Handbook of Types of Menses

8/15/2019 Handbook of Types of Menses

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The

AMERICAN

BOARD

of

SURGERY

B

ISurgery

2015 – 2016


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Te

AMERICAN BOARD

of

SURGERY

Booklet of Information

Surgery

2015 – 2016

Office of the Secretary

American Board of Surgery Inc.

Suite 860

1617 John F. Kennedy Boulevard

Philadelphia, PA 19103-1847

Tel. 215-568-4000

Fax 215-563-5718

www.absurgery.org


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Te Booklet o Inormation – Surgeryis published by the American Board oSurgery (ABS) to outline the requirements

or certification in surgery. Applicants areexpected to be amiliar with this inorma-tion and bear ultimate responsibility orensuring their training meets ABS require-ments, as well as or acting in accordance

with the ABS policies governing each stageo the certification process.

Tis edition o the booklet supersedes allprevious publications o the ABS concern-ing its policies, procedures and require-

ments or examination and certification insurgery. Te ABS, however, reserves theright to make changes to its ees, policies,procedures and requirements at any time.

Applicants are encouraged to visit the

ABS website at www.absurgery.org or themost recent updates.

Admission to the certificationprocess is governed by the policies and

requirements in effect at the time an

application is submitted and is at thediscretion o the ABS.


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TABLE OF CONTENTS

I. INTRODUCTION ....................................................4

A. Mission .......................................................4

B. Purpose ......................................................4C. History ........................................................4

D. Cercaon Process ...................................5

E. Specialty of Surgery Dened .......................5

F. Website Resources .....................................8

II. REQUIREMENTS FOR CERTIFICATION ................. 9

A. Exam Admissibility: Seven-Year Limit ...........9B. General Requirements................................9

C. Undergraduate Medical Educaon ...........10

D. Graduate Surgical Educaon ....................101. General Informaon .....................................10

2. Specic Requirements ..................................11

E. Operave Experience ...............................14F. Upcoming Requirements ..........................15

G. Leave Policy ..............................................16

H. Ethics and Professionalism .......................16

I. Addional Consideraons.........................181. Military Service .............................................18

2. Foreign Graduate Educaon .........................183. Flexible Rotaons Opon .............................19

4. Re-entry to Residency Training.....................20

5. Osteopathic Trainees ....................................20

6. Informaon for Program Directors ...............21

7. Reconsideraon and Appeals .......................21

III. EXAMINATIONS IN SURGERY ........................... 22A. In-Training Examinaon ...........................22

B. Qualifying Examinaon ............................221. General Informaon .....................................22

2. Applicaon Process .......................................23

3. Admissibility and Opportunies ...................24

4. Taking QE Aer PGY-4 ..................................24

5. Readmissibility ..............................................25

C. Cerfying Examinaon .............................261. General Informaon .....................................26

2. Admissibility and Opportunies ...................27

3. Readmissibility ..............................................28

D. Special Circumstances..............................28

1. Persons with Disabilies ...............................282. Examinaon Irregularies.............................29

3. Substance Abuse ...........................................29

IV. ISSUANCE OF CERTIFICATES AND MOC .............30

A. Reporng of Status...................................30

B. Maintenance of Cercaon (MOC) ..........31

C. Revocaon of Cercate ..........................31 D. Cercaon in Surgical Speciales ...........33

V. ABOUT THE ABS ............................................... 35

A. Nominang Organizaons ........................35

B. Ocers and Directors...............................35

C. Commiees, Component Boards and

Advisory Councils.....................................36

D. Senior Members, Former Ocers, Executive Sta .........................................37

(click to go to page)


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I. INTRODUCTION

A. MissionTe American Board o Surgery serves the public

and the specialty o surgery by providing leadershipin surgical education and practice, by promotingexcellence through rigorous evaluation and exami-nation, and by promoting the highest standards orproessionalism, lielong learning, and the continu-

ous certification o surgeons in practice.B. Purpose

Te American Board o Surgery is a private,nonprofit, autonomous organization ormed or theollowing purposes:

• o conduct examinations o acceptable candidateswho seek certification or maintenance o certifica-tion by the board.

• o issue certificates to all candidates meeting theboard’s requirements and satisactorily complet-ing its prescribed examinations.

• o improve and broaden the opportunities or thegraduate education and training o surgeons.

Te ABS considers certification to be voluntary and limits its responsibilities to ulfilling the pur-poses stated above. Its principal objective is to pass

judgment on the education, training and knowledgeo broadly qualified and responsible surgeons andnot to designate who shall or shall not perormsurgical operations. It is not concerned with theattainment o special recognition in the practice o

surgery. Furthermore, it is neither the intent nor thepurpose o the board to define the requirements ormembership on the staff o hospitals or institutionsinvolved in the practice or teaching o surgery.

C. History

Te American Board o Surgery was organizedon January 9, 1937, and ormally chartered on July19, 1937. Te ormation o the ABS was the result oa committee created a year earlier by the AmericanSurgical Association, along with representatives romother national and regional surgical societies, to

establish a certification process and national certiy-ing body or individual surgeons practicing in the U.S.

Te committee decided that the ABS should beormed o members rom the represented organiza-tions and, once organized, it would establish acomprehensive certification process. Tese findingsand recommendations were approved by the coop-erating societies, leading to the board’s ormation in


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1937. Tis was done to protect the public and improvethe specialty.

Te ABS was created in accordance with the

Advisory Board o Medical Specialties, the acceptedgoverning body or determining certain specialtyfields o medicine as suitable or certification. In 1970it became known as the American Board o MedicalSpecialties (ABMS) and is currently composed o 24member boards, including the ABS.

D. The Cercaon Process

Te American Board o Surgery considerscertification in surgery to be based upon a processo education, evaluation and examination. TeABS holds undergraduate and graduate education

to be o the utmost importance and requires theattestation o the residency program director that anapplicant has completed an appropriate educationalexperience and attained a sufficiently high level oknowledge, clinical judgment and technical skills,

as well as ethical standing, to be admitted to thecertification process.Individuals who believe they meet the ABS’

educational, proessional and ethical requirementsmay begin the certification process by applying oradmission to the Qualiying Examination (QE). Te

application is reviewed and, i approved, the appli-cant is granted admission to the examination.

Upon successul completion o the QE, theapplicant is considered a candidate or certificationand granted the opportunity to take the CertiyingExamination (CE). I the candidate is also successulin passing the CE, the candidate is deemed certifiedin surgery and becomes a diplomate o the ABS.

Possession o a certificate is not meant to implythat a diplomate is competent in the perormance othe ull range o complex procedures that encompass

each content area o general surgery as defined insection I-E. It is not the intent nor the role o the ABSto designate who shall or shall not perorm surgicalprocedures or any category thereo. Credentialingdecisions are best made by locally constitutedbodies and should be based on an applicant’s extento training, depth o experience, patient outcomesrelative to peers, and certification status.

E. Specialty of General Surgery Dened

1. Scope of General Surgery

General surgery is a discipline that requiresknowledge o and amiliarity with a broad spectrum


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o diseases that may require surgical treatment. Bynecessity, the breadth and depth o this knowledgewill vary by disease category. In most areas, the

surgeon will be expected to be competent indiagnosing and treating the ull spectrum o disease.However, there are some types o disease in whichcomprehensive knowledge and experience is notgenerally gained in the course o a standard surgicalresidency. In these areas the surgeon will be able

to recognize and treat a select group o conditionswithin a disease category.

2. Required Residency Experience for Inial

Cercaon in General Surgery

Residency training in general surgery requires

experience in all o the ollowing content areas:• Alimentary ract (including Bariatric Surgery)

• Abdomen and its Contents

• Breast, Skin and Sof issue

• Endocrine System• Solid Organ ransplantation

• Pediatric Surgery

• Surgical Critical Care

• Surgical Oncology (including Head and NeckSurgery)

• rauma/Burns and Emergency Surgery

• Vascular Surgery

General surgery as a field comprises, but is not

limited to, the perormance o operations andprocedures (including endoscopies) relevant tothe content areas listed above. Additional expectedknowledge and experience in the above areasincludes:

• echnical proficiency in the perormance o coreoperations/procedures in the above areas, plusknowledge, amiliarity, and in some cases techni-cal proficiency, with the more uncommon andcomplex operations in each o the above areas.

• Clinical knowledge, including epidemiology,anatomy, physiology, clinical presentation, andpathology (including neoplasia) o surgicalconditions.

• Knowledge o anaesthesia; biostatistics andevaluation o evidence; principles o minimally

invasive surgery; and transusion and disorders ocoagulation.


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• Knowledge o wound healing; inection; fluidmanagement; shock and resuscitation; immunol-ogy; antibiotic usage; metabolism; management

o postoperative pain; and use o enteral andparenteral nutrition.

• Experience and skill in the ollowing areas: clini-cal evaluation and management, or stabilizationand reerral, o patients with surgical diseases;management o preoperative, operative and

postoperative care; management o comorbiditiesand complications; and knowledge o appropriateuse and interpretation o radiologic and otherdiagnostic imaging.

3. Te ollowing disciplines have training programs

related to, but separate rom and generally in ad-dition to, general surgery. As the primary surgicalpractitioner in many circumstances, the certifiedgeneral surgeon is required to be amiliar withdiseases and operative techniques in these areas.

Te certified general surgeon will have experienceduring training that will allow or diagnosis andmanagement o a select group o conditions inthese areas. However, comprehensive knowledgeand management o conditions in these areasgenerally requires additional training.

• Bariatric Surgery • Solid Organ ransplantation

• Pediatric Surgery

• Toracic Surgery

• Vascular Surgery

4. In addition, the certified general surgeon is expectedto be able to recognize and provide early manage-ment and appropriate reerral or common urgentand emergent problems in the surgical fields o:

• Gynecology

• Urology

• Hand Surgery

5. Te certified general surgeon is also expected tohave knowledge and skills in the managementand team-based interdisciplinary care o theollowing patient groups:

• erminally ill patients, to include palliative careand management o pain, weight loss, and cachexiain patients with malignant and chronic conditions.

• Morbidly obese patients, to include metabolicderangements, surgery or weight loss, and thecounseling o patients and amilies.


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• Geriatric surgical patients, to include operativeand nonoperative care, management o comorbidchronic diseases, and the counseling o patientsand amilies.

• Culturally diverse groups o patients.

F. Website Resources

Te ABS website, www.absurgery.org , is updatedregularly and offers many resources or individuals

interested in ABS certification. Potential applicantsare encouraged to amiliarize themselves with thewebsite. Applicants should use the website to submitan online application, check their application’sstatus, update their personal inormation, register

or an examination, and view their recent examina-tion history.In addition, the ollowing policies are posted

on the website. Tey are reviewed regularly andsupersede any previous versions.

•Credit or Foreign Graduate MedicalEducation

• Ethics and Proessionalism

• Examination Admissibility

• Examination o Persons with Disabilities

• Flexible Rotations Policy

• Leave Policy

• Limitation on Number o ResidencyPrograms

• Military Activation• Osteopathic Trainees Policy

• Privacy Policy

• Public Reporting o Status

• Reconsideration and Appeals• Re-entry to Residency Training Afer Hiatus

• Regaining Admissibility to General SurgeryExaminations

•Representation o Certification Status

• Revocation o Certificate

• Substance Abuse


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II. REQUIREMENTS FOR CERTIFICATION

Admission to the ABS certification process isgoverned by the requirements and policies in effect at

the time o application. All requirements are subjectto change.

A. Exam Admissibility: Seven-Year Limit

Applicants or certification in surgery whocompleted residency in the 2012-2013 academic

year or thereafer will have no more than sevenacademic years to achieve certification.

Te seven-year period starts immediately uponcompletion o residency. I individuals delay inapplying or certification, or ail to take an examina-

tion in a given year, they will lose examinationopportunitiesI applicants are unable to become certified within

seven years o completing residency, they are nolonger eligible or certification and must pursue areadmissibility pathway to re-enter the certification

process. See Section III or urther inormation.

B. General Requirements

Applicants or certification in surgery must meetthese general requirements:

• Have demonstrated to the satisaction othe program director o a graduate medicaleducation program in surgery accredited by theAccreditation Council or Graduate MedicalEducation (ACGME) or Royal College o Physi-cians and Surgeons o Canada (RCPSC) that they

have attained the level o qualifications requiredby the ABS. All phases o the graduate educa-tional process must be completed in a mannersatisactory to the ABS.

• Have an ethical, proessional, and moral status

acceptable to the ABS.• Be actively engaged in the practice o general

surgery as indicated by holding admittingprivileges to a surgical service in an accreditedhealth care organization, or be currently engaged

in pursuing additional graduate education in acomponent o surgery or other recognized surgi-cal specialty. An exception to this requirement isactive military duty.

• Hold a currently registered ull and unrestricted

license to practice medicine in the United Statesor Canada when registering or the CertiyingExamination. A ull and unrestricted medical


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license is not required to take the QualiyingExamination. emporary, limited, educationalor institutional medical licenses will not be

accepted or the Certiying Examination, even ithe candidate is in a ellowship.

An applicant must immediately inorm the ABSo any conditions or restrictions in orce on anyactive medical license he or she holds in any stateor province. When there is a restriction or condi-tion in orce on any o the applicant’s medicallicenses, the Credentials Committee o the ABSwill determine whether the applicant satisfies theabove licensure requirement.

Rarely, the above requirements may be modified

or waived by the ABS Credentials Committee iwarranted by unique individual circumstances.

C. Undergraduate Medical Educaon

Applicants must have graduated rom an accred-ited school o allopathic or osteopathic medicine in

the United States or Canada. Graduates o schools omedicine in countries other than the United Statesor Canada must present evidence o certification bythe Educational Commission or Foreign MedicalGraduates (ECFMG®). (See also II-I-2. Credit or

Foreign Graduate Education.)D. Graduate Surgical Educaon

1. General Informaon

The purpose o graduate education in surgeryis to provide the opportunity to acquire a broad

understanding o human biology as it relates tosurgical disorders, and the technical knowledgeand skills appropriate to be applied by a surgicalspecialist. Tis goal can best be attained by meanso a progressively graded curriculum o studyand clinical experience under the guidance andsupervision o certified surgeons, which providesprogression through increasing levels o responsibil-ity or patient care up to the final stage o completemanagement. Major operative experience andindependent decision making at the final stage o

the program are essential components o surgicaleducation. Te ABS will not accept into the certi-fication process anyone who has not had such anexperience in the specialty o surgery, as previouslydefined in section I-E, regardless o the number oyears spent in educational programs.

Te graduate educational requirements setorth on these pages are considered to be the


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minimal requirements o the ABS and should notbe interpreted to be restrictive in nature. Te totaltime required or the educational process should be

sufficient to provide adequate clinical experienceor development o sound surgical judgment andadequate technical skill. Tese requirements do notpreclude additional needed educational experiencebeyond the minimum 60 months o residency, andprogram directors are encouraged to retain residents

in a program as long as is required to achieve thenecessary level o perormance.

Te integration o basic sciences with clinicalexperience is considered to be superior to ormalcourses in such subjects. Accordingly, whilerecognizing the value o ormal courses in the studyo surgery and the basic sciences, the ABS willnot accept such courses in lieu o any part o therequired clinical years o surgical education.

Te ABS may at its discretion require that amember o the ABS or a designated diplomate

observe and report upon the clinical perormanceo an applicant beore establishing admissibilityto examination, or beore awarding or renewingcertification.

While residency programs may develop their own vacation, illness and leave policies or residents, oneyear o approved residency toward ABS require-ments must be 52 weeks in duration and include atleast 48 weeks o ull-time clinical activity. All timeaway rom clinical activity o two days or more mustbe accounted or on the application or certification.

(See also II-G. Leave Policy.)2. Specic Requirements

o be accepted into the certification process,applicants must have satisactorily completed theollowing:

• A minimum o five years o progressive residencyeducation ollowing graduation rom medicalschool in a program in general surgery accreditedby the ACGME or RCPSC. (See II-I-5 or policyregarding residents in osteopathic training programs.)

Repetition o a year o training at one clinical levelmay not replace another year in the sequence otraining. For example, completing two years at thePGY-2 level does not permit promotion to PGY-4;a categorical PGY-3 year must be completed and

verified by the ABS resident roster. Te only excep-tion would be in some cases when credit is grantedor prior training outside the U.S. or Canada.


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A list o U.S. programs accredited by the ACGMEmay be ound at www.acgme.org .

• All phases o graduate education in general

surgery in an accredited general surgeryprogram. Experience obtained in accreditedprograms in other recognized specialties, althoughcontaining some exposure to surgery, is notacceptable.

Additionally, a flexible or transitional first yearwill not be credited toward PGY-1 trainingunless it is accomplished in an institution withan accredited program in surgery and at least sixmonths o the year is spent in surgical disciplines.

• Te 60 months o general surgery residencytraining at no more than three residencyprograms. Te three-program limit applies tothe five years (PGY 1-5) o progressive clinicaltraining in general surgery that are to be countedas the applicant’s complete residency, regard-

less o whether these years were completed as apreliminary or categorical resident.

I a resident completes a PGY year (e.g., PGY-1)at one institution and then repeats the same yearat another institution, only one o these years willbe counted as residency experience and only oneo these programs will be included in the three-program limit. In addition, any credit granted orprior training outside the U.S. or Canada will becounted as one institution.

For applicants who trained at more than one pro-

gram, documentation o satisactory completiono all years in prior programs rom the appropriateprogram directors must be submitted. Individu-als who completed the five progressive years oresidency at more than three programs will berequired to repeat one or more years at a singleinstitution to comply with the three-program limit.

• No ewer than 48 weeks o ull-time clinicalactivity in each residency year, regardless o theamount o operative experience obtained. Teremaining our weeks o the year are considerednon-clinical time that may be used or anypurpose. Te 48 weeks may be averaged over thefirst three years o residency, or a total o 144weeks required, and over the last two years, or atotal o 96 weeks required.

• At least 54 months o clinical surgical experiencewith progressively increasing levels o responsi-


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bility over the five years in an accredited surgeryprogram, including no ewer than 42 months devoted to the content areas o general surgery

as previously defined in section I-E.• No more than six months during all junior

years (PGY 1-3) assigned to non-clinical ornon-surgical disciplines that are supportive o theneeds o the individual resident and appropriateto the overall goals o the general surgery trainingprogram. Experience in surgical pathology andendoscopy is considered to be clinical surgery, butobstetrics and ophthalmology are not. No morethan 12 months total during all junior years maybe allocated to any one surgical specialty other

than general surgery.• Te programs Advanced Cardiovascular Life

Support (ACLS), Advanced Trauma Life Support ® (ATLS® ) and Fundamentals of LaparoscopicSurgery ™ (FLS). Applicants are not required to

be currently certified in these programs; howeverdocumentation o prior successul certificationmust be provided with the application.

• At least six operative and six clinical peror-mance assessments conducted by the program

director or other aculty members while inresidency. Te ABS does not collect the assessmentorms; when signing an individual’s application,the program director will be asked to attest that theassessments have been completed. Sample evalua-tion orms and urther inormation are available at

www.absurgery.org .

• Te entire chie resident experience in eitherthe content areas o general surgery, as definedin section I-E, or thoracic surgery , with no morethan our months devoted to any one component.

(Exceptions will be made or residents who have beenapproved under the flexible rotations option; see II-I-3.)

All resident rotations at the PGY-4 and PGY-5levels should involve substantive major operativeexperience and independent decision making.

• Acting in the capacity o chie resident in generalsurgery or a 12-month period, with the major-ity o the 12 months served in the final year. Teterm “chie resident” indicates that a resident hasassumed ultimate clinical responsibility or patientcare under the supervision o the teaching staff andis the most senior resident involved with the directcare o the patient.


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In certain cases, up to six months o the chieresidency may be served in the next to the lastyear, provided it is no earlier than the ourth clini-

cal year and has been approved by the ResidencyReview Committee or Surgery (RRC-Surgery)ollowed by notification to the ABS. (Specialrequirements apply to early specialization in vascularsurgery and thoracic surgery; see www.absurgery.org.)

• Te final two residency years in the sameprogram, unless prior approval or a differentarrangement has been granted by the ABS.

E. Operave Experience

• Applicants must have been the operating surgeon

or a minimum o 750 operative procedures inthe five years o residency , including at least 150operative procedures in the chie resident year.Te procedures must include operative experiencein each o the content areas listed in the definitiono general surgery set orth in section I-E.

• In addition, they must have a minimum o 25cases in the area o surgical critical care patientmanagement, with at least one case in each othe seven categories: ventilatory management; bleeding (non-trauma); hemodynamic instability ;

organ dysunction/ailure; dysrhythmias; invasiveline management and monitoring ; and parenteral/ enteral nutrition.

• Applicants who completed residency in the2014-2015 academic year or thereafer must

also have participated as teaching assistant in aminimum o 25 cases by the end o residency.

Applicants are required to submit a report withtheir application that tabulates their operativeexperience during residency, including the numbero patients with multiple organ trauma where a majorgeneral surgical operation was not required. Appli-cants must also indicate their level o responsibility(e.g., surgeon chie year, surgeon junior years, teach-ing assistant, first assistant) or the procedures listed.

Applicants may claim credit as “surgeon chie

year” or “surgeon junior years” only when theyhave actively participated in making or confirm-ing the diagnosis, selecting the appropriateoperative plan, and administering preoperativeand postoperative care. Additionally, they musthave personally perormed either the entire

operative procedure or the critical parts thereo,and participated in postoperative ollow-up. All o


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the above must be accomplished under appropriatesupervision.

When previous personal operative experience

justifies a teaching role, residents may act as teach-ing assistants and list such cases during the ourthand fifh year only. Applicants may claim credit asteaching assistant only when they have been presentand scrubbed and acted as assistant to guide a more

junior trainee through the procedure. Applicants

may count up to 50 cases as teaching assistanttoward the 750 operative case total; howeverthese cases may not count toward the 150 chie year cases. Applicants may not claim credit bothas surgeon (surgeon chie or surgeon junior) and teaching assistant.

F. Upcoming Requirements

250 Cases by End of PGY-2

Applicants who began residency in July 2014or thereafer will be required to have perormed at

least 250 operations by the end o the PGY-2 year.Te 250 cases can include procedures perormed assurgeon or first assistant. O the 250 cases, at least 200 must be either in the defined categories, endos-copies, or e-codes. A maximum o 50 non-definedcategory cases may be applied to this requirement.

Cases will be tracked through the ACGME caselog. Te 250 cases must be completed in two consecu-tive residency years, ending with the PGY-2 year.

Flexible Endoscopy Curriculum

Applicants who complete residency in the 2017-

2018 academic year or thereafer will be requiredto have completed the ABS Flexible EndoscopyCurriculum, available at www.absurgery.org . Tecurriculum contains several “levels” that must beattained during residency. Te final level includessuccessul completion o the Fundamentals oEndoscopic Surgery™ (FES) program. Applicants willneed to provide documentation o FES certificationwith their application.

Residents are highly encouraged to complete allother requirements in the ABS Flexible Endoscopy

Curriculum beore seeking FES certification, and toplan ahead to allow time or FES testing and possiblere-testing. Te FES didactic materials are availablewithout charge at www.esdidactic.org . Preparationor the FES skills test can be achieved using resourcesalready available at an institution — purchase oa simulator is not necessary. Further inormationregarding FES is available at www.esprogram.org .


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G. Leave Policy

Leave During a Standard Five-Year Residency

For documented medical problems or maternity

leave, including pregnancy and delivery, that directlyaffect the individual (i.e., not amily leave), the ABSwill accept 142 weeks o training in the first threeyears o residency and 94 weeks in the last two yearso residency.

Other arrangements beyond the standard medicalleave described above require prior written approvalrom the ABS. Such requests may only be made by theprogram director and must be sent in writing by mailor ax (no emails) to the ABS office. Requests shouldinclude a complete schedule o the resident’s training

with calendar dates, including all leave time.Six-Year Opon

I permitted by the residency program, the fiveclinical years o residency training may be completedover six academic years. All training must be com-

pleted at a single program with advance approval romthe ABS. Forty-eight weeks o training are requiredin each clinical year and all individual rotations mustbe ull-time. Te first 12 months o clinical trainingwould be counted as PGY-1, the second 12 monthsas PGY-2, and so orth. No block o clinical training

may be shorter than one month (our weeks).Under this option, a resident may take up to 12

months off during training. Te resident would firstwork with his or her program to determine an appro-priate leave period or schedule. Te program wouldthen request approval or this plan rom the ABS.

Use o the six-year option is solely at the program’sdiscretion, and contingent on advance approval rom theABS. Te option may be used or any purpose approvedby the residency program, including but not limited toamily issues, visa issues, medical problems, maternity

leave, volunteerism, educational opportunities, etc.

H. Ethics and Professionalism Policy

Te ABS believes that certification in surgerycarries an obligation or ethical behavior and proes-sionalism in all conduct. Te exhibition o unethical

or dishonest behavior or a lack o proessionalism byan applicant, examinee or diplomate may thereorecause the cancellation o examination scores;prevent the certification o an individual, or result inthe suspension or revocation o certification at any

subsequent time; and/or result in criminal chargesor a civil lawsuit. All such determinations shall be atthe sole discretion o the ABS.


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Unethical and unproessional behavior is denotedby any dishonest behavior, including cheating;lying; alsiying inormation; misrepresenting one’s

educational background, certification status and/orproessional experience; and ailure to report miscon-duct. Te American Board o Surgery has adopted a“zero tolerance” policy toward these behaviors, andindividuals exhibiting such behaviors may have theirexam scores cancelled; be permanently barred rom

taking ABS examinations; be permanently barredrom certification; reported to state medical boards;and/or legally prosecuted under state or ederal law,including thef, raud and copyright statutes.

Unethical behavior is specifically defined by the

ABS to include the disclosure, publication, reproduc-tion or transmission o ABS examinations, in wholeor in part, in any orm or by any means, verbal orwritten, electronic or mechanical, or any purposes.Tis also extends to sharing examination inormationor discussing an examination while still in progress.

Unethical behavior also includes the possession,reproduction or disclosure o materials or inormation,including examination questions or answers or specificinormation regarding the content o the examination,beore, during or afer the examination. Tis definitionspecifically includes the recall and reconstruction oexamination questions by any means and such effortsmay violate ederal copyright law.

All applicants, examinees, or diplomates must ullycooperate in any ABS investigation into the validity,integrity or security o ABS examinations. All ABS

examinations are copyrighted and protected by law;the ABS will prosecute violations to the ull extentprovided by law and seek monetary damages orany loss o examination materials. (See also III-D-2.Examination Irregularities.)

Possession o a currently valid, ull and unrestrictedstate medical license is an absolute requirement orcertification. I a state medical license afer finaldecision is probated, restricted, suspended, or revoked,this will trigger a review by the ABS CredentialsCommittee at its next meeting. Te committee will

review the action, and determine i any action isrequired in regard to the diplomate’s certificate insurgery. Normally the state action will be duplicated inregard to the certificate, but the committee afer reviewmay choose at its discretion to adopt either a morelenient or more stringent condition on the certificate i

warranted by the nature o the disciplinary inraction.(See also IV-C. Revocation o Certificate.)


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I. Addional Consideraons

1. Military Service

Credit will not be granted toward the require-ments o the ABS or service in the U.S. ArmedForces, the U.S. Public Health Service, the NationalInstitutes o Health or other governmental agenciesunless the service was as a duly appointed residentin an accredited program in surgery.

2. Credit for Foreign Graduate Educaon

Te ABS does not grant credit directly to residentsor surgical education outside the U.S. or Canada. TeABS will consider granting partial credit or oreigngraduate medical education to a resident in a U.S.

general surgery residency program accredited by theACGME, but only upon request o the programdirector. Preliminary evaluations will not be providedbeore enrollment in a residency program, either to aresident or program director.

Te program director is the primary judge othe resident’s proficiency level and should makethe request or credit only afer having observedthe individual as a junior resident or at least sixmonths to ascertain that clinical perormance isconsistent with the level o credit requested. I a

resident is elt to be a candidate or credit, he or sheshould normally begin residency at the PGY-2 orPGY-3 level so that the appropriate level o clinicalskills can be assessed.

Residents must take the ABS In-raining Exami-nation (ABSIE®) beore any credit may be request-ed. Te resident’s scores on the ABSIE should beconsonant with the level o credit requested.

Credit or oreign training may be granted in lieuo the first or second clinical years o residency, andrarely the third. Credit is never given or the ourth

or fifh clinical years, which must be completedsatisactorily in an accredited U.S. program. Programdirectors who wish to advance residents to seniorlevels (PGY-4) must have obtained ABS approvalprior to beginning the PGY-4 year; otherwise creditor these years will be denied.

Te granting o credit is not guaranteed. I theresident moves to another program, the credit is nottranserable and must be requested by the resident’snew program director afer a new period o evaluation.

All requests or credit and related inquiries

must come rom the program director and be sentin writing by letter or ax (no emails). Requests will


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not be approved unless all required documenta-tion is submitted. Requests or more than one yearo credit, which require approval o the ABS Creden-

tials Committee, must be submitted by March 15, toprovide program directors with a decision by May 1.Program directors will be notified o credit decisionsby letter rom the ABS executive director.

4See www.absurgery.org or the complete policy,including all required documentation.

Canadian Residents

Applicants who trained in Canada must havecompleted all o the requirements in a Canadiansurgery program accredited by the RCPSC or incombination with a U.S. surgery program accredited

by the ACGME. No credit or surgical educationoutside the U.S. and Canada will be granted toapplicants who complete a Canadian program.Applicants rom Canadian programs must complywith ABS requirements or certification.

Internaonal Rotaons

Te ABS will accept in certain circumstancesrotations outside the U.S. or Canada toward its resi-dency training requirements. I program directorswish to credit training abroad toward ABS require-ments, they must ully justiy the reasons or it and

receive approval or such training in advance. Nosuch rotations will be permitted in the first (PGY-1)or last (PGY-5) year o residency training.

o request approval or an international rotation,a letter should be sent by mail or ax (no emails)to both the ABS and the RRC-Surgery, signed byboth the program director and the designatedinstitutional official (DIO). Te program will receiveseparate approval letters; both must be receivedprior to implementation o the international rota-tion. Further details regarding rotation criteria and

inormation to be included in the request or creditare available rom www.absurgery.org .

3. Flexible Rotaons Opon

Te ABS has instituted a policy to permit greaterflexibility in the clinical rotations completed by

general surgery residents. Program directors, withadvance approval o the ABS, are allowed to custom-ize up to 12 months o a resident’s rotations in thelast 36 months o residency to reflect his or heruture specialty interest. No more than six months o

flexible rotations are allowed in any one year. Tis isan entirely voluntary option or program directorsand may be done on a selective case-by-case basis.


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o request flexible rotations or a resident, a lettershould be sent by mail or ax (no emails) to both theABS and the RRC-Surgery. Te letter must be signed

by both the program director and the DIO, andbe accompanied by a block diagram outlining thespecific resident’s individualized rotations. Approvalmust be obtained or each individual resident, eveni the program received approval in the past orthe same arrangement. Te program will receive

separate approval letters rom the ABS and RRC-Surgery; both must be received prior to implementa-tion o flexible rotations.

4See www.absurgery.org or the complete policy,including a list o suggested rotations by specialty.

4. Re-entry to Residency Training Aer HiatusResidents who withdraw rom one surgical

residency and have a hiatus beore entering anotherresidency, during which they are not engaged inany structured academic surgical activity, may be

expected to have some degradation o knowledge andskills during that time. Any hiatus and re-entry intotraining in which a resident has been absent romresidency training or our or more years must bereviewed thereore by the ABS Credentials Commit-tee and approved i the individual is to qualiy or

certification at completion o training. Failure toobtain such approval may result in reusal to admitthe resident to the certification process despitecompletion o five years o accredited training.

Program directors who wish to accept such

residents into their program should enroll them ora minimum five-month trial period to evaluate theirclinical skills and training level, and subsequentlysend a report to the ABS providing the results othis trial period and the ABSIE score or the sameyear. Such approval would normally be requested

by June 1 in a given year, and would be acted on atthe June meeting o the Credentials Committee sothe resident could enter the program on July 1 at theappropriate level.

4See www.absurgery.org or the complete policy.

5. Osteopathic Trainees

In 2015 the ABS published a new policy regardingthe entry o osteopathic surgical residents into theABS certification process, in light o the SingleGME Accreditation System. Tese residents will be

required to complete at a minimum the last threeyears o residency training (PGY-3, -4, and -5) in


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an ACGME-accredited general surgery residencyprogram. See the ull policy at www.absurgery.org .

6. Further Informaon for Program Directors

When making advancement determinations,program directors are cautioned against appointingresidents to advanced levels without first ensuringthat their previous training is in accordance withABS certification requirements. Program directors

should contact the ABS prior to making a promo-tion decision i there is any question o a resident’scompleted training not meeting ABS requirements.

At the end o each academic year, the ABSrequires that program directors veriy the satisac-tory completion o the preceding year o training or

each resident in their program, using the residentroster inormation submitted to the ABS. Forresidents who have transerred into their program,program directors must obtain written verificationo satisactory completion or all prior years o

training. Upon applying or certification, residentswho have transerred programs must provide this verification to the ABS.

In addition to its own requirements, the ABSadheres to ACGME program requirements or resi-dency training in general surgery. Tese include that

program directors must obtain RRC-Surgery approvalin these situations: (1) or resident assignments o sixmonths or more at a participating non-integrated site;or (2) i chie resident rotations are carried out priorto the last 12 months o residency. Documentation osuch approval or prior ABS approval should accom-pany the individual’s application.

7. Reconsideraon and Appeals

Te ABS may deny or grant an applicant orcandidate the privilege o examination whenever

the acts in the case are deemed by the ABS to sowarrant.Applicants and candidates may request reconsid-

eration and appeal as outlined in ABS Reconsidera-tion and Appeals Policy , available rom the ABSoffice or website, www.absurgery.org . A request

or reconsideration, the first step, must be made inwriting to the ABS office within 90 days o receipt onotice o the action in question.


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III. EXAMINATIONS IN SURGERY

ABS examinations are developed by committeesconsisting o ABS directors and experienced

diplomates nominated to serve as exam consultants.All are required to hold current, time-limitedcertificates and participate in the ABS Maintenanceo Certification (MOC) Program. Neither directorsnor consultants receive any remuneration or theirservices. All ABS examinations are protected underederal copyright law.

Te ABS has aligned the content o its examina-tions with that o the SCORE® Curriculum Outline orGeneral Surgery Residency . Te outline is available atwww.absurgery.org or www.surgicalcore.org .

A. The In-Training Examinaon (ABSITE)

Te ABS offers annually to residency programsthe In-raining Examination, a ormative multiple-choice examination designed to measure theprogress attained by residents in their knowledge o

the applied science and the management o clinicalproblems related to surgery. Te ABSIE is admin-istered as a single examination to all residency levelsin a secure online ormat.

Te ABSIE is solely meant to be used by programdirectors as a ormative evaluation instrument inassessing residents’ progress, and results o theexamination are released to program directors only.Te ABS will not release score reports to examinees.Te exam is not available on an individual basis and isnot required as part o the certification process.

Exam Irregularities: Te ABS updated in August2015 how irregularities in the ABSIE administra-tion will be handled. When irregular behavior isdetected, the residency program will be required toinvestigate the situation and submit to the ABS a

report o its findings, including its decisions regardingthe individuals concerned. In addition, the ABSIEscores o individuals identified by the ABS as havingbeen involved in the irregularities will not be released.Te program will also be required to administer theABSIE to all o its residents on the first day o the

exam window or the next three years. See the ullpolicy at www.absurgery.org .

B. The Qualifying Examinaon (QE)

1. General Informaon

Te Qualiying Examination is an eight-hour,computer-based examination offered once per year.Te examination consists o approximately 300


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multiple-choice questions designed to evaluate anapplicant’s knowledge o general surgical principlesand applied science. Inormation regarding exam

dates and ees, as well as an exam content outline, isavailable at www.absurgery.org .

Exam results are mailed and posted on theABS website two to three weeks afer the exam.Examinees’ results are also reported to the directoro the program in which they completed their final

year o residency. New for 2016: Starting this academic year, the

ABS will permit residents who will successullycomplete their PGY-4 year in June to apply or andtake the QE. All requirements must be met — see

section 4 on the ollowing page or details.2. QE Applicaon Process

Individuals who believe they meet the require-ments or certification in surgery may apply to theABS or admission to the certification process. All

training must be completed by end o August or theapplicant to be eligible or that year’s QE. Applica-tion requirements and the online application processare available rom the ABS website, www.absurgery.org . Te individual who served as the applicant’sprogram director during residency must attest thatall inormation supplied by the applicant is accurate.

An applicaon will not be approved unless:

• Every rotation completed during residency train-ing is listed separately and consecutively.

• All time away rom training o two days or moreor vacation, medical leave, etc., is reportedaccurately.

• Documentation o current or past certification inACLS, ALS and FLS is provided.

• Cases are listed or patient care/nonoperativetrauma, in addition to the 25 cases required insurgical critical care patient management.

• For applicants who trained in more than oneprogram, documentation o satisactory comple-

tion or all years in each program is provided.• For international medical graduates, a copy o

their ECFMG certificate is provided.

Note that residents are not required to meet RRC-Surgery defined category minimums at the time o

application — they must only meet ABS requirements.Applicants should keep a copy o all submitted


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inormation as the ABS will not urnish copies.Applicants are also strongly advised to maintain acurrent mailing address with the ABS during the

application process to avoid unnecessary delays.Te acceptability o an applicant does not dependsolely upon completion o an approved program oeducation, but also upon inormation received by theABS regarding proessional maturity, surgical judg-ment, technical capabilities and ethical standing.

3. Admissibility and Examinaon Opportunies

An individual will be considered admissible to theQualiying Examination only when all requirementso the ABS currently in orce at the time o applica-tion have been satisactorily ulfilled, including

acceptable operative experience and the attestationo the program director regarding the applicant’ssurgical skills, ethics and proessionalism.

• Individuals will have no more than sevenacademic years ollowing residency to complete

the certification process. Te seven-year periodbegins upon completion o residency , not whenan individual’s application is approved.

• Once the application is approved, the applicantwill be granted a maximum o our opportunitieswithin a our-year period

to pass the QE. A newapplication is not required during this period. Ithe applicant chooses not to take the examinationin a given year, this is considered a lost opportu-nity as the our-year limit is absolute.

• Te granting o our opportunities in our years

is contingent on sufficient years being lef in theapplicant’s seven-year eligibility period.

Applicants who exceed the above limits will loseadmissibility to the ABS certification process andmust ulfill one o the readmissibility pathways

described in section 5 on the ollowing page i theystill wish to pursue certification.

4. Taking the QE Aer PGY-4

Starting with the 2016 QE, the ABS will permitresidents who will successully complete their

PGY-4 year in June to apply or and take the QE.All training and application requirements mustbe met at the time o application, including 750total cases, 150 chie year cases, 25 cases in surgicalcritical care, 25 teaching assistant cases, and currentor past certification in ACLS, ALS and FLS.

aking the exam afer PGY-4 will count towardthe our opportunities in our years that are granted


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to successully complete the QE. However, theoverall seven-year limit to achieve certification willnot go into effect until completion o residency.

Individuals who pass the QE afer their PGY-4year will not have any official status with the ABSuntil their residency training has been satisactorilycompleted according to ABS requirements. Teyalso will not be eligible to take the General SurgeryCertiying Exam (CE) until that time.

5. QE Readmissibility

Individuals who are no longer admissible to theABS certification process may regain admissibilitythrough the ollowing pathways. For additionaldetails on these pathways, please see Regaining

Admissibility to General Surgery Examinations atwww.absurgery.org .

Standard Pathway

Te individual must complete an additional year(12 months) o structured education in surgery in

an ACGME-accredited general surgery residencyprogram, in which the program director has agreedto provide the applicant with structured teach-ing that meets ABS guidelines. Te structurededucational program must be submitted to the ABSin advance or approval and must be a ull-time

activity. Te program director is required to submitquarterly summaries to the ABS o the applicant’sprogress. Upon completion o the year, the programdirector must provide written attestation that theindividual has successully completed all require-

ments. Te individual must then complete an applica-tion or readmissibility and provide documentation oa current ull and unrestricted medical license.

Upon application approval, the individual willbe admissible to the QE or our opportunitieswithin our years. I the individual does not pass

the QE during this period, and still wishes to pursuecertification, he or she will need to appeal to theABS Credentials Committee or re-entry to thecertification process.

Alternave Pathway

Te individual may pursue an alternative educa-tional pathway to acquire and demonstrate adequatesurgical knowledge. All pathway requirements mustbe completed in the same year or 12-month period.Te initial readmissibility application requires docu-mentation o a current ull and unrestricted medical

license; evidence o 60 hours o Category 1 continuingmedical education (CME) with sel-assessment


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completed in the last 24 months; satisactory comple-tion o the American College o Surgeons’ SurgicalEducation and Sel-Assessment Program (SESAP —

this may be used to satisy the aorementioned CMErequirement); two reerence letters; and a 12-monthoperative experience report.

Upon approval o the application, the applicantis granted one opportunity to take and pass asecure readmissibility examination derived rom

the ABSIE. Upon successul completion o thisexam, the applicant is admissible to the QE or oneopportunity , which must be taken in that same year.

Applicants who ail to successully complete theABSIE-based exam or the QE will be required torepeat the entire pathway , including the applicationprocess and examination, to regain admissibility tothe QE. Up to three consecutive opportunities arepermitted to successully complete this pathway,including the QE. Once the three opportunitiesare exhausted, the individual will need to appeal to

the ABS Credentials Committee or re-entry to thecertification process.

Time Limitaons

I an individual has not actively pursued admissibil-ity or readmissibility to the certification process within

10 years afer completion o residency, he or she willbe required to re-enter ormal residency training orPGY-4 and PGY-5 level training in a surgery programaccredited by the ACGME or RCPSC to regain admis-sibility to the certification process.

C. The Cerfying Examinaon (CE)1. General Informaon

Te Certiying Examination is an oralexamination consisting o three 30-minute sessionsconducted by teams o two examiners that evaluates

a candidate’s clinical skills in organizing the diag-nostic evaluation o common surgical problems anddetermining appropriate therapy. It is the final steptoward certification in surgery.

Te CE is designed to assess a candidate’s surgical judgment, clinical reasoning skills and problem-

solving ability. echnical details o operationsmay also be evaluated, as well as issues related to acandidate’s ethical and humanistic qualities.

Te content o the CE is generally, though notexclusively, aligned with the SCORE Curriculum

Outline or General Surgery . Te majority o theexamination ocuses on topics listed in the outlineas Core. Te remainder covers topics listed as


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Advanced , or complications o more basic scenarios.Candidates are expected to know how to perormand describe all Core procedures.

Te CE is administered several times per year in various U.S. cities. Te exams are conducted by ABSdirectors along with associate examiners who areexperienced ABS diplomates. All examiners are activein the practice o surgery, hold current, time-limitedcertificates, and participate in the ABS MOC Program.

Te ABS makes every effort to avoid conflicts o inter-est between candidates and their examiners.

Please reer to www.absurgery.org or urther detailsabout the CE, including exam dates, ees, the CE siteselection process, and an oral exam video. Examina-tion results are mailed and posted on the ABS websitethe day afer the final day o exam. Examinees’ resultsare also reported to the director o the program inwhich they completed their final year o residency.

2. Admissibility and Examinaon Opportunies

o be admissible to the CE, a candidate musthave successully completed the QE and hold a ulland unrestricted license to practice medicine inthe United States or Canada and provide evidenceo this to the ABS office. Te license must be validthrough the date o the examination. emporary,

limited, educational or institutional medicallicenses will not be accepted, even i a candidate iscurrently in a ellowship.

• Individuals will be granted a maximum o threeopportunities within a three-year period to passthe CE, immediately ollowing successul comple-tion o the QE. Candidates will be offered oneopportunity per academic year. I a candidatechooses not to take the examination in a givenyear, this is considered a lost opportunity as thethree-year limit is absolute.

• Te granting o three opportunities in three yearsis contingent on sufficient years being lef in theapplicant’s seven-year eligibility period.

Te limits outlined above are absolute; exceptionswill only be made or active duty military service

outside the United States. Candidates are stronglyencouraged not to delay taking the CE or the firsttime as such delays may adversely affect perormance.

Candidates who exceed the above limits willlose admissibility to the ABS certification process

and must ulfill one o the readmissibility pathwaysdescribed in the next section i they still wish topursue certification.


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3. CE Readmissibility

Individuals who are no longer admissible to the CEmay regain their admissibility through the ollowing

pathways. For additional details on these pathways,please see Regaining Admissibility to General SurgeryExaminations at www.absurgery.org .

Standard Pathway

Te individual must complete an additional year

(12 months) o structured education in surgery inan ACGME-accredited general surgery residencyprogram, in which the program director has agreedto provide the applicant with structured teaching thatmeets ABS guidelines. Te structured educationalprogram must be submitted to the ABS in advance

or approval and must be a ull-time activity. Teprogram director is required to submit quarterlysummaries to the ABS o the applicant’s progress.Upon completion o the year, the program directormust provide written attestation that the individualhas successully completed all requirements. Teapplicant must then complete an application orreadmissibility and provide documentation o acurrent ull and unrestricted medical license.

Alternave Pathway

o regain admissibility to the CE through the

alternative pathway, individuals must successullycomplete the entire QE alternative pathway asdescribed in section III-B-5.

Upon successul completion o either o the abovepathways, the individual will be admissible to the CE

or three opportunities within three years. I theindividual is not successul in passing the CE duringthis period, he or she will need to appeal to the ABSCredentials Committee or re-entry to the certifica-tion process.

D. Special Circumstances

1. Persons with Disabilies

Te ABS complies with the Americans withDisabilities Act by making a reasonable effort toprovide modifications in its examination process

to applicants with documented disabilities. Tesemodifications are appropriate or such disabilitiesbut do not alter the measurement o skills or knowl-edge that the examination process is intended to test.Te ABS has adopted a specific policy and procedure

regarding the examination o such applicants, whichis available at www.absurgery.org . Any disability thatan applicant believes requires modification o the


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administration o an examination must be identifiedand documented by the applicant in accordancewith this policy. All materials submitted to the ABS

documenting the disability must be received nolater than the published application deadline or theexamination in question.

2. Examinaon Irregularies and UnethicalBehavior

Examination irregularities, i.e., cheating inany orm, or any other unethical behavior by anapplicant, examinee or diplomate may result inthe barring o the individual rom examinationon a temporary or permanent basis, the denial orrevocation o a certificate, and/or other appropri-

ate actions, up to and including legal prosecution.Determination o sanctions or irregular or unethi-cal behavior will be at the sole discretion o the ABS.(See also II-H. Ethics and Proessionalism.)

3. Substance Abuse

Applicants with a history o substance abusewill not be admitted to any examination unlessthey present evidence satisactory to the ABS thatthey have successully completed the program otreatment prescribed or their condition and are

currently compliant with a monitoring programdocumenting continued abstinence.


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IV. ISSUANCE OF CERTIFICATES AND

MAINTENANCE OF CERTIFICATION

A candidate who has met all requirements andsuccessully completed the Qualiying and CertiyingExaminations o the ABS will be deemed certified insurgery and issued a certificate by the ABS, signed by itsofficers, attesting to these qualifications.

It is the current policy o the ABS that all certificates

issued on or afer January 1, 1976, are valid or a periodo 10 years, rom the date o issuance through Decem-ber 31 o the year o expiration. Certificates issued priorto January 1, 1976, are valid indefinitely.

Diplomates who certiy or recertiy afer July 1,2005, must participate in the ABS Maintenance o

Certification Program to maintain their certification.Te ABS reserves the right to change the duration o itscertificates or the requirements o MOC at any time.

A. Reporng of Status

Te ABS considers the personal inormation andexamination record o an applicant or diplomateto be private and confidential. When an inquiry isreceived regarding an individual’s status with the ABS,a general statement is provided indicating the person’scurrent situation as pertains to ABS certification,

along with his or her certification history.Te ABS will report an individual’s status as either

Certified or Not Certified. In certain cases, one o theollowing descriptions may also be reported: In theExamination Process, Clinically Inactive, Suspendedor Revoked. Te ABS will also report whether a diplo-

mate enrolled in the ABS MOC Program is meetingthe program’s requirements. Please reer to the PublicReporting o Status Policy on the ABS website ordefinitions o the above terms.

Individuals may describe themselves as certified by

the ABS or as an ABS diplomate only when they hold acurrent ABS certificate. Tose whose certificates haveexpired will be considered not certified. An individual’sstatus may be verified at www.absurgery.org .

Te ABS supplies biographical and demographicdata on diplomates to the ABMS or its Directory o

Board Certified Medical Specialists, which is availableat www.certificationmatters.org . Upon certification,diplomates will be contacted by the ABMS andasked to speciy which inormation they would liketo appear in the directory. Diplomates will havetheir listings retained in the directory only i theymaintain their certification according to the ABSMOC Program.


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B. Maintenance of Cercaon

Maintenance o Certification is a program ocontinuous proessional development created by the

ABS in conjunction with the ABMS and its other23 member boards. MOC is intended to documentto the public and the health care community theongoing commitment o diplomates to lielonglearning and quality patient care.

MOC consists o our parts to be ulfilled over the10-year certification period:

Part 1: Professional Standing – A ull and unre-stricted medical license, hospital/surgical centerprivileges and proessional reerences

Part 2: Lifelong Learning and Self-Assessment – 90hours o Category 1 CME credit relevant to yourpractice over a three-year cycle, with at least 60 othe 90 hours including sel-assessment credit

Part 3: Cognitive Expertise – Successul comple-tion o a secure examination at 10-year intervals

Part 4: Evaluation of Performance in Practice –Ongoing participation in an outcomes registry orquality improvement program

Surgeons certified by the ABS are required to

participate in the ABS MOC Program to maintainall ABS certificates they hold. MOC requirementsrun in three-year cycles. At the end o each cycle,diplomates must report to the ABS by completingan online orm about their MOC activities. Pleasereer to www.absurgery.org or more inormation on

current MOC requirements.Surgeons who pass the secure exam (Part 3) prior

to the expiration date o their certificate will receivea new certificate with an expiration date extending10 years rom the expiration date o the previouscertificate.

Te ABS considers MOC to be voluntary in thesame manner as original certification. o ensure receipto materials pertaining to MOC, diplomates shouldnotiy the ABS promptly o any changes o address.

C. Revocaon of CercateCertification by the American Board o Surgery

may be subject to sanction such as revocation orsuspension at any time that the directors shalldetermine, in their sole judgment, that the diplo-mate holding the certification was in some respectnot properly qualified to receive it or is no longerproperly qualified to retain it.


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Te directors o the ABS may consider sanctionor just and sufficient reason, including, but notlimited to, any o the ollowing:

• Te diplomate did not possess the necessaryqualifications nor meet the requirements toreceive certification at the time it was issued; alsi-fied any part o the application or other requireddocumentation; participated in any orm oexamination irregularities; or made any material

misstatement or omission to the ABS, whether ornot the ABS knew o such deficiencies at the time.

• Te diplomate engaged in the unauthorized disclo-sure, publication, reproduction or transmission oABS examination content, or had knowledge o

such activity and ailed to report it to the ABS.• Te diplomate misrepresented his or her status

with regard to board certification, including anymisstatement o act about being board certifiedin any specialty or subspecialty.

• Te diplomate engaged in conduct resulting ina revocation, suspension, qualification or otherlimitation o his or her license to practice medi-cine in any jurisdiction and/or ailed to inormthe ABS o the license restriction.

• Te diplomate engaged in conduct resulting inthe expulsion, suspension, disqualification orother limitation rom membership in a local,regional, national or other organization o his orher proessional peers.

• Te diplomate engaged in conduct resulting in

revocation, suspension or other limitation on hisor her privileges to practice surgery in a healthcare organization.

• Te diplomate ailed to respond to inquiries rom theABS regarding his or her credentials, or to participate

in investigations conducted by the board.• Te diplomate ailed to provide an acceptable level

o care or demonstrate sufficient competence andtechnical proficiency in the treatment o patients.

• Te diplomate ailed to maintain ethical, proes-

sional and moral standards acceptable to the ABS.Te holder o a revoked or suspended certificate

will be given written notice o the reasons or itssanction by express letter carrier (e.g., FedEx) to thelast address that the holder has provided to the ABS.

Sanction is final upon mailing o the notification.Upon revocation o certification, the holder’sstatus will be changed to Not Certified and the


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holder will be required to return the certificate tothe ABS office.

Individuals may appeal the decision to revoke

or suspend a certificate by complying with the ABSReconsideration and Appeals Policy , available rom theABS office or website (www.absurgery.org ). A requestor reconsideration, the first step, must be made inwriting to the ABS office within 90 days o receipt onotice rom the ABS o the action in question.

Should the circumstances that justified therevocation o certification be corrected, the directorso the ABS at their sole discretion may reinstate thecertificate afer appropriate review o the individual’slicensure and perormance using the same standardsas applied to applicants or certification, and ollow-ing ulfillment by the individual o requirementsor certification or recertification as previouslydetermined by the ABS.

Requirements or certificate reinstatement willbe determined by the ABS on a case-by-case basis

in parallel with the type and severity o the originalinraction, up to and including complete repetition othe initial certification process. Individuals who havehad their certification revoked or suspended and thenrestored, regardless o their initial certification statusor prior dates o certification, will be required to take

and pass the next MOC examination to reinstate theircertification. Upon passing the examination, theywill be awarded a new, time-limited certificate andenrolled in the ABS MOC Program.

D. Cercaon in Surgical Speciales

Te ABS has been authorized by the ABMS to awardcertification to individuals who have pursued special-ized training and met defined requirements in certaindisciplines related to the specialty o surgery: vascularsurgery; pediatric surgery; surgical critical care (SCC);

complex general surgical oncology; surgery o thehand; and hospice and palliative medicine.

Individuals seeking certification by the ABS inthese specialties must ulfill the ollowing require-ments:

•Be currently certified by the ABS in generalsurgery (see next page or exceptions).

• Possess a ull and unrestricted license to practicemedicine in the U.S. or Canada.

• Have completed the required training in thediscipline.

• Demonstrate operative experience and/or patientcare data acceptable to the ABS.


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• Show evidence o dedication to the discipline asspecified by the ABS.

• Receive avorable endorsement by the director o

the training program in the particular discipline.• Successully complete the prescribed examinations.

Further inormation regarding certification inthese specialties is available rom www.absurgery.org .

Primary Cercaon in Vascular Surgery

A primary certificate in vascular surgery took effectJuly 1, 2006. Individuals who complete an accreditedindependent (5+2) or early specialization (4+2)

vascular surgery program ollowing general surgeryresidency are no longer required to obtain certifica-tion in general surgery prior to pursuing vascularsurgery certification.

However, these individuals must have an approvedapplication or the General Surgery Qualiying Exambeore entering the vascular surgery certificationprocess, meeting all training and application require-

ments. Upon application approval, these individualsmay then pursue certification in vascular surgery,or certification in both general surgery and vascularsurgery in whichever order they preer.

Surgical Crical Care: Examinaon While in Residency

Individuals who completed an ACGME-accreditedtraining program in SCC or anesthesiology criticalcare (ACC) afer three years o progressive generalsurgery residency may take the SCC CertiyingExamination while still in residency. A ull and unre-stricted medical license is not required at that time.

However, i successul on the exam, they will onlybe considered certified in SCC once they becomecertified in surgery. When entering the SCC/ACCprogram, these individuals must have a guaranteedcategorical position in an accredited surgery programavailable to them upon completion.

Joint Training in Thoracic Surgery

Individuals may pursue an early specialization(4+3) pathway leading to certification in bothgeneral surgery and thoracic surgery through a jointtraining program accredited by the ACGME o ouryears o general surgery ollowed by three years othoracic surgery at the same institution. See www.absurgery.org or urther details.


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V. ABOUT THE ABS

A. Nominang Organizaons

Te American Board o Surgery is composed o

a board o directors elected to single six-year termsrom among nominees provided by national andregional surgical societies, known as nominatingorganizations. In addition, three directors are electedthrough an at-large process. Te ABS also has one

public member, elected by open nomination.Founding OrganizationsAmerican College o SurgeonsAmerican Medical AssociationAmerican Surgical Association

Regional Surgical Organizations

Central Surgical AssociationNew England Surgical Society Pacific Coast Surgical AssociationSoutheastern Surgical CongressSouthern Surgical AssociationSouthwestern Surgical Congress

Western Surgical Association Academic/Research OrganizationsAssociation or Academic Surgery Society o University Surgeons

Specialty Surgical OrganizationsAmerican Association or the Surgery o rauma

American Pediatric Surgical AssociationAmerican Society o ransplant SurgeonsSociety o American Gastrointestinal Endoscopic SurgeonsSociety or Surgery o the Alimentary ractSociety o Surgical Oncology Society or Vascular Surgery

Program Director AssociationsAssociation o Pediatric Surgery raining Program DirectorsAssociation o Program Directors in Surgery Association o Program Directors in Vascular Surgery Surgical Critical Care Program Directors Society

Other ABMS Surgical BoardsAmerican Board o Colon and Rectal Surgery American Board o Plastic Surgery American Board o Toracic Surgery

B. Ocers and Directors

Te officers o the ABS include a chair and vice

chair elected by the directors rom among themselves.Te vice chair is elected or a one-year term and thenserves the succeeding year as chair. A third electedofficer, the secretary-treasurer, also serves as executivedirector and is not necessarily chosen rom among

the directors, although prior experience in somecapacity with the ABS as a director, examinationconsultant or associate examiner is highly desirable.


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2015-2016 Ocers

Stephen R.. Evans, M.D., Chair John G. Hunter, M.D., Vice Chair Frank R. Lewis Jr., M.D., Secretary-Treasurer

2015-2016 DirectorsFizan Abdullah, M.D. Chicago, Ill.Marwan S. Abouljoud, M.D. Detroit, Mich.Reid B. Adams, M.D. Charlottesville, Va.Roxie M. Albrecht, M.D. Oklahoma City, Okla.Mark S. Allen, M.D. Rochester, Minn.

Marjorie J. Arca, M.D. Milwaukee, Wis.Kenneth S. Azarow, M.D. Portland, Ore.

Kevin E. Behrns, M.D. Gainesville, Fla.Karen J. Brasel, M.D. Portland, Ore.Jo Buyske, M.D. Philadelphia, Pa.William C. Chapman, M.D. St. Louis, Mo.Dai H. Chung, M.D. Nashville, enn.

Martin A. Croce, M.D. Memphis, enn.John F. Eidt, M.D. Greenville, S.C.Stephen R.. Evans, M.D. Columbia, Md.Robert D. Fanelli, M.D. Sayre, Pa.Vivian Gahtan, M.D. Syracuse, N.Y.Mary . Hawn, M.D. Stanord, Cali.

O. Joe Hines, M.D. Los Angeles, Cali.yler G. Hughes, M.D. McPherson, Kan.John G. Hunter, M.D. Portland, Ore.Gregory J. Jurkovich, M.D. Sacramento, Cali.K. Craig Kent, M.D. Madison, Wis.Mary E. Klingensmith, M.D. St. Louis, Mo.Frank R. Lewis Jr., M.D. Philadelphia, Pa.

Frederick A. Luchette, M.D. Maywood, Ill.Mark A. Malangoni, M.D. Philadelphia, Pa.Christopher R. McHenry, M.D. Cleveland, OhioJohn D. Mellinger, M.D. Springfield, Ill.

David W. Mercer, M.D. Omaha, Neb.Lena M. Napolitano, M.D. Ann Arbor, Mich.David . Netscher, M.B.B.S. Houston, exasRobert S. Rhodes, M.D. Philadelphia, Pa.Anne G. Rizzo, M.D. Falls Church, Va.William J. Scanlon, Ph.D.* Oak Hill, Va.Margo C. Shoup, M.D. Warrenville, Ill.Lee L. Swanstrom, M.D. Portland, Ore.Spence M. aylor, M.D. Greenville, S.C.

Douglas S. yler, M.D. Durham, N.C.Mark L. Welton, M.D. Stanord, Cali.James F. Whiting, M.D. Portland, Maine

*Public member

C. Commiees, Component Boards andAdvisory Councils

Standing Commiees and Chairs

Credentials Committee Roxie M. Albrecht, M.D.

General Surgery Residency Committee David W. Mercer, M.D.

Advanced Surgical Education Committee

Frederick A. Luchette, M.D.Diplomates Committee Margo C. Shoup, M.D.


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Component Boards and Advisory Councils

Vascular Surgery Board

John F. Eidt, M.D., Chair Daniel G. Clair, M.D.

Michael C. Dalsing, M.D.Vivian Gahtan, M.D.Karl A. Illig, M.D.K. Craig Kent, M.D.

Frank R. Lewis Jr., M.D. (ex officio)Erica L. Mitchell, M.D.

Samuel R. Money, M.D.Amy B. Reed, M.D.Robert S. Rhodes, M.D. (ex officio)Spence M. aylor, M.D.

Pediatric Surgery Board

Kenneth S. Azarow, M.D., Chair Fizan Abdullah, M.D.Mary L. Brandt, M.D.Dai H. Chung, M.D.

Mary J. Edwards, M.D.Frank R. Lewis Jr., M.D. (ex officio)Frederick J. Rescorla, M.D.John H.. Waldhausen, M.D.

Trauma, Burns and Critical Care BoardGregory J. Jurkovich, M.D., ChairRoxie M. Albrecht, M.D.Karen J. Brasel, M.D.Eileen M. Bulger,M.D.Martin A. Croce, M.D.

David G. Greenhalgh, M.D.Frank R. Lewis Jr., M.D. (ex officio)Frederick A. Luchette, M.D.

Robert C. Mackersie, M.D.Lena M. Napolitano, M.D.David . Netscher, M.D.Anne G. Rizzo, M.D.David A. Spain, M.D.

Ronald M. Stewart, M.D.Samuel A. isherman, M.D.

Surgical Oncology Board

Douglas S. yler, M.D., Chair Reid B. Adams, M.D.Mark S. Allen, M.D.

Peter D. Beitsch, M.D.Michael A. Choti, M.D.Gerard M. Doherty, M.D.

Jeffrey E. Gershenwald, M.D.Kelly K. Hunt, M.D.Frank R. Lewis Jr., M.D. (ex officio)

Christopher R. McHenry, M.D.Margo C. Shoup, M.D.

Gastrointestinal Surgery Advisory Council

yler G. Hughes, M.D., Chair Kevin E. Behrns, M.D.Mark C. Callery, M.D.

Robert D. Fanelli, M.D.O. Joe Hines, M.D.Frank R. Lewis Jr., M.D. (ex officio)David W. Mercer, M.D.

Ninh . Nguyen, M.D.Daniel J. Scott, M.D.Nathaniel J. Soper, M.D.

Lee L. Swanstrom, M.D.Mark A. alamini, M.D.Mark L. Welton, M.D.

Transplantation Advisory Council

James F. Whiting, M.D., Chair Marwan S. Abouljoud, M.D.

William C. Chapman, M.D.Frank R. Lewis Jr., M.D. (ex officio)

Kim M. Olthoff, M.D.Dr. Peter G. Stock, M.D.

Dr. Lewis W. eperman, M.D.

General Surgery Advisory Council

Mary E. Klingensmith, M.D., Chair Jo Buyske, M.D. (ex officio)Robert D. Fanelli, M.D.Mary . Hawn, M.D.

yler G. Hughes, M.D.Frank R. Lewis Jr., M.D. (ex officio)

Frederick A. Luchette, M.D.Mark A. Malangoni, M.D. (ex officio)John D. Mellinger, M.D.David W. Mercer, M.D.

William J. Scanlon, Ph.D.

D. Senior Members, Former Ocers, Sta Senior Members

Marshall J. Orloff, M.D. 1969-1972

W. Gerald Austen, M.D. 1969-1974

George D. Zuidema, M.D. 1969-1976

William Silen, M.D. 1970-1973John A. Mannick, M.D. 1971-1977

Frank G. Moody, M.D. 1972-1978

Harry A. Oberhelman Jr., M.D. 1972-1978

Seymour I. Schwartz, M.D. 1973-1979

Walter Lawrence Jr., M.D. 1974-1978

Marc I. Rowe, M.D. 1974-1978

F. William Blaisdell, M.D. 1974-1980

Larry C. Carey, M.D. 1974-1982William J. Fry, M.D. 1974-1982

Hiram C. Polk Jr., M.D. 1974-1982

Arlie R. Mansberger Jr., M.D. 1974-1983

Stanley J. Dudrick, M.D. 1974-1984

Robert E. Hermann, M.D. 1975-1981

Lazar J. Greenfield, M.D. 1976-1982

Donald G. Mulder, M.D. 1976-1984E. Tomas Boles Jr., M.D. 1977-1981

Walter F. Ballinger, M.D. 1977-1982

Ward O. Griffen Jr., M.D. 1977-1983

Tomas M. Holder, M.D. 1977-1983

Morton M. Woolley, M.D. 1977-1985

G. Robert Mason, M.D. 1977-1986

Richard E. Ahlquist Jr., M.D. 1978-1984

Robert W. Gillespie, M.D. 1978-1984Stephen J. Hoye, M.D. 1978-1984

John W. Braasch, M.D. 1979-1985

Donald D. runkey, M.D. 1980-1987


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Albert W. Dibbins, M.D. 1981-1987

Richard D. Floyd M.D. 1981-1987

LaSalle D. Leffall Jr., M.D. 1981-1987

James A. O’Neill Jr., M.D. 1981-1987

John L. Sawyers, M.D. 1981-1987

Arthur J. Donovan, M.D. 1981-1988

Samuel A. Wells Jr., M.D. 1981-1989

Lewis M. Flint, M.D. 1982-1988

Bernard M. Jaffe, M.D. 1982-1988

John S. Najarian, M.D. 1982-1988

Basil A. Pruitt Jr., M.D. 1982-1988

Jeremiah G. urcotte, M.D. 1982-1988

Paul M. Weeks, M.D. 1983-1987

P. William Curreri, M.D. 1983-1989

Ronald K. ompkins, M.D. 1983-1989Alred A. de Lorimier, M.D. 1983-1990

Harvey W. Bender Jr., M.D. 1984-1989

Murray F. Brennan, M.D. 1984-1990

R. Scott Jones, M.D. 1984-1990

James E. McKittrick, M.D. 1984-1990

H. Brownell Wheeler, M.D. 1984-1990

Edward M. Copeland III, M.D. 1984-1991

Richard O. Kraf, M.D. 1985-1988Marc I. Rowe, M.D. 1985-1991

Andrew L. Warshaw, M.D. 1985-1993

Charles M. Balch, M.D. 1986-1992

Kirby I. Bland, M.D. 1986-1992

John L. Cameron, M.D. 1986-1992

Jerry M. Shuck, M.D. 1986-1994

Arnold G. Diethelm, M.D. 1987-1993

Ira J. Kodner, M.D. 1987-1993

Edward A. Luce, M.D. 1987-1993

Richard E. Dean, M.D. 1988-1994

Wallace P. Ritchie Jr., M.D. 1988-1994

Michael J. Zinner, M.D. 1988-1994

Layton F. Rikkers, M.D. 1988-1995

William A. Gay Jr., M.D. 1989-1995

Keith A. Kelly, M.D. 1989-1995

Richard L. Simmons, M.D. 1989-1995

Jack R. Pickleman, M.D. 1989-1996Jay L. Groseld, M.D. 1989-1997

Haile . Debas, M.D. 1990-1996

Alden H. Harken, M.D. 1990-1996

David L. Nahrwold, M.D. 1990-1996

Robert B. Rutherord, M.D. 1990-1996

Jose E. Fischer, M.D. 1991-1998

Palmer Q. Bessey, M.D. 1992-1998

John M. Daly, M.D. 1992-1998David M. Heimbach, M.D. 1992-1998

J. David Richardson, M.D. 1992-1999

Robert W. Beart Jr., M.D. 1993-1996

Henry W. Neale, M.D. 1993-1996

Richard H. Dean, M.D. 1993-1999

Glenn D. Steele Jr., M.D. 1993-2000

Laurence Y. Cheung, M.D. 1994-2000

Daniel L. Diamond, M.D. 1994-2000

Anthony A. Meyer, M.D. 1994-2000Richard A. Prinz, M.D. 1994-2000

Ronald G. ompkins, M.D. 1994-2000

Patricia J. Numann, M.D. 1994-2002

David Fromm, M.D. 1995-2001

David E. Hutchison, M.D. 1995-2001

Frank R. Lewis Jr., M.D. 1995-2001

Peter C. Pairolero, M.D. 1995-2001

William L. Russell, M.D. 1995-2001Robert W. Barnes, M.D. 1996-2002

Robert D. Fry, M.D. 1996-2002

Donald J. Kaminski, M.D. 1996-2002

Mark A. Malangoni, M.D. 1996-2003

Ronald V. Maier, M.D. 1996-2004

G. Patrick Clagett, M.D. 1997-2003

Tomas M. Krummel, M.D. 1997-2003

Bradley M. Rodgers, M.D. 1997-2003

imothy J. Eberlein, M.D. 1998-2004

Julie A. Freischlag, M.D. 1998-2004

Frank W. LoGero, M.D. 1998-2004

Bruce E. Stabile, M.D. 1998-2004

Barbara L. Bass, M.D. 1998-2005

Jeffrey L. Ponsky, M.D. 1998-2006

Richard L. Gamelli, M.D. 1999-2005

Marshall M. Urist, M.D. 1999-2005

William G. Cioffi , M.D. 2000-2006

Keith E. Georgeson, M.D. 2000-2006

James C. Hebert, M.D. 2000-2006

Keith D. Lillemoe, M.D. 2000-2006

Michael S. Nussbaum, M.D. 2000-2006Courtney M. ownsend Jr., M.D. 2000-2007

imothy C. Flynn, M.D. 2000-2008

Luis O. Vasconez, M.D. 2001-2003

Irving L. Kron, M.D. 2001-2005

David V. Feliciano, M.D. 2001-2007

David N. Herndon, M.D. 2001-2007

Michael G. Sarr, M.D. 2001-2007

Teodore N. Pappas, M.D. 2001-2007Jon S. Tompson, M.D. 2001-2007

Richard H. Bell Jr., M.D. 2002-2006

James W. Fleshman Jr., M.D. 2002-2008

Russell G. Postier, M.D. 2002-2009

Steven C. Stain, M.D. 2002-2010

Tomas Stevenson, M.D. 2003-2004

Jonathan B. owne, M.D. 2003-2007

Carlos A. Pellegrini, M.D. 2003-2009

James A. Schulak, M.D. 2003-2009

Marshall Z. Schwartz, M.D 2003-2009

E. Christopher Ellison, M.D. 2003-2011

Randolph Sherman, M.D. 2004-2006

Jeffrey B. Matthews, M.D. 2004-2010

John J. Ricotta, M.D. 2004-2010

William P. Schecter, M.D. 2004-2010

Ronald J. Weigel, M.D. 2004-2010

Stanley W. Ashley, M.D. 2004-2012Larry R. Kaiser, M.D. 2005-2008

Karen R. Borman, M.D. 2005-2011

Leigh A. Neumayer, M.D. 2005-2011

John B. Hanks, M.D. 2005-2011

Jo Buyske, M.D. 2006-2008

Nicholas B. Vedder, M.D. 2006-2011

Lenworth M. Jacobs Jr., M.B.B.S. 2006-2012

Nathalie M. Johnson, M.D 2006-2012J. Wayne Meredith, M.D. 2006-2012

Fabrizio Michelassi, M.D. 2006-2012

Kenneth W. Sharp, M.D. 2006-2012

Richard C. Tirlby, M.D. 2006-2012

Tomas F. racy Jr., M.D. 2006-2012

Tomas H. Cogbill, M.D. 2006-2013

John R. Potts III, M.D. 2007-2012

L.D. Britt, M.D. 2007-2013

B. Mark Evers, M.D. 2007-2013V. Suzanne Klimberg, M.D. 2007-2013

Joseph L. Mills, M.D. 2007-2013

Cameron D. Wright, M.D. 2008-2013

J. Patrick Walker, M.D. 2006-2014

Joseph B. Coer, M.D. 2007-2

Handbook of Types of Menses

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Transcript of Handbook of Types of Menses