Looking forward – February 2017

David B. Hoyt

David B. Hoyt, MD, FACS

In his 2012 American College of Surgeons (ACS) Presidential Address, A. Brent Eastman, MD, FACS, FRCSEd(Hon), noted that the College’s founder, Franklin H. Martin, MD, FACS, had always envisioned this organization as a world fellowship of surgeons. In his address, Dr. Eastman called upon the College to revitalize its efforts to collaborate with the international surgical community and to become more involved in efforts to relieve the global disease burden, adding, “I believe that international collaboration is essential to the future of our profession.”*

To initiate a dialogue on expanding the College’s role and presence internationally, Dr. Eastman participated in two International Surgical Leaders Forums,  one at the 2012 Clinical Congress, during which he conferred with the presidents of international surgical associations, and one in July 2013 at the ACS Washington, DC, office. Representatives from Australia, Canada, France, Hong Kong, Ireland, Japan, Latin America, Lebanon, Malaysia, Mexico, the Philippines, the U.K., and the U.S. gathered at this second meeting to discuss best practices in global surgery.

More recently, the ACS Board of Regents (B/R) formed four workgroups under the leadership of then-Chair of the B/R Valerie W. Rusch, MD, FACS, with the overall goal of developing strategic plans for expanding the College’s international activities. These panels are focused on Membership, Education, Quality Programs, and Surgical Capacity Building and are now working under the umbrella of an ad hoc Regental Committee on Global Engagement. In this column, I identify some of the activities that have already occurred within each of these domains, as well as plans for the future.

Membership

A key purpose of the International Surgical Leaders Forums that Dr. Eastman convened was to revitalize the International Relations Committee (IRC). Managed by the ACS Division of Member Services under the direction of Patricia L. Turner, MD, FACS, and chaired by George Velmahos, MD, FACS, the IRC is the gateway to international activity and outreach for the College. It is charged with developing partnerships between the ACS, international surgeons, and international surgical and other health care organizations to address issues pertaining to surgical practice, education, research, advocacy, and leadership. The aim is to achieve and safeguard standards of clinical care, access, safety, professionalism, and quality improvement for surgery worldwide. Specific responsibilities include the following:

  • Provide guidance on the College’s international engagement activities
  • Coordinate the provision of international scholarships and traveling fellowships, including the recent addition of the Dr. Pon Satitpunwaycha Fund, which will allow international chapters to create a local educational course that includes faculty from the ACS
  • Present panel sessions on topics of international interest and welcome international surgeons to Clinical Congress
  • Manage and maintain the College’s connection to international surgical societies and leaders
  • Importantly, to enable surgeons in low- and middle- income countries (LMICs) to become members of the College, the B/R in 2016 approved a recommendation from the International Fellowship Subcommittee of the IRC that the ACS accept World Bank-based tiered dues payments.

Another ACS body that promotes international activity and falls under the aegis of Member Services is the Board of Governors (B/G) Chapter Activities International Workgroup. This panel was established to increase collaboration between the ACS and international colleagues and to serve as an advocate for ACS international chapters. At present, the workgroup is organized into four international regions based on the existing Committee on Trauma (COT) Regions—Latin America, the Middle East, Europe, and Asia. Region Chiefs are responsible for facilitating interaction between Governors and ACS chapters within their territory and for assisting in the development of new chapters. Clearly, chapters in other areas of the world would benefit from this type of leadership, and expansion efforts are under consideration.

To improve communication between the international chapters and the ACS leadership, each of the four regions now participates in the online ACS Communities. Topics of discussion in these communities have run the gamut from questions about specialty surgery to notices about upcoming international regional meetings, including a recent meeting of the European chapters, which took place in Lisbon, Portugal.

Among its other achievements, the Chapter Activities International Workgroup has collaborated with the Chapter Activities Domestic Workgroup to launch the Chapter Partner Program. This program allows surgeons around the world to meet, collaborate, and strengthen their relationships under the ACS banner.

Education

With leadership from Ajit K. Sachdeva, MD, FACS, Director, the ACS Division of Education encourages International Fellows to participate in the Clinical Congress, and, as noted earlier, the IRC offers a number of scholarships to this end. For those international surgeons who can devote neither the time nor money to the annual journey, we offer a variety of webcast packages.

In addition, International Fellows are eligible for discounted subscriptions to Selected Readings in General Surgery (SRGS®). Published eight times a year, SRGS comprises summaries of articles published in the world’s most prominent medical journals and pertaining to the most relevant topics in general surgery, including breast, colorectal, and biliary tract diseases. SRGS can be accessed on any mobile device.

Likewise, surgeons everywhere can use their digital devices to access the Surgical Education and Self-Assessment Program (SESAP®). Now in its 16th edition, SESAP uses a robust process of self-evaluation in a supportive environment to help surgeons evaluate and maintain their clinical competence and expand their knowledge.

I recently had the privilege of participating in another educational program that has taken on an international presence: the ACS Surgery Review Course in Thessaloniki, Greece, which the Greek Chapter of the ACS presented with leadership from Dimitrios Linos, MD, PhD, FACS, ACS Governor. The Lebanon Chapter also has presented the course with leadership from ACS Governor Jamal J. Hoballah, MD, MBA, FACS, and it was offered at a joint meeting of the Australasian chapters.

Quality Programs

Quality improvement is of utmost concern to health care professionals in every nation. The ACS leadership has been spreading the word about how ACS Quality Programs, led by Clifford Y. Ko, MD, MS, MSHS, FACS, have been successfully implemented in the U.S. to reduce complications and health care spending through its Inspiring Quality initiative. This message has been warmly received outside of the U.S. as well, with many international surgeons expressing interest in participating in the ACS National Surgical Quality Improvement Program (ACS NSQIP®). The College is working to adapt the programs to their needs.

International ACS NSQIP participants have access to the ACS NSQIP Surgical Risk Calculator to assist in medical decision making and to track their cases and outcomes using the ACS Surgeon Specific Registry. They also may access practice guideline recommendations at the point-of-care using Evidence-Based Decisions in Surgery modules.

International Fellows also may enroll in one of the College’s highly regarded Trauma Programs, including the Advanced Trauma Life Support® (ATLS®) program, which has been taught in more than 60 countries worldwide. In fact, more than half of all ATLS activity is conducted outside of the U.S. Other Trauma Programs that are available to international surgeons and allied health care professionals include the Trauma Quality Improvement Program and the Advanced Trauma Operative Management® program, which the Japan Board of Surgery now recognizes as part of its credentialing process.

Furthermore, institutions have sought verification from our Cancer Programs, including the Commission on Cancer and the National Accreditation Program for Breast Centers.

Surgical capacity building

With the establishment of the Operation Giving Back (OGB) program in 2004, the ACS recommitted to global surgical outreach. Today, under the leadership of Medical Director Girma Tefera, MD, FACS, OGB is a comprehensive resource center where Fellows can investigate and participate in domestic and international surgical volunteer opportunities through a network of high-impact partner organizations. Surgeons who have devoted much of their careers to outreach are acknowledged annually at the Clinical Congress with the presentation of the B/G Humanitarian and Volunteerism Awards.

OGB is committed to helping LMICs to develop a sustainable infrastructure for the delivery of surgical care. For example, we are working with organizations in sub-Saharan and West Africa to determine how to consistently deliver accessible, quality care to underserved populations in these regions.

The Young Fellows Association (YFA) of the ACS also is an important advocate for global surgery, and members of the YFA offer suggestions on how to get involved in related programs in the article on page 33 of this issue. In addition, the YFA Member Services Committee is working to establish a program to maintain contact with international Fellows ages 45 and younger who express interest in participating in the activities of the ACS.

Furthermore, a Fellow of the ACS, John G. Meara, MD, DMD, FACS, chairs The Lancet Commission on Global Surgery. This group, which comprises several other prominent Fellows, serves to spotlight the essential role of surgery in improving global health care, to define the current state of surgical care delivery around the world, and to develop recommendations to improve the status of global surgical care.

Next steps

At the October 2016 B/R meeting, the workgroups of the ad hoc Regental Committee on Global Engagement shared summaries of their strategic plans for both the next five years and the next 10 years. In addition, plans to add workgroups on advocacy and communications were discussed.

Clearly, the ACS is committed to fulfilling Dr. Martin’s and Dr. Eastman’s vision of being an international organization—one that meets the needs of surgeons and surgical patients in all four corners of the world. As the world becomes a little smaller and more interdependent, this goal is increasingly relevant.


*Presidential Address: The next hundred years. Bull Am Coll Surg. 2012;
97(12):8-10. Available at: bulletin.facs.org/2012/12/presidential-address/. Accessed January 23, 2017.

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