Not sure what programs are doing this, but here is an overview from the ABS website:
http://home.absurgery.org/default.jsp?policyesp&ref=index_pd
Early Specialization Program
Introduction
The American Board of Surgery (ABS) approved in January 2003 a new pathway, known as the Early Specialization Program (ESP), for combined certification in general surgery and vascular surgery or general surgery and pediatric surgery, to be accomplished in a training program one year shorter than the currently separate programs. The combined program must be approved by the Residency Review Committee for Surgery (RRC-S) before implementation.
It is intended that ESP will be implemented in a limited number of residency programs and will be evaluated closely over the next few years to determine the equivalency of the new training paradigm to conventional training. If it becomes evident that graduates of the new program do not meet the same educational goals as conventional program graduates, modification or termination of the program may occur.
ESP will not result in a shortening of requirements for general surgery certification. Sixty months of training continue to be required and all other special requirements of the RRC-S continue to be applicable. The change is that 12 months of experience in a general surgery essential content area - vascular or pediatric surgery - which normally occurs in the PGY-5 year, will count toward both general surgery certification and specialty certification.
Residency Program Requirements
Residency programs in general surgery and either vascular or pediatric surgery that elect to participate in this program must continue to meet all requirements of the RRC-S in effect for programs in those areas.
Institutions which have a vascular surgery or pediatric surgery residency in addition to a general surgery residency are eligible to apply to participate in the new program. In this initial evaluation period, only programs which are present in a single institution may participate. Specific requirements which must be met are the following:
1) Written approval by the program directors of the participating programs at a given site and documentation of the commitment and ability to meet the criteria for ESP.
2) The general surgery and specialty program must both be in excellent standing with the RRC-S, normally be demonstrated by a four- or five-year approval cycle, and must have no major program deficiencies in the most recent program review.
3) There must be no program deficiencies in the defined categories of the SOL in RRC-S reporting for the most recent three years.
4) The pass rate for first-time takers in the general, vascular, and pediatric surgery qualfying and certifying examinations must meet RRC-S minimums (>60%).
5) Submission of a feasibility plan by all participating program directors, with an outline of the specific curriculum for participating residents.
6) The vascular or pediatric surgery residency programs must be approved by the RRC-S for two clinical years of clinical training.
Candidate Eligibility
Residents who wish to apply for the ESP must have spent all years of general surgery training at the same institution. The resident must be in good standing, not subject to any current disciplinary action, and the program director must certify that candidates have a balanced experience in the essential content areas (see next section).
Resident Rotation Requirements
1) The Essential Content Areas of Surgery (ECA) have been defined by the ABS as the following:
Abdomen
Alimentary tract
Head and neck
Skin, soft tissue, and breast
Endocrine surgery
Surgical oncology
Trauma/burns
Critical care
Vascular Surgery
Pediatric Surgery
Transplantation
2) Secondary areas/rotations are the following:
Plastic surgery
Thoracic surgery
Endoscopy
3) Additional technical experience which is separately evaluated by the RRC as defined categories, but which generally involve one of the ECAs, are:
Laparoscopy
Advanced laparoscopy
4) Other specialty areas which have been previously defined are:
Anesthesia
Gynecology
Neurosurgery
Orthopedics
Urology
Thirty-six of the first 48 months of surgical residency must be spent in areas 1, 2, or 3 above. Since 12 months of the PGY-4 and PGY-5 years will be spent in either vascular or pediatric surgery residency, the total time spent in ECAs will then be 48 out of 60 months, an increase of 12 months over present requirements.
Requirements in PGY-4 and PGY-5 Years
Residents will be approved to begin the program at the PGY-4 level. The requirements for the PGY-4 and PGY-5 years are as follows:
1) During the 24 months of the PGY-4 and PGY-5 years, a minimum of 12 months must be spent as chief resident in surgery. Chief resident rotations are defined as rotations in which the resident is the most senior resident on the service, is directly responsible for overseeing all patients on the service, and reports directly to the responsible attending physician.
2) A maximum of 12 months of the 24 months of the PGY-4 and PGY-5 years may be devoted to training in the ESP-designated specialty (e.g., vascular surgery or pediatric surgery). This would normally be the 12 months of the PGY-5 year.
3) It is highly desirable that the 12 months in the non-ESP-designated specialty essential content areas occur in the PGY-4 year. Exceptions will be considered on a case-by-case basis and requests for such exceptions must include justification that such arrangements will not compromise broad experience in surgery (general surgery).
4) It is desirable that the 12 months as chief resident in surgery be in the non-ESP-designated specialty essential content areas. Exceptions, which would allow up to 4 months of experience in the ESP-designated specialty to be considered part of the chief resident experience, will be considered on a case-by-case basis. Requests for such exceptions must also include justification that such arrangements will not compromise broad experience in surgery (general surgery).
5) No more than four months as chief resident in surgery may be devoted to any single ECA.
6) In situations where part of the PGY-4 year is spent on ESP-designated specialty rotations, an equivalent amount of time must be spent as chief resident during the PGY-5 year in ECAs other than the ESP-designated specialty.
7) The 12 months devoted to the ESP-designated specialty credited toward training in Surgery must be spent entirely in clinical rotations and cannot include research rotations. Nonoperative rotations (e.g. interventional radiology) during the PGY-5 year are also not creditable toward the certification requirements in surgery. In such situations, individuals will not be admissible to the certification process in surgery until completion of acceptable operative rotations in the PGY-6 year that are of at least equal length to the non-creditable rotations.
8) Residents participating in the Early Specialization Program will not be considered for certification in surgery until they have completed 24 months of acceptable clinical rotations beyond their PGY-3 year; the training curriculum must be clearly defined at the time of program application to the RRC-S.
Eligibility for Certification
Residents who successfully complete the ESP will be eligible for certification in surgery at the end of the PGY-5 year and certification in either vascular surgery or pediatric surgery at the end of the PGY-6 year of training. Applications to enter the certification process may be made at the completion of the PGY-5 year, and the candidate may take the Qualifying Examination in Surgery (QE) at that time, during the PGY-6 year, or subsequently. The Certifying Examination in Surgery (CE) may be taken following successful completion of the QE. All rules and procedures governing the QE and CE processes for general surgery residents will also apply to graduates of the ESP.
Specialty certification will be possible after completion of the PGY-6 year and will require prior successful completion of the certification process in general surgery. All rules and procedures for specialty certification that apply to other graduates will apply to graduates of the ESP.
Oversight
The RRC-S will administratively manage the Early Specialization Program and will receive all institutional applications, conduct the review process, and integrate this into the traditional RRC-S review of residency programs.
Review and approval of applications will be completed by a joint committee of the RRC-S and American Board of Surgery. This committee will monitor performance of institutions and individual residents at six-month intervals and make reports to the RRC-S and ABS on the status of programs which have elected to participate in the ESP, any problems which have been encountered in implementation, and the performance of resident participants in the programs on the In-Training Examination, QE and CE.
Outcome Measures
Specific outcome measures which will be used to judge the success of the program are the following:
1) First-time pass rates on the QE and CE of the American Board of Surgery for graduates of the ESP program.
2) Operative experience records of graduates of the ESP as well as all other surgical residents at the institutions participating in the program. All residents in these programs must continue to meet all minimum requirements of the RRC for Surgery in regard to Defined Category Cases, Total Cases, and Chief Year cases.
3) Dropout rates of candidates who begin programs, and other measures of resident satisfaction with the program as the committee may develop.
