Looking forward – February 2018

David B. Hoyt

David B. Hoyt, MD, FACS

The American College of Surgeons (ACS) online community platform, ACS Communities, recently began its fourth year. Under the leadership of Tyler G. Hughes, MD, FACS, Editor-in-Chief, the communities have become one of the most popular benefits of membership in the College, and the network continues to grow both in terms of number of communities and member engagement.

An ancient concept

The communities, in many ways, fill a basic human need to use communication to foster the survival and evolution of social groups. Communication as a means of promoting civilization dates back around 70,000 to 30,000 years ago, during what historian Yuval Noah Harari, PhD, refers to as the Cognitive Revolution. It is believed that at this time accidental genetic mutations changed the inner wiring of the brains of sapiens, enabling them to think in unprecedented ways and to share information that extended beyond offering warnings of imminent danger and pointing to the location of food, for example. Early man was now able to make logical connections, engage in social interactions, and to transmit information about more complex subjects.*

With this new ability, humans developed and shared legends, myths, and religions within their own social groups. This ability to tell stories and find meaning in them served as the basis of shared cultural mores needed to bond members of communities. The broad consequences of this evolution included the ability to plan and execute complex actions; establish larger, more cohesive social groups; and innovate by applying the group’s collective intelligence.*

A popular form of communication

For the last few years, many members of the College have found that the ACS Communities provide a valuable means of tapping into the collective intelligence of their peers to address challenges they face in treating difficult cases, learn about innovative practices, and share their common interests. The communities have become an important part of our culture.

The total number of communities as of December 1, 2017, was 115, of which 76 were open and 39 were closed. (Open communities are accessible to all members of the ACS, and closed communities exist primarily to provide online work forums for ACS governing bodies and committees.) The five most active communities were the General Surgery, Rural Surgery, Breast Surgery, Minimally Invasive Surgery, and Bariatric Surgery Communities. By far the most widely used community was the General Surgery Community, with 22,239 members, 1,468 total discussion posts, 111 new threads, 1,357 replies to discussions, and 208 replies to sender.

All of the volunteer editors have done a great job of developing their communities, and I want to thank them all for their hard work and commitment. The Breast and Colon and Rectal Communities are both active, with a lively exchange of clinical and nonclinical posts. Editors Mike Stark, MD, FACS, of the Endocrine Community and Don Nakayama, MD, FACS, of the History Community (which now has 700 members) have done a phenomenal job of growing their communities and encouraging meaningful dialogue.

The members of the Women in Surgery Community have succeeded in addressing both clinical and nonclinical matters in a professional manner. The Surgeons as Writers Community is relatively small but provides great help to surgeons who write both for professional and personal reasons.

Some frequent posters have developed an international reputation. For example, Patrick Molt, MD, FACS, a general surgeon from Fairfield, IL, and Mark Crabbe, MD, FACS, a general surgeon from Sumter, SC, are respected commenters because their remarks and advice are rooted in scientific evidence and clinical experience.

The ACS Communities are for everyone

Some contributors, however, seem to believe the ACS leadership is not listening to them or is too focused on certain surgeons at the expense of others, and stridently voice their discontent in the communities. I can assure you that many College leaders, myself included, follow the communities regularly to get a better feel for the issues that are of greatest concern to surgeons in the trenches. This feedback gives us firsthand insights into the matters on which we need to take a stand or offer professional counsel.

While we value thoughtful critiques from our colleagues, it can be discouraging when a few individuals choose to vent their frustrations without offering or acknowledging any solutions. I understand that some members of the communities read the digests regularly and enjoy seeing someone offer the same advice they would give, but are hesitant to offer their own posts. I believe that some people may be reticent to comment because they would prefer to avoid an online debate that leads nowhere.

If you are among the individuals who have been resistant to post, I invite you to post once to see how easy it is, even if only to introduce yourself and let others know you find their posts beneficial. To those few individuals who may view the communities as an outlet for airing their grievances, certainly I encourage you to speak your mind about how the College could better serve its members and represent your interests. But at the same time, I would remind these posters to tap into their emotional intelligence and consider whether their remarks are fostering a healthy dialogue about the issues or are driving people away. Are they sharing important information and offering innovative solutions to the challenges surgeons are facing? Are they encouraging other surgeons to add their perspective so that we can creatively and collectively improve surgeons’ ability to provide quality care?

I would also recommend that contributors post in the community that is focused on their concerns. For instance, if legislative and regulatory issues are topping your list of priorities, consider posting in the Advocacy Community rather than in the General Surgery Community. The surgeons and staff who read posts in the Advocacy Community are more likely to share your frustrations and are focused on resolving these challenges, whereas the members of the General Surgery Community may be more interested in getting advice about clinical matters.

The ACS Communities platform provides a valuable means of telling stories that allow us to reinforce our principles as a professional society, to learn from each other, and to arrive at evidence-based solutions to problems, both clinical and nonclinical. All members of this organization are encouraged to participate in this powerful tool that can bring us together and promote our cultural values.


*Harari YN. Sapiens: A Brief History of Humankind. New York, NY: HarperCollins Publishers; 2015.

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