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| The American Board of Neurological Surgery (ABNS) determines the certification process by which a program may be accredited to train residents in neurosurgery. To become board certified, an individual must have graduated from an accredited medical school and have completed neurosurgical residency training in a program that is accredited by the Accreditation Council for Graduate Medical Education (ACGME). There is a prescribed formula of minimal requirements for neurosurgical residency and training. Twelve months must be spent acquiring basic or fundamental skills. This period preferably is taken at the beginning of training and generally consists of a surgical internship at an ACGME-accredited program in the United States. This training must include not less than six months of surgical disciplines other than neurosurgery. The remaining six months should include other fundamental skills, but should not include more than six weeks of neurosurgery. Recently it has been suggested that up to three months may be spent in neurology. In addition to this year, training in neurosurgery must include at least 60 months in the neurological sciences. Thirty-six months must be specifically devoted to clinical neurosurgery in an ACGME-accredited neurosurgery program, of which 12 months must be as senior or chief resident. As senior or chief resident, the trainee must have major or primary responsibility for patient management as well as administrative responsibilities. This level of responsibility varies among residency programs but is a crucial element of training. It prepares the individual to assume, in a graduated fashion, responsibility for patients and their complex neurosurgical problems. In addition to neurosurgical training, at least three months must be spent in clinical neurology, again in an ACGME-accredited neurology residency program. Six months of neurology training is recommended but not required. The remaining 21–24 months of training can be divided among neuropathology, neurology, neuroradiology, additional neurosurgery, and research. These additional months give programs a character and flavor that make them unique. In some institutions, these months are largely spent in the laboratory. In others, there may be an exchange program with other institutions. It is important to assess each program and learn how it structures these months. All neurosurgery programs are under the auspices of the ACGME as as such are bound by their rules including the 80 hour work regulations. Training in neurosurgery is progressive, requiring graduated experience and increasing responsibility. The ABNS requires that at least 24 months of training in clinical neurosurgery be done at one institution. Training taken outside the parent institution will not be recognized unless approved by the trainee’s program director. The program director plays an important role in the training of a neurosurgeon through regular evaluations and determinations of rotations.
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