The Ideal Candidate

Statement by the Association of Pediatric Surgery Training Program Directors
on Flexibility in General Surgery Residency Specialty – Specific Guidelines

Background:  In 2011 the American Board of Surgery approved a new policy to permit greater flexibility in the structure of general surgery residency training. The policy allows up to 12 months of flexible rotations so program directors may tailor training to a resident’s future career interest. The board offered the following guidelines for such rotations in Pediatric Surgery.

A senior rotation in Pediatric Surgery is recommended for residents to gain exposure to advanced pediatric surgery and to demonstrate capabilities critical for selection to pediatric surgery programs. 

The following surgical rotations are also felt to be of benefit:

  • Thoracic/esophageal
  • Surgical oncology
  • Head and neck/endocrine surgery
  • Hepatobiliary
  • Advanced minimally invasive surgery
  • Colorectal surgery
  • Surgical critical care


The purpose of this document is to provide general surgery residents interested in pediatric surgery and their program directors a consensus of the Association of Pediatric Surgery Training Program Directors as to the characteristics of an ideal candidate for pediatric surgery training.  These recommendations may help inform the decisions made by these potential applicants as to the use, if any, of the flexibility allowed by the ABS in General Surgery training.

Characteristics of the ideal applicant include the following:

  • Expected completion of an ACGME approved General Surgery Residency. Most successful candidates for Pediatric Surgery obtain their General Surgery education in university-based General Surgery Programs. 
  • Readiness of the applicant to enter into independent practice of general surgery at the time he/she begins training in Pediatric Surgery to include:
    • Eligibility for certification by the American Board of Surgery
    • Demonstration of a broad fund of medical knowledge as documented by objective measures to include assessment by the applicants program director, performance on the ABSITE, USMLE examinations and satisfactory completion of SCORE, FLS, PALS and ATLS.
    • Documented mastery of preoperative and postoperative patient care for general surgery patients undergoing a broad range of surgical procedures. This documentation should include a statement from the program director that the candidate has had semiautonomous responsibility for patient care and a composite of the resident’s evaluations focused on this domain of patient care.
    • Competence in performing a broad range of basic and intermediate general surgical procedures including advanced laparoscopic and open surgical procedures. The scope of experience should include thoracic/esophageal, head and neck, endocrine, liver and pancreas resection, biliary reconstructive surgery, colorectal surgery including the surgical management of inflammatory bowel disease and the surgical management  of benign and malignant tumors of the abdomen and chest  A statement by the program director giving specific data on typical senior-level experiences at their institution which could reasonably be expected for the applicant at the time of completion of his/her residency is desirable.
    • Mastery of professionalism, system based care, etc., as documented by a composite of evaluations provided by the program director.
    • Active involvement in the addition of new knowledge or advanced pediatric surgical care (example ECMO or MIS  fellowships). This may be documented through participation in basic or clinical research, involvement in surgical quality/safety programs such as the National Surgical Quality Improvement Project, demonstrated interest in education through participation in institutional GME organizations or organizations such as the Association of Program Directors in Surgery, or Society of Surgical Education.  Objective evidence of success through publication of peer reviewed work in any of these areas is desired.  This domain may be satisfied with or without doing additional nonclinical time during the five-year General Surgery Residency.
  • Interest in the care of infants and children as demonstrated by a personal statement, letters of recommendations and elective clinical or research experiences. Objective demonstration of commitment to and passion for the care of children is advantageous.
  • Objective demonstration of excellence through institutional, regional (i.e. local chapters of the ACS) or national awards/recognitions.
  • Competence in administrative duties including the leading of a surgical team, maintenance of schedules, successful compliance with institutional rules including the 80-hour work week, timely documentation of medical records, etc. This should be documented by a specific evaluation by the Program Director.


The APSTPD recognizes that both candidates and program directors in general surgery face considerable challenges in providing these outcomes. We do not feel that proscriptive requirements for specific rotations are necessary or desirable given the variety of training programs in the United States. Our desire is to provide access to Pediatric Surgery training for the men and women from all types of general surgery training programs who are best suited for advanced training in pediatric surgery by dint of their personal accomplishments and demonstrated ability.