Resigned to History? Declining ABS Core Procedures and Implications for General Surgery Training
by Joshua Kravitz, M.S.; Sarah C Gaston, D.O.; Peter Muscarella II, M.D. | April 10, 2026
Article Citation: Stewart BP, Shlafstein MD, Cunningham AS, McLoughlin RJ. Resigned to history? Exploring the decline of American Board of Surgery core procedures. Surgery. 2025 Sep;185:109553. doi: 10.1016/j.surg.2025.109553.
What is this article about?
American Board of Surgery has established roughly 150 surgeries as core operations that are essential components of a general surgeon’s scope of practice. These core procedures include cystotomy, vagotomy, open common bile duct exploration, and laparoscopic common bile duct exploration. This article explores the frequency and classification of these procedures from the National Surgical Quality Improvement Program (NSQIP) from 2012 to 2023. During this time period there was a significant decline in the overall number of procedures performed. With regard to number of specific procedures, cystostomy, vagotomy, and open CBD exploration decreased, while laparoscopic common bile duct exploration increased. The data indicates that cystostomy, vagotomy, and open common bile duct exploration have become uncommon for general surgery residents to encounter in modern practice. The authors suggest a re-evaluation of core procedures through a contemporary lens to remove rarely utilized procedures from the core list and to elevate the previously deemed core procedures to the advanced/fellowship training level.
Why should you read the article?
General surgery residents are expected to graduate with competence in the American Board of Surgery’s defined “core” operations, but that expectation assumes adequate case exposure. This article quantifies how infrequent several ABS-designated core procedures have become and shifts the discussion from anecdotal to measurable data in national trends. For residents, program directors, and curriculum leaders, the data highlights where competency cannot reasonably be inferred from case counts alone and where assessment strategies may need to evolve. The article urges the reader to define “core” by contemporary practice and not historical lists.
How can you use this article?
Medical students, surgical educators, and curriculum leaders can use this article to better understand how general surgery training is evolving in modern operative practice. For students interested in surgery, it offers a helpful perspective on which procedures remain central to contemporary training, and which have become rare enough that exposure may be limited. The article reinforces an important educational principle: surgical competence is built not only through case volume, but through development of sound clinical judgment, operative decision-making, and adaptability in the operating room. More broadly, the article encourages learners to think critically about how competence is developed and assessed in modern surgical education, including the growing role of simulation, structured teaching, and targeted operative experiences.
Review Authors: Joshua Kravitz, M.S.; Year 3 Medical Student (Co-authored with Sarah C. Gaston, D.O. and Peter Muscarella II, M.D.), Ohio University Heritage College of Osteopathic Medicine, Portsmouth, OH. Organization: Association for Surgical Education