This month’s column highlights two educational resources unique to the American College of Surgeons (ACS). Selected Readings in General Surgery (SRGS®), a critical resource for all practicing general surgeons, offers the latest information and research to help provide state-of-the-art care while earning continuing medical education (CME) credit. In addition to SRGS, the ACS Committee on Trauma (COT) provides a variety of courses to support today’s trauma surgeon and all the members of the trauma care team.
SRGS: All you need to know
For more than 40 years, SRGS has been the premier literature review for general surgeons who want up-to-date information on evidence-based medicine and to remain on the cutting edge of practice.
SRGS was founded in 1974 by Robert N. McClelland, MD, FACS, professor of surgery, University of Texas Southwestern Medical Center, Dallas. The ACS took ownership of SRGS in 2007 when Dr. McClelland retired. “Selected Readings has taken its place as a vital component of the offerings of the American College of Surgeons and contributes to the value of these offerings in several areas, including the program for Maintenance of Certification in surgery,” Dr. McClelland said.* Today, Lewis M. Flint, MD, FACS, co-author of this article, is Editor-in-Chief of SRGS, and the publication remains dedicated to the same core values that are at the heart of the ACS mission: to improve the care of the surgical patient and to safeguard standards of care in an optimal and ethical practice environment.
The science behind SRGS
In 2014, approximately 14,000 peer-reviewed journal articles were published on topics related to general surgery, and, according to a recent American Board of Surgery report, surgeons perform, on average, nearly 400 operations a year.† Thus, it would be inordinately difficult for practicing surgeons to review every article that would be of value to them and their patients, which is why the SRGS is such an essential resource.
SRGS is published eight times a year in the following months: February, March, May, July, August, September, October, and December. Each issue focuses on a specific topic and includes an overview of about 80 pages, written by Dr. Flint. These summaries provide insightful reviews of approximately 150 articles published in the world’s most prominent medical journals. Some subscription types also provide access to reprints of specific key articles cited in the overview, which Dr. Flint includes as recommended reading.
SRGS issues are published on a revolving cycle of the most relevant topics in general surgery, including liver disease, vascular surgery, general oncology, breast disease, pediatric surgery, rural surgery, and trauma. This wide range of topics ensures that readers are exposed to a breadth of learning experiences to help them provide excellent patient care, as well as maintain their general surgery knowledge base, develop comparative and critical literature reading skills, and effectively prepare for recertification exams.
Variety of formats
No two surgeons have the exact same preferences. Some general surgeons prefer to read a print journal, while others are more interested in Web-based learning; still others prefer a mixed format. SRGS offers a range of subscription types to better meet the needs of its diverse surgical readership. Some of the most popular subscriptions are as follows:
- SRGS print: Subscribers receive a hard copy of SRGS eight times per year. The print version includes both the overview and the selected article reprints. Print subscriptions are available with or without CME, and special rates are available for surgery residents.
- SRGS Premium and SRGS Practicing Surgeon: Both SRGS Premium and SRGS Practicing Surgeon are online versions of the publication. The Premium version is identical to the print version, which means it includes the overview and the selected article reprints. The Practicing Surgeon version does not include the reprints.
- SRGS Connect Plus Print: Surgeons who don’t want to choose between the print and online versions of SRGS can take advantage of this subscription format, which is available with or without online access to article reprints. Subscribers also receive a hard copy of each issue and have access to the materials online.
All online versions of SRGS provide access to additional materials, including “What You Should Know,” a compilation of 10 monthly review articles written by surgeons, for surgeons; and “The Knowledgeable Surgeon,” an engaging monthly editorial review written by Bernard Jaffe, MD, FACS, former editor-in-chief of Surgical Rounds and professor of surgery at Tulane University School of Medicine, New Orleans, LA.
In addition, SRGS is launching a new feature—an audio companion to the overview, which will be available to all subscription types sometime this year.
National pulse check
Today, more than 45 million U.S. citizens are age 65 and older, accounting for 14 percent of the nation’s total population. According to a 2014 report published by the U.S. Census Bureau, the size of this demographic is projected to nearly double to 83.7 million by 2050. Additionally, for better and for worse, the entire health care policy arena is changing, with increasing demands for measurable care.‡ As an example of how attuned SRGS is to the prevailing and critical issues that surgeons face today, SRGS will launch 2016 with an issue on geriatrics and palliative care, which will highlight surgical advancement in elderly care; and an issue on ethics, patient safety, and the business of medicine, which will examine some of the ways surgeons can remain viable in the changing health care frontier.
Furthermore, in response to the continuing emphasis on lifelong learning and Maintenance of Certification, SRGS offers subscribers the opportunity to earn 80 hours of CME credit every year (10 credits per issue). Each issue of SRGS contains 20 multiple-choice pre- and posttest questions. To earn credit, subscribers complete the pretest, read the issue, and then take the posttest. Progress on the pretest and posttest can be saved and completed later. When completed, the correct answer for each question and score are provided, and CME credits are posted automatically to the ACS MyCME database, which stores all members’ CME credits in one location. Thus, subscribers may view their transcripts, print their certificates, and keep track of the documentation needed for credentialing, renewing state licenses, and recertifying with medical boards in a centralized location.
COT education and training: Meeting the needs of today’s trauma team
The ACS COT develops and implements meaningful programs for trauma care in local, regional, national, and international arenas. The trauma education curriculum comprises six standalone courses: Advanced Trauma Life Support® (ATLS®); Trauma Evaluation and Management® (TEAM®); The Rural Trauma Team Development Course (RTTDC); Disaster Management and Emergency Preparedness (DMEP); Advanced Trauma Operative Management (ATOM®); and Advanced Surgical Skills for Exposure in Trauma (ASSET). Each course may be taken independently, but they each build upon the framework of ATLS, the largest and earliest course.
The ATLS program provides a systematic, concise approach to the care of a trauma patient. The ACS COT developed ATLS and introduced the program in 1980. Since then, ATLS has been offered internationally, training more than 1 million providers in more than 70 countries. In the Provider Course, students learn how to treat the greatest threat to life first by using a systematic ABCDE (airway, breathing, circulation, disability, exposure) approach, which is both universal and easy to remember. ATLS participants learn safe and reliable methods for treating patients during the so-called “golden hour”—the first hour following a traumatic injury, during which there is the highest likelihood that medical treatment will prevent death.
Specific elements of the ATLS program are as follows:
- Intended audience: Physicians, physician extenders, dentists, nonphysicians (nurses, physician assistants, paramedics, ambulance personnel)
- Topics/objectives addressed:
- How to assess a patient’s condition rapidly and systematically
- Primary survey, ABCDE
- Resuscitation and stabilization of patients according to priority
- Course lengths:
- Student Course: Two days and 2.5 days
- Instructor Course: One day, 1.5 days, and two days
- Student Refresher Course: Half day and one day
TEAM introduces the concepts of trauma assessment and management to medical students in their clinical years. The core content is adapted from the ATLS course and is an expanded version of the ATLS Initial Assessment and Management lecture. The TEAM format is flexible, with a 90-minute slide presentation and optional components. The program includes a three-segment initial assessment video demonstration, a series of clinical trauma case scenarios for small-group discussion, and skills sessions. The slide/lecture presentation, included in the faculty DVD, can be easily adapted into a medical school’s curriculum. The TEAM program provides a standardized introductory course in the evaluation and management of trauma for medical students and multidisciplinary team members. The ATLS Committee strongly encourages the participation of ATLS instructors, as they are familiar with the philosophy, purpose, and content of the program.
Because TEAM is an abbreviated version of the ATLS course, it is not a replacement for ATLS participation. Medical students are encouraged to take the ATLS course in their final year of medical school or after graduation.
The RTTDC emphasizes a team approach to the initial evaluation and resuscitation of the trauma patient at a rural health care facility. More than 60 percent of U.S. trauma deaths occur in rural areas, and this course assists health care professionals in determining whether there is a need to transfer the patient to a higher level of care. The one-day course includes interactive lectures on medical procedures, communication strategies, and three team-performance scenarios.
Developed by the COT’s Rural Trauma Committee, RTTDC is based on the concept that in most situations, rural facilities can form a trauma team of at least three core members.
Specific elements of the RTTDC are as follows:
- Intended audience: Any health care professional who is part of the trauma care team
- Topics/objectives addressed:
- Identify local resources and limitations
- Initiate transfer process early
- Establish a performance improvement process
- Define a relationship between the rural trauma facility and the regional trauma system and ensure that communication is strong
- Course length: The course is offered in a single-day or modular format, which allows hospitals and trauma centers to tailor the course to their needs.
The DMEP course teaches planning methods, preparedness, and medical management of trauma patients in mass casualty disaster situations. Through lecture and interactive scenarios, health care providers learn incident command terminology, principles of disaster triage, injury patterns, and availability of assets for support.
The COT recognizes that a mass casualty event is not just another busy night in an urban trauma center. Most physicians have little or no background or experience in such circumstances. The DMEP course teaches skills that apply to any kind of mass casualty event and helps institutions be better prepared to address the needs of patients who experience this type of trauma. The course is open to anyone who may be a first receiver of casualties following a disaster. DMEP participants learn both the skills and practical ways of thinking that lead to better performance in a range of disaster situations.
Specific elements of DMEP are as follows:
- Intended audience: Acute care providers (surgeons; anesthesiologists; emergency medicine physicians; emergency department, operating room, intensive care unit, and trauma nurses; and pre-hospital professionals), hospital administrators, public health personnel, and emergency managers
- Topics/objectives addressed:
- Emphasizes an all-hazards approach
- Planning, triage, incident command, injury patterns and pathophysiology, and consideration for special populations
- Pitfalls and barriers in disaster planning
- Epidemiology and history of disasters
- Course length:
- One-day didactic and interactive provider course
- e-DMEP: The first trauma education e-course developed and is available on the ACS E-Store.
The ATOM course is an effective method of increasing surgical competence and confidence in the operative management of penetrating injuries to the chest and abdomen. This course uses a hands-on approach to teaching the surgical skills needed to manage atypical and complex cases as well as the confidence that surgeons need to be able to treat these injuries. The student-to-instructor ratio for this course is one-on-one or two-on-one.
Specific elements of the ATOM course are as follows:
- Intended audience: Senior surgical residents, trauma fellows, military surgeons, and fully trained general surgeons who are not frequently called on to treat penetrating injuries
- Topics/objectives addressed:
- The lecture portion teaches the management of penetrating injuries, including trauma laparotomy and spleen and diaphragm, liver, pancreas and duodenum, genitourinary, cardiac, and vascular injuries
- The lab session presents students with scenarios in which they must identify and repair simulated injuries to the chest and abdomen
- Course length: One-day provider course (six 30-minute lectures followed by a three-hour lab session)
The ASSET course uses human cadavers to expose students to the anatomic structures that, when injured, may pose a threat to life or limb. Students use a course manual that provides an overview of surgical exposures in the following key areas: neck, chest, abdomen and pelvis, and upper and lower extremities. The one-day course covers each section, beginning with a case-based overview followed by a hands-on training. Students assess their ability to perform each procedure independently and are evaluated on knowledge and technical skills.
Specific elements of the ASSET course are as follows:
- Intended audience: Mid-level and senior surgical residents, trauma and acute care surgical fellows, and any surgeon who wants to review this anatomy
- Topics/objectives addressed:
- Allows practice on techniques that are used rarely but are good to know in critical moments
- 50 procedures, including fasciotomies, venous and arterial exposure, exposure and repair of organ tissue, as well as proper use of surgical instruments
- Course length: One day
Find more information about the COT trauma education programs described here online.
*McClelland RN. SRGS. 2007;34(7):4.
†Ritchie WP, Rhodes RS, Biester TW. Work loads and practice patterns of general surgeons in the United States, 1995–1997. Ann Surg. 1999;230(4):533.
‡Ortman JM, Velkoff VA, Hogan H. An aging nation: The older population in the United States. Population estimates and projections. Current Population Reports. May 2014. Available at: www.census.gov/prod/2014pubs/p25-1140.pdf. Accessed January 6, 2016.