General Surgery Credit for Foreign Graduate Medical Education

Introduction

This policy outlines the terms under which the American Board of Surgery (ABS) may grant general surgery credit for training completed outside the U.S. or Canada. It aims to promote transparency, consistency, and fairness in the evaluation of prior non-U.S. and non-Canadian surgical training.

Please note, the ABS cannot provide early or preliminary evaluation to candidates or program directors.

Requirements for Program Directors

Program directors of U.S.-based, ACGME-accredited general surgery residency programs are solely responsible for submitting all communications, requests, and applications regarding foreign training credit. Approval is not automatic nor guaranteed.

Management of Mandatory Six-Month Observation Period

• Verify Enrollment: Ensure the candidate is actively enrolled in the program for a minimum of six months before submission of any official credit requests.
• Conduct Structured Assessment: Use the six-month period to evaluate the candidate’s clinical competence, professionalism, and readiness for the requested clinical level.
• Gather Required Evaluations: Document performance using Entrustable Professional Activities (EPAs), informed by the Clinical Competency Committee (CCC), faculty evaluations, and other program-based assessments.

If the request is approved, the observation period will count toward the required 60 months of training and toward completion of the current year of training.

Documentation Requirements

Programs that choose to request credit for foreign training must compile the following documentation, to be submitted on official letterhead as a single PDF attachment in this exact order:

1. Proof of Medical School: Documentation of satisfactory completion of foreign medical school.
2. Proof of Foreign Residency: Documentation of satisfactory completion of foreign residency training.
3. Specialist Certification: Specialist certification in the applicant’s home country and successful completion of any required certifying examinations equivalent to surgical board certification.
   1. Alternative: If the country has no formal pathway to specialist certification or exams were skipped, include a letter of explanation with a chronological listing of former foreign and U.S. practice after specialty training.
4. Documentation of Commensurate ACGME Milestones (when applicable)
5. U.S. Training History: A chronological listing of all U.S. training, explicitly noting accreditation status and whether the resident occupied an accredited or supernumerary (above accredited limit) position.
6. Operative Logs: An operative case log showing appropriate numbers and types of cases, including the resident’s specific role in each case, when available.
7. PD Attestation: Written attestation from the program director confirming satisfactory completion of all U.S. or Canadian surgical resident training years for which credit is sought.
8. Summative Entrustment Worksheet: A completed Summative Entrustment Worksheet demonstrating performance at or above the requested competency level. Worksheet instructions are available here.
9. Certified Translations: A notarized English translation for any original documentation not written in English.

Critical Requirement: Requests that do not meet all of these documentation formatting requirements will not be considered.

Transfer Policy

• Managing Resident Transfers: Previously granted credits do not transfer between programs. If the resident moves to another program, the credit is not transferable and must be requested by the resident’s new program director after a new six-month period of evaluation.

Requirements for Candidates and Applicants

While program directors are responsible for application submission, candidate eligibility depends on enrollment status and clinical performance.

Candidates Must

• Maintain enrollment in a U.S. ACGME-accredited general surgery residency program
• Complete the final two years of training (PGY-4 and PGY-5) completely and satisfactorily within the same ACGME-accredited U.S. general surgery residency program
  • No credit will be granted for PGY-4 or PGY-5 training
• Complete a minimum six-month observation period within the requesting program before any credit can be considered

For programs seeking credit for the PGY-3 year, the resident must:

• Be enrolled in the general residency program
• Have completed a surgical fellowship within the same institution
• Have completed at least two full years of combined training in general surgery and surgical fellowship within the same institution
• Have completed a general surgery residency in a non-U.S. program
• Display clinical performance commensurate with the PGY-3 level
•  Submit all of the required documents as noted above

Special Categories

• Canadian Applicants: Credit for postgraduate surgical education outside the U.S. and Canada is not available to Canadian applicants. These applicants must complete requirements in a program accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) or combined with an ACGME-accredited U.S. program.
• Prior U.S. Training: Prior ACGME-accredited training as a preliminary resident at the PGY-1 or PGY-2 level may be credited year-for-year if completed within the preceding five years and documented in writing by the responsible program director. Credit will only be granted for a single year (e.g., a preliminary PGY-1 followed by a categorical PGY-1 results in only one year of credit). The program director must submit a written request to the ABS for approval.Training at the PGY-3 level will only be accepted if accomplished as a categorical resident in an accredited program.
• Non-ACGME Fellowships: These fellowships will not be credited as the ABS cannot evaluate the quality of non-accredited training

The ABS’s Review Process and Determination

The ABS processes applications and applies credit based on strict processes.

Review and Approval Structure

• One-Year Requests: May be approved directly by the president and CEO of the ABS
• Two-Year Requests: Must be reviewed and approved by the Education and Training Committee of the ABS Council
  • For requests received by March 15, the committee will provide a decision to program directors within 30 days of the request

Notification will come from the president and CEO of the ABS via an official letter.

How Credit is Applied

Illustrative Scenarios

These scenarios are to help clarify how the policy is applied but are not exhaustive and do not guarantee approval.

Scenarios That May Be Considered

These pathways apply to physicians who finished non-U.S. general surgery training and are entering residency directly at Institution A, are currently fellows at Institution A, or are residents at Institution A after a fellowship at Institution A or B. Following the six-month observation, the program director may request credit based on demonstrated competence.

Scenarios That WILL NOT Be Considered

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