The mission of the ABS is to serve the public and the specialty of surgery by providing leadership in surgical education and practice, by promoting excellence through rigorous evaluation and examination, and by promoting the highest standards for professionalism, lifelong learning, and the continuous certification of surgeons in practice.
4 Incorporated in 1937 as a member of the American Board of Medical Specialties, the purposes of the ABS are to conduct examinations of acceptable candidates who seek certification or maintenance of certification by the board, to issue certificates to all candidates who meet the board’s requirements and satisfactorily complete its prescribed examinations, and to improve and broaden the opportunities for the graduate education and training of surgeons.
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The ABS publishes an annual information booklet
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The American Board of Surgery Booklet of Information-Surgery contains information on the background of the ABS, requirements for certification, issuance of certificates, maintenance of certification process, and the ABS-sponsored examinations.
The ABS requires the attestation of the residency program director that an applicant has completed the required educational experiences and attained sufficient knowledge, clinical judgment, and technical skills. Additionally, the applicant must demonstrate ethical behavior as verified by the program director to be admitted to the certification process.
Content areas for residency programs are in alignment with the ACGME program accreditation requirements.
1 Specifically, residency programs must provide educational experiences in the management of conditions and operations related to the alimentary tract; abdomen and its contents; breast; skin and soft tissue; endocrine system; solid organ transplantation; pediatric surgery; surgical critical care; surgical oncology, including head and neck surgery; trauma, burns, and emergency surgery; and vascular surgery. In addition, applicants must have demonstrated knowledge of epidemiology, anatomy, physiology, pathology (including neoplasia), anesthesia, biostatistics, principles of minimally invasive surgery, transfusion and disorders of coagulation, wound healing, infection, fluid management, shock and resuscitation, immunology, use of antibiotics, metabolism, pain management, and nutrition. Knowledge and skills related to the interdisciplinary care of specific patient groups is also required, including terminally ill patients, morbidly obese patients, geriatric patients, and patients representing culturally diverse groups.
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These educational needs must be met within specific timeframes, and the minimum requirements of experience and certification must be achieved.
6 Applicants must have at least 5 years of progressive training in a program accredited by the ACGME or Royal College of Physicians and Surgeons of Canada and complete the sequence at no more than 3 programs. In each postgraduate year, residents must have completed at least 48 weeks of full-time clinical activity, which may be averaged over the first 3 years and the last 2 years to allow for fellowship interviews, illness, and pregnancy. Two additional weeks in postgraduate years 1 through 3 and in postgraduate years 4 and 5 are allowed for personal medical problems or pregnancy. Graduates of ACGME-accredited osteopathic residency programs must have completed 3 years in the program after the program has received ACGME accreditation to be eligible for ABS certification. (Residents receive credit for a full year if ACGME program accreditation is obtained at any point during an academic year.)
Residents must participate in at least 250 operations by the end of the second postgraduate year and have a minimum of 750 operative procedures as the operating surgeon during the course of the 5-year clinical curriculum. One hundred fifty cases or more must be done as a chief resident. To foster independence, those desiring certification must show that they participated as teaching assistants to other residents in a minimum of 25 cases. Experience with the care of critically ill patients is also expected, with the documentation of a minimum of 25 patients with a defined set of critical care needs.
Specific educational assessments must be taken and certifications awarded to meet certification requirements.
6 Applicants must show current or past certification in advanced trauma life support, advanced cardiac life support, and fundamentals of laparoscopic surgery. Completion of the ABS flexible endoscopy curriculum will be required for graduates in 2018 and beyond. Applicants are also required to have undergone at least 6 operative and 6 clinical performance assessments to demonstrate that they meet competency in technical and clinical skills.
Application to the certification process may begin as early as the end of the postgraduate year 4 provided all certification requirements are met, although most apply at the end of their postgraduate year 5 as a chief resident. Applicants must provide evidence of their educational experiences and required skill certifications and have their application signed and verified by their residency director. If accepted, applicants are allowed to sit for the first examination in the process. The first part is the Qualifying Examination, which typically takes place during the summer immediately after graduation. Programs accredited by the ACGME are expected to have at least 65% of their graduates pass this examination on the first attempt to maintain accreditation.
1 Thus, this examination represents high stakes for both programs and graduates.
The Qualifying Examination is a test of knowledge using a multiple-choice format.
5 The examination takes approximately 8 hours to complete and is offered in a computer-based format once per year at a secure testing center. This examination must be applied for and passed within no more than 4 academic years after residency. Once the applicant has passed the Qualifying Examination, he or she may sit for the Certifying Examination. Applicants have an additional 3 years in which to pass the Certifying Examination.
The Certifying Examination is a test of clinical judgment, application of knowledge to clinical problems, management of operative complications, and assessment of technical knowledge.
5 It is the last step to initial certification. In addition to meeting the requirements already outlined, applicants must have a full and unrestricted medical license in the United States or Canada. This examination is given orally and consists of three 30-minute periods during which 2 examiners test the candidates’ knowledge, skill, and management of various conditions commonly found in patients requiring surgery, as well as the broad group of surgical problems that are commonly managed by the general surgeon. The Certifying Examination is given 5 times per year. Examiners are a mix of ABS directors and associate examiners who are also ABS diplomates who are currently certified and participate in the maintenance of certification program.
Both examinations are validated across examination administrations by professional psychometricians employed by the ABS. The specific topics for both examinations are chosen from the Surgical Council on Resident Education Curriculum Outline.
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After both examinations are successfully passed, candidates are welcomed as diplomates with a certificate from the ABS that verifies their board certification. This certificate is valid for 10 years.