. They will also be required to complete all modules of the SSO CGSO eLearning Curriculum within a 12-month period. The SSO CGSO Board Review Course is offered once annually; candidates will be expected to attend this course and complete all required activities for CME and self-assessment credit.
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.
After completing all pathway requirements, the candidate must take and pass the CGSO QE (even if they had passed it previously) in order to become admissible to the CGSO CE again. The CGSO QE is administered once annually at computer testing centers on a specific date in the fall.
If unsuccessful in passing the CGSO QE or CGSO CE after completion of the first year, applicants have the option of continuing with this pathway for up to two additional years, with the same yearly requirements, to assist them in their examination efforts.
4. Fees
Applicants will be required to purchase educational resources from the SSO and SCORE as noted above. Applicants who are unsuccessful in passing the CGSO QE or CGSO CE after 12 months and decide to continue in the pathway will need to purchase the same educational programs for every 12 months they are in the pathway.
At a minimum, the mentoring component of this pathway will require participants to meet initially with SSO 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 utilized.
Additional one-on-one mentoring by experienced surgeons selected by the SSO is available if desired by the participant. Fees for mentoring interventions will be provided by the SSO upon entry to the program.
All financial arrangements for these programs will be directly between the candidate and the SSO, without ABS involvement. The ABS has no financial relationship with the SSO regarding 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 for any educational materials and/or mentoring sessions must be addressed with the SSO directly.
5. Additional Information
Individuals who enter this pathway acknowledge that neither the SSO nor the ABS is offering any guarantees or assurances of success from this program. Rather, the program should be regarded by all participants as a pilot effort to define a more effective way of remediating candidates who have been unsuccessful in obtaining ABS certification in CGSO through their own efforts. This pathway has been created to provide candidates with validated, structured learning materials related to CGSO and 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.