- What This Credential Actually Is
- The Two Layers: Exam Eligibility vs. Award Requirements
- The Fellowship Gate: One Year, ACGME, Verified
- Primary Certification and Licensure Prerequisites
- Practice Time, Privileges, and the 125-Case Rule
- Fees, Registration, and Remote Proctoring
- What You Qualify to Sit For: Format and Blueprint
- Sequencing Your Qualification Path
- After You Qualify: Ten-Year Certification and OCC
- Frequently Asked Questions
- Exam eligibility needs a one-year ACGME hand fellowship plus verification, licensure and ethics requirements; the award adds further practice criteria.
- The award requires 125 major hand cases within a consecutive 12-month period inside three years, with at least 50% hand operative caseload.
- Two years of active practice, privileges and qualifying AOBOS/AOBS primary certification must be in place before certification is awarded.
- The initial fee is $3,000; the exam is 100 Type A questions in two hours, passing at 500 on a 200-800 scale.
What This Credential Actually Is
Before you plan a path, get the name straight. The credential covered here is the Subspecialty Certification in Hand Surgery, offered by the American Osteopathic Board of Orthopedic Surgery (AOBOS) under the American Osteopathic Association (AOA). "Hand Surgery CAQ" is the label many surgeons still use for it, and it is the label this site retains, but the current official name is the subspecialty certification title. If you are new to the terminology, our explainers on what Hand Surgery CAQ is and what Hand Surgery CAQ stands for cover the naming history in more detail.
Why does this matter for requirements? Because the criteria you must satisfy are the AOBOS criteria for this specific subspecialty credential. Eligibility rules, case-volume thresholds and exam logistics described for other "CAQ" programs in other specialties do not transfer. Everything below applies to the AOBOS hand surgery pathway only.
The Two Layers: Exam Eligibility vs. Award Requirements
The single most useful way to understand the requirements is to separate two distinct gates:
- Eligibility to sit for the examination is tied to your training: a one-year ACGME hand fellowship, with verification, plus licensure and ethics requirements.
- Eligibility to be awarded certification is broader: it layers practice-based criteria on top of a passing exam result.
This split catches candidates off guard. A surgeon fresh out of fellowship can be positioned to sit for the exam, yet will not hold the certification until the practice, privileging and case-volume conditions are also documented. Plan for both from the beginning rather than discovering the second layer after you pass.
| Requirement | Needed to sit for the exam? | Needed for the award? |
|---|---|---|
| One-year ACGME hand fellowship (verified) | Yes | Yes |
| Licensure and ethics requirements | Yes | Yes |
| Qualifying AOBOS/AOBS primary certification | Not a sitting requirement | Yes |
| Two years of active practice | Not a sitting requirement | Yes |
| Hospital/surgical privileges | Not a sitting requirement | Yes |
| 125 major hand cases in a consecutive 12-month period within three years | Not a sitting requirement | Yes |
| At least 50% hand operative caseload | Not a sitting requirement | Yes |
| Passing score of 500 (200-800 scale) | Result of sitting | Yes |
The Fellowship Gate: One Year, ACGME, Verified
The training prerequisite is a one-year ACGME-accredited hand fellowship, completed and verified. Three practical points follow from that phrasing:
- Accreditation matters. The fellowship must be an ACGME program. Informal or non-accredited hand training does not satisfy this requirement, regardless of its clinical quality.
- Verification is a process, not a formality. Your program director's attestation and your training records need to reach the board in the form it requires. Start confirming with your fellowship office well before you intend to apply.
- Completion is the trigger. Because the exam path opens after the fellowship, fellows often begin the application and documentation work during the final months of training so nothing stalls the process.
If you are still choosing a fellowship, treat accreditation status as a non-negotiable screening criterion. Our overview of hand surgery CAQ training discusses what the fellowship year typically covers and how it maps to exam content.
Primary Certification and Licensure Prerequisites
Two credentials sit underneath the subspecialty certification: your license and your primary board certification.
Licensure and ethics
Licensure and ethics requirements apply to exam eligibility. In practice this means holding a license in good standing and being able to demonstrate that your professional record meets the board's ethical standards. Any licensure action, disciplinary matter or lapse deserves early attention, because resolving documentation questions late can delay your sitting.
Qualifying AOBOS/AOBS primary certification
For the award itself, you need a qualifying AOBOS or AOBS primary certification. This is the osteopathic orthopedic surgery or osteopathic surgery foundation on which the hand subspecialty credential rests. Notice the timing logic: the primary certification requirement is part of the award conditions rather than the exam-sitting conditions, so a surgeon whose primary certification is still in progress should map out exactly when that credential will be in hand relative to the subspecialty timeline. If you are weighing how the credentials fit together, see our broader piece on Hand Surgery CAQ certification.
Practice Time, Privileges, and the 125-Case Rule
This is the part of the requirements that is genuinely specific to hand surgery and the part most often underestimated. The award requires all of the following:
- Two years of active practice.
- Privileges to perform the relevant procedures.
- 125 major hand cases performed within a consecutive 12-month period, falling within three years.
- At least 50% hand operative caseload.
Decoding the case-volume language
Each phrase in the case requirement does real work, so read it carefully:
- "Major" hand cases: the count is of major procedures, not every minor hand-related encounter. Keep your logs organized so each case can be classified.
- "Consecutive 12-month period": the 125 cases must fall inside one unbroken year, not be assembled from scattered months.
- "Within three years": that qualifying 12-month window must sit inside a three-year span, which creates a clock you should track from the start of practice.
- "At least 50% hand operative caseload": beyond raw volume, hand surgery must make up at least half of your operative practice. A general orthopedic practice with occasional hand cases may struggle with this proportion.
The caseload proportion is a practice-design question, not just a documentation one. Surgeons choosing a first job should ask directly whether the role will deliver sufficient hand volume and a mix weighted toward hand work. Our overview of hand surgery CAQ jobs looks at the settings where this credential is relevant, including academic, hospital-employed and hand-focused group practices, and why practice mix matters when you are building toward the case threshold.
Fees, Registration, and Remote Proctoring
The initial fee is $3,000. That figure covers the initial certification process as set out by the board; confirm what is and is not included, and whether any additional charges apply, against the current official fee schedule. For a fuller discussion of budgeting, see our Hand Surgery CAQ certification cost breakdown.
Exam delivery is remote, using MonitorEDU proctoring. AOA guidance references the PARADIGM practice interface, which is worth exploring so the testing environment is familiar before exam day. Candidates should expect:
- A private remote setting that meets the proctoring rules.
- Equipment checks before you begin, so test your computer, camera, microphone and connection in advance.
- Authorized whiteboard or tools only; what is permitted is defined by the board, so confirm the current list rather than assuming.
No open-book or adaptive format has been verified, so prepare as though you will be working closed-book from memory and clinical reasoning.
The September 25, 2026 sitting has already passed. For how testing windows and deadlines are structured, and where to look for the next opportunity, see our guide to Hand Surgery CAQ exam dates.
What You Qualify to Sit For: Format and Blueprint
Meeting the requirements puts you in front of a compact exam: 100 Type A single-best-answer multiple-choice questions in two hours, delivered as one block without a scheduled break. The passing score is 500 on a 200-800 scale. Our passing score guide explains how to interpret a scaled threshold.
The official blueprint is undated and organizes content into 12 categories expressed as ranges rather than fixed counts. Because the blueprint is range-based, you should treat the percentages as approximate emphasis rather than exact question numbers:
| Domain | Blueprint Range |
|---|---|
| Arthritis | 13-15% |
| Nerve | 12-14% |
| Infection | 11-13% |
| Joint | 10-12% |
| Osseous | 9-11% |
| Tendon | 8-10% |
| Tumor | 7-9% |
| Microsurgery | 6-8% |
| Vascular | 5-7% |
| Amputation | 3-5% |
| Pediatrics | 3-5% |
| Soft Tissue | 1-3% |
Arthritis is the largest single category, followed by Nerve and Infection. Together those three make up a substantial share of the exam, so they deserve outsized preparation time. For a content-level walkthrough of each category, read our complete guide to all 12 exam domains.
Why the requirements and the blueprint interact
Your practice mix shapes your gaps. A surgeon whose caseload leans toward trauma and fractures will feel comfortable in Osseous and Joint but may be rusty on Arthritis, Infection or Tumor, which appear less often in daily operative work yet carry real weight on the exam.
- Audit your last 12 months of cases against the 12 categories.
- Identify categories where you operate rarely but the blueprint weights heavily.
- Prioritize those for structured review.
Sequencing Your Qualification Path
The requirements unfold over several years, so sequencing is the real planning task. One reasonable way to organize the path, for a surgeon moving from fellowship into practice:
Documentation Foundation
- Confirm the ACGME program status and the verification process
- Resolve any licensure or ethics documentation questions early
- Begin building a case log habit with procedure-level tagging
Accrue Practice Credit
- Secure privileges and confirm they cover the relevant procedures
- Track hand caseload as a share of total operative work
- Confirm primary AOBOS/AOBS certification status
Land the Case Window
- Identify the consecutive 12-month period holding 125 major hand cases
- Verify that hand surgery represents at least 50% of operative caseload
- Assemble records for submission
Exam preparation can run in parallel with this accrual. Because the blueprint weights Arthritis, Nerve and Infection most heavily, schedule those early in your review and revisit lower-weighted areas like Soft Tissue, Pediatrics and Amputation later. Our Hand Surgery CAQ study guide builds this out in detail, and the one-page cheat sheet is useful for last-stage review. To test yourself against the format, try the Hand Surgery CAQ practice tests.
After You Qualify: Ten-Year Certification and OCC
Qualifying is not the end of the requirements story. The certification is a ten-year credential maintained through OCC (Osteopathic Continuous Certification). For the 2025-2027 cycle, the published expectations include:
- 60 CME hours, of which 15 must be Category 1-A.
- A quality-improvement attestation.
- Maintenance of professional standing.
Hand surgery retains the long-form ten-year OCC exam, so the subject mastery you build for the initial exam has lasting value. Think of your first round of preparation as an investment you will partially draw on again a decade later. If you are evaluating whether that ongoing commitment is worthwhile, see our analysis of whether the certification is worth it, along with the salary guide for how the credential relates to earnings discussions.
Key Takeaway
Treat the requirements as a documentation project that starts in fellowship and runs through your first years of practice. The exam is only one gate; the award hinges on privileges, practice time, the 125-case window and a hand-focused caseload.
Frequently Asked Questions
Not necessarily. Exam eligibility is tied to the one-year ACGME hand fellowship with verification, licensure and ethics requirements. The two years of active practice, privileges, primary certification and case-volume criteria apply to the award of certification. Confirm the current sequencing with the board.
The requirement is 125 major hand cases within a consecutive 12-month period that falls inside a three-year span. Because "major" is a defined classification, check the board's current guidance on which procedures qualify and keep a detailed, procedure-level log so your window can be documented.
It can be difficult. The award requires at least 50% hand operative caseload, meaning hand surgery must account for at least half of your operative work. Surgeons in mixed practices should assess their case mix early and discuss practice design with their group.
The initial fee is $3,000. The exam is delivered remotely with MonitorEDU proctoring, requires a private setting and equipment checks, and permits only authorized whiteboard or tools. See our cost breakdown for budgeting detail.
It is a ten-year certification maintained through OCC. The 2025-2027 cycle requires 60 CME hours including 15 Category 1-A, a quality-improvement attestation and professional standing, and hand surgery retains the long-form ten-year OCC exam.