ATTENTION RESIDENTS

The American Board of Thoracic Surgery (ABTS) has changed the operative case requirements for certification for all residents effective July 1, 2002. (More Information)

Candidates must fulfill all residency requirements of the Board in force at the time their applications are received.

Candidates for certification must complete a minimum of 24 months of residency training in thoracic and cardiovascular surgery in a program accredited by the RRC/TS. This must include 12 months of continuous senior responsibility. The director of the thoracic training program is required to approve the application form by signature, certifying that the candidate has satisfactorily completed the residency in thoracic surgery as described above. Once an application is received, it is considered the official and only record. The Board assumes that the appropriate signatures authenticate the accuracy of the case lists and all other information submitted on the application.

Education and adequate operative experience in both general thoracic surgery and cardiovascular surgery are essential parts of any approved thoracic surgery residency program, irrespective of the area of thoracic surgery in which a candidate may choose to practice.

The operative experience requirement of the American Board of Thoracic Surgery has two parts, volume or intensity of cases and distribution of index cases.

The Board's operative experience requirements include an annual average of 125 major operations performed by each resident for each year that the program is approved by the RRC-TS. In a 2-year program, this requirement is met if a resident performs a total of 250 major cases over the course of his or her residency; in a 3-year program, the resident must perform 375 major cases.

This guideline on intensity of cases conforms with the Special Requirements in Thoracic Surgery as published by the ACGME and the RRC-TS. The application of any candidate whose supervised operative experience fails to meet the requirement of an annual average of 125 major operations with a minimal number of 100 in any one year will be referred to the Credentials Committee for review.

INDEX CASES (DISTRIBUTION)

Index cases are Full Credit Cases only.

The applications of candidates whose operative experience does not include the required number of index cases as listed below will be sent to the Credentials Committee for review. The number of index cases required to meet the minimal acceptable standards in the various areas are:

Endoscopic procedures may be counted for credit whether they are performed as independent procedures or immediately preceding a thoracic operation.

Re-operation procedures can be "counted twice" for any adult cardiac procedure.

Major vascular operations outside the thorax, and procedures such as pacemaker implantation and closed EP, should be listed separately.

The Board recognizes that supervised operative experience in a well-organized teaching setting that is approved by the RRC-TS protects the patient, who, in most instances, is the personal and identifiable responsibility of a faculty surgeon. This supervised experience optimally prepares the candidate to begin the independent practice of cardiothoracic surgery after the completion of residency.

The Credentials Committee has been authorized by the Board to reject a candidate if his or her operative experience during the thoracic surgery residency is considered to be inadequate. The candidate, the program director, and the RRC-TS will be notified if such action is taken. If the Credentials Committee finds the applicant's operative experience inadequate and additional training is required, the additional training must be approved by the Board in advance. Should the program director determine that a resident needs additional training beyond the number of years that have been approved by the ACGME and the RRC-TS, before submitting an application for admission to the ABTS certification process, this additional training must also be approved by the Board in advance.

Even though emphasis on one or another facet of thoracic surgery (pulmonary, cardiovascular, esophageal, thoracic trauma, etc.) may have characterized a candidate's residency experience, the candidate is nevertheless held accountable for knowledge concerning all phases of the field, including extracorporeal perfusion (physiological concepts, techniques, and complications), cardiac devices, management of dysrhythmias, and thoracic oncology. In addition, the candidate should have responsibility for the care of pediatric general thoracic surgical patients and be competent in video-assisted thoracoscopic surgery. The candidate should also have an in-depth knowledge of the management of acutely ill patients in the intensive care unit. This requires an understanding of cardiorespiratory physiology, respirators, blood gases, metabolic alterations, cardiac output, hyperalimentation, and many other areas. By virtue of his or her residency in thoracic surgery, the candidate is expected to be fully qualified in the surgical care of critically ill patients.

Credit will be allowed for supervised operative experience in a well-organized teaching setting only when the following criteria are met:

Supervision and active participation by the thoracic surgery faculty are required in preoperative, intraoperative, and postoperative care.

The Board also emphasizes that first-assisting at operations is an important part of resident experience, particularly in complex or relatively uncommon cases.

Before applying for examination, prospective candidates should consider whether they are able to meet the minimum requirements of the Board, which includes certification by the American Board of Surgery for residents who started their training before July 2003. All residents must meet the new operative case requirements, which are listed above.

Residents who began their training in 2001 or after are required to use both the online application and the CTSNet Op Logs functions. Residents who began training in 2000 or before have the option of submitting their cases utilizing their instituional databases as long as the reports are in the same format as the Board's form or the CTSNet Op Log version. The standard paper application is still available upon request for residents who began their training in 2000 or before. The online application is an efficient and precise method for submitting the application and the operative case reports from CTSNet. All residents are strongly urged to use both the online application and operative logs.

Directions for utilizing the online application should be carefully followed since some of the forms must be printed from the Internet, signed by the appropriate individual and sent to the Board office with a copy of the medical license and the registration fee. A list of the documents that must be submitted with the online application is available on this website. A copy of the resident's valid license to practice medicine must be included with the application materials.

When the resident is ready, the draft online application is reviewed by the Program Director. Once he/she approves the application, the Program Director submits it online to the Board office.

The operative case logs are considered the property of the resident and are not kept in the Board office once the resident is certified. Each applicant should consult with his or her Program Director regarding the correct way to complete the operative case list forms.

The application, either the paper version or the online version that is submitted is considered a final document. The incomplete or incorrectly completed application may delay processing for one year. Residents are encouraged to address questions regarding the ABTS' requirements to their Program Director.

The deadline for submitting the completed application is August 1. Failure to meet that deadline will result in a delay of at least one year.

The ABTS takes particular note of the problems facing those with a disability and stands ready to alter its examination procedures in such a way that individuals who are competent to practice thoracic surgery have the opportunity to take the Board's examination under circumstances that accommodate the individual's disability. Individuals requiring special consideration because of a disability should notify the Board at least 60 days before the August 1 deadline for submitting an application.

Candidates are notified of their eligibility for examination when their applications have been approved.

The ABTS' policy is to consider a candidate for examination only after he or she has completed a thoracic surgery residency program approved by the RRC-TS.

Separate written and oral examinations are held annually at times and places determined by the Board. Information regarding the dates and places of the examinations is published in the Examination and Licensure column of the Journal of the American Medical Association, the Journal of Thoracic and Cardiovascular Surgery, and the Annals of Thoracic Surgery.

PART I: Written Examination
The examination consists of a written examination designed primarily to assess cognitive skills. The content of the questions on this examination represents uniform coverage of all aspects of the thoracic surgery specialty.

PART II: Oral Examination
Successful completion of the Part I (written) examination is a requirement for admission to the Part II (oral) examination. The oral examination is designed to test the candidate's knowledge, judgment, and ability to correlate information in the management of clinical problems in general thoracic and cardiovascular surgery

EXAMINATION SEQUENCE
Candidates should apply for the examination within 5 years of the satisfactory completion of their thoracic surgery residency. Any candidates applying for the examination five years or more after the satisfactory completion of residency will be considered individually. Additional training may be required of these individuals. To be eligible, the recommended additional training must be completed before an application can be submitted.

After a candidate is declared eligible for the written examination (Part I), the candidate must pass Part I within 4 years. The candidate who successfully completes Part I of the examination then must pass Part II within the succeeding 4 years.

Candidates who fail an examination (Part I or Part II) are eligible to repeat the examination the following year.

Candidates who fail either Part I or Part II of the examination three times, or do not pass either part of the examination within the allotted time period of four years, will be required to complete an additional thoracic surgical educational program which must be approved in advance by the Board before they will be permitted to retake the examination. The required additional training must be completed within the succeeding 2-year period after failing either the written or the oral examination. Candidates who complete the required additional training must file an addendum to their application, have their eligibility for examination reviewed by the Credentials Committee, and pay a new registration fee. They will be given two more opportunities to take the examination (Part I or Part II) within the succeeding 2 years.

Candidates who fail either Part I or Part II a fifth time will be required to complete another approved thoracic surgery residency before they will be eligible to re-apply for examination by the Board.

Candidates who do not appear for their scheduled examination (Part I or Part II) or who cancel less than 6 weeks prior to either examination may forfeit their examination fee.

The Board is a non-profit corporation, and the fees from candidates are used solely to defray actual expenses incurred in conducting examinations and carrying out the business of the Board. The Directors of the Board serve without remuneration.

After a candidate has met the requirements for eligibility and passed the examination, a certificate attesting to the candidate's qualifications in thoracic surgery will be issued by the Board. The certificate is valid for 10 years.

RECERTIFICATION -- MAINTENANCE OF CERTIFICATION
Applicants who are certified in thoracic surgery are issued certificates that are valid for 10 years from the date of certification, after which the certificates will no longer be valid. Certificates can be renewed before expiration by fulfilling the requirements for recertification specified by the American Board of Thoracic Surgery at that time. A Recertification (Maintenance of Certification) Booklet is available upon request.

INACTIVE STATUS
Diplomates holding a valid certificate from the ABTS and who expect to be clinically inactive for a period of one year or more may apply for inactive status. Learn more about this option.

Individuals who receive an unfavorable ruling from a committee of the Board may appeal such determination by mailing a notice of appeal to the ABTS office within 30 days of the date such ruling was mailed. A copy of the appeals procedure will be mailed to the candidate.

The only appeal permitted if an applicant fails the written examination is a request for a hand re-scoring to verify the accuracy of the score as reported. This request must be made within 30 days of the time the examination results are received by the candidate.

The only appeal with respect to the oral examination is the opportunity to request immediate re-examination following the completion of the oral examination. A candidate who believes that any of his or her examiners has been unfair or biased during a portion of the oral examination may request re-examination by another examiner. The grade on re-examination will be the final grade of the candidate for that portion of the examination.

Qualified applicants who have a history of chemical dependency that have been reported to the Board and who submit documentation suitable to the Board that their dependency has been under control for a period of at least two years will be admitted to the examination process.

For candidates who are already in the examination process and develop a chemical dependency as reported to the Board, the process will be suspended until the candidate can provide documentation suitable to the Board that the condition has been under control for a period of two years. At that time, the candidate will be readmitted to the examination process. The requirement to be accepted for examination within five years of completion of an approved thoracic surgery residency will not be waived.

No certificate shall be issued or a certificate may be revoked by the Board if it determines that:

the candidate for certification or Diplomate did not possess the required qualifications and requirements for examination, whether such deficiency was known to the Board or any Committee thereof before examination or at the time of issuance of the certificate as the case may be;

the candidate for certification or Diplomate withheld information in his or her application or made a material misstatement or any other misrepresentation to the Board or any Committee thereof, whether intentional or unintentional.

the candidate for certification or Diplomate was convicted by a court of competent jurisdiction of any felony or misdemeanor involving moral turpitude and, in the opinion of the Board, having a material relationship to the practice of medicine;