After graduating from a U.S, neurosurgery residency, the final step in training is to become certified by the American Board of Neurological Surgery (ABNS). The first step in this process is the written boards, which must be passed prior to graduation from neurosurgery residency. The second part of the certification process happens after neurosurgery graduation: the ABNS Oral Board Examination. During the period after graduation from residency but prior to passing the oral boards, neurosurgeons are considered “board eligible.” After passing the oral board exam, the neurosurgery candidate becomes a certified diplomate of the ABNS and is “board certified.”
The neurosurgery oral board’s format was revised in 2017 and now includes three oral examination sessions, each 45 minutes long. One session is focused on general neurosurgery and a second session will focus on the examinee’s self-selected subspecialty focus (spine, tumor, vascular, pediatrics, etc.) or the examinee may choose a second session of general neurosurgery cases. The third session is now composed of the examinee’s own cases. As part of the oral board’s application process, the examinee must enter 125 consecutive operative cases of their own from post-residency/fellowship neurosurgery practice into the ABNS POST online case submission system. The ABNS examiners typically select 5-8 of these 125 cases to review during the examination. Importantly, the timing of oral board’s application submission has changed as well: neurosurgery residents who graduate on or after June 30, 2017, must submit their oral board’s application no later than December 31, three calendar years following their residency graduation. For candidates who graduated prior to June 30, 2017, the application must be submitted within four years of graduation.
The newest component of the oral board’s application process is an updated web-based surgical case entry system termed Practice Outcomes of Surgical Therapies (POST). The POST case entry system was opened in the spring of 2018 and replaced the incumbent Neuro Log system. The major changes in the new system are a transition from free text entry (Neuro Log) to discrete data fields (POST), mainly in the form of drop down menus to describe patient variables, diagnoses, procedures and outcomes.
The new POST case entry system has modernized and streamlined data entry, but there are also important changes to note that may help future applicants. The new POST system is certainly well organized and comprehensive; however, it also requires a significant time commitment to complete the required 125 cases. An informal survey of five candidates submitting oral boards applications in the fall of 2018 found that the average time spent entering cases into the system prior to final submission ranged between 110-150 hours with the average applicant surveyed spent ~1 hour per case entry. The applicants surveyed case entry periods ranged three to four months of aggressive case entry, which typically occurred outside working hours. In addition to the POST cases, there are other important components of the board application process to be aware of, including entry of practice information, letters of support from mentors and colleagues and the verification of logged cases by all of the hospitals where cases were performed during the case collection period. (https://abns.fluidreview.com/). Several important takeaways from the oral board application process and early experience with the POST system:
- Understand the deadlines for submission
- Begin the case entry process early after residency graduation
- Appropriately plan for the time commitment required to enter cases
- Avoid waiting until the last minute to start the oral board application process!
Ultimately, the board certification process is the culmination of a strenuous but rewarding journey to becoming an ABNS board-certified neurosurgeon, but like all other parts of the process, handle it with precision and care.
Jeremiah Johnson, MD
Baylor College of Medicine
YNC Secretary, Chair-elect