Neurosurgical Residency Training
All post-graduate training described below must be acquired as a resident in a neurological surgery training program or programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). It must be under the ultimate direction and control of the resident’s neurosurgery Program Director.
- Residents Who Began Training Prior to July 1, 2009
- PGY-1, Twelve months of fundamental clinical skills
- 12 month surgical internship in an institution accredited by the ACGME, or
- 6 months in surgical disciplines and 6 months of other clinical disciplines under the Program Director of an ACGME accredited neurosurgical residency; up to 3 months of neurosurgery and 3 months of neurology may be included.
- Sixty months of neurosurgical residency training in ACGME accredited programs under the direction of a neurosurgical Program Director. This must consist of:
- 36 months of core clinical neurosurgery, including 12 months as chief resident; at least 24 months must be spent in one program.
- 3 months of clinical neurology; this may be done during the PGY-1, although that does not shorten the required length of training.
- 21 to 24 months (depending on when neurology is done) of electives, i.e.: neuropathology, neuroradiology, research, and/or more neurosurgery, possibly in areas of special interest such as complex spine surgery, endovascular, or pediatric neurosurgery, and/or clinical and non-clinical neurosciences.
Residents Who Began Training between July 1, 2009, and June 30, 2013
- Seventy-two months of neurosurgical residency training in ACGME accredited programs under the direction of a neurosurgical Program Director. This must consist of:
- 42 months of core clinical neurosurgery, including 12 months as chief resident; at least 21 months must be spent in one program.
- PGY-1 must include a minimum of 3 months of fundamental clinical skills training (critical care, trauma and other rotations as designated by the Program Director); it may include up to 6 months of neurosurgery that will count toward the 42 months required.
- 3 months of clinical neurology taken during the first 3 years of training, preferably during the PGY-1.
- 24 months of electives, i.e.: neuropathology, neuroradiology, research, and/or more neurosurgery, possibly in areas of special interest such as complex spine surgery, endovascular, or pediatric neurosurgery, and/or clinical and non-clinical neurosciences.
Residents Who Began Training after June 30, 2013
- Eighty-four months of neurosurgical residency training in ACGME accredited programs under the direction of a neurosurgical Program Director. This must consist of:
- 54 months of core clinical neurosurgery, including
30 months of electives, i.e.: neuropathology, neuroradiology, research, and/or more neurosurgery, possibly in areas of special interest such as complex spine surgery, endovascular, or pediatric neurosurgery, and/or clinical and non-clinical neurosciences.
Outside rotations of 6 to 12 months at an ACGME accredited program may be counted towards the core 54 months of neurosurgery training. The program director must request credit from the ABNS prior to the rotation.
Credit towards the 30 months of elective time may be requested by a program director for prior educational experiences, such as a PhD degree in a relevant subject, clinical rotations other than fellowships obtained at non-ACGME accredited programs, and neurosurgical training completed outside of the U.S., particularly if the resident is certified in that country. Written requests submitted by the program director to the ABNS must contain a complete description of the experience and justification of the request.
The Board will evaluate ACGME case log data as a measure of the breadth of resident experience at the completion of residency training.
- 12 months as chief resident during the last two years of training (PGY-6 or 7); 21 months must be spent in one program.
- 3 months of basic neuroscience (e.g., neurology, neuro-otology, neuroradiology, neuropathology) taken in the first 18 months of training.
- 3 months of critical care relevant to neurosurgery patients taken in the first 18 months of residency.
- 6 months of structured education in general patient care (e.g.: trauma, general surgery, orthopedic surgery, otolaryngology, plastic surgery, etc.).
- 21 months must be spent in one program.
Training of any type, including research, done in institutions outside of the parent program and its affiliated hospitals will not count toward meeting these requirements unless credit is requested in writing from the Board prospectively by the Program Director and approved in writing. As of July 1, 2013, rotations of 6 to 12 months in other ACGME accredited neurosurgical programs may be granted clinical neurosurgery credit that will count toward the required 54 months; otherwise credit is elective only. The ABNS may also grant elective credit for training in non-ACGME accredited U.S or foreign centers on an individual basis when undertaken with the advice and approval of the Program Director. Approval for training periods of less than three months will not ordinarily be granted since they are of questionable educational value.
Training devoted to neuroscience education, critical care, or other disciplines related to neurosurgery may also be acquired as a full time resident in ACGME accredited training programs (such as general and orthopedic surgery) that are in the same institution as the resident’s neurosurgery program. This training does not need the Board’s approval as long as it remains under the ultimate direction and control of the resident’s neurosurgery Program Director.
Upon petition from a resident’s Program Director, the Board may grant elective credit for training done before entering an accredited neurosurgery program if the resident had substantially more than the prerequisite training in general surgery, neurology, or the basic neurological sciences at acceptable institutions. If the training resulted in a PhD in a neuroscience field, one year of elective credit will be given. Neurosurgery residency training completed abroad, particularly if it concluded with certification in that country, may also merit retroactive elective credit if the ABNS is petitioned by the Program Director. Credit is not automatic. It must be requested by the Program Director and approved in writing by the Board.
Training by preceptorship does not fulfill these requirements. Furthermore, no credit is given for training done by fellows or other individuals not enrolled as residents tracking toward certification in ACGME accredited neurosurgery programs. Resident training cannot be obtained during repeated short intervals in a number of institutions. These provisions in no way alter the basic minimum requirements.
Leaving or Transferring from a Residency Program
Should a resident leave a training program, the Director must send a letter to the ABNS stating the credit for training in both time and category that has been successfully completed. Should the individual enter a new neurosurgery program, the new Program Director may honor that credit depending on his or her 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 is handled in the same manner as above. Both the original and new Program Directors must submit training information in writing to the ABNS prospectively.
The ABNS Primary Examination is an important step in the certification process. It is available to all residents in ACGME accredited neurosurgery programs and is designed to evaluate candidates’ knowledge and provide direction for continued learning. The ABNS prepares the 375 question examination with the guidance of the National Board of Medical Examiners (NBME). Most questions are multiple choice covering information on the basic sciences, critical care, fundamental clinical skills, imaging, neuroanatomy, neurobiology, neurology, neuropharmacology, neurosurgery, pathology and other disciplines deemed suitable and important. It is given each year on the middle Saturday of March at most U.S. neurosurgical residencies. The ABNS and RRC require residents to pass the Examination for credit toward certification before completing training. Many Program Directors require passage before the chief year.
Neurosurgeons who completed residency training in ACGME accredited programs may take the Primary Examination as often as they wish. Individuals who entered Canadian neurosurgery programs prior to July 16, 1997 may also take it. ABNS Rules and Regulations do not allow it to be offered to fellows or medical school students, etc.
Neurosurgical residency graduates are sent application packets at the end of their training. The packet contains a hospital release form, a business associate agreement, information on NeuroLog, a list of Minor Cases, and basic instructions. All of these can also be downloaded as PDFs from the ABNS website www.abns.org. NeuroLog is the Board’s web-based data collection program for recording patient practice data.
Upon receipt of an application, the Board takes appropriate steps to verify the statements of fact in it. Prior to accepting a candidate into the certification process, the Board requires a statement from the 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. Inquiries are made from other references about training, practice, and hospital privileges. The Board also searches 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 practice data, ABNS Directors make a decision on the candidate’s eligibility for oral examination and potential certification. Permission will not be granted until all aspects of the requirements have been met to the satisfaction of the Board.
Candidates should be scheduled for oral examination, the final step in the certification process, within five years of completing 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 to be within the certification process and must re-pass the Primary Examination in order to return to tracking toward certification. Three years (not another five) will then be allowed to complete the process.
Candidates for initial certification must submit a chronological log of 150 consecutive, major, surgical cases for which he or she was the responsible surgeon. Each must have a minimum of three months follow-up. All cases must be within an 18 month time period and none may be older than 24 months at the time received. A list of minor procedures must be sent as well. No cases done during residency or subsequent fellowships (even though done outside the fellowship) may be included.
Data is entered through NeuroLog, the ABNS web-based data logging site accessed at the Board’s website www.abns.org. In order to receive a password to begin, email the Board at firstname.lastname@example.org. The program is based on text boxes to fill with information on each case. Once completed, the data is reviewed by an ABNS Director (not office staff) as part of the credentialing process. The information must be complete enough for the reviewer to understand what was done, why, and the outcome. Approval takes an average of six months.
The essential accuracy of the data is verified by the signature of the Hospital Administrator, or Chief of Staff, or Chairman of surgery or neurosurgery at each hospital on the data. The Board performs hospital audits to confirm accuracy on approximately 7% of submissions.
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 approval. Permission to take the examination will not be granted until the ABNS is satisfied as to the quality of the candidate’s data.
Once the Practice Date has been filed with the Board, the application should be submitted with all of the required addenda:
- Current application fee, which will not be refunded even though the application may be denied
- Two 2 ˝" by 2 ˝" photographs signed on the front
- A list of medical papers and books published
- Addenda for longer answers to questions
- Copies of all licenses to practice medicine
- Signed Consent and Release form
- Completed and signed Business Associate Agreement
- Hospital Verifying signature sheets for practice data
- Minor procedure list
- Screenshots of hospital websites
- Business card
Once all parts of an application, including the practice data, have been approved by ABNS Directors, the candidate is placed in a pool for scheduling for the next oral examination. With few exceptions, the examinations are scheduled five months in advance. They 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. Examiners present clinical vignettes for patient management and problem solving. 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 the patients, plan and perform operations, if indicated, and deal with complications. Subjects covered are:
- Neurosurgery – intracranial and vascular diseases
- Neurosurgery – spine
- Other – critical care, functional and stereotactic neurosurgery, pain, pediatric and congenital disorders, peripheral nerve and plexus, neurology
Grades are given on diagnosis, management and handling of complications.
Candidates who pass the oral examination become certified Diplomates of the American Board of Neurological Surgery. A Certificate is sent to him or her once it has been suitable engrossed and signed by the Officers of the Board.
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, including 36 months of core clinical neurosurgery, are eligible for ABNS certification though the same process as graduates from U.S. programs. They must also, however, hold a Fellowship from the Royal College of Surgeons, Canada in neurosurgery.