- What "CHS Training" Actually Covers
- The Surgical Training Pathway: ACGME Fellowship Requirements
- Eligibility Checklist Before You Register
- Training Across the 11 Content Categories
- Training for the Exam Format Itself
- Registration Fees and Dates Your Training Plan Must Respect
- A Domain-by-Domain Training Timeline
- Oral Case Training After Part I
- Continuing Certification Training Requirements
- Frequently Asked Questions
- CHS training spans two phases: the ACGME fellowship pathway and Part I/Part II exam preparation.
- Fellows starting July 1, 2023 or later need two consecutive years in one ACGME-accredited program and at least 150 major congenital cases, including 50 in year...
- Part I is written at Pearson Professional Testing Centers with three-option multiple-choice questions starting in 2025.
- Initial fees total $4,900 across application, written, and oral examination stages.
What "CHS Training" Actually Covers
When surgeons search for CHS training, they are usually asking about two distinct but connected things. The first is the formal surgical training pathway required by the American Board of Thoracic Surgery before a candidate is even eligible to sit for Certification in Congenital Cardiac Surgery, also listed on the board's own site as Congenital Heart Surgery (CHS). The second is exam preparation training - the study process needed to pass the Part I written exam and then the Part II oral case examination.
This article walks through both layers. If you already understand the eligibility rules and want a deeper breakdown of exam content itself, pair this page with the CHS Exam Domains 2026: Complete Guide to All 11 Content Areas. If you are still confirming whether you qualify to apply at all, start with CHS Requirements 2026: Eligibility, Prerequisites & How to Qualify.
The Surgical Training Pathway: ACGME Fellowship Requirements
Before exam preparation ever becomes relevant, candidates must complete qualifying thoracic and congenital cardiac surgery training. For fellows who began their programs on or after July 1, 2023, the requirement is specific: two consecutive years in a single ACGME-accredited congenital cardiac surgery program, with at least 150 major congenital cases logged across that period, including a minimum of 50 cases in the first year alone.
This structure means your operative case log functions as a training document in itself. Programs track this closely, and case distribution across the training years is scrutinized during program endorsement, which is a required piece of the initial eligibility package alongside current primary ABTS certification and unrestricted medical licensure.
Why Case Volume Matters for Exam Readiness
Operative exposure and written exam content are not separate tracks - the cases you scrub into during fellowship directly map onto the clinical reasoning tested on Part I and the case-based discussion format of Part II.
- Broad exposure across septal defects, conotruncal anomalies, and outflow tract lesions builds intuition the written exam rewards
- Under-represented case types in your training log often correspond to your weakest content categories
- Program endorsement signals to ABTS that your training breadth, not just your case count, supports readiness
Eligibility Checklist Before You Register
Before submitting an application, confirm each of the following is documented and current:
- Current primary ABTS certification in general thoracic surgery
- Unrestricted medical licensure in your practicing jurisdiction
- Completion of qualifying thoracic and congenital cardiac surgery training
- Verified operative experience meeting minimum case thresholds
- Formal program endorsement supporting your application
A full walkthrough of how these pieces fit together, including documentation nuances, is covered in CHS Requirements 2026: Eligibility, Prerequisites & How to Qualify. Once eligibility is confirmed, training shifts from clinical accumulation to structured exam review.
Training Across the 11 Content Categories
ABTS's 2025 Booklet of Information lists 11 content categories that structure Part I written preparation. These are presented as unweighted coverage areas rather than percentage-weighted domains, which means candidates should train broadly rather than concentrating effort on categories they assume carry more questions.
Domain 1: Septal Defects
Foundational lesion category covering atrial and ventricular septal pathology and surgical closure strategy.
Domain 2: Anomalies of Venous Connection
Systemic and pulmonary venous return abnormalities and their surgical correction pathways.
Domain 3: Anomalies of the Aorta, Aortic Arch, and Coronary Arteries
Arch obstruction, coronary anomalies, and related reconstructive techniques.
Domain 4: Anomalies of the Tricuspid and Mitral Valves
Atrioventricular valve pathology outside the AV canal spectrum.
Domain 5: Anomalies of the Aortic Valve and Left Ventricular Outflow Tract
Left-sided obstructive disease and valve-sparing versus replacement strategies.
Domain 6: Anomalies of the Pulmonary Valve and Right Ventricular Outflow Tract
Right-sided outflow obstruction and reconstruction options.
Domain 7: Conotruncal Anomalies
Tetralogy spectrum, transposition physiology, and truncus arteriosus management.
Domain 8: Anomalies of Atrioventricular Connection, Univentricular Heart, and Atrial/Visceral Situs
Single-ventricle pathways and situs abnormalities requiring staged palliation reasoning.
Domain 9: Diseases of the Myocardium
Cardiomyopathies and myocardial disease processes relevant to surgical decision-making.
Domain 10: Pre-, Intra-, and Post-Operative Evaluation and Management of Congenital Cardiac Disease
Perioperative judgment spanning the entire care episode, not isolated to the operating room.
Domain 11: Acquired Cardiovascular Diseases in Infants and Children
Non-congenital cardiovascular disease presenting in the pediatric population.
For a deeper category-by-category breakdown with study emphasis for each, see CHS Exam Domains 2026: Complete Guide to All 11 Content Areas. Because these categories are unweighted, a training plan that skips Domain 9 or Domain 11 to spend extra weeks on more "exciting" congenital lesions can leave real gaps.
Training for the Exam Format Itself
Content knowledge alone does not guarantee a pass - training for the exam's actual format matters. Part I is administered in person at Pearson Professional Testing Centers, and as of 2025 the multiple-choice questions present only three answer options rather than the traditional four or five. This narrower option set changes test-taking strategy: elimination-based guessing is less forgiving, and precise recall of first-line management carries more weight than recognizing plausible distractors.
Written success is a prerequisite for advancing to the in-person Part II oral examination, so training sequencing matters. Trying to rehearse oral case presentation before passing Part I is premature; resources are better spent building the written foundation first.
Key Takeaway
Practice with three-option question formats specifically - reviewing old four-option style banks without adjusting your elimination strategy can create false confidence. Run timed blocks that mirror the Pearson center environment.
To calibrate what "ready" looks like numerically, review CHS Passing Score 2026: Exactly What You Need to Pass and CHS Pass Rate 2026: What the Data Shows. ABTS reported 7 passes among 8 written examinees and 4 passes among 4 oral examinees in 2025 - small cohorts that should be read cautiously rather than treated as a statistically reliable trend.
Registration Fees and Dates Your Training Plan Must Respect
Training timelines should be built backward from published exam dates and forward from fee payment deadlines. Initial certification carries a total cost of $4,900, broken into three components:
| Fee Component | Amount |
|---|---|
| Application Fee | $650 |
| Written Examination Fee | $1,750 |
| Oral Examination Fee | $2,500 |
| Total Initial Cost | $4,900 |
These figures do not include travel or preparation materials. For a full cost breakdown, including how to budget around these stages, see CHS Certification Cost 2026: Complete Pricing Breakdown. On timing, the 2026 written window runs December 7-11, 2026, with the corresponding oral examination scheduled June 4-5, 2027 in Dallas. A complete calendar of application deadlines is maintained at CHS Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
A Domain-by-Domain Training Timeline
A structured multi-month plan helps distribute review evenly across all 11 content categories rather than letting familiar lesions crowd out weaker areas. The following is a general template; adapt week counts to your available runway before the December window.
Foundational Lesions
- Review Septal Defects and Anomalies of Venous Connection
- Build a personal case-log gap map from fellowship training
Arch and Valve Pathology
- Cover Anomalies of the Aorta, Aortic Arch, and Coronary Arteries
- Study Tricuspid/Mitral and Aortic Valve/LVOT categories together for contrast
Right-Sided and Conotruncal Complexity
- Focus on Pulmonary Valve/RVOT anomalies and Conotruncal Anomalies
- Use spaced repetition specifically on staged-repair sequencing questions
Single Ventricle and Systemic Categories
- Deep review of AV connection, univentricular heart, and situs anomalies
- Layer in Diseases of the Myocardium and Acquired Cardiovascular Diseases
Perioperative Integration and Timed Practice
- Emphasize Pre-, Intra-, and Post-Operative Evaluation and Management questions, which cut across every lesion type
- Run full timed three-option practice blocks under Pearson-like conditions
For a condensed reference during final review, keep the CHS Cheat Sheet 2026: One-Page Review of Must-Know Facts nearby, and run realistic practice sets on our practice test platform to simulate the three-option format under time pressure.
Oral Case Training After Part I
Once written success is achieved, training shifts toward the in-person Part II oral examination. Oral preparation differs fundamentally from written review: it rewards verbal case reasoning, operative decision defense, and management flow under direct questioning rather than recall of isolated facts. Candidates preparing for Dallas should rehearse structured case presentations covering the same 11 content categories, but framed as "walk me through your operative plan" rather than multiple-choice recognition.
Key Takeaway
Mock oral sessions with colleagues who have already navigated Part II are more valuable at this stage than additional written question banks - the skill being tested has shifted.
Some candidates underestimate how different this phase feels compared to written prep. For a candid look at difficulty across both exam stages, see How Hard Is the CHS Exam? Complete Difficulty Guide 2026.
Continuing Certification Training Requirements
Training obligations do not end at initial certification. Since January 2024, ABTS continuing certification uses non-time-limited certificates that remain valid conditional on meeting five-year milestones; existing time-limited certificates transition at their expiration date. Maintaining certification requires unrestricted licensure, active hospital privileges, professional references, and 150 Category 1 CME credits per five-year period, with at least 75 of those specifically related to thoracic surgery.
Beyond CME, holders must maintain qualifying congenital case activity, complete an online continuing-certification assessment, and satisfy patient-safety and improvement requirements. This means training, in the CHS context, is a career-long commitment rather than a one-time exam push - a point worth weighing when evaluating Is the CHS Certification Worth It? Complete ROI Analysis 2026 or researching CHS Jobs and typical practice settings that expect this credential.
Candidates weighing the full financial and career picture, including how certification may relate to compensation trends, often review CHS Salary Guide 2026: Complete Earnings Analysis alongside continuing certification obligations before committing to the full training pathway. General background on the credential itself, including how it is defined, is available through CHS Certification and What Is CHS Certification?.
Frequently Asked Questions
Formal exam-focused training typically begins during the later stages of fellowship, but the operative case exposure that underpins exam readiness - including meeting the 150-case minimum with 50 in the first year for fellows starting July 1, 2023 or later - begins on day one of training.
There is no official mandated duration; candidates typically build a multi-month plan working through all 11 content categories, adjusted to individual case exposure and available study time before the December testing window.
Written success is required before advancing to the in-person Part II oral examination, so oral-specific rehearsal is generally most efficient after Part I is passed.
Part I is administered in person at Pearson Professional Testing Centers, and candidates should train under similarly timed, distraction-free conditions to simulate that environment.
No. Continuing certification since January 2024 uses non-time-limited certificates tied to five-year milestones, including CME credits, case activity, an online assessment, and patient-safety requirements, making training an ongoing responsibility.
For a broader entry point into how all of these pieces connect - eligibility, the 11 content categories, fees, and dates - the CHS Study Guide 2026: How to Pass on Your First Attempt ties this training roadmap together, and continued practice on our exam prep platform can help translate this plan into measurable readiness.