- What Hand Surgery CAQ Certification Actually Is
- Who Certifies It and How the Exam Is Delivered
- Eligibility Versus Award Requirements
- Exam Format at a Glance
- The 12-Category Blueprint
- Where the Points Are: Arthritis, Nerve and Infection
- Fees, Timing and Registration Mechanics
- Staying Certified: Ten-Year OCC
- Who Values the Credential
- Sequencing Your Preparation by Domain
- Frequently Asked Questions
- Hand Surgery CAQ here means Subspecialty Certification in Hand Surgery, issued through the American Osteopathic Board of Orthopedic Surgery (AOBOS).
- The exam is 100 Type A single-best-answer questions in two hours, with no scheduled break.
- A score of 500 on a 200-800 scale is passing; the initial fee is $3,000.
- Arthritis (13-15%), Nerve (12-14%) and Infection (11-13%) carry the heaviest blueprint ranges.
What Hand Surgery CAQ Certification Actually Is
The official name of this credential is Subspecialty Certification in Hand Surgery. "Hand Surgery CAQ" is the shorthand many surgeons, recruiters and job postings still use, and it is the label this site retains. It marks a board-recognized level of subspecialty competence in the surgical care of the hand and upper extremity, built on top of a candidate's primary orthopedic or surgical board certification.
It helps to be precise about what the credential is not. It is not a residency credential and not a fellowship completion certificate. It is a separate, examination-based certification awarded after training, a period of independent practice and a documented case volume. If you are searching for plain definitions of the term itself, our companion pages What Is Hand Surgery CAQ? and What Does Hand Surgery CAQ Stand For? cover the vocabulary, while this article focuses on how the certification works in practice.
Who Certifies It and How the Exam Is Delivered
The certifying body is the American Osteopathic Board of Orthopedic Surgery (AOBOS), operating under the American Osteopathic Association (AOA). That detail matters because several unrelated credentials in medicine share the same acronym; only the AOBOS pathway applies to this article and to the preparation material on this site.
The exam is delivered with MonitorEDU remote proctoring, and AOA guidance references the PARADIGM practice interface, which candidates can use to become familiar with the testing environment before the real sitting. Expect a private remote setting, equipment checks before you begin, and authorized whiteboard or tools only. There is no verified claim that the exam is open-book or adaptive, so plan for a standard, closed, fixed-length experience.
Eligibility Versus Award Requirements
One of the most commonly misunderstood features of this certification is that being allowed to sit for the exam and being awarded the certificate are two different thresholds. Passing the test alone does not complete the process.
| Stage | What Is Required |
|---|---|
| Eligibility to sit | One year of ACGME hand fellowship with verification, plus licensure and ethics requirements |
| Award of certification | Qualifying AOBOS/AOBS primary certification |
| Award of certification | Two years of active practice with privileges |
| Award of certification | 125 major hand cases within a consecutive 12-month period, completed within three years |
| Award of certification | At least 50% hand operative caseload |
In practical terms, a surgeon can finish a hand fellowship, become eligible and take the exam, yet still not hold the certification until the practice-based requirements are documented. That sequence is why early-career hand surgeons should begin tracking cases from their first independent year. For a full walk-through of documentation and prerequisites, see Hand Surgery CAQ Requirements: Eligibility, Prerequisites & How to Qualify.
Why the Case Rules Deserve Early Attention
The 125 major hand cases must fall within a consecutive 12-month period, and that period must sit inside a three-year window. The 50% hand operative caseload expectation means a mixed general orthopedic practice with only occasional hand work may struggle to qualify. Surgeons planning their first-job negotiations should consider whether the position will actually deliver enough hand volume.
Exam Format at a Glance
| Feature | Detail |
|---|---|
| Question count | 100 |
| Question type | Type A single-best-answer multiple choice |
| Time allowed | Two hours, one block |
| Scheduled break | None |
| Passing score | 500 on a 200-800 scale |
| Proctoring | MonitorEDU, remote, private setting |
Two hours for 100 questions leaves roughly 72 seconds per item on average, and with no scheduled break you must manage stamina and pacing yourself. Type A questions present a clinical stem, often a patient scenario, imaging description or operative decision point, and ask for the single best answer among plausible options. That rewards candidates who can rank management options rather than simply recall isolated facts.
The scaled score means a 500 is not simply "50 correct." Details on how the scale works are covered in Hand Surgery CAQ Passing Score: Exactly What You Need to Pass, and a candid look at difficulty appears in How Hard Is the Hand Surgery CAQ Exam?
The 12-Category Blueprint
The official content outline is divided into 12 categories and expressed as ranges rather than fixed percentages. The version published is undated, so treat the ranges as a reliable guide to relative emphasis rather than a guarantee of exact item counts on any given form.
| Domain | Weight 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% |
A full breakdown of every category, with the clinical topics each tends to cover, lives in Hand Surgery CAQ Exam Domains: Complete Guide to All 12 Content Areas.
Where the Points Are: Arthritis, Nerve and Infection
Together, the three largest domains account for a substantial share of the exam. Because the ranges for each sit between roughly 11% and 15%, a strong command of these areas buffers weaker performance elsewhere.
Arthritis (13-15%)
The single largest category. Expect decision-making around degenerative, inflammatory and post-traumatic disease of the hand and wrist.
- Thumb carpometacarpal and basal joint disease and the range of operative options
- Rheumatoid hand and wrist: deformity patterns, tendon involvement and surgical timing
- Interphalangeal and metacarpophalangeal arthritis: arthrodesis versus arthroplasty reasoning
- Wrist arthritis patterns and salvage procedures
Nerve (12-14%)
Compression, injury and reconstruction questions reward both anatomical precision and strategy.
- Carpal tunnel, cubital tunnel and other compression syndromes: diagnosis and release approaches
- Peripheral nerve injury classification, repair timing and grafting versus transfer decisions
- Brachial plexus and tendon transfer principles for restoring function
- Electrodiagnostic interpretation in clinical stems
Infection (11-13%)
Hand infections are urgent presentations, and the exam tests recognition and first-line management.
- Flexor tenosynovitis, felon, paronychia and deep space infections
- Septic arthritis and osteomyelitis of the hand
- Bite wounds and organisms associated with particular exposures
- Necrotizing infections and when to escalate to urgent operative debridement
Fees, Timing and Registration Mechanics
The initial fee is $3,000. Budgeting for that figure early helps, especially when it overlaps with other early-career licensing and credentialing costs. A fuller accounting, including how to think about the total outlay, is in Hand Surgery CAQ Certification Cost: Complete Pricing Breakdown.
On timing, the September 25, 2026 sitting has already passed, so candidates reading this should confirm the next available window directly with AOBOS and the AOA before planning around any date. Our page on Hand Surgery CAQ Exam Dates: Testing Windows, Deadlines & Scheduling explains how to track scheduling announcements.
Staying Certified: Ten-Year OCC
Certification runs for ten years and is maintained through Osteopathic Continuous Certification (OCC). For the 2025-2027 cycle, the requirements include:
- 60 CME credits, of which 15 must be Category 1-A
- A quality-improvement attestation
- Documentation of professional standing
In addition, hand surgery retains the long-form ten-year OCC exam. In other words, the cognitive assessment does not disappear after initial certification; it returns as part of the ten-year cycle. Surgeons who treat the initial exam as a one-time hurdle sometimes underestimate this, so keeping reference notes and study habits organized is worth the effort. Weighing that long-term commitment against the career benefits is the subject of Is the Hand Surgery CAQ Certification Worth It? Complete ROI Analysis.
Who Values the Credential
Subspecialty certification in hand surgery tends to matter most in settings where hand and upper-extremity work is a core service line rather than an occasional referral:
- Hospital systems and academic centers that credential surgeons for hand call coverage and elective hand surgery
- Orthopedic groups with dedicated hand divisions, where partners are expected to hold subspecialty-level recognition
- Trauma and replantation programs that rely on surgeons comfortable with microsurgery, vascular repair and amputation care
- Multispecialty and orthopedic-focused ambulatory practices with high-volume elective hand procedures such as releases, joint reconstruction and tendon work
Credentialing committees and recruiters often treat the certification as a signal of verified training and sustained hand-focused practice, which is consistent with the 50% hand operative caseload requirement behind it. For a closer look at the employment landscape and compensation considerations, see Hand Surgery CAQ Jobs and Hand Surgery CAQ Salary Guide: Complete Earnings Analysis. We do not quote specific earnings here, because compensation varies widely by region, employer model and case mix.
Sequencing Your Preparation by Domain
Because the blueprint is uneven, preparation should be too. A sensible approach is to build outward from the heaviest categories, then interleave the smaller ones so they stay fresh. Here is an illustrative structure tied directly to the 12 domains:
Arthritis and Joint
- Cover the largest category first, then the closely related Joint domain (10-12%) while the surgical logic is fresh
- Practice ranking operative options rather than memorizing lists
Nerve and Infection
- Nerve (12-14%): compression, injury classification, transfers
- Infection (11-13%): recognition, organisms, escalation triggers
Osseous, Tendon and Tumor
- Fracture and nonunion management, flexor and extensor tendon repair and rehabilitation concepts, and tumor recognition and workup
Microsurgery, Vascular, Amputation, Pediatrics and Soft Tissue
- Consolidate the smaller categories, then finish with timed 100-question blocks to rehearse two-hour pacing with no break
The two-hour, no-break format is the reason the final stage should be full-length timed practice. For deeper planning, our Hand Surgery CAQ Study Guide: How to Pass on Your First Attempt expands this framework, and the Hand Surgery CAQ Cheat Sheet: One-Page Review of Must-Know Facts is useful for last-week review. You can also build exam-style stamina with the timed question sets on the main practice test site.
Key Takeaway
Do not wait until you have passed to start documenting cases. The 125 major hand cases within a consecutive 12-month period and the 50% hand caseload requirement determine when you are actually awarded certification, regardless of when you take the exam.
Frequently Asked Questions
Here it refers to Subspecialty Certification in Hand Surgery, awarded through the American Osteopathic Board of Orthopedic Surgery (AOBOS) under the AOA. "CAQ" is the label retained for the credential, though the current official name is Subspecialty Certification in Hand Surgery. More on the terminology is on our Hand Surgery CAQ Meaning page.
The exam has 100 Type A single-best-answer multiple-choice questions, delivered in a single two-hour block with no scheduled break. A scaled score of 500 on a 200-800 scale is passing.
You may sit after completing a one-year ACGME hand fellowship, provided verification, licensure and ethics requirements are met. However, being awarded the certification additionally requires qualifying primary certification, two years of active practice with privileges, 125 major hand cases in a consecutive 12-month period within three years, and at least 50% hand operative caseload.
Arthritis (13-15%), Nerve (12-14%) and Infection (11-13%) have the largest blueprint ranges, followed by Joint (10-12%) and Osseous (9-11%). Smaller categories such as Soft Tissue (1-3%) still deserve review, since the blueprint ranges are guidance on emphasis, not a reason to skip topics.
It lasts ten years and is maintained through OCC. The 2025-2027 cycle requires 60 CME credits including 15 Category 1-A, a quality-improvement attestation and professional standing, and hand surgery retains the long-form ten-year OCC exam. For a broader overview, see Hand Surgery CAQ Certification and Hand Surgery CAQ Pass Rate: What the Data Shows.