What Is the ATLS Retake Policy? (2026 Guide)

The short answer on ATLS retakes

There isn't a published national retake rule. The American College of Surgeons does not publish a public numeric retake or attempt limit for the ATLS post-test; candidates who don't meet a course requirement are directed to their local course coordinator or course director and to the ATLS policy manual for remediation and retesting. That surprises people who come from a board-exam background, where the attempt count and the waiting period are printed in a candidate handbook.

ATLS isn't structured that way. It's a course, not a standardized licensing exam, and the people who decide what happens after a miss are the faculty standing in the room with you. That's a feature, not a loophole — most shortfalls get addressed the same day, with a instructor watching you run the sequence again.

You can fall short in two different places

Course completion has two components, and both are pass/fail:

• The written multiple-choice post-test. ACS states on its official course pages that "CME will only be granted upon successful completion of the course with a minimum post-test score of 75%." That 75% is the only written threshold ACS publishes. If you've seen 80% quoted on a third-party site or a departmental email, note that no ACS source states it — don't plan around it.
• The practical assessment. Satisfactory performance at the skills stations and on the initial-assessment scenario simulation, judged against fixed course criteria — skills, knowledge, and attitudes. Not curved, not scaled.

You also have to attend the entire in-person portion per the course center's schedule and complete the required online pre-course modules and pretest. Missing a half day of the practical work is, functionally, its own kind of failure, and it's the one that's hardest to remediate on the spot.

Because there are two gates, "I failed ATLS" is ambiguous until you know which one. The path forward differs. Our breakdown of what the passing score for the ATLS exam actually means goes deeper on how the two components combine.

What happens after each type of shortfall

Component	Standard ACS publishes	Typical route forward
Online pre-course modules and pretest	Required before the in-person portion	Complete before the course start; the host site controls access
Written post-test	Minimum score of 75% (stated as the CME requirement)	Handled by the course director under the ATLS policy manual; no public attempt limit
Skills stations	Satisfactory demonstration of skills, knowledge, attitudes (pass/fail)	Coaching and re-demonstration at faculty discretion, usually during the course
Initial-assessment scenario	Pass/fail against fixed course criteria	Repeat scenario with faculty observation, per the policy manual
Attendance	Full in-person portion required	Site-specific; often means re-registering for a later course

Nothing in that middle column is negotiable. The right-hand column is where local judgment lives, and it's why two hospitals can handle the same situation somewhat differently.

Why ACS leaves remediation to the course site

ATLS is delivered by facilities formally approved as course sites by their State or Provincial Committee on Trauma chair and/or the ACS. Scheduling runs through the local site or learning.facs.org rather than a centralized testing vendor with a fixed national date calendar. ACS reports the program reaches more than 50,000 learners a year across over 80 countries. A single rigid retake rule written for that spread would be either meaningless or unenforceable.

Instead the standard is uniform — same manual, same algorithm, same criteria — while the remedy is local. In practice that means your course director can watch you botch a needle decompression, walk you through it, and re-test you before lunch. A national exam board can't do that.

There's also no national ATLS pass rate to benchmark yourself against. ACS doesn't publish one, because ATLS is a competency-based course with on-site remediation, not a standardized exam that reports a pass-rate statistic. If someone quotes you a figure, ask where it came from.

Practical steps if you miss the mark

1. Ask which criterion you missed, in writing if you can

"You didn't pass" is not actionable. "You missed the 75% minimum on the post-test" and "you didn't secure the cervical spine before moving to breathing in the scenario" are. The faculty know exactly which criteria were flagged.

2. Talk to the course coordinator before you leave the building

They own the schedule, the room, and the faculty availability. Remediation opportunities shrink the moment everyone drives home. If a repeat scenario is possible, it's usually possible that day or the next morning.

3. Ask specifically about the ATLS policy manual

That's the document the director works from. You don't need to read it cover to cover, but naming it signals you want the formal pathway rather than an informal brush-off, and it keeps the conversation anchored to program policy.

4. Fix the actual gap, not your nerves

Most written shortfalls trace to the same handful of areas: shock classification and hemorrhage control, airway decisions with cervical spine protection, thoracic trauma, and head injury management. Most scenario shortfalls trace to sequence — treating a finding before finishing the step you're on, or skipping the reassessment. Our guide on how to pass the ATLS exam maps the sequence habits that faculty grade hardest.

The number of questions won't tell you your margin

People about to retake want to know how many items they can afford to miss. You can't compute that reliably: ACS does not publish the number of items on the ATLS written post-test. Third-party sites commonly cite around forty multiple-choice questions, but that isn't an ACS figure, and ACS doesn't disclose a scored-item count either. There's also no unscored or pilot item pool published — the post-test is a course quiz, not a standardized board exam with field-tested questions.

ACS likewise doesn't publish a fixed clock time for the written post-test, so treat any specific minutes figure you find online as unverified. What ACS does publish is course length: Traditional runs 2 days, Hybrid roughly 1.5 days or 1 day, and Refresher 1 day or 0.5 days, each preceded by required online work. More on that in how many questions are on the ATLS exam.

Retaking versus renewing — two different problems

Don't confuse a failed component with an expired card. ATLS verification status is current for four years from the date you complete a Traditional, Hybrid, or Refresher course. After that, a Refresher course renews your status, and ACS allows a 6-month grace period after expiration. Miss that window and you're generally looking at a full course again rather than the shortened Refresher.

So the calendar question and the competency question have separate answers. One is scheduling; the other is remediation.

Site, country, and instructor-track variations

Course sites set their own registration terms, and fees vary — ACS doesn't publish a single national price for ATLS, so cost depends on the verified course site or host institution. Confirm with the specific center before assuming a retake carries no additional charge.

Eligibility can also vary slightly. ACS describes the audience as health care clinicians involved in the evaluation and treatment of the injured patient, giving physicians and advanced practice providers the opportunity to obtain or maintain current status; some sites enroll other qualified providers, and details differ by country.

Instructor-track requirements are separate again. ATLS Educators must teach at least four ATLS Instructor courses within a four-year period to stay verified as instructors — a maintenance requirement, not a retake rule.

How to make the second attempt the last one

Two things separate people who pass on the repeat from people who struggle twice. First, they stop studying the manual linearly and start rehearsing the ABCDE sequence out loud until it's automatic under interruption. Second, they answer written questions under time pressure rather than re-reading chapters, because recognition of a page is not the same as recall in a room.

If the practical side was the problem, find a colleague who's ATLS-verified and run the initial assessment on a chair for ten minutes at a time. Say every step. The faculty are grading whether the sequence is reflexive, not whether you know it exists. And if you're weighing whether the difficulty is really about knowledge or about pace, how hard the ATLS exam is is worth a read before you re-register.