General Surgery Readmissibility to 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 (GSQE)
• General Surgery Certifying Examination (GSCE)

Two 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 requires passing of a specific examination for readmissibility.

Individuals who wish to pursue readmissibility should begin the process by contacting the appropriate ABS exam manager.

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. Any candidate who completed training 10 or more years ago 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 have not pursued admissibility are required to complete and submit the GSQE application and meet those requirements.

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. Please see our lapsed certificates policy for additional information.

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 GSQE or GSCE through one pathway, the individual may pursue another pathway(s). There is a three-year limit on Alternative Pathway 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 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

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. Individuals who have not actively pursued admissibility are required to complete and submit the GSQE application meeting those requirements. This application must also be received by February 1. Note that those who have not actively pursued admissibility are not required to complete SESAP or provide references.

2. Application

Pathway applicants who are submitting a readmissibility application 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 $550 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 the application for the Alternate Pathway does not grant any official ABS status to the applicant.

Pathway applicants who are submitting a Qualifying Examination application 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. Application form which will cover information regarding your undergraduate and graduate medical education. Applicants must list chronologically all rotations and activities from the beginning of residency. Each rotation must be listed separately by clinical activity, not grouped together as a yearly total. Applicants must also list all time away from training of two days or more outside your normally scheduled days off, including time taken for research, vacation, interviews, meetings, medical leave, visa issues, and early departures for fellowships.
2. Operative Experience Report from general surgery residency meeting the ABS case requirements. The ABS will accept the ACGME General Surgery Defined Category and Minimum Report.
   • Case requirements are: 850 total cases, 200 chief cases, 40 surgical critical care patient management cases, and 25 teaching assistant cases
3. Documentation of ACLS, ATLS, FLS and FES certification
4. Attestation signed electronically
5. Application fee paid by credit card through the ABS website

Note that approval of the GSQE application for Alternate Pathway I 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 nationwide. 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 GSQE for four opportunities within four years or to the GSCE for three opportunities within three years and will be considered “in the examination process” during this time.

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