The following policy outlines the requirements and process for programs requesting a training waiver to allow for extended leave without extending training time. Submitting a trainee waiver request does not guarantee that the trainee will avoid extending their training.
Introduction
As programs transition to competency-based assessment of surgical trainees with the mandated use of Entrustable Professional Activities (EPAs), the American Board of Surgery (ABS) has developed a process to guide future training waiver requests. This new process is anchored in competency-based education principles rather than focusing on extended training time.
The ABS currently mandates a minimum duration of progressive education and at least 48 weeks of full-time clinical activity per training year for all specialty areas, regardless of the amount of operative experience obtained.
The current specialty-specific ABS leave policies acknowledge the need to take time away from training for major and significant life events. Accordingly, when permitted by their programs, trainees may take documented leave to:
- Care for a new child, whether for the birth, the adoption, or placement of a child in foster care
- Care for a seriously ill family member (partner, child, or parent)
- Grieve the loss of a family member (partner, child, or parent)
- Recover from the trainee’s own serious illness
For more information on the time limits and additional leave options, please see the appropriate specialty specific leave policy:
- General surgery leave policy
- Vascular surgery leave policy
- Pediatric surgery leave policy
- Surgical critical care leave policy
- Complex general surgical oncology leave policy
Training Waiver Criteria
Training waiver applications for all individuals will be considered on a rolling basis, except for those in their final year of training.
For requests received mid-training (PGY-1 through 4 residents/first-year fellows):
- The trainee must demonstrate a competency level at or above their peer level at the time of waiver submission, as determined by the institution’s Clinical Competency Committee (CCC). The program will be required to submit an updated Summative Entrustment Worksheet at the end of training for final review.
For requests received in the final year of training (PGY-5/chief year residents/second year fellows or those in SCC fellowship):
- The trainee must demonstrate competency at a practice-ready level for all EPAs at the end of training. The program will be required to submit an updated Summative Entrustment Worksheet at the end of training for final review.
- Requests must be submitted via the ABS program portal at least three months prior to the anticipated completion date:
- For programs ending on June 30: Requests must be submitted no later than March 31
- For programs ending on July 31: Requests must be submitted no later than April 30
Trainees may be granted leave at the discretion of the program director during the program year. However, these time deficits along with competency assessments will be evaluated and accounted for as part of the waiver application process. This approach ensures a comprehensive review of the trainee’s overall performance and readiness for independent practice, while allowing sufficient time for processing before the program’s conclusion.
If a trainee moves to another program, the training waiver is not transferable and must be requested by the trainee’s new program director after a six-month period of evaluation.
How to Request a Training Waiver
Programs must submit the following materials via the ABS program portal when requesting a training waiver :
- Formal letter: Includes information on the length of training time deficit, the plan to make up the time, and the expected completion date of training
- Operative Experience Report: ACGME Defined Categories and Minimums report must be submitted and if applicable demonstrate that the trainee meets the minimum requirements for both total cases and any specified categories within the specialty, both at the time of training waiver and at the end of training
- Summative Entrustment Worksheet: Completed by the program to provide a trainee’s comprehensive performance across all EPAs
- EPA Phases: Nonoperative/Preoperative, Intraoperative, Postoperative, and Overall Entrustment
- Summative Entrustment Level: Limited Participation, Direct Supervision, Indirect Supervision, Practice Ready, N/A
- Worksheets are available for:
- Worksheet instructions available here
- Program EPA Participation Profile: Total number of EPA microassessments completed by all trainees in your program in the most recent quartile
- Rotation Summary: Listing of all rotations completed by the trainee, including dates and specialty
- Program Director Attestation: Signed attestation confirming that:
- Training waiver requests submitted at mid-training demonstrate a trainee’s competency level at or above peers.
- The trainee has fulfilled all ACGME and any additional ABS training requirements for their specialty as part of the application process.
- The program’s CCC has reviewed and approved the trainee waiver request.
Review of Training Waiver Requests
The ABS will review the case log and submitted rotation schedule for each request received on a rolling basis. When reviewing requests, a holistic assessment of the trainee’s readiness for ABS certification will be conducted.
Trainees must be in good standing when the training waiver request for waiver is submitted. Trainees who have successfully completed remediation will be eligible for waiver requests. Trainees currently on probation or undergoing remediation at the time of the request will be ineligible for a training waiver.
Training waivers are not intended as a means for accelerating training within residency or fellowship programs. Waiver requests will be considered only in exceptional circumstances where significant life events necessitate extended leave that exceeds the limits outlined in the applicable specialty-specific ABS leave policy.
All other application requirements, including case number requirements, remain unchanged and are required as part of the application process for initial certification.
Candidates whose training waiver requests are not approved will be required to extend their training to address any time deficits. This extension is necessary to meet the training requirements. The duration of the extension will be determined based on the specific time deficit and must ensure full compliance with ABS standards for training completion.
For questions regarding this policy, please contact the ABS.
The current posted version of this policy supersedes all prior versions.