- Part I has 250 questions split into two 2 hour 45 minute sections, totaling 5 hours 30 minutes.
- General Thoracic and Cardiac each make up roughly half the exam - study time should match that split.
- Total cost through Part I is $2,400 ($650 application + $1,750 written); the oral exam adds $2,500 more.
- The 2026 window runs December 7-11, delivered at Pearson Professional Testing Centers.
Quick Facts at a Glance
This cheat sheet condenses everything a candidate preparing for Certification in Thoracic Surgery needs to remember about the American Board of Thoracic Surgery (ABTS) Part I Written/Qualifying Examination. Keep this page open while you build your study plan, and use it as a final review the week before test day. For a deeper walkthrough of preparation strategy, see the full Thoracic Surgery Study Guide 2026: How to Pass on Your First Attempt.
| Item | Detail |
|---|---|
| Certifying body | American Board of Thoracic Surgery (ABTS) |
| Exam delivery | Computer-based, Pearson Professional Testing Centers |
| 2026 testing window | December 7-11 |
| Total questions | 250 multiple-choice, including clinical vignettes and possible images |
| Time allotted | Two sections of 2 hours 45 minutes each (5 hours 30 minutes total) |
| Application fee | $650 |
| Written exam fee | $1,750 |
| Total through Part I | $2,400 |
| Combined with oral exam | $4,900 |
| 2025 pass rate | 79.1% (136 of 172 candidates) |
Part I Exam Format
The Part I Written/Qualifying Examination is a computer-based test administered at Pearson Professional Testing Centers in the United States. It is built from 250 multiple-choice questions, many presented as clinical vignettes and some accompanied by images - chest imaging, echocardiograms, or intraoperative photos are the kind of visual stimuli you should expect to interpret quickly under time pressure.
The test is split into two equal sections, each running 2 hours 45 minutes, for a total seat time of 5 hours 30 minutes. That structure matters for pacing: with 125 questions per block, you have a little over a minute per question on average, but vignette-style items with images will eat more time than straightforward recall questions. Budget accordingly rather than pacing every question identically.
Domain Breakdown
Unlike exams with many small content areas, this certification is built around two large domains that together make up the entire test. Understanding how they're weighted - and how they overlap - is the single most important strategic insight for your prep. For a complete walkthrough of both areas, read the Thoracic Surgery Exam Domains 2026: Complete Guide to All 2 Content Areas.
Domain 1: General Thoracic (~50%)
Covers the non-cardiac chest: lung, esophagus, mediastinum, chest wall, pleura, and airway. Within this domain, Lung topics alone represent 20-30% of the overall examination - a substantial single-organ concentration worth dedicated review blocks.
- Lung cancer staging, resection technique, and perioperative management
- Esophageal disease, including benign and malignant pathology
- Mediastinal masses and airway reconstruction
- Chest wall and pleural disorders
Domain 2: Cardiac (~50%)
Covers the surgical management of heart disease. Acquired Heart Disease specifically accounts for 25-35% of the overall examination, making it the single largest identifiable sub-topic on the entire test.
- Coronary artery disease and revascularization strategy
- Valvular disease diagnosis and surgical decision-making
- Aortic pathology and perioperative cardiac physiology
- Postoperative cardiac complications and management
Key Takeaway
Because General Thoracic and Cardiac are each roughly half the exam, allocate study time close to a 50/50 split - but within Cardiac, give Acquired Heart Disease extra weight since it alone is 25-35% of the whole test, and within General Thoracic, prioritize Lung at 20-30%.
Fees, Dates & Registration
Budgeting for this certification means accounting for two separate exams. The application fee is $650, and the written exam fee is $1,750, bringing the total through Part I to $2,400. Candidates who continue on to the oral examination pay an additional $2,500, for a combined application-and-examination total of $4,900. For a line-by-line breakdown of what each fee covers and when it's due, see the Thoracic Surgery Certification Cost 2026: Complete Pricing Breakdown.
The 2026 written examination window is scheduled for December 7-11, delivered through Pearson Professional Testing Centers. Registration deadlines and scheduling logistics are covered in detail in the Thoracic Surgery Exam Dates 2026: Testing Windows, Deadlines & Scheduling article - mark your calendar early, since testing center seats can fill during a narrow window.
| Fee Component | Amount |
|---|---|
| Application fee | $650 |
| Part I written exam fee | $1,750 |
| Subtotal through Part I | $2,400 |
| Oral examination fee | $2,500 |
| Combined total (both exams) | $4,900 |
Eligibility Snapshot
Eligibility for Part I requires completion of an approved thoracic surgery training pathway - traditional, integrated six-year, or an approved joint pathway - along with the required operative case experience and an unrestricted U.S. medical license. Operative requirements average around 125 major cases per year, though exact totals and distributions vary by pathway.
If you're still mapping your training route toward eligibility, the Thoracic Surgery Requirements 2026: Eligibility, Prerequisites & How to Qualify guide walks through each pathway option in detail, and the Thoracic Surgery Training resource covers how training structures feed into board eligibility.
Pass Rate Data
Official 2025 written results show 136 passes among 172 candidates, which calculates to 79.1% based on the board's own reported counts. This figure is not identified as a first-attempt-only cohort, so treat it as a general benchmark of written-exam performance rather than a precise predictor of your individual odds. For more context on how this compares across years and what it implies about exam difficulty, see the Thoracic Surgery Pass Rate 2026: What the Data Shows and How Hard Is the Thoracic Surgery Exam? Complete Difficulty Guide 2026 articles.
If you want to know exactly what score threshold you're aiming for, the Thoracic Surgery Passing Score 2026: Exactly What You Need to Pass page explains how scoring works on this exam.
Content Checklist by Domain
Use this checklist as a rapid self-assessment. If you can confidently explain each bullet out loud without notes, that topic is likely exam-ready.
General Thoracic Checklist
- Can you stage a lung cancer case using TNM staging ninth edition and explain how stage affects surgical candidacy?
- Do you know the workup and operative approach for esophageal cancer versus benign esophageal disease?
- Can you differentiate management of anterior, middle, and posterior mediastinal masses?
- Do you understand indications for chest wall resection and reconstruction?
Cardiac Checklist
- Can you walk through indications for CABG versus percutaneous intervention in coronary disease?
- Do you know surgical decision points for aortic and mitral valve repair versus replacement?
- Can you describe management of thoracic aortic aneurysm and dissection?
- Do you understand common postoperative cardiac complications and their surgical management?
Final-Week Review Plan
In the final stretch before your test date, resist adding new material. Instead, cycle through weak spots identified from practice questions, with review time allocated to match domain weight.
Cardiac Review
- Re-drill Acquired Heart Disease topics, since this sub-area alone is 25-35% of the full exam
- Review valve and coronary decision trees
General Thoracic Review
- Focus heavily on Lung topics (20-30% of the exam)
- Review esophageal and mediastinal cases
Timed Practice Blocks
- Simulate the two 2 hour 45 minute sections back-to-back
- Practice image-based vignette questions specifically
Light Review Only
- Skim high-yield notes for both domains
- Confirm Pearson testing center logistics and required ID
A full run-through of a practice exam under realistic timing conditions on our practice test platform is one of the most effective ways to confirm your pacing across both 2 hour 45 minute blocks before the real thing.
After Part I: The Oral Exam
Passing Part I is a milestone, not the finish line. Certification in Thoracic Surgery requires both the written and oral examinations. The oral exam carries its own separate $2,500 fee, which is why the combined application-and-examination total reaches $4,900 for candidates completing both steps. Start thinking about oral exam preparation - case presentation, verbal decision-making under scrutiny - well before your written results arrive.
To understand whether the full investment of time and money into this credential pays off across a career, review the Is the Thoracic Surgery Certification Worth It? Complete ROI Analysis 2026 analysis, and browse the kinds of roles this credential supports in the Thoracic Surgery Jobs overview. For a broader sense of career earning potential, see the Thoracic Surgery Salary Guide 2026: Complete Earnings Analysis.
Certification Maintenance
New certificates issued under this program are non-time-limited, but they remain subject to continuing certification requirements, with milestones assessed every five years. Each five-year cycle requires 150 AMA Category 1 CME credits, of which 75 must be specifically in cardiothoracic surgery, along with ongoing licensure, professional standing, and assessment requirements.
Key Takeaway
Plan your continuing education early in each five-year cycle rather than scrambling at the end - 75 of your 150 required CME credits must be cardiothoracic-specific, so choose conferences and courses accordingly.
If you're still early in your journey and want foundational context on the specialty and credential itself, these resources are useful starting points: What Is Thoracic Surgery Certification?, What Is Thoracic Surgery?, and Thoracic Surgery Certification. For quick definitional clarity, see Thoracic Surgery Meaning, What Does Thoracic Surgery Mean?, What Does Thoracic Surgery Stand For?, and What Is A Thoracic Surgery?.
Before you close this tab, bookmark this cheat sheet and pair it with timed practice on our practice test site - reviewing facts is useful, but applying them under the real two-section, 5 hour 30 minute format is what actually builds exam-day readiness.
Frequently Asked Questions
There are 250 multiple-choice questions, including clinical vignettes and possible images, split into two equal sections of 2 hours 45 minutes each.
The application fee is $650 and the written exam fee is $1,750, totaling $2,400 through Part I. Adding the $2,500 oral examination brings the combined total to $4,900.
General Thoracic and Cardiac each comprise approximately half of the exam. Within those, Acquired Heart Disease is 25-35% and Lung is 20-30% of the overall examination.
Official 2025 results show 136 passes among 172 candidates, a 79.1% rate calculated from the board's counts. This is not reported as a first-attempt-only figure.
New certificates are non-time-limited, but they are subject to continuing certification with milestones every five years, including 150 AMA Category 1 CME credits per cycle, 75 of which must be in cardiothoracic surgery.