AANS Neurosurgeon | Volume 27, Number 3, 2018


Update from the American Board of Neurological Surgery

The American Board of Neurological Surgery (ABNS) has been changing rapidly in the past several years to meet the needs of its diplomates, candidates and the public. The ABNS has undergone a revolution of novel ideas, simpler processes and more relevant exams that are aimed at improving patient safety and fulfilling the broad aims of the ABNS. The primary mission of the ABNS is to encourage the study, improve the practice, elevate the standards and advance the science of neurological surgery, and thereby to serve the cause of public health. Since 2015, Fredric B. Meyer, MD, FAANS, professor of neurosurgery and dean of Mayo Clinic Medical School, has served as executive director of the ABNS. Dr. Meyer runs the Board focused on the ABNS mission and a fiscally responsible, non-profit mindset and has overseen all these dynamic changes.

There are currently 4,178 active diplomates including 259 (6.1 percent) women, a percentage that is steadily increasing. There are 2,430 neurosurgeons participating in Maintenance of Certification (MOC), 1,513 retired and 1,062 deceased. Since its founding in 1940, the ABNS has certified 7,022 neurosurgeons.

I will now cover the most significant changes to the ABNS certifying enterprise that may interest and impact all neurosurgeons:

1. Modifications to the National Board of Medical Examiners (NBME)/ABNS Primary Examination 2017 and Beyond

This goal of the ABNS is to make sure our candidates are tested by a more relevant and clinically applicable examination on the basic science and clinical principles the ABNS directors believe are important. The ABNS eliminated the “factoid” questions, instead asking more disease- and condition-oriented basic science questions that our neurological surgeons encounter in their practice. The ABNS has changed the Neurobiology Case Category of the ABNS Primary Exam to Neuroscience. In addition, the number of Neuroscience questions will change from 49 to 30 questions on the NBME exam. The ABNS has also changed the Case category of Neurology to Clinical Neurology. The number of Clinical Neurology questions will change from 53 questions to 40 questions. As a result of the above actions, we will concomitantly increase the number of Neurosurgery and Critical Care case category questions. These changes very much parallel the changes that will be made in the Resident Matrix Curriculum that can be found on the Society of Neurological Surgeons (SNS) website.

2. Oral Examination Modifications

The Oral Examination of the ABNS will undergo its most significant redesign in the past several decades to address the change in our candidates’ practices. The current format is three one-hour examination sessions that focus on cranial, spinal and “other” neurosurgical topics. Different medical boards conduct their oral examinations in different ways, and some do not have an oral examination at all. 

The ABNS sought to maintain an oral examination process that is relevant, rigorous and of value to both our specialty and to the cause of public safety. At the Spring 2017 examination, a new format will be used.

The new format includes three 45-minute sessions (not one hour sessions):

  • One session focused on general neurosurgery topics (just as it was prior to 2017)
  • One session focused on a subspecialty topic that the applicant may choose (spine and peripheral nerve, tumor, vascular, trauma/critical care, functional, pediatric or a second general session)
  • One session focused on an evaluation of the applicants’ own cases. At present, each applicant submits 150 consecutive cases as part of his or her credentialing process. From this pool, the ABNS will select 10 cases for possible discussion, some of which will be randomly generated and others will be chosen by ABNS directors. On exam day, five to six actual cases may be discussed. The purpose of this session is for the applicant to take the examiners through their case management process with a focus on knowledge, management and safety. The exam will be relevant and reflective of each candidate’s practice. 

3. The New MOC

The new MOC process will be more relevant, safer for our patients and less time consuming for all. The final product is yet to be released; however, here are some of the elements proposed for the new MOC that the ABNS knows are huge improvements and ones our diplomates have suggested over the years:

Part I: The ABNS will obtain proof that you are credentialed and possess hospital privileges in good standing. The hospital chief medical office (CMO) or chair will sign off on this for you.

Part II: Certified Medical Examination (CME) requirements will remain, but we are going to maintain our flexible choices that respect your neurological surgery time commitments. More to come on this issue.

Part III: The “all or none” MOC test is gone! You have been heard loud and clear! By Summer 2017, the old exam will be replaced by an adaptive learning tool that will teach  diplomates selected important new Level I or II neurological surgical advances in our field that are pertinent for their “on call” obligations. There will be no need for preparations or studying because the Part III ABNS learning tool will be a self-contained learning module. It can be completed at your convenience on your own computer, much like many learning modules that your hospital may administer.

Part IV:  There will be a more safety-oriented approach adopted. More to come on this Part soon.

In conclusion, the changes the ABNS has made in our certifying and re-certifying process will help elevate our specialty and be more relevant to our candidates and diplomats. Thanks for being our partner.


Rich Ellenbogen, MD, FAANS
Secretary, ABNS



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PHILIPP M LIPPE, MD, FACS, FAANS(L), FACPM | December 11, 2016 at 11:01 pm

Bravo. I applaud the ABNS on its insight and foresight. These changes will serve the NS Specialty well and benefit patients and neurosurgeons alike. Other ABMS members should emulate.

Domenic Esposito M.D.,FACS,FAANS | December 31, 2016 at 1:44 am

Change should imply improvement in a process which had some deficiencies. I have no problem with the new format but would be interested in knowing what aspects of the previous format were deficient Also what was the reasoning behind the in depth questioning in several fundamental areas of knowledge that was replaced by the rapid fire six shooter model. Perhaps an article on the evolution written by someone who has lived the changes would explain the evolution of the exam to those of us who have blindly accepted that the 2nd format was an improvement on the 1980’s version and why this new format is superior to both older formats.