- Understanding CHS Certification and Who It's For
- Core Eligibility Requirements
- Training Pathway for Fellows Starting in 2023 or Later
- Registration, Fees, and Testing Mechanics
- The 11 Content Domains You Must Master
- Exam Format and Question Style
- 2026-2027 Exam Timeline
- Continuing Certification After You Pass
- Aligning Preparation With the Eligibility Timeline
- Frequently Asked Questions
- CHS requires current primary ABTS certification plus verified congenital operative experience before you can register.
- Fellows starting July 1, 2023 or later need two consecutive years in one ACGME-accredited program and 150 major congenital cases, with 50 in year one.
- Initial fees total $4,900: $650 application, $1,750 written, $2,500 oral, excluding travel.
- The 2026 written exam runs December 7-11, 2026; the oral exam follows June 4-5, 2027 in Dallas.
Understanding CHS Certification and Who It's For
Certification in Congenital Cardiac Surgery, administered by the American Board of Thoracic Surgery (ABTS), verifies that a surgeon has the training, operative volume, and cognitive command needed to independently manage the full spectrum of congenital heart disease. Unlike a general licensing exam, CHS sits on top of an already-completed primary thoracic surgery certification - it is a subspecialty credential, not an entry point into cardiothoracic surgery. If you are still trying to pin down exactly what CHS is or how the acronym is used across the ABTS ecosystem, it helps to start there before diving into eligibility mechanics.
This guide focuses on what actually determines whether you can sit for the exam in the first place: training pathway, operative case logs, licensure, and program endorsement. For a broader look at how the credential fits into a congenital surgery career, see our overview of CHS Certification.
Core Eligibility Requirements
Before you can register for Part I, ABTS requires candidates to satisfy several parallel conditions. None of these are optional or waivable on a case-by-case basis without documented equivalence, so it pays to map your own file against each one early.
- Current primary ABTS certification. You must already hold general thoracic surgery certification in good standing; CHS is layered on top of it, not a substitute for it.
- Unrestricted medical licensure. Any active restriction, probation, or pending board action anywhere you hold a license can delay or block eligibility.
- Qualifying thoracic and congenital cardiac surgery training. Your fellowship must meet ABTS's accreditation and duration standards, which have tightened for newer trainees (see below).
- Verified operative experience. Case logs must be independently verified and meet minimum congenital case thresholds tied to your training start date.
- Program endorsement. Your program director must formally attest to your competence and readiness - this is not a formality and can be the longest step in the process.
Training Pathway for Fellows Starting in 2023 or Later
ABTS revised the training requirement for fellows entering congenital cardiac surgery programs on or after July 1, 2023. If this applies to you, the pathway is more specific than the general "qualifying training" language suggests:
Post-July 2023 Training Standard
Fellows must complete two consecutive years in a single ACGME-accredited congenital cardiac surgery program - program-hopping across two different accredited programs does not satisfy this requirement.
- At least 150 major congenital cases logged across the full training period
- At least 50 of those cases completed within the first year alone
- Cases must be verified through the standard ABTS documentation process, not self-reported totals
The first-year minimum is worth flagging specifically: it front-loads operative exposure so that trainees build a substantial case base early rather than compressing volume into the final months of fellowship. If you're mapping out your own fellowship timeline, our CHS Training overview walks through how programs typically structure rotations to hit these thresholds without shortchanging any single anomaly category.
Key Takeaway
If your fellowship started before July 1, 2023, confirm with your program director which training standard actually applies to you - grandfathered pathways and the newer two-year/150-case rule are not interchangeable, and misreading which one governs your file can delay registration.
Registration, Fees, and Testing Mechanics
Initial CHS certification carries a total cost of $4,900, broken into three distinct payments tied to different stages of the process:
| Fee Component | Amount | When It's Paid |
|---|---|---|
| Application | $650 | At initial eligibility submission |
| Written Examination (Part I) | $1,750 | Before the December testing window |
| Oral Examination (Part II) | $2,500 | Only after passing the written exam |
These figures exclude travel, lodging, and any preparation resources you invest in along the way. Because the oral fee is only owed after a written pass, candidates effectively pay in stages rather than committing the full $4,900 upfront. For a complete breakdown of how these costs compare against other paths in congenital surgery credentialing, see CHS Certification Cost 2026.
Part I is administered at Pearson Professional Testing Centers, which means you schedule your seat through Pearson's standard testing-center network rather than at a single ABTS-run site. Part II, the oral examination, is held in person and requires travel regardless of where you live or trained.
The 11 Content Domains You Must Master
ABTS organizes Part I content into eleven categories spanning the full landscape of congenital heart disease. These are unweighted - ABTS does not publish a percentage breakdown telling you that one domain counts more than another - but that doesn't mean every domain deserves equal study time relative to your own clinical exposure gaps.
Domain 1: Septal Defects
Foundational lesions that recur throughout more complex anatomy questions later in the exam.
Domain 2: Anomalies of Venous Connection
Systemic and pulmonary venous return anomalies, often paired conceptually with situs and connection questions.
Domain 3: Anomalies of the Aorta, Aortic Arch, and Coronary Arteries
Arch reconstruction principles and coronary anomaly recognition frequently intersect with outflow tract questions.
Domain 4: Anomalies of the Tricuspid and Mitral Valves
Atrioventricular valve pathology considered independently of full AV canal defects.
Domain 5: Anomalies of the Aortic Valve and Left Ventricular Outflow Tract
Left-sided obstructive lesions and their surgical staging considerations.
Domain 6: Anomalies of the Pulmonary Valve and Right Ventricular Outflow Tract
Right-sided outflow pathology, frequently linked conceptually to conotruncal anomalies.
Domain 7: Conotruncal Anomalies
Complex lesions spanning both ventricular outflow tracts, a historically dense tested area.
Domain 8: Anomalies of Atrioventricular Connection, Univentricular Heart, and Atrial/Visceral Situs
Single-ventricle physiology and situs abnormalities requiring integrated anatomic reasoning.
Domain 9: Diseases of the Myocardium
Cardiomyopathy and myocardial disease processes as they intersect with surgical decision-making.
Domain 10: Pre-, Intra-, and Post-Operative Evaluation and Management of Congenital Cardiac Disease
Perioperative judgment questions that test management reasoning rather than pure anatomy.
Domain 11: Acquired Cardiovascular Diseases in Infants and Children
Non-congenital cardiac disease in pediatric patients, a category candidates sometimes underprepare for.
For a deeper walkthrough of how these categories interconnect and where candidates commonly lose points, our CHS Exam Domains Guide breaks each one down further.
Exam Format and Question Style
Part I is a written, multiple-choice examination. Beginning in 2025, questions use three answer options instead of the traditional four - a format shift that changes guessing math slightly and rewards precise elimination over broad pattern-matching. You must pass the written exam before you are permitted to sit for the in-person Part II oral examination; there is no path to skip or defer this sequencing.
The oral examination that follows is case-based and conducted face-to-face, testing real-time surgical reasoning rather than recall. Because ABTS reported small cohorts in 2025 - 7 passes among 8 written examinees and 4 passes among 4 oral examinees - it's worth treating any single-year statistic with caution rather than as a stable trend. Our CHS Pass Rate analysis puts these numbers in context, and How Hard Is the CHS Exam? covers what the format and small sample size actually mean for your preparation. If you want a precise sense of what a passing effort looks like, CHS Passing Score 2026 addresses that question directly.
2026-2027 Exam Timeline
The written examination window for the 2026 cycle is December 7-11, 2026. Candidates who pass move on to the oral examination, scheduled for June 4-5, 2027, in Dallas. This roughly six-month gap between written pass and oral testing gives successful candidates time to prepare specifically for case-based oral reasoning rather than cramming both formats simultaneously.
Key Takeaway
Because eligibility documentation (endorsement, case verification, licensure checks) can take months to finalize, candidates targeting the December 2026 window should have their application materials substantially complete well before autumn 2026.
For the full registration calendar, deadline structure, and how these dates interact with application submission, see CHS Exam Dates 2026.
Continuing Certification After You Pass
Passing Part I and Part II does not close the file permanently. Since January 2024, ABTS issues non-time-limited certificates that remain valid conditional on meeting recurring five-year milestones. Certificate holders on the older time-limited system transition to this model as their existing certificates expire.
The five-year continuing requirements include:
- Unrestricted licensure maintained throughout the period
- Active hospital privileges
- Professional references attesting to ongoing practice
- 150 Category 1 CME credits per five-year period, with at least 75 specifically related to thoracic surgery
- Qualifying congenital case activity demonstrating continued clinical engagement
- An online continuing-certification assessment
- Patient-safety and quality-improvement participation
This structure means the exam itself is only the first milestone in a career-long compliance cycle, not a one-time credentialing event.
Aligning Preparation With the Eligibility Timeline
Because eligibility, registration, and study preparation all run on overlapping clocks, it's worth sequencing your study plan against the dates that actually govern your candidacy rather than a generic exam-prep calendar. Once your program endorsement and case logs are confirmed, shift fully into content review, working domain by domain rather than trying to review everything simultaneously.
Documentation and Domains 1-4
- Finalize case log verification and program endorsement paperwork
- Begin structured review of septal defects, venous connection, arch/coronary anomalies, and AV valve pathology
Domains 5-8
- Work through outflow tract anomalies and conotruncal lesions together, since they overlap conceptually
- Dedicate focused time to single-ventricle physiology and situs anomalies, a historically dense area
Domains 9-11 and Integration
- Cover myocardial disease and acquired pediatric cardiovascular conditions, often underweighted in self-study
- Integrate perioperative management reasoning across all anatomic categories
For a full structured plan built around this sequencing, our CHS Study Guide 2026 lays out a complete week-by-week approach, and practicing under realistic three-option question conditions on our practice test platform can help you calibrate before test day rather than encountering the format for the first time at Pearson.
It's also worth thinking beyond the exam itself. Understanding whether CHS certification is worth it for your specific career stage, and what CHS jobs and earnings patterns look like for certified surgeons, can help you decide how aggressively to pursue the December 2026 window versus a later cycle.
Frequently Asked Questions
Yes. CHS is a subspecialty certification layered on top of current primary ABTS thoracic surgery certification, not a standalone entry credential.
At least 150 major congenital cases across two consecutive years in one ACGME-accredited program, with a minimum of 50 cases completed in the first year.
No. Written success on Part I is required before you are permitted to sit for the in-person Part II oral examination.
Initial fees total $4,900, broken into a $650 application fee, $1,750 written examination fee, and $2,500 oral examination fee, not including travel or preparation costs.
Since January 2024, certificates are non-time-limited but conditional on meeting five-year milestones covering licensure, CME, case activity, an online assessment, and patient-safety requirements.