I. Training in Neurological Surgery

A. Fundamental Clinical Skills – Internship Year - 12 months
B. Neurological Surgery Residency - 60 months minimum
C. Special Considerations
D. Program Director's Endorsement

II. The Primary Examination

III. ABNS Board Certification

A. Application requirements
B. Oral examination

I. Training in Neurological Surgery

To be eligible for certification by the American Board of Neurological Surgery (ABNS), each applicant must be a graduate of a medical school acceptable to the Board. A candidate must then have successfully completed an internship and neurosurgical residency training in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). An exception applies for residents from Canadian neurosurgical programs who began training before July 16, l997. Qualified individuals interested in ABNS certification should contact the Board office.

Neurosurgical training programs in the United States are reviewed and accredited by the Residency Review Committee for Neurological Surgery (RRC) 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 Year - 12 months
Twelve 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 residency training.

This requirement may be satisfied by training for one or more years in an ACGME accredited general surgery program in the United States. The training may likewise be acquired during the course of training in an ACGME accredited neurosurgical residency program. Such training must include at least 6 months in surgical disciplines other than neurosurgery. The remaining 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 6 weeks of neurosurgery. Up to 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 60 months of training as a full-time resident in an ACGME accredited neurosurgical training program.

(1) At least 36 months must be devoted to core clinical neurosurgery with progressive responsibility culminating in 12 months as senior-most 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 24 months of training in core clinical neurosurgery must be obtained in one institution.
Trainees are required to record the operative procedures performed during their residency. The ABNS prefers that this record be provided to the via the web-based NeuroLog database logging system available to all residents and Program Directors. 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 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 months are recommended, but 3 months are required. Up to 3 months of this training may be acquired during the 12 months of training in fundamental clinical skills; however, doing neurology during the internship year does not shorten the requirement for 60 months of residency training thereafter.

(3) The remaining 21 to 24 months (see 2 above) must be devoted to aspects of the basic or clinical neurological sciences, which may include neuropathology, neuroradiology, and research. Trainees are expected to acquire basic knowledge and skills in each of these disciplines. Some of the time might be dedicated to additional neurology or subspecialty neurosurgical training, for instance pediatric neurosurgery, or spine or endovascular surgery, and/or other disciplines related to the nervous system.

(4) An individual’s training is not complete and a Program Director’s endorsement cannot be provided until the Primary Examination has been passed for credit toward certification.

C. Special Considerations
Modification of the above requirements to fulfill specific training goals may be formulated for an individual resident.

Program Directors must request credit and receive approval in writing from the ABNS in advance if training is to be undertaken outside the parent program. Such training shall not count toward fulfilling the requirements for certification unless credit is specifically requested by the resident's program director in writing and approved by the Board in advance. Training other than as an appointed resident in an ACGME accredited 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.

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 basic neurological sciences in institutions acceptable to the Board.

Should a resident transfer from one accredited neurosurgical training program to another, the ABNS must receive the written consent from 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 resident is responsible for ascertaining that any prior training may count toward completion of residency.

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 the candidate:

(1) Has fulfilled the professional training requirements of the Board.

(2) Has performance satisfactorily in the program has been satisfactory.

(3) Has passing of the Primary Examination for credit.

(4) Is recommended by his or her program director as being professionally competent for the independent practice of neurological surgery and suitable for consideration by the Board for certification.

II. The Primary Examination

Each applicant for certification must first successfully pass the Primary Examination for credit toward certification. This examination is prepared by the ABNS and 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-accredited neurosurgical training programs and to neurosurgeons who have successfully completed such training. Residents may take it either for credit toward certification or self-assessment, as determined by his or her Program Director. An individual’s training is not complete and a Program Director’s endorsement cannot be provided until the Examination has been passed for credit.

The Primary Examination is given once each year, usually the last Saturday in March, at most ACGME accredited neurosurgical training programs. Applications must be filed with the ABNS by mid-December.

III. ABNS Board Certification

A. Application Requirements
As neurosurgical residents complete training, the ABNS sends application packets outlining the requirements for continuing the process to become a certified Diplomate. Candidates for certification must complete and file accurate applications with the Board, together with the required supporting documents. The ABNS will not schedule a candidate for oral examination until all requirements have been fulfilled and approved by the Directors.

Each candidate must be scheduled for oral examination within five years of completing training; otherwise, he or she will no longer be considered actively involved in the certification process. Post-graduate fellowships do not extend this window of opportunity but are counted within the interval to complete the process. In order to comply with this five-year rule, applications should be filled out and sent to the ABNS office as soon as possible after completion of residency and logging of twelve months of practice data. Six to twelve months may be required for the entire application to be reviewed and approved by the various ABNS Committees and full Board.

A completed application includes the application form, business agreement, hospital release, copies of licenses, appropriate fee, and at least one year of practice data, with oldest case not more than two years old at the time of review. Letters of recommendation and hospital privileges will be requested.

(1) Application Form

Application forms are available from the ABNS office or may be printed from this website. A candidate who fails to apply to the ABNS in time to be scheduled for oral examination within 5-years of completion of training is no longer considered to be within the certification process. To re-enter the process, the candidate must re-take and pass the Primary Examination. After re-passing, the candidate has 3 years to submit an application as outlined above, have it reviewed and approved, and take the oral examination.

(2) Practice Data Requirements

Each applicant for ABNS Certification must submit a list of all operative and non-operative in-patients for whom he or she was the responsible physician or surgeon during a period of 12 consecutive months, with at least 3 months of follow-up. The list does not include out-patients or consultations in which the applicant did not assume primary responsibility for patient’s care. If the case log includes less than 100 operative cases, it must continue until 100 cases have been collected for analysis. Data collection should begin shortly after the applicant begins practice and sent to the Board as soon as 12 months have been accumulated. This process should ideally be completed within 3 years of completing residency training. Again, 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 Board. The ABNS expects applicants to record their data in the web-based NeuroLog database system; however, forms and an example can be requested from the Board office or printed from this website.

(3) Letters of Recommendation

The applicant shall supply names and addresses of 3 or more physicians with whom he or she has had professional contact to attest to the quality of his or her professional conduct. At least 2 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

Each applicant must have unencumbered and unrestricted hospital staff privileges for neurosurgical practice in all hospitals in which he or she cares for patients, as well as 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 an application has been reviewed and approved by the Credentials Committee and received a favorable review by the full Board at a regularly scheduled meeting, the candidate will be scheduled for the oral examination. If the application is not completed within 5-years of the candidate’s completion of 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 the 5-year time frame will not be scheduled for oral examination until he or she has again passed the Primary Examination for credit and thereby returned to the certification process. Such candidates must then submit a request for oral examination accompanied by the then applicable fee. The new request, along with an updated application, must be approved by the ABNS and the applicant scheduled for oral examination within 3-years after passing the Primary Examination.

The oral examination lasts 3-hours and covers the diagnosis, management, and outcome of surgical and medical diseases of the nervous system. Notwithstanding the growing tendency toward subspecialization, the examination covers all of neurosurgery; questions from all aspects of the discipline must be answered. The primary thrust relates to clinical practice via a case history format, including symptoms, findings, and 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 the first time, he or she may apply for re-examination. The candidate has 3-years in which to take the oral examination a second time. In the event that the individual fails again or the 3-year time frame lapses, he or she must re-pass the Primary Examination for credit, thereby returning to the certification process. Such candidates must then submit new information and the applicable fee as requested by the Board. The applicant will again have 3-years to be complete the certification process, including passing the oral examination.