The oral examination is the last event in the initial certification process, which begins with neurosurgical residency in an ACGME accredited neurosurgical program and passage of the written examination. Where the written examination explores an applicant’s knowledge in various relevant disciplines; the oral examination explores knowledge and judgment in clinical neurosurgical practice after an applicant has been an independent practitioner.
The oral examination is accomplished in a series of face-to-face examinations involving the applicant, current and former directors of the board and guest examiners. Examination of a candidate’s knowledge and judgment typically includes questions regarding the preoperative evaluation, intraoperative technical and judgmental issues and post-operative management, including appropriate treatment of complications.
The oral examination of the American Board of Neurological Surgery (ABNS) has undergone periodic review and revision over the years. Different medical boards conduct the oral examination in different ways and some do not have an oral examination. The ABNS seeks to maintain an oral examination process that is relevant, rigorous and of value to both our specialty and to the public. Commencing with the spring 2017 examination, a new format is being followed.
Candidates who pass the oral examination become certified diplomates of the ABNS.
The ABNS strives hard to create a level “playing field” for all candidates applying for ABNS certification.
1) The ABNS discourages review of a candidate’s actual oral exam cases/slide presentations at any oral board preparation course. The course content and recommendations may not be consistent with the actual ABNS examination
2) Candidates are encouraged to review their oral board cases/PowerPoint with colleagues, residency or practice mentors as a way to prepare for the oral exam
3) To promote a fair process for all candidates, whether they participate in preparation courses or not, guest examiners and Directors will not participate in any oral board preparation course for the 12 month period following their participation as an ABNS examiner
Exam is comprised of three sessions, each 45 minutes in length
One session will consists of five questions focused on general neurosurgery
- Trauma craniotomy
- Intracerebral hemorrhage (from any cause)
- Acute stroke care; hemicraniectomy, suboccipital decompression
- Vascular dissection
- Atherosclerotic vascular disease
- Brain or spinal abscess
- Intratumoral hemorrhage, pituitary apoplexy
- Cauda equina syndrome
- Spinal cord injury management
- Spinal fracture management
- Brain metastasis, adult glioblastoma, supratentorial meningioma
- Neurology (MS, temporal arteritis, other that mimics a surgical presentation)
- Baclofen pump failure, drug withdrawal/overdose
- Peripheral nerve disorders
One session will consist of five questions focused on the pre-identified area of focused practice chosen by the candidate
- Degenerative spine
- Spinal tumors
- Spinal vascular malformations
- Spinal pain
- Glioma management
- Brain metastases
- Vestibular or other schwannoma
- Brain mapping
- Pineal region tumor
- Intraventricular tumors
- Spinal tumors
- CNS lymphoma
- Pituitary/sellar tumors
- Endoscopic surgery
- Skull base tumors
- SAH/aneurysm care (clipping, endovascular)
- Cavernous malformation
- Ischemic disease/stroke
- Moya-Moya disease
- Movement disorders
- Pain, trigeminal neuralgia
- Behavioral disorders
- Neurology (Parkinson’s disease, Essential tremor)
- Brain, spine, peripheral nerve injury surgery
- Injury physiology
- Critical care management
- Intracranial pressure management
- Secondary injury
- Systemic injuries
- Full spectrum of cranial and spinal pediatric neurosurgery
The candidate may choose a second general session of five cases.
Applicant Cases Session
The third session will consist of five cases using case material submitted by the candidate.
- From the 125 cases submitted as part of the credentials review
- 10 cases chosen for use at oral exam; five will be selected by the examiners for presentation by the candidate with discussion
- Case data fields will generate a slide presentation for each case using ABNS software
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Summary of Changes Relating to Oral Exam Retakes and Deadline
Summary of Changes Relating to Oral Exam Retakes and Deadline
- Commencing in May 2017, one session of the oral examination is devoted to questioning on a candidate’s own cases.
- Cases used in the examination (typically 8-10) are selected from the 125 cases that the candidate has submitted as part of the application and credentialing process.
- Candidates who fail the oral examination (regardless of which session(s) the candidate failed), and who seek to retake the examination have an option with respect to the session of the oral exam retake devoted to questioning on the candidate’s own cases. (A.) they may elect to be questioned on cases from their initially submitted case data (some limitations may apply); or (b.) they can elect to submit 75 new consecutive cases, from which the ABNS will select the 8-10 cases that will be used in the retake of the oral examination.
- If the candidate elects to be questioned on their initially submitted case data, the cases selected for the retake will be different from the cases selected in the initial examination.
- If the candidate elects to submit new cases, the cases must be submitted in the same manner as the original data and they must be consecutive cases. The date of the first case can be any time the candidate chooses, if it is not more than 12 months prior to the date the candidate last failed the oral examination. (For example, if the candidate failed the oral examination in November 2018, the date of the first case of the new data submission cannot be earlier than November 2017). The submission is subject to audit and if the ABNS discovers that the cases were not consecutive or that the data submitted is inaccurate, then the candidate may be permanently excluded from the certification process. If the candidate selects this option, the cases will again be reviewed as in the original credentialing process and must be approved prior to scheduling the candidate for retaking the oral examination.
- If the candidate fails a second time, they will be required to submit 75 new consecutive cases, unless a new data set had already been submitted following the first failure.
- Notwithstanding these changes, the following deadlines still apply: (a) the candidate must successfully complete the entire certification process within seven years of completing residency (except if for example that residency is completed on June 20, then the candidate has until December 31, of the 7th year to compete the process); (b) applications for retaking the oral examination must be submitted within 18 months of the date the candidate took the examination that they failed; (c) candidates must be scheduled to retake the oral examination no later than two years from the date of the examination that they failed. After three oral examination failures a candidate is no longer in the certification process and must restart the entire process over if they wish to become certified.
- As a result of the above deadlines, it may not be possible for a candidate to submit new case data for both a second and third examination within the required time frames unless the candidate is aggressive about submitting the oral examination applications and beginning the case collection process as soon as possible.
- As a result of this process and the above deadlines and to give candidates the greatest opportunity to take the oral examination with new cases three times (as applicable) within the mandated timeframes, the ABNS is changing the deadline for submission of the initial application for oral examination. For all candidates who complete residency on or after June 30, 2017, the deadline of submission is now December 31st of the calendar year that is three years following the completion of their residency training (e.g., a candidate who completed their residency training on June 30, 2017 would be required to submit a completed application no later than December 31, 2020). This is a change from the previous deadline, which was December 31st of the calendar year that was four years following the completion of a candidate’s residency training. Candidates who completed residency prior to June 30, 2017 are still subject to the four-year deadline.
- Candidates are urged to be diligent and to submit their completed application (with all elements, including case data) as soon as possible after the completion of residency. For most candidates, it should be possible to submit completed applications within 24-30 months following residency.
- Please carefully review the “Deadlines for Submission” page which gives additional information on the submission deadlines and requests for extensions.
Please note: These rules and processes are subject to additional modification in the future. The ABNS will provide advance notice of additional changes. Candidates are advised to periodically check the ABNS website for updates and information.