Sometime in the last year of residency, you will receive information from the American Board of Neurological Surgery outlining the process of certification. Most residents are aware that certification—and the dreaded oral examination—will happen at some point in the future and that there is some sort of new continuing education requirement, but pressing issues that attend the end of residency can take precedence over planning for certification. With that in mind, this article will address the basics of board certification in neurosurgery, as
Initial ABNS certification first requires meeting the training requirements in a program accredited by the Accreditation Council for Graduate Medical Education and passing the primary examination by the completion of residency. It then involves two steps, the application and the oral examination. An application to sit for the oral examination must be completed within five years of residency graduation. Importantly, a fellowship or other postgraduate work does not extend the five-year window.
The best known element of the application process is the practice data requirement. Practice data must be submitted for 12 consecutive months. The practice data must detail all operative cases during that period with at least three-month follow-up and include at least 100 operative cases, with no case being more than two years old when the data is reviewed. Cases performed as a fellow, even if done as a credentialed surgeon providing, for example, trauma coverage (as happens in some fellowships) cannot be used in the practice data. According to the ABNS, practice data ideally should be obtained within three years of finishing residency. The ABNS maintains the NeuroLog online database system to record practice data and requires its use. In addition to practice data, recommendations are required from at least three physicians, two of whom must be from your community. At least one of the recommendations must be from a physician who is ABNS-certified. The applicant must also hold a valid medical license in the state of practice and have unrestricted hospital privileges.
After an application review process that can take from six to 12 months (something to keep in mind in deciding when to start recording your practice data), the oral examination is scheduled. The three-hour oral exam covers the gamut of neurosurgery. It is given in a case history format which includes the symptoms, findings on exam, results of diagnostic tests, work-up, differential diagnosis, surgical and nonsurgical management including anatomy, pathology, physiology, and descriptions of surgical procedures. Those who fail the oral examination must retake it within three years. If the oral examination is not passed on the second try or if the exam is not retaken within the three-year period, the written exam must be taken again and passed, and the application process, including the submission of a new round of practice data, must be repeated.
After the oral examination is passed, a 10-year certificate is issued. To maintain certification, one must participate in the MOC program. The program consists of a series of three-year cycles that culminate in the MOC Cognitive Examination component, a multiple-choice examination which is the only requirement for the 10th year, although it may be taken in the eighth or ninth year.
In each three-year cycle, all requirements for three components must be met. (1) To show Evidence of Professional Standing, verification of an unrestricted medical license and hospital privileges must be obtained, in addition to a questionnaire completed by the chief of staff at your primary hospital. (2) To meet the requirements for Lifelong Learning and Self-Assessment, 150 hours of continuing medical education must be completed every three years in addition to participation in the Self-Assessment in Neurological Surgery,or SANS, online examinations. (3) Evidence of Performance in Practice requires the submission of the details of 10 consecutive “key cases,” of which there are currently 13, which span the intracranial, endovascular, spine, and pediatric subspecialties. Additionally, 20 of your patients will be surveyed to test your physician-patient communication skills. Provided that the cognitive examination is passed in years eight, nine, or 10, and all requirements are met in each of the three-year cycles, a new 10-year certificate will be issued and the three-year MOC cycles repeat.
In summary, although there are many requirements for both obtaining and maintaining ABNS certification, knowledge of the requirements, attention to detail, and planning should help to make the process straightforward and relatively pain-free.
K. Michael Webb, MD, a founding partner with NeuroTexas PLLC, Austin, Texas, currently is undergoing the certification process. The author reported no conflicts for disclosure. The author thanks M. Sean Grady, MD, secretary of the American Board of Neurological Surgery, www.abns.org, for his assistance with this article.
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