As of October 6, 2024, the Review Committee for General Surgery (RCS) of the Accreditation Council for Graduate Medical Education (ACGME) has refined the procedure for review and approval of Flexibility in Surgical Training (FIT) requests. Effective immediately, programs should no longer submit a separate request for acknowledgement and approval of FIT to the ABS. Programs will continue to receive a letter of notification from the RCS for approved FIT requests. Programs are reminded that the FIT approval letter for each applicable rotation must be submitted to the ABS by the program as necessary for individual resident certification. The RCS will not provide separate approval letters to the ABS. Information on FIT requests, and how to apply, can be found on the ACGME website.
Approval Process
Programs will receive a letter of notification/approval from the RCS. It is the responsibility of the program to submit the approval letter to the ABS when applying for certification of residents.
When submitting a request for approval of a FIT rotation(s) during general surgery residency, a formal letter of request, with the program number, co-signed by the program director and the DIO, and all requested documentation listed in the applicable checklist provided by the ACGME, must be emailed to the associate executive director of the Review Committee for Surgery.
Please note that approval must be obtained for each individual resident, regardless if the program received approval in the past for the same arrangement. The ABS approval letter should be submitted with the resident’s application to the General Surgery Qualifying Exam (GSQE).
Additional information is available on the ACGME website. Any questions should be directed to the RCS.
Additional Information
Example of Block Diagram
In addition to the formal letter of request co-signed by the program director and the DIO, all FIT requests require submission of a block diagram outlining the specific resident’s individualized rotations. Below is a sample block diagram.
Resident, PGY Level, Specialty of Interest | Flexible Rotations | In Lieu of: |
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Jane Smith, PGY-4, Transplant | Transplant Surgery (3 months) | Thoracic (1 month) Endocrine/Oncology (2 months) |
Aaron Jones, PGY-5, Surgical Oncology | Colorectal Surgery (2 months) | MIS (1 month) Trauma Surgery (1 month) |
Chief Year Rotations
In creating a plan for flexible rotations, programs should be aware that PGY-5 rotations that are not in the content areas of general surgery or (noncardiac) thoracic surgery, and/or where the resident is not the most senior resident involved with the direct care of the patient, cannot be considered a chief year rotation. If completion of such a rotation is desired, program directors must make certain that the resident will complete sufficient chief year rotations in their PGY-4 year, and obtain approval from the RCS in advance.
Specialty-Specific Guidelines
The guidelines below are not intended to be prescriptive. They were created by the ABS to assist program directors in the design of flexible rotations for residents interested in a specific specialty. However, regardless of a resident’s future specialty, the development of leadership skills and the ability to make independent decisions are critical for all residents and should be the hallmark of the surgical chief resident year.
Flexible Rotations vs. ESPs: While the guidelines below mention the curricula of early specialization programs (ESPs) as a reference, ABS approval is not required for ACGME-accredited ESPs.
Specialty Area | Recommended Training/Rotations |
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Acute Care Surgery / Surgical Critical Care | Exposure in senior residency years to vascular surgery, cardiothoracic surgery and open abdominal surgery is recommended. |
Cardiothoracic Surgery | An elective PGY-3 rotation in cardiothoracic surgery is recommended. Program directors may also refer to the early specialization curriculum for guidance on suggested rotations. |
Colorectal Surgery | Specific training in all aspects of abdominal surgery, including open and advanced minimal invasive surgery, should be emphasized. Proficiency in open colon resection, laparoscopic colon resection and endoscopy are essential to the entering colorectal fellow. |
Gastrointestinal Surgery | Specific procedures to be emphasized are open and laparoscopic incisional hernia repair, laparoscopic inguinal hernia repair, Nissen fundoplication, laparoscopic colectomy, and laparoscopic small bowel procedures, as well as extensive training in endoscopy.
Experience in the last two years of residency should include:
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Pediatric Surgery | A senior rotation in pediatric surgery is recommended for residents to gain exposure to advanced pediatric surgery and demonstrate capabilities critical for selection to pediatric surgery programs.
The following surgical rotations are also felt to be of benefit:
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Surgical Oncology | Senior-level experience in the six areas of the surgical oncology curriculum (upper GI, hepatobiliary, colorectal, endocrine, breast, and melanoma/sarcoma) is recommended. |
Transplantation | For general surgery residents with an interest in transplant surgery, it is recommended that additional time be spent on the following rotations during the last 24 months of residency to better prepare them for their fellowship training:
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Vascular Surgery | Program directors should refer to the early specialization program curriculum for guidance on suggested rotations. |
For questions regarding this policy, please contact the contact us.