PATHWAY ONE: SUBSPECIALTY CERTIFICATION FOR CANDIDATES TRAINED AFTER JULY 1, 2008

Admission into the Subspecialty Certification in Congenital Cardiac Surgery for all congenital cardiac surgeons trained beginning July 1, 2008 and thereafter is based on the requirements listed below.

COMPLETION OF AN ACGME CONGENITAL HEART SURGERY RESIDENCY

The factual knowledge, technical skills, and problem-solving and judgment necessary to treat patients with congenital heart conditions are developed in a congenital heart surgery residency program that is approved by the RRC-TS and accredited by the ACGME. The highest educational standards are best achieved in residency programs in which close supervision and instruction as well as progressive individual responsibility for operative and postoperative care are possible.

The ABTS realizes that an examination primarily tests the factual knowledge acquired by the candidate and the candidate’s ability to reason. However, the limitations of an examination as the only assessment of clinical competence are well recognized. Therefore, an important part of the responsibility for determining clinical competence rests upon the Program Director of each congenital heart surgery residency. For this reason and others, only applicants who successfully complete an ACGME-accredited congenital heart surgery residency program and who are recommended by their training Program Director are considered for examination. It is during the period of the residency program that the trainee's ethical and moral character, judgment, technical skills, and ability to cope with a wide variety of clinical problems can be most accurately assessed. Thus, the endorsement of the candidate by the Program Director is required to complete eligibility for certification by the ABTS. Primary certification by the ABTS is required for applicants for the Subspecialty Certificate in Congenital Heart Surgery.

The pathway to subspecialty certification in congenital heart surgery is as follows: successful completion of thoracic surgery residency and congenital heart surgery residency training in accredited programs, thoracic surgery primary certification by the ABTS, and successful completion of written and oral examinations in congenital heart surgery, given by the Board to approved applicants in order assess the candidate’s factual knowledge, technical skills, and problem-solving and judgment in congenital heart surgery. These written and oral examinations are constructed and given by the Board with consultation and assistance in developing the examinations, and in analyzing the results, obtained from content experts, psychometricians, and others. The validity and reliability of the examination process and content are scrutinized continually.

To enter the examination process, a candidate must submit an application to the ABTS office that includes the specifics of their congenital heart surgical operative experience during the congenital heart surgery residency, and the attestation by signature of the Program Director indicating satisfactory completion of the congenital heart surgery program. Program procedure logs and applications are mailed to the Board office. Approved applicants must then achieve a passing score on both the written and oral examinations, which acknowledges that the candidate possesses sufficient factual knowledge, technical skills, and problem-solving and judgment necessary for competence in congenital heart surgery.

The procedures for establishing a candidate's qualifications will be reviewed periodically and revised, when appropriate, in a continuing effort to provide public assurance that congenital heart surgeons granted a Subspecialty Certificate by the ABTS have been adequately trained and educated in, and are competent to practice the specialty of congenital heart surgery.

GENERAL REQUIRENTS FOR RESIDENTS WHO BEGAN TRAINING ON JULY 1, 2008 AND THEREAFTER

Subspecialty certification by the ABTS may be achieved for congenital heart surgery residents who began training on July 1, 2008 and after by fulfillment of these requirements:

  1. Successful completion of a full residency in congenital heart surgery in a program approved by the ACGME RRC-TS within twelve (12) consecutive months and at a single institution.
  2. Operative case experience verified by the congenital heart surgery Program Director that meet or exceed currently required minimum surgical volume and index case distribution shown on this web page.
  3. Primary certification by the ABTS.
  4. In good standing with the ABTS including Maintenance of Certification and all dues and fees.
  5. A currently registered, full and unrestricted license to practice medicine granted by a state or other United States jurisdiction. The license must be valid at the time of application for admission to examination and maintained at least until the Subspecialty Certificate is granted by the ABTS. A temporary and/or limited license such as an educational, institutional, or house staff permit is not acceptable to the Board.
  6. Ethical standing in the profession and a moral status in the community that are acceptable to the Board.

CONGENITAL HEART SURGERY RESIDENCY PROGRAM REQUIREMENTS

Candidates must have successfully completed all of the residency training requirements of an ACGME-approved congenital heart surgery program that are in force at the time their congenital heart surgery program begins.

Candidates for certification must complete twelve (12) consecutive months of residency training in congenital heart surgery in a single program, accredited by the ACGME RRC-TS. The Program Director of the congenital heart surgery residency must approve the application form by original signature, certifying that the candidate has satisfactorily completed the residency in congenital heart surgery, that the applicant's operative logs accurately reflect the applicant's primary surgeon experience, and must endorse by written evaluation each candidate’s qualifications. The application needs to be prepared by the candidate and then reviewed and submitted by the Program Director. Once an application is received by the ABTS, 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, and reserves the right to seek validation of any information contained in the application.

OPERATIVE EXPERIENCE CREDIT

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

  1. The resident participated in the diagnosis, preoperative planning, surgical indications, and selection of the appropriate operation;
  2. The resident performed, under appropriate supervision in a well-organized teaching setting approved by the RRC-TS, those technical manipulations that constituted the essential parts of the surgical procedure itself;
  3. The resident was substantially involved in postoperative care.

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

Although the Board also acknowledges that first-assisting at operations is an important part of resident experience, particularly in complex or relatively uncommon cases, index and major cases for credit toward the ABTS application for certification require that the resident be the primary surgeon.

OPERATIVE CASE CRITERIA

A broad education and adequate operative experience in congenital heart surgery are essential to any approved congenital heart surgery residency program, irrespective of the area of congenital heart surgery in which a candidate may choose to practice. The operative experience requirement of the ABTS has two parts. One is concerned with the intensity or volume of cases, and the other with the distribution of cases (index cases).

1. Surgical Volume (Intensity)

The Board's operative experience requirements include performance of seventy-five (75) major congenital heart operative procedures as primary surgeon during the twelve (12) months of residency training.

This guideline on intensity of cases conforms with the Program 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 75 major congenital heart operations as primary surgeon will be referred to the Board’s Credentials Committee for review. Additional training time may be necessary for the candidate to meet the surgical case intensity requirement.

Repeated incidences of a program’s failure to meet operative volume requirements for its residents may be reported to the RRC-TS.

2. Index Cases (Distribution)

Index Cases are full credit, primary surgeon cases only, performed during the twelve (12) months of congenital heart surgery residency training. Applicants are required to have an extensive education and adequate operative experience in sufficient depth and breadth of the entire scope of congenital heart surgery so as to be able to practice independently after program completion. The number of index cases required to meet the minimal acceptable standards in the various areas are as follows.

Index Cases

Operative experience must include a minimum of 75 major congenital cases and must include at least the following minimum numbers of index cases:

5 Ventricular Septal Defect
4 Atrioventricular Septal Defect repairs
4 Tetralogy of Fallot repair
4 Arch reconstruction including coarctation procedures
5 Arterial Switch, Norwood, Damus Kaye Stansel, Truncus Arteriosus Repair [any combination to a total of at least 5]
5 Glenn/Fontan procedures
5 Systemic-to-pulmonary artery shunt procedures

In order to ensure an appropriately diverse distribution of cases, the applicant’s case log cannot exceed a maximum of the specified number for the following cases for credit among the 75 major congenital cases:

5 Secundum Atrial Septal Defect/Patent Foramen Ovale closure
5 Patent Ductus Arteriosus ligation or division
5 Pulmonary Artery banding
10 Right Ventricle-to-Pulmonary Artery Conduit insertion/replacement;
Pulmonary Valve replacement
5 Other valve repair or replacement (patients 18 years of age or under only)

Residents are required to use the application and operative logs forms found on this web site. The application of a candidate whose operative experience does not include the required number of index cases as listed will be sent to the CHS Credentials Committee for review. Additional training time may be necessary for the candidate to meet the surgical case distribution requirement.

The Board recognizes that supervised operative experience in a well-organized teaching setting that is approved by the RRC protects the patient, who is the ultimate responsibility of a faculty surgeon. This supervised experience optimally prepares the candidate to begin the independent practice of congenital heart surgery after the completion of residency training. The evaluation of the candidate by the surgical faculty validates such preparation.

The ABTS CHS Credentials Committee is authorized by the Board to reject a candidate if the operative experience during the congenital heart surgery residency is considered to be inadequate in volume and/or intensity depth and/or breadth. The candidate, the Program Director, and the RRC 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 of undertaking such training. Should the Program Director determine that a resident needs additional training beyond the twelve (12) months that has been approved by the ACGME and the RRC-TS before submitting a candidate’s application, this additional training must also be approved by the Board in advance.

Even though emphasis on one or another facet of congenital heart surgery may have characterized a candidate's residency experience, the candidate is nevertheless held accountable for knowledge concerning all phases of the field. The candidate should also have an in depth knowledge of the management of acutely ill patients age18 and under in an 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 the residency training in congenital heart surgery, the candidate is expected to be knowledgeable in the surgical care of critically ill patients and the critical care of surgical patients.

APPLICATION

Before applying for examination in congenital heart surgery, prospective candidates should consider whether they are able to meet the minimum requirements of the Board. All residents must meet the operative case requirements as listed above, which can also be found in the Congenital Cardiac Surgery Booklet of Information.

Residents are required to use the paper application and operative case reporting forms found on this web site. Original signatures are required on all documents.  Application must b e made within one (1) year (2 application cycles) of successful completion of the congenital cardiac surgery residency program.  All documents should be mailed to the Board office with a copy of the current, valid medical license and registration fee. A list of the documents that must be submitted with the application is available on this web site.

When completed by the resident, the paper application needs to be reviewed by the Program Director. Once the Program Director has approved the application, he or she must submit the application by mail to the Board office.

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

The application that is electronically "finalized" is considered to be a final document. Any incomplete or incorrectly complete application will delay processing for one year. Inaccurate information provided in a completed application may invalidate the application and may jeopardize the candidate’s eligibility. Residents are encouraged to address questions regarding the ABTS requirements to their Program Director or the Board office.

The deadline for finalizing the completed application is August 15. Failure to meet that deadline will result in a delay of one year. Applications received after August 15 will not be considered for that year’s examination.

The ABTS takes particular note of the problems facing those candidates with a disability, and stands ready to alter its examination procedures in such a way that a candidate who is competent to practice congenital heart surgery has the opportunity to take the Board’s examinations under circumstances that accommodate the individual’s disability. Individuals requiring special consideration because of a disability should notify the Board in writing at least 60 days before the August 15 deadline for submitting an application.

Candidates are notified of their eligibility for examination by mail when their application has been approved

EXAMINATION

It is the policy of the ABTS to consider a candidate for subspecialty certification examination only after he or she has completed a congenital heart surgery residency program approved by the RRC-TS.

The examination for subspecialty certification in congenital heart surgery consists of separate written and oral examinations held at times and places determined by the Board. Information regarding the dates and locations of the examinations is published in the Journal of Thoracic and Cardiovascular Surgery and the Annals of Thoracic Surgery, as well as on this web site.

The 2017 Part I (written) examination in congenital heart surgery will be given on December 4, 2017, in electronic format at Pearson Professional Testing Centers located throughout the United States. Specific information will be provided to approved applicants.

The Part II (oral) examination will be held in 2017 on June 8.  Specific information regarding the location and time will be provided to approved candidates. 

PART I: Qualifying (Written) Examination

The written examination is designed primarily to assess cognitive skills. The content of the questions on this examination represents uniform coverage of all aspects of the congenital heart surgery specialty.

PART II: Certifying (Oral) Examination

Successful completion of the Part I examination is a requirement for admission to the Part II Certifying (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 congenital heart surgery. Candidates are expected to be proficient in all areas of congenital heart surgery.

EXAMINATION SEQUENCE

            Candidates beginning training July 1, 2013 and thereafter must apply for the subspecialty examination within one (1) year after the satisfactory completion of their congenital heart surgery resi­dency.  The Board considers “one year” to include two registration cycles.  Any candidate applying for the examination more than one year after the satisfactory comple­tion of the congenital heart surgery residency will be considered individually by the Credentials Committee.  To be eligible for the subspecialty certification process, any recommended additional training must be completed before an application can be submitted.

          After a candidate is declared eligible for the writ­ten examination (Part I) in congenital heart surgery, he or she must pass Part I within three (3) years. The candidate who successfully completes Part I of the examination then must pass Part II within the succeeding three (3) years.  Candidates must become certified within a total of seven (7) years from the end of their congenital heart surgery residency.

            Candidates who fail an examination (Part I or Part II) may be eligible to take the examination the follow­ing year, for a total of three (3) attempts in three (3) years for each exam.

            Candidates who fail either Part I or Part II of the examination three (3) times, or do not pass either part of the examination within the allotted time period of three (3) years, will be required to complete an additional congenital heart surgical training program, which must be approved in advance of the additional training by the Board, before the candidate will be permitted to retake the examination. The required additional training must be completed within the succeeding two (2) year period after losing eligi­bility for either the Part I or Part II examination. Can­didates who are participating in additional training will be considered “in training” and the Board’s eligibility rule will be “on hold” until that training has been completed. Candidates who complete the required additional training must have their eligibility for examination reviewed by the Executive Director of the ABTS and/or the CHS Credentials Committee prior to being permitted to retake the examination. Once readmitted to the examination process, candidates will be given two (2) more opportunities to pass the exami­nation (Part I or Part II) within the succeeding two (2) years.

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

FEES

2017 Part II (Oral) Examination $1,525
2017 Registration (not transferable or refundable) $   600
2017 Part I (Written) Examination $1,300
2015 Part I Re-Examination $1,300

No applications will be accepted after August 15 each year.

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.

American Board of Thoracic Surgery
633 North St. Clair Street, Suite 2320
Chicago, IL 60611
Tel: 312-202-5900
Fax: 312-202-5960

Copyright © 1998 - 2011 by The American Board of Thoracic Surgery.