General Surgery In-Service Examination

The examination is a means to assist the Residency Evaluation and Standards Committee in the evaluation of AOA-approved general surgery residency programs. The purpose of the exam is:

  1. to evaluate the resident's level of knowledge relative to other residents' knowledge at the same level of training;
  2. to identify areas of deficiency in a resident's surgical education;
  3. to track a resident's progress from year to year; and
  4. to enable the program director, director of medical education, and the Residency Evaluation and Standards Committee to evaluate the strengths and deficiencies of each training program.


Examination Date

The exam is typically held on the second Saturday in January at each AOA-approved general surgery residency program site. The exam is scheduled for a later date in January if the second Saturday is during a holiday weekend.

Exam Requirement

General surgery residents are required to participate in the exam to comply with the AOA basic document "Approval of Residency Training Programs - General Surgery, Chapter 1, section III-L."

Test Specifications

The exam is a 300 type-A multiple choice item criterion referenced exam. The exam indicates the resident's knowledge of the four- year general surgery residency curriculum. Individual achievement is independent of the performance of others by using item response theory techniques. The exam is a one level exam and there is not a passing score.

The test specifications should adequately reflect the different elements of the general surgery residency curriculum. The test specifications are as follows:

Associated Specialties

Infectious Diseases
Internal Medicine
Osteopathic Manipulative Medicine (OMM)

6 items
5 items
8 items
7 items
10 items
4 items
9 items
5 items

Clinical Sciences

Blood & Blood Products
Fluid & Electrolytes
Incisions & Wound Healing
Pain Management
Surgical Infections


9 items
14 items
7 items
7 items
11 items
6 items
9 items
9 items

Principal Surgical Areas

Critical Care
Gallbladder/Biliary Tree
Head & Neck
Skin & Soft Tissue
Trauma & Emergency

16 items
6 items
11 items
12 items
14 items
21 items
6 items
10 items
10 items
9 items
11 items
6 items
7 items
10 items
14 items
11 items

 Total Items  300

Exam Registration

Exam Registration is completed online with the NBOME. Each program directors and coordinator with an AOA-approved general surgery residency program is provided with an email notification of the upcoming January exam. The following information is included in the written exam notice.

Resident Participation Report

The Resident Participation Report must be completed and signed by the director of medical education and by the program director. The program director signature indicates that the program director is aware of the exam date, time, proctor, and the residents registered for the exam. The completion of this report provides the ACOS with the following information:

  1. the names and AOA numbers for each general surgery resident in the residency program;
  2. the mailing address and telephone number for the delivery of the exam materials; and
  3. the name of the exam proctor.

Payment of the exam fee must accompany the Resident Participation Report upon receipt by the ACOS. Exams will not be distributed to a residency program without payment of the exam fee. The Resident Participation Report submission deadline is the first Monday of December. Upon receipt of this report, the ACOS will send a written confirmation to the director of medical education and a courtesy copy to the program director. The purpose of this notice is to:

  1. confirm the examinees;
  2. confirm the receipt of the payment of the exam fee for each resident in the general surgery residency program;
  3. confirm the designation of a qualified exam proctor

Exams will not be distributed to a residency program without payment of the exam fee.

Exam Proctor

The general surgery residency program director and faculty from the general surgery residency program may not serve as proctors (to avoid any question of conflict of interest). All other employees of the institution may serve as a proctor, i.e. the director of medical education or staff of the medical education department.

The exam proctor instructions are mailed with the exam materials to the test site.

Test Site

The exam is administered at the base site of each AOA-approved general surgery residency program.

Residents who are out of town undertaking an out-rotation may participate in the exam at the site of their out-rotation or with an AOA-approved general surgery residency program that is near the resident's out-rotation. The resident's program director must submit written notice to the ACOS that the resident will participate in the exam at a site other than the resident's base program. The written notice must include a courtesy copy to the proctor and/or program director of the resident's alternate test site as well as the proctor's name and phone number; the delivery address for the exam materials; and the name of the resident. The exam must be administered on the same day and at the same time as the annual exam.

Make-Up Exams

The make-up exam must be taken within one week from original exam date at the resident's base residency program. Make-up exams are only administered when a resident and the program director have documented an absence due to illness. Residents who leave an exam site early due to illness must participate in the make-up exam. For these residents, the results of the original exam will not be considered.

Receipt of Exams Materials from the Test Site

The following examination materials must be completed  and returned to the ACOS within one week of the administration of the exam:

Rules of Conduct Forms                                                                                                                                                                               
Roster of Examinees' Names
DME Administration Letter/Certificate of Compliance                                                    
Proctor Comments Forms

The certificate of compliance must also be returned with the exam materials. The certificate is an attestation by the director of medical education and the exam proctor that the exam has been administered in full compliance with the ACOS policies and procedures.

Scoring and Reporting

There is not a passing score. The exam results will not be included in the consideration for approval of individual resident training by the ACOS Residency Evaluation and Standards Committee.

The NBOME will deliver the score reports to the ACOS within 30 days receipt of the completed examination materials from the ACOS. The NBOME provides a final report as well as individual resident score reports.

The director of medical education and the program director are provided with the individual resident score reports for residents at that institution by April 30. The score report is not sent directly to the resident. By only submitting the score report to the director of medical education and the program director, the committee compels the resident and the program director to meet and review the resident's exam performance. The score will reflect a resident's standing relative to other residents who took the exam.

The individual score reports are placed in the ACOS annual resident report files for review by the ACOS Residency Evaluation and Standards ommittee. A master copy of all of the individual score reports for that year is maintained for seven years. The NBOME maintains the score results on their database. The NBOME will only release score information to the ACOS or as the ACOS authorizes in writing the specific release of information to others.

The NBOME and the committee will report trends identified with the curriculum and/or with weaknesses in individual programs to the Residency Evaluation and Standards Committee.

Reference Guide for 2019
(Microsoft Word Document)