I. Training in Neurological Surgery

A. Residents Starting Prior to July 1, 2009
B. Residents Starting July 1, 2009 and after
C. Exceptional Circumstances

II. The Primary Examination

A. Application requirements
B. Practice Data Requirements
C. Oral examination
D. Certification of Neurosurgeons Trained in Canadian Programs

Prior to July 1, 2009

The first year of training is alternately called fundamental clinical skills, internship, or simply post-graduate year 1. It is often a general surgery internship but more frequently is under the authority of a neurosurgical residency Program Director. The training should be undertaken prior to beginning neurosurgical residency but must be completed prior to beginning the third year of residency. It must include not less than six months of surgical disciplines other than neurosurgery. The remaining six months may include up to three months of neurosurgery and three months of neurology. Any neurology done at this time will count toward completion of the Board’s requirement for three months of training in that area; however, it will not count in time toward completion of residency training. Neurosurgery done during the year will not count in content or time toward completion of residency requirements. Other training a Program Director might consider appropriate would include anesthesiology, cardiothoracic surgery, critical care, emergency room experience, non-neurosurgical care of patients with traumatic injuries, pain management, and pediatric surgery.

Neurosurgical residency then begins in the second year. This training must be spent as a full time resident enrolled in a program recognized by the ABNS and accredited by the RRC for Neurological Surgery or, for applicants entering residency programs prior to July 16, 1997, a Canadian equivalent.

At least 36 months must be devoted to core clinical neurosurgery with progressive responsibilities culminating in 12 months at the most senior level. The entire 36 months must be done in programs accredited by the RRC or, for applicants entering residency programs prior to July 16, 1997, Canadian equivalents. At least 24 months must be obtained in one program.

At least three months must be devoted to clinical neurology as a full time assigned resident in a program accredited by the RRC for Neurology or, for individuals entering residency programs prior to July 16, 1997, a Canadian equivalent. Six months are recommended, but three are required. Up to three months of this training may be acquired during the twelve months of training in fundamental clinical skills (see above).

At the discretion of the Program Director, the remaining undesignated 21+ months may be devoted to the basic or clinical neurosciences. These should include neuropathology, neuroradiology, and research; the ABNS expects residents to acquire basic knowledge and skills in each of these areas. Elective time may also be dedicated to additional neurosurgery with special emphasis on, for example, complex spine surgery, endovascular surgery, or pediatric neurosurgery.

Training of any type (research or fellowships, etc.) in an institution outside of the parent program and its affiliated hospitals will not count toward meeting certification requirements unless credit is requested from the Board prospectively by the Program Director and approved in writing. The ABNS may grant elective credit for training in non-accredited or foreign centers on an individual basis when undertaken as an integral part of the residency program with the advice and approval of the Program Director. All requests for such elective training away from the parent program must be submitted in writing to the ABNS prospectively. Approval for training for periods of less than three months will not ordinarily be granted since shorter rotations are of questionable educational value.

Residency training cannot be obtained during repeated short intervals in a number of institutions.

Prior to accepting a candidate into the certification process, the Board requires a statement from the individual’s Program Director to the effect that he or she has met the minimum training requirements, performed in a satisfactory manner, and is well prepared to enter into the independent practice of neurosurgery.

Permission for oral examination will not be granted until all aspects of the training requirements have been met to the satisfaction of the Board.

B. July 1, 2009 and After
Neurosurgical training is a minimum of 72 months in length, including the PGY-1, which is under the complete control of the neurosurgical Program Director. It must be done as a full time resident enrolled in a program recognized by the ABNS and accredited by the RRC for Neurological Surgery.

At least 42 months must be devoted to core clinical neurosurgery with progressive responsibilities culminating in 12 months at the most senior level. The entire 42 months must be done in programs accredited by the RRC. At least 21 months must be obtained in one program.

The PGY-1 must include a minimum of 3 months of fundamental clinical skills training (critical care, trauma, and other rotations as determined by the Program Director), and may include up to 6 months of neurosurgery, which will count toward the 42 months required.

At least three months must be devoted to clinical neurology done in an ACGME accredited neurology program. It must be taken during the first three years of training, preferably during the PGY-1. Six months are recommended, but three are required.

At the discretion of the Program Director, the remaining undesignated 24 months may be devoted to the basic or clinical neurosciences. These should include neuropathology, neuroradiology, and research; the Board expects residents to acquire basic knowledge and skills in each of these areas. Elective time may also be dedicated to the neurosurgery subspecialties, for instance enfolded fellowships with special emphasis on complex spine surgery, endovascular surgery, or pediatric neurosurgery.

Training of any type (research or fellowships, etc.) in an institution outside of the parent program and its affiliated hospitals will not count toward meeting certification requirements unless credit is requested from the ABNS prospectively by the Program Director and approved in writing. The Board may grant elective credit for training in non-accredited or foreign centers on an individual basis when undertaken as an integral part of the residency program with the advice and approval of the Program Director. All requests for such elective training away from the parent program must be submitted in writing to the ABNS prospectively. Approval for training for periods of less than three months will not ordinarily be granted since shorter rotations are of questionable educational value.

Residency training cannot be obtained during repeated short intervals in a number of institutions.

Prior to accepting a candidate into the certification process, the Board requires a statement from the individual’s Program Director to the effect that he or she has met the minimum training requirements, performed in a satisfactory manner, and is well prepared to enter into the independent practice of neurosurgery.

Permission for oral examination will not be granted until all aspects of the training requirements have been met to the satisfaction of the Board.

C. Exceptional Modifying Circumstances
Should a resident leave an accredited training program, the Director of the program must send a letter to the ABNS stating the credit for training, in both time and category, which has been successfully completed. Should the individual enter a new neurosurgical residency program, the new Program Director may honor such credit depending upon a direct appraisal of the resident's professional and educational progress. That Program Director must then write to the Board stating how much credit will be accepted.

Information on transferring residents must be treated in the same manner as above. Both the original and the new Program Director must submit the information in writing to the ABNS prospectively

Upon petition from a Program Director and approval by the Board, credit may be granted for training done before entering an accredited neurosurgical program if the resident has had substantially more than the prerequisite training in general surgery, neurology, or the basic neurological sciences at acceptable institutions. If such training resulted in a PhD, one year of elective credit will be given. Credit is not automatic; it must be requested by the Program Director and approved in writing by the Board. Neurosurgical residency training completed abroad, particularly if it concluded with certification in that country, may also merit retroactive credit if the ABNS is petitioned by the Program Director.

Training by preceptorship does not fulfill certification requirements. Furthermore, no credit is given for training done by fellows or other individuals not enrolled as residents tracking toward certification in accredited programs.

The above provisions in no way alter the basic minimum requirement calling for 72 months of neurosurgical residency training to include 3 months of clinical neurology and 42 months of core clinical neurosurgery, 21 months of which must be in one institution and 12 months with senior resident responsibility.

II. PRIMARY EXAMINATION

The Primary Examination is an important step in the process toward certification. It is carefully designed to evaluate candidates' knowledge and provide direction for continued learning. It is prepared by the ABNS under the purview of the National Board of Medical Examiners (NBME). Most questions are multiple choice covering information on basic sciences, critical care, fundamental clinical skills, neuroanatomy, neurobiology, neuroimaging, neurology, neuropathology, neuropharmacology, neurosurgery, and other disciplines deemed suitable and important. The Examination is given once each year, usually the middle Saturday of March, at most residency programs in the U.S.

Each applicant for oral examination must first successfully pass the Primary Examination for credit toward certification. ABNS and RRC Rules and Regulations require residents entering training after July 1, 1998 to pass the Examination for credit before the completing training. Many Program Directors require passage before the senior resident year.

The Examination is available to all residents in programs accredited by the RRC and, for individuals entering residency programs prior to July 16, 1997, a Canadian equivalent. Residents may take it for credit toward certification or self-assessment at the discretion of their Program Directors. Neurosurgeons who have completed residency training may take it as often as they wish for credit or self-assessment. ABNS Rules and Regulations do not allow it to be offered to fellows or medical school students, etc.

III. ABNS CERTIFICATION

A. Applications
Candidates for oral examination and certification are sent application packets at the conclusion of their residency training. Nonetheless, it is the responsibility of the candidate to obtain application forms. They can be found in PDF format at the Board’s website www.abns.org. Along with the application, the packet contains a hospital release form, a business associate agreement, information on NeuroLog, the Board’s web-based data collection program for recording patient practice data, and the ABNS Bylaws, Rules and Regulations, and Code of Ethics.

Candidates should keep in mind that they must be scheduled for oral examination, the final step in the certification process, within five years of completing residency training. Eighteen months are usually needed between submission of an application, including practice data, and sitting for oral examination. Thus, compliance with this regulation requires early submission of all information. If the five-year limit lapses, the individual is no longer considered within the certification process and must re-pass the Primary Examination in order to return to tracking toward certification. Three years will then be allowed to complete the process, including oral examination.

Applications should be filed with the Board as soon the practice data has been logged (see PRACTICE DATA below). They must be accompanied by:

1. Current, appropriate application fee (which will not be refunded even though the application may be denied),
2. Two 2 ½" by 2 ½" photographs signed on the front,
3. List of all medical papers and books published, if any,
4. Addenda, if needed, for longer answers to questions,
5. Copies of all licenses to practice medicine,
6. Signed hospital release, and
7. Completed and signed Business Associate Agreement.

Upon receipt of an application, the Board will take appropriate steps to verify the statements of fact in it. Inquiries will be made from references about training, practice, and hospital privileges. The Board will also search each applicant’s licenses to practice medicine through the Federation of State Medical Boards. In addition, at its discretion the Board may send representatives to review the candidate's practice. After considering all available information pertaining to the entire certification process, including review of practice data, ABNS Directors will make a decision regarding the candidate's eligibility for oral examination and potential certification. Candidates must inform the Board of any changes in the information found in his or her application before oral examination.

Incomplete or fraudulent information on the application constitutes grounds for deferring action or denying oral examination. Should a candidate's credentials be disputed, there is a hearing mechanism for adjudication.

B. Practice Data
An additional part of the application process is submission of a list of all inpatients for whom the candidate was the responsible physician or surgeon, plus all outpatient operations, during the preceding twelve consecutive months of practice. Cases done during a fellowship cannot be used, whether done as part of the fellowship or outside of it. A minimum of 100 operative procedures is required. The oldest case cannot be more than two years old at the time of review. The essential accuracy of the data must be verified by the signature of the Hospital Administrator, or Chief of Staff, or Chairman of Surgery or Neurosurgery at each hospital included in the data.

The ABNS asks that all patient information be compiled on NeuroLog, which can be accessed at the Board’s website, www.abns.org.  The web based program is based on text boxes to be filled in with complete information.  In order to receive a password to begin, email the Board at abns.moc@abns.org.

Once completed, the data will be reviewed by an ABNS Director as part of the credentialing process. Approval takes an average of four months. Since candidates must be scheduled for oral examination within five years of completing training, they should bear in mind the length of time needed for data review. Permission to take the oral examination will not be granted until the ABNS is satisfied as to the quality of the candidate’s practice.

C. Oral Examination

Once all parts of an application, including the practice data, have been approved by ABNS Directors, the candidate will be placed in a pool for scheduling for oral examination. With a few exceptions, the examinations are scheduled five months in advance.

Oral examinations are given in Houston, Texas, in May and November. They last three hours and are conducted in an interview setting with two examiners each hour. Subjects covered are

1. Neurosurgery - intracranial and vascular diseases
2. Neurosurgery – spinal
3. Other - critical care and fundamental clinical skills, functional and stereotactic neurosurgery, pain, pediatric and congenital disorders, peripheral nerve and plexus, and concerns highlighted by the reviewer of the candidate’s practice data,
4. Neurosurgical neurology.

The examinations are presented as clinical problem solving and patient management vignettes. Case histories are given, including appropriate scans and other visual aids to augment the presentation and development of cases. Candidates explain how they would proceed to evaluate and manage patients, plan and perform operations, if indicated, and deal with complications.

If a candidate cannot accept or becomes unable to attend a specific scheduling date for oral examination, he or she must notify the ABNS at least thirty days prior to that examination. Except in extreme and unforeseeable circumstances, failure to do so will result in forfeiture of the examination fee and prevent rescheduling for one year. Decisions regarding exceptions to this policy will be made exclusively by the Board.

A candidate who passes the oral examination becomes a certified Diplomate of the American Board of Neurological Surgery. A Certificate will be sent to him or her once it has been suitably engrossed and signed by the Officers of the Board.

A candidate who fails his or her first oral examination must wait a minimum of one year before taking it for a second time; it must be taken within three years of failure. For instance, a neurosurgeon failing the May 2007 oral examination may be re-examined in May or November 2008, 2009 or 2010. The individual need only request re-examination and submit the current fee.

A candidate who has failed the oral examinations on two or more occasions is no longer considered tracking toward certification. He or she must re-pass for credit the Primary Examination before re-entering the certification process and applying for oral examination. Current letters of reference from two neurosurgeons (one an ABNS Diplomate) attesting to the nature and quality of the candidate's practice must be submitted to the Board, along with letters verifying hospital privileges. An additional year of current practice data will most likely also be required, and the candidate must pay the oral examination fee. Under these circumstances, he or she must retake the oral examination within three years of re-passing the Primary Examination. Should the candidate not apply for or fail to appear for oral examination within three years, he or she must pass the Primary Examination again before re-applying for oral examination.

D. CERTIFICATION OF NEUROSURGEONS TRAINED IN CANADIAN PROGRAMS

Residents entering accredited Canadian neurosurgical residency programs prior to July 16, 1997 and satisfactorily completing a minimum of 12 months of fundamental clinical skills and 60 months of training are eligible for ABNS certification through the same means as graduates from U.S. programs. They must also, however, hold a Fellowship from the Royal College of Surgeons, Canada in neurosurgery (FRCS [C]). When applying for oral examination, each Canadian graduate must:

1. Have fulfilled equivalent training acceptable to the ABNS.
2. Have passed the Primary Examination for credit toward certification.
3. Hold a Fellowship in neurosurgery from the Royal College of Surgeons (Canada).
4. Submit an application for oral examination and certification with the things listed above, plus a copy of the FRCS(C), in addition to one year of current practice data.

All of this must be approved by the Board in the manner described previously. A candidate who passes the oral examination, the final step in the certification process, will be certified as Diplomate of the American Board of Neurological Surgery.