Primary Certification Processes
I. Training in Neurological Surgery
A. Fundamental Clinical Skills (internship/similar year) - 12 months
B. Neurological Surgery Residency - 60 months (minimum)
C. Special Considerations
D. Program Director's Endorsement
II. The Primary (written) Examination
III. ABNS Board Certification
A. Application requirements
B. Oral examination
I. Training in Neurological Surgery
To be eligible for board certification in neurological surgery in the United States, each applicant must be a graduate of a medical school acceptable to the American Board of Neurological Surgeons (ABNS). A candidate must then have successfully completed an internship and neurosurgical residency training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). An exception applies for residents from Canadian training programs who began training before July 16, l997. Qualified individuals interested in ABNS certification should contact the ABNS office.
Neurosurgical training programs in the United States are reviewed and accredited by the Residency Review Committee (RRC) for Neurological Surgery under authority delegated to it by the ACGME. The ACGME is sponsored by the American Board of Medical Specialists (ABMS), the American Hospital Association (AHA) , the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), and the Council of Medical Specialty Societies (CMSS). The RRC consists of six neurosurgeon members, two representatives each from the ABNS, the AMA, and the American College of Surgeons (ACS). The ABNS does not accredit training programs.
A. Fundamental Clinical Skills (internship/similar year) - 12 months
Twelve (12) months must be devoted to acquiring adequate knowledge in fundamental clinical skills. This year of training is preferably taken prior to beginning neurosurgical residency, and must be completed prior to beginning the third year of neurosurgical residency training.
This requirement may be satisfied by training for one (1) or more years in an ACGME accredited general surgery program in the United States. This training may likewise be acquired during the course of training in an ACGME accredited neurosurgical residency program. Such training must include at least six (6) months in surgical disciplines other than neurosurgery. The remaining six (6) months should include other fundamental clinical skills considered appropriate by the neurosurgical training program director. This portion of the year may not include more that six (6) weeks of neurosurgery. Up to three (3) months of neurology may be included, thereby satisfying the ABNS requirement for neurology training.
B. Neurological Surgery Residency - 60 months (minimum)
Each resident must complete a minimum of sixty (60) months of training as a full-time resident in an ACGME accredited neurosurgical training program.
(1) At least thirty-six (36) months must be devoted to core clinical neurosurgery, with progressive responsibility culminating in twelve (12) months as senior or chief resident. As senior resident, the trainee shall have major or primary responsibility for patient management, as well as administrative responsibilities, as designated and deemed appropriate by the program director. Training in clinical neurosurgery must be progressive and not obtained during repeated short periods in a number of institutions.
At least twenty-four (24) months of training in core clinical neurosurgery must be obtained in one institution.
Trainees are required to record their operative procedures performed during their residency. The ABNS prefers that this record is provided to the ABNS via the web-based NEURO-LOG database system, available to all residents through their Program Director or ABNS office. The ABNS furnishes passwords and ID numbers to gain access to this program, or residents may get started through communications with their program director.
(2) A minimum of three (3) months must be devoted to clinical neurology. This period must be taken as a full- time assigned resident in a neurology residency program accredited by the ACGME. Six (6) months are recommended, but three (3) are required. Up to three (3) months of this training may be acquired during the twelve (12) months of training in fundamental clinical skills; however, doing neurology during internship does not shorten the requirement for 60 months of residency training thereafter.
(3) The remaining twenty-one (21) to twenty-four (24) months must be devoted to aspects of the basic or clinical neurological sciences, which may include neurology, neuropathology, neuroradiology, neurosurgery, research and/or other disciplines related to the nervous system. Trainees shall be expected to acquire basic knowledge and skills in each of these disciplines. Some of this time may be dedicated to additional subspecialty neurosurgery training, i.e. pediatric neurosurgery, spine, or endovascular surgery.
(4) An individual’s training is not complete and a Program Director’s endorsement cannot be provided until the Primary (written) Examination has been passed for credit.
C. Special Considerations
Modification of the above requirements to fulfill specific training goals may be formulated for an individual trainee. Program Directors must request credit and receive approval in writing from the ABNS in advance of the following actions:
(1) Training undertaken outside the parent program shall not count toward fulfilling the requirements for certification unless specifically requested by the trainee's program director in writing and approved by the Board in advance of such training.
(2) Training other than as an appointed resident in an ACGME approved neurosurgical training program shall not be considered as fulfilling the ABNS requirements unless specifically requested by the Program Director and approved by the Board in advance of such training.
(3) On a Program Director’s recommendation, the ABNS may at its discretion consider and give retroactive credit to a trainee who, before entering an accredited neurosurgical residency program, has had substantially more than the prerequisite training in general surgery, medical neurology, or the basic neurological sciences in institutions acceptable to the Board.
(4) Should a trainee transfer from one accredited neurosurgical training program to another, the ABNS must receive the written consent of the Program Directors of both programs, along with notification of the type and amount of training to be allowed in the transfer. The Program Director receiving the trainee is responsible for ascertaining that any prior training counting towards completion of residency satisfies the ABNS requirements as outlined above.
D. Program Director's Endorsement
Prior to acceptance of a candidate for oral examination, the ABNS requires a statement from his or her program director to the effect that:
(1) The candidate has fulfilled the professional training requirements of the Board.
(2) The candidate's performance in the program has been satisfactory, including passing of the primary examination for credit.
(3) The program director recommends the candidate as being professionally competent for the independent practice of neurological surgery and suitable for consideration by the Board for certification.
II. The Primary (written) Examination
Each applicant for certification must first successfully pass for credit the Primary Examination. This written examination prepared by the ABNS includes material on fundamental clinical skills, critical care, neuroanatomy, neurobiology, neurology, neuropathology, neuropharmacology, neuroradiology, neurosurgery and other relevant disciplines deemed suitable and appropriate by the Board.
The Primary Examination is open to all residents in ACGME-approved neurosurgical training programs and to neurosurgeons who have successfully completed ACGME accredited training programs who are still involved in tracking for primary certification. Residents may take the test either for credit toward certification or for self-assessment (only as determined by a trainee's Program Director). An individual’s training is not complete and a Program Director’s endorsement cannot be provided until the Primary (written) Examination has been passed for credit.
The Primary Examination is given once each year, usually the last Saturday in March, at most ACGME-accredited training programs. Applications must be filed with the ABNS by mid-December.
III. ABNS Board Certification
A. Application Requirements
When a neurosurgical resident completes his or her residency training, the ABNS will forward him or her a packet of information outlining the requirements for continuing the certification process to become a diplomate of the American Board of Neurological Surgery. Candidates for certification must complete and file an accurate application with the ABNS office, together with hard copy of the supporting documents required in the following sections. The ABNS will not schedule a candidate for oral examination until these requirements have been fulfilled and received in the ABNS office.
Each candidate must be scheduled by the ABNS office for oral examination within five years of completing training; otherwise, he or she shall no longer be considered to be actively involved in the certification process. The application form should be filled out and sent to the ABNS office as soon as possible after completion of residency, ideally right after beginning practice. The remaining requirements can then be submitted later as completed. A year or more may be required for the entire application requirements to be reviewed and validated by the various ABNS oversight committees. The completed application, including these other requirements, should reach the Board office within three years of completing training, so that the candidate's credentials can be reviewed by the Board in time to comply with this five-year rule. Financial penalties may be imposed on those applications received more than three years beyond the completion of residency training. Post-graduate fellowships do not extend this interval, but are counted within the five year window of opportunity to complete this process.
The completed application should include the application form, practice data (at least one year, with first case entered within two years of application completion, letters of recommendation, licensure, and hospital privileges (see following sections).
(1) Application Form
The application should be filled out and sent to the ABNS office as soon as possible after completion of residency, ideally right after beginning practice. The application form is available on the ABNS website. A candidate who fails to apply to the ABNS in time to be scheduled for oral examination within 5 years of training completion is no longer considered to be within the certification process. To re-enter the process, the candidate must re-take and pass the written Primary Examination. After passing this test, the candidate has 3 years to submit the following for review and approval, and to take the oral examination:
- Request for oral examination, along with current fee
- Name and addresses of 2 neurosurgeons from whom practice reference letters may be requested
- Names and addresses of all hospitals where he or she has admitting privileges or cares for patients
- 12 months (plus 3 months follow-up) of current practice data.
(2) Practice Data Requirements
Each applicant for ABNS Board Certification must submit a consecutive list of all patients for whom he or she was the responsible in-patient physician or surgeon during a period of twelve (12) consecutive months (operative and non-operative). This list does not include outpatient clinic visits or consultations in which the applicant did not assume primary responsibility for the patient’s care. If the case log includes less than 100 cases, the list must continue until 100 cases are collected for analysis. Data collection may begin shortly after the applicant begins practice, and can be sent to the Board as soon as twelve months have been accumulated, together with at least three (3) months of clinical follow-up. This process should ideally be completed within three years of completing residency training. The oldest case cannot be more than two years old at the time of review.
The list of cases shall include all information as determined by the ABNS. The ABNS expects all applicants to record their data in the web-based NEURO-LOG database system; however, hardcopy forms and an example can be obtained from the ABNS office. Beginning January 1, 2005, all practice data must be collected through NEURO-LOG, available through the ABNS office or on the ABNS website.
(3) Letters of Recommendation
The applicant shall supply names and addresses of three or more physicians with whom he or she has had professional contact, to attest to the quality of the applicant's professional conduct. At least two of these must be neurosurgeons who practice in the applicant's community, and at least one must be an ABNS Diplomate.
(4) Licensure
A currently valid license to practice medicine in the state, province or country where the applicant practices is a requirement for oral examination and issuance of an ABNS Certificate. Such license must be unrestricted and unencumbered by proceedings which threaten its continuance.
(5) Hospital Privileges
Prior to oral examination, each applicant shall have unencumbered and unrestricted hospital staff privileges for neurosurgical practice in all hospitals in which he or she cares for patients, and in all hospitals where the applicant has practiced since the completion of neurosurgical training. Privileges must be unrestricted in respect to the hospital's usual requirements for a neurosurgeon, and be unencumbered by any official hospital proceeding that threatens the continuation of such privileges.
B. Oral Examination
Once the application have been reviewed and approved by the Credentials Committee, and has received a favorable review by the full Board at a regularly scheduled ABNS meeting, the ABNS office will schedule the candidate for the oral examination. If the application is not completed within five years of completing training, he or she shall no longer be considered to be actively involved in the certification process. An applicant who fails to apply to the ABNS in time to be scheduled for oral examination within five years of completing training will not thereafter be scheduled for oral examination until he or she has again passed the Primary Examination for credit, and thereby returns to the certification process. Such candidates must then submit a new request for oral examination accompanied by the then applicable fee. The new request along with an updated application form must be approved by the ABNS, and the applicant scheduled for oral examination within the three year period following the most recent passing of the Primary Examination.
The oral examination lasts three hours and covers the diagnosis and management of surgical and medical diseases of the nervous system. Notwithstanding the growing tendency toward subspecialization, the examination covers all of neurosurgery, and questions from all aspects of the discipline must be answered. The primary thrust relates to clinical practice tested via a case history format, including symptoms, findings, and the results of diagnostic tests. Work up, differential diagnosis, and management are evaluated with attention given to relevant anatomy, pathology, and physiological mechanisms, as well as descriptions of how operations should be performed if indicated. The examination is structured to focus on problems which neurosurgeons may expect to encounter and manage in general practice.
If an individual fails to obtain a passing score on the oral examination, he or she may apply for repeat testing, accompanied by the applicable fee. If the five year application window expires thereafter, the deadline will be extended until the second oral examination can be scheduled, as long as the application has been submitted in a timely fashion after the first examination. In the event that the same individual fails the test again, then he or she must again pass the Primary Examination for credit, thereby returning to the certification process. Such candidates must then submit a new request for oral examination accompanied by the then applicable fee. The new request along with an updated application form must be approved by the ABNS, and the applicant scheduled for oral examination within the three year period following the most recent passing of the Primary Examination.
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