General Surgery Re-entry to Residency After Hiatus

This policy applies to individuals who withdrew from surgical residency training and had a hiatus of three to six years during which time they were not engaged in any formal surgical training. The individual may re-enter surgery residency at the same program that they previously completed training or at a separate program. This policy does not apply to individuals who have had a hiatus of more than six years.

Background

Residents who had a hiatus during their residency training may be expected to have experienced degradation of knowledge and skills during that time. Any hiatus in which the individual has been absent from residency training for three to six years must therefore be reviewed by the ABS Education & Training Committee for approval in order for the individual to ultimately qualify for board certification. Failure to obtain such approval will result in refusal to admit the individual to the certification process despite cumulative completion of five years of accredited training.

Re-Entry Process (Trial Period and Official Re-Entry)

Program directors who wish to accept such individuals into their program should enroll them for a trial period at the PGY-1 through PGY-4 levels at the beginning of the academic year. The decision regarding which PGY level to start the trial period is at the discretion of the program director, however, it is recommended that a resident start the trial period at the last PGY level that they completed (examples one and two below).
For residents who had a hiatus of three years but have been clinically engaged (e.g., general surgery moonlighting, trauma and critical care call, etc.) at the same institution in which they originally trained during the hiatus, it is acceptable (based on program director assessment) to have the resident start a trial period at the subsequent PGY level (example three below) at the same institution. Residents who have had a hiatus of greater than three years should start a trial period at the last PGY level that they completed regardless of clinical activity during the hiatus (example four below).

Residents may not initiate a trial period at the PGY-5 level.

The trial period should be a minimum of nine months to determine if the individual’s surgical knowledge, operative skills, and clinical management abilities are appropriate to the assigned level. The resident must take the ABSITE examination. The ABSITE score, Entrustable Professional Activity (EPA) Assessments and Clinical Competency Committee assessments (i.e., Milestones, EPAs, and summative assessments) should be used to make an informed decision about the appropriate PGY level as well as to inform the program directors application for the re-entry process. These individuals are expected to meet the same entrustment as peer residents at the anticipated level of re-entry.

When applicable, the trial period will count toward the 60 months of training required for certification provided the resident successfully completes the assigned PGY level. If the individual does not successfully meet the PGY standards of the trial period, then the training will not count toward the 60-month training requirement. The trial period is not a guarantee of the opportunity to complete surgery residency, nor does it guarantee access to the certification process.

If the resident transfers to a different residency program, the approval of the trial period is not transferable and must be requested by the resident’s new program director after a new nine-month period of evaluation.

Examples:

1. A resident completes PGY-1 through PGY-2 of categorical surgery residency before taking a three-year hiatus. The resident has been completely disengaged from the surgery residency. The resident could start the trial period as a PGY-2 resident.
2. A resident completes PGY-1 through PGY-3 of categorical surgery residency before taking a four-year hiatus. The resident has been completely disengaged from the surgery residency. Upon re-entry, the resident could start the trial period as a PGY-3 resident.
3. A resident completes PGY-1 through PGY-2 of categorical surgery residency before taking a three-year hiatus. The resident has some residency engagement via moonlighting calls for general surgery at the same institution during the hiatus. The resident could start the trial period as a PGY-3 resident based on program director assessment.
4. A resident completes PGY-1 through PGY-3 of categorical surgery residency before taking a four-year hiatus. The resident has some residency engagement via moonlighting calls for general and trauma surgery at the same institution during the hiatus. The resident could start the trial period as a PGY-3 resident.
5. A resident completes PGY-1 through PGY-4 of categorical surgery residency before taking a three-year hiatus. The resident may or may not have had clinical experience during the hiatus. The resident could start the trial period as a PGY-4 resident.

Requesting Approval

The program director must contact the ABS at the initiation of a trial period and prior to official re-entry as noted below:

1. The program director must contact the ABS by May 1st prior to the trial period start date with details regarding the individual and plan of anticipated re-entry. The program director will be notified of approval.
2. At the conclusion of the trial period, the program director must send an official report by email to the ABS providing the results of the trial period to include the following:
   1. Documentation of the ABSITE score during the trial period
   2. Program EPA participation profile: Total number of EPA microassessments completed by all trainees in the program for the most recent quartile
   3. Summative Entrustment Worksheet: Completed by the program to provide a trainee’s comprehensive performance across all EPAs
      1. EPA phases: Nonoperative/Preoperative, Intraoperative, Postoperative, and Overall Entrustment
      2. Summative entrustment level: Limited Participation, Direct Supervision, Indirect Supervision, Practice Ready, N/A
      3. Worksheet available here, worksheet instructions available here.
3. A formal request for approval of the resident to continue in the program at the desired level

Submission of final report is due by April 15 of the re-entry year for review by the Education and Training Committee at their June meeting.

For questions regarding this policy, please use the contact form on the ABS website.

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