Credit for Foreign Graduate Medical Education - General Surgery

The following policy outlines the terms under which the ABS will grant credit in general surgery for training completed outside the U.S. or Canada.

Introduction

The ABS accepts applications for partial credit for foreign graduate medical education. Candidates must be currently enrolled in an U.S. ACGME-accredited general surgery residency program. All communications, requests and applications must be submitted by the program director. Credit may be given for one, two, and rarely three years of training.

Requests for Credit

Candidates for credit must be enrolled in a program and must have served there for a minimum of 6 months before any requests can be considered. Requests can be made during the resident’s PGY-1, PGY-2, or PGY-3 years, following a mandatory six-month observation period.
Requests for credit from the program director must be accompanied by the following:

Documentation of satisfactory completion of foreign medical school
Documentation of satisfactory completion of foreign residency training
Documentation of specialty certification in the foreign venue, if achieved
Chronological listing of former foreign and U.S. practice after specialty training
Chronological listing of all U.S. training, with specific description of accreditation status of training program and whether or not resident occupied an accredited or supernumerary (above accredited limit) position in program
An operative case log with appropriate numbers and types of cases; An operative log of cases during U.S. training and role in each as operating surgeon or first assistant, if available)
Attestation by program director of satisfactory completion of all U.S. or Canadian surgical resident training years for which credit is sought
Documentation of commensurate ACGME Milestones when applicable

Credit will not be granted for the PGY-3, PGY-4 or PGY-5 years. Retroactive credit may only be granted for the PGY-1 or PGY-2 years.
All requests for credit and related inquiries must be sent on official letterhead from the program director and must be be received by the ABS via email (requests must be initiated by first contacting the exam coordinator). All materials must be sent in a single PDF attachment. Requests for more than one year of credit must be submitted by March 15 with all required documentation.
Preliminary evaluations cannot be provided prior to enrollment in a residency program, either to a candidate or program director.
Requests will not be approved without the documentation above. Requests for credit should be submitted only once all required documentation, as outlined above, is available. Requests for more than one year of credit must be submitted by March 15.

Maximum of Two Years of Credit Granted

Accepting Trainee at a Higher Clinical Level for a Foreign Trained Surgeon

If seeking to have a trainee enter at the PGY-4 level:

Trainee must complete six months of general surgery training under the supervision of the program director who is submitting the request for credit

- Clinical skills must be commensurate with at least the PGY-3 level

- Documentation of ACGME Milestones at Level 3 or above for all milestones
Trainee may also be participating in surgical fellowship (e.g., transplantation, advanced GI, etc) at the same institution for at least six months

- Level of clinical competence must be supported by an operative case log that has the appropriate types of advanced cases.

PGY-3-year waiver for trainee already in the program may be considered only when the trainee has met the following criteria:

Has completed at least two full years of combined training in general surgery residency and surgical fellowship in the institution requesting the credit, AND
Has successfully completed general surgery in a non-US program with documentation of appropriate clinical activity, AND/OR
Has successfully completed a surgical fellowship in either a US or non-US program

Scenarios That May Be Considered

The general surgery program at Institution A is requesting credit for a surgeon who successfully completed residency in a non-US surgical residency program and who is currently in a transplantation fellowship also at Institution A.

The general surgery program may submit a credit request for placement at the PGY-4 level. The request must include a formal letter from the general surgery program and items 1-7 of the required documentation listed above.
The general surgery program at Institution A accepted a new resident at either the PGY-1, PGY-2, or PGY-3 level, and who successfully completed a non-US surgical residency program.

After a six-month observation period, the general surgery program director may request up to two years of credit. The request must include a formal letter from the general surgery program and items 1-8 of the required documentation listed above. Credit would be applied towards the PGY-1 and PGY-2 years only.
The general surgery program at Institution A has a resident who has completed two years of surgery training at Institution A and has successfully completed a non-US surgical residency program.

The program may request promotion to the PGY-4 level. The request must include a formal letter from the general surgery program and items 1-8 of the required documentation listed above.

Scenarios That Will NOT Be Considered

The general surgery program at Institution A is requesting credit to enter the program at an advanced clinical level for a surgeon who successfully completed residency in a non-US surgical program and who is currently completing a transplantation fellowship at Institution B.

This request will not be considered.
The general surgery program at Institution A has a resident who completed three years at the PGY-1 and PGY-2 levels. The resident has not completed a general surgery program in a non-US program. The program is requesting promotion to the PGY-4 level.

This request will not be considered. Completion of a PGY-3 year is required.
The general surgery program at Institution A has a resident who completed three years at the PGY-1 and PGY-2 levels. The resident has not completed a general surgery program in a non-US program. The resident has completed a surgical fellowship in the US at either Institution A or Institution B. The program is requesting promotion to the PGY-4 level.

This request will not be considered. Completion of a PGY-3 year is required.

Approval Process

Requests for credit for one year of residency training may be approved at any time by the president and chief executive officer of the ABS; requests for more than one year of credit must be approved by the ABS Education and Training Committee. Requests for more than one year of credit must be received by March 15 in order for the Education and Training Committee to review and provide program directors with a decision within 60 days of the request.
Program directors will be notified of credit decisions by letter from the ABS president and chief executive officer.

Credit Granted

Credit may only be given for PGY-1, PGY-2, or PGY-3 years. PGY-4 and PGY-5 years must be completed satisfactorily in an accredited U.S. program. The granting of credit is not guaranteed.
If the resident moves to another program, the credit is not transferable and must be requested by the resident's new program director after a new six-month period of evaluation.

Canadian Residents

Applicants who complete a Canadian program must have completed all of the requirements in a Canadian surgery program accredited by the RCPSC or in combination with a U.S. surgery program accredited by the ACGME. Credit for postgraduate surgical education outside the U.S. and Canada is not available to Canadian applicants. Applicants from Canadian programs must comply with ABS requirements for certification.

Prior U.S. Training

Prior residency training in ACGME-accredited surgical residencies as a preliminary (non-categorical) resident at the PGY-1 or PGY-2 level may be credited on a year-for-year basis if satisfactory completion of each year is documented in writing by the responsible program director. The training must have been completed within the five-year period preceding the request. Credit will only be granted for the specific level of training completed; candidates who complete two years at the same level of training (e.g., a preliminary PGY-1 followed by a categorical PGY-1) will receive credit for only one year. Training at the PGY-3 level will only be accepted if accomplished as a categorical resident in an accredited program.

International Rotations

Under certain circumstances, the ABS will accept residency rotations outside the U.S. or Canada. Program directors may request credit towards training abroad but must receive ABS approval in advance.
No such rotations will be permitted in the first year (PGY-1) of general surgery and vascular surgery residency training. For the ABS to consider international rotations in the PGY-5 chief year, the program must include documentation of ACGME approval of chief rotations in the PGY-4 year. The ABS is unable to consider these requests without this documentation.
To request approval, a letter should be sent on official letterhead via email to both the ABS and the RC-Surgery. All materials must be sent in a single PDF attachment. The letter must be signed by both the program director and the designated institutional official (DIO) and contain the information outlined in the ACGME International Rotation Policy (pdf).
The program will receive a separate approval letter from the ABS and the ACGME; both must be received prior to implementation of the international rotation.
Required Rotation Length: While the ACGME will allow rotations to be two weeks in duration, the ABS requires at least two weeks for a rotation to be considered for credit.

Non-Residency Fellowships

It has become increasingly common for foreign medical graduates to complete non-ACGME accredited fellowships in specialty areas of general surgery (e.g., transplant, cardiac or pediatric surgery) prior to entering residency. The ABS is unable to evaluate the quality of such training, and it will be creditable only on a limited basis.

For questions regarding this policy, please contact the ABS coordinator.

Updated: October 2022