Complex General Surgical Oncology Readmissibility to Examinations

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

A. Standard Pathway

1. Overview

The ABS recognizes that surgeons seeking readmissibility to certification examinations benefit from structured mentorship and clinical experience. These guidelines outline key components of a 12-month proctoring plan. 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.

These guidelines apply to individuals pursuing readmissibility through a Proctored Clinical Practice Pathway. They do not apply to examination-based readmissibility pathways unless specifically required by the relevant Specialty Board of the ABS.

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.

All proctoring 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.

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.
      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. Admissibility and Exam Opportunities
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).

B. 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:

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 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 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:

1. SSO CGSO eLearning Curriculum – DeckerMed
2. SCORE Curriculum for Complex General Surgical Oncology (CGSO-SCORE)
3. SSO CGSO Board Review Course
4. Participants will be required to show proof of attendance in bi-weekly Multidisciplinary Tumor Board discussions.
5. 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.

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