American Board of Surgery

General Surgery Training & Certification Requirements

Training Requirements

  • Below is a general overview of the training requirements for general surgery certification. For complete details, please refer to the ABS Booklet of Information - Surgery (pdf).
  • Applicants who will not complete residency training by June 30 of their chief year must notify the ABS. All training must be completed by end of August to be eligible for that year's General Surgery Qualifying Exam.

Program and Time Requirements

  • A minimum of 5 years of progressive residency education satisfactorily completed in a general surgery program accredited by the ACGME or RCPSC. (See also Osteopathic Trainees Policy)
  • The 60 months of training at no more than 3 residency programs. If credit is granted for prior foreign training, it will count as one program. See also Limit on Number of Programs and Credit for Foreign Medical Education.
  • At least 48 weeks of full-time clinical activity in each residency year, regardless of the amount of operative experience obtained.

    The 48 weeks may be averaged over the first 3 years of residency, for a total of 144 weeks required, and over the last 2 years, for a total of 96 weeks required. See our Leave Policy for further details; all time away from training must be accounted for on application form.

  • A categorical PGY-3 year completed in an accredited general surgery residency program. Note that completing three years at PGY-1 and -2 levels does not permit promotion to PGY-4; a categorical PGY-3 year must be completed and verified by the ABS' resident roster. The only exception is in cases where 3 years' credit has been granted for prior foreign graduate training.
  • At least 54 months of clinical surgical experience with increasing levels of responsibility over the 5 years, with no fewer than 42 months devoted to the content areas of general surgery.
  • No more than 6 months assigned to non-clinical or non-surgical disciplines during all junior years (PGY 1-3).
  • No more than 12 months allocated to any one surgical specialty other than general surgery during all junior years (PGY 1-3).
  • The final two residency years (PGY 4-5) in the same program.

Specific Requirements

Chief Resident Year

  • Acting in the capacity of chief resident in general surgery for a minimum of 48 weeks over the PGY-5 and PGY-4 years, per the definition below. Note that the RC-Surgery requires prior approval for chief rotations in the PGY-4 year.

    The term "chief resident" indicates that a resident has assumed ultimate clinical responsibility for patient care under the supervision of the teaching staff and is the most senior resident involved with the direct care of the patient.

  • The entire chief resident experience in either the content areas of general surgery or (noncardiac) thoracic surgery, with no more than 4 months devoted to any one area. All rotations at the PGY-4 and -5 levels should involve substantive major operative experience and independent decision making.

Operative Experience

The following operative requirements are effective with applicants graduating residency in the 2017-2018 academic year. The previous operative case numbers are noted in parenthesis — applicants who graduated before the 2017-2018 year will be required to meet those numbers.

  • At least 850 (previously 750) operative procedures as surgeon over 5 years, with at least 200 (previously 150) in the chief resident year. Teaching assistant cases may count toward the 850 total; however these cases may not count toward the 200 chief year cases.
  • At least 40 (previously 25) cases in surgical critical care, with at least one in each of the seven categories: ventilatory management; bleeding (non-trauma); hemodynamic instability; organ dysfunction/failure; dysrhythmias; invasive line management and monitoring; and parenteral/enteral nutrition.
  • At least 25 cases as teaching assistant by the completion of residency.

  • At least 250 operations by the beginning of PGY-3 year, effective with applicants who began residency in July 2014. The 250 cases can include procedures performed as operating surgeon or first assistant. Of the 250, at least 200 must be either in the defined categories, endoscopies, or e-codes (see below for info on e-codes). Up to 50 non-defined cases may be applied to this requirement.

    E-Codes: General surgery residents can use e-codes to receive ACGME case log credit for vascular surgical procedures. E-codes allow more than one resident to take credit for an arterial exposure and repair. The resident who accomplishes the exposure should add an "E" to the case ID for the system to allow credit for a second procedure on the same patient. The relevant CPT codes to use are: 35201 (Repair blood vessel, direct; neck); 35206 (upper extremity); 35216 (intra-thoracic without bypass); 35221 (intra-abdominal), and 35226 (lower extremity). Four categories are available under Trauma for residents to enter arterial exposures.

    (posted January 2020)

For specific inquiries regarding ABS training requirements, please send an email to the ABS coordinator.

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Resident Performance Assessments

In June 2012, the ABS approved a new requirement for assessment of operative and clinical performance as part of a broader ongoing effort to standardize the knowledge and skills expected of general surgery residents.

 

  • Clinical and Operative Assessment Requirement
  • Applicants who complete their general surgery residency training in the 2015-2016 academic year or thereafter will be required to obtain during residency at least 6 operative performance assessments and 6 clinical performance assessments, conducted by their program director or other faculty members.
  • When signing an individual's application, the program director will be asked to attest that these 12 assessments have been completed. However the applicant bears ultimate responsibility for ensuring these assessments are performed while in residency. The completed assessment forms will not be collected by the ABS.
  •  
  • Posted below are evaluation forms that may be used to fulfill this requirement. While no specific form is mandated, programs are strongly encouraged to use either these forms or an equally validated form. Please note that some of these assessments may be done via Medhub by an attending.  

Medhub has the following clinical and operative forms available for faculty to use: 

  • Clinical/CEX forms labeled as CAMEO (Clinical Assessment & Management Examination) & Mini CEX
  • Operative-Lap Surgery Assessment & Open Surgery Assessment

 

GAGES Requirement

  • The ABS announced in 2014 a new requirement to ensure all ABS-certified general surgeons have completed a standard curriculum in the use of endoscopic techniques. This new requirement will apply to certification applicants who complete their residency training in the 2017-2018 academic year or thereafter.
  • During their general surgery residency, applicants will be required to have completed the ABS Flexible Endoscopy Curriculum (pdf).

Residents will be trained in basic upper and lower endoscopy, augmenting their endoscopy suite experience with cases in the ICU and operating room. Technical progress is assessed during this block using the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES). GAGES scores should be recorded for residents at baseline and then at least intermittently through the course of their endoscopic experience. The goal is for residents to consistently achieve a GAGES score of ≥ 18 during their procedures. There should also be exposure to multidisciplinary GI meetings such as pathology conferences and GI conferences. 

LEVEL IV (Typically completed in PGY-3 or -4) This initial senior experience encompasses improvements in both cognitive and technical skills with cases assessed using GAGES to achieve a minimum score of 18 for both upper and lower endoscopy — a score achieved by “experienced” endoscopists during the GAGES validation studies. Residents continue with more advanced cognitive modules for therapeutic endoscopic techniques. Clinical experience for residents, outside of their dedicated endoscopy experience, should take place in the operating room and ICU, and continued work in the endoscopy suite of the home institution or other affiliated or associated institutions is encouraged. 

Medhub has the following GAGES forms available for faculty to use: 

  • GAGES - Colonoscopy Scoresheet (1 required with a score of 18 or higher)
  • GAGES - Upper GI Endoscopy Scoresheet (1 required with a score of 18 or higher)

Operative Assessment Forms

Clinical Assessment Form (CEX)

Taking the QE in the PGY4 Year

Program Policy:

1. Score at least 75% correct on the ABS In-Training Exam

2. Meet the American Board of Surgery’s Requirements

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