The Board of Directors of the American College of Surgeons Professional Association (ACSPA) and the Board of Regents (B/R) of the American College of Surgeons (ACS) met October 20, 2018, at the Westin Boston Waterfront, MA. The following is a summary of key activities discussed. The information provided was up-to-date at the time of the meeting.
From January 1, 2017, through September 20, 2018, the ACSPA and its political action committee, ACSPA-SurgeonsPAC, collected $895,000 in donation receipts from more than 1,650 ACS members and staff. SurgeonsPAC disbursed $710,000 to more than 130 congressional candidates, leadership PACs, and political campaign committees. Commensurate with congressional party ratios, 57 percent of the amount given went to Republicans and 43 percent went to Democrats.
The Regents approved a new Honors Committee award that recognizes and honors a physician for exemplary service in the advancement of military progress in surgery.
Convention and Meetings
The dates for Clinical Congress 2030 have been changed to October 13–17. The ACS continues to extend association management services to domestic chapters and to nine College chapters. Another 18 clients have contracted for services.
Division of Education
The Division of Education presented the proposed program for Clinical Congress 2019 for comment and review.
Committee on Ethics
The division’s Committee on Ethics selected four recipients of the Fellowship in Surgical Ethics, which prepares surgeons for careers that combine clinical surgery with scholarly studies in surgical ethics. The committee also is developing guidelines for ethical use of social media.
Division of Member Services
A record number of Initiates—a total of 1,971, with 1,333 from the U.S. and its territories, 26 from Canada, and 612 from 73 other countries—were welcomed into the ACS in 2018. The Initiate class size has continued to rise for the last six years. More than 900 Initiates attended Convocation 2018. Also at the Convocation, the Initiate classes of 1968 and 1993 celebrated 50 and 25 years of Fellowship, respectively.
The Board accepted resignations from 25 Fellows and changed the status from Active or Senior to Retired for 70 Fellows. As of September 1, 2018, the ACS had 81,660 members: 64,564 Fellows, 2,866 Associate Fellows, 10,845 Resident Members, 2,844 Medical Student Members, and 541 Affiliate Members.
The division engaged in several recruitment and retention activities in 2018, including the development of communications campaigns for Resident Members to transition to Associate Fellow membership and to renew their membership. Other efforts focused on creating a survey for Senior and Retired Fellows to determine the services and resources they need from the ACS and their interest in assisting with the development of programs and resources related to preparing for retirement. Several projects to increase Affiliate membership were implemented along with a Resident-Get-a-Resident recruitment campaign, which resulted in 46 new Resident Members. In addition, a comprehensive revision of the member benefits brochures and corresponding web pages occurred, along with development of flyers targeted to each surgical specialty.
The ACS has 14 Advisory Councils (ACs) since the addition of a new AC for Oral and Maxillofacial Surgery in 2018. Each ACS specialty category now has an AC.
The ACs submitted 132 proposals for Panel Sessions, Postgraduate/Skills Courses, Meet-the-Expert sessions, and Town Hall meetings at Clinical Congress 2019. Electronic newsletters continue to be produced to communicate with specialty colleagues on ACS activities and specialty-specific issues and programming, along with targeted electronic communications from the AC Chairs highlighting Clinical Congress programming and encouraging attendance.
The Archives serves as the historical memory of the ACS—collecting and preserving inactive records of enduring value and making them available for research. Last year, the Archives processed and cataloged roughly 400 linear feet of material, chiefly paper records, but also images, motion pictures, audio recordings, and artifacts. The Archives responded to 175 research requests, including 15 in-person visits. In addition, the Archives received material relating to Joseph E. Murray, MD, FACS—the Nobel Laureate in Medicine for 1990. Dr. Murray is the sole Nobel Laureate of the 10 ACS Fellows who have been accorded the Nobel Prize. The Surgical History Group awarded its first Archives Fellowship to David E. Clark, MD, FACS, to study how World War I accelerated the transfer of global leadership from Europe to the U.S. and the College’s role in this transition.
Board of Governors
The Governors serve a critical role as liaisons between the Board of Regents and rank-and-file Fellows. Through various Board of Governors (B/G) activities and events, Governors bring forth the voices and views of their surgical colleagues and develop resources to support Fellows. Key projects and activities for 2018 included conducting the B/G Annual Survey on gender inequality and harassment, burnout, and disruptive and impaired physicians; submission of more than 30 session proposals for Clinical Congress 2019; and publication of several articles in the Bulletin on locum tenens surgery and the 2017 B/G Annual Survey. Educational efforts focused on the development of essays for young surgeons and the creation of a PowerPoint presentation on ACS patient education resources. In conjunction with the publication of the ACS Guidelines on Perioperative Management of Antithrombotic Medication in the Journal of the American College of Surgeons (JACS), a session on the topic was offered at Clinical Congress 2018.
The College’s international presence continues to increase. In 2017, a comparative analysis of international offerings was conducted, focusing on an evaluation of requirements for Fellowship, member benefits, dues structure, and annual meeting dates, resulting in more targeted recruitment and retention messaging. Additionally, the International Relations Committee (IRC), in collaboration with the international ACS chapters, is working to develop additional programs and services and improve existing benefits for international members.
International scholarships and travel awards
2018 marked the 50th anniversary of the International Guest Scholarship Program. These scholarships are awarded to surgeons from outside the U.S. and Canada to attend the Clinical Congress and network with colleagues to enhance surgical practice in their home country. Since inception, the ACS has awarded 353 scholarships. The majority of initiated and completed applications are from surgeons who are not Fellows of the ACS. Ongoing outreach highlighting member benefits for Fellows, as well as the value of the FACS designation, is conducted with applicants and awardees.
IPV Task Force
The College formed an Intimate Partner Violence (IPV) Task Force in 2018 to raise awareness of the incidence of IPV in the surgical community; educate surgeons to recognize the signs and consequences of IPV in themselves and their colleagues; provide resources for survivors, including prevention and escape strategies; and create resources and curricula in partnership with other national professional and educational organizations to instruct surgeons about how to recognize IPV in colleagues and trainees. The task force developed a survey for deployment to ACS members. The task force will analyze the survey data and use its findings to determine the types of resources that would be of value to the surgical community. A tool kit of resources has been created and is available on the ACS website.
Leadership and Advocacy Summit
More than 500 ACS leaders and members attended the Leadership portion of the 2018 ACS Leadership & Advocacy Summit. Attendees enjoyed presentations by notable speakers on topics such as mentoring for a career in surgical leadership, applying ethics in surgical leadership, having impact on lives beyond one’s practice, leading in times of crisis, managing change, leading complex teams, and thinking strategically.
More than 300 surgeons and trainees participated in the Advocacy portion of the summit, which focused on ACS health policy priorities, as well as the political environment in Washington, DC. The Advocacy program incorporated comprehensive advocacy training and legislative issue briefings to prepare attendees for congressional visits. A record number of attendees from 45 states participated in more than 275 meetings on Capitol Hill—nearly 100 with members of Congress. The 2019 Leadership & Advocacy Summit is scheduled for March 30–April 2.
Military Health System Strategic Partnership
The ACS and the U.S. Department of Defense Military Health System Strategic Partnership (MHSSPACS) and the Division of Research and Optimal Patient Care (DROPC) assisted in the creation of a systemwide Military National Surgical Quality Improvement Program (ACS NSQIP®) Consortium, which includes all Military Treatment Facilities (MTF) within the U.S., along with a few outside of the U.S. The surgeon champions and research staff from these MTFs meet biennially. The MHSSPACS also is working with the ACS Committee on Trauma (COT) to evaluate military trauma centers and trauma systems of importance to national security. The Military Readiness Project (also referred to as the KSA, or Knowledge Skills and Abilities Project) has vetted more than 400 knowledge touchpoint questions based primarily on the Joint Trauma System’s Clinical Practice Guidelines, as well as additional materials such as trauma textbooks. The test is designed to ensure that military surgeons have sufficient knowledge for deployment to a small surgical base.
In addition, the MHSSPACS is identifying areas of trauma research that are relevant to combat casualty care and for investigation in civilian centers. The Department of Defense/Combat Casualty Care Research Project has provided funding to study post-traumatic pulmonary embolism. The Excelsior Surgical Society is resurrecting the Senior Visiting Surgeons Program to allow for the exchange of surgeons between military and civilian centers, as was done at Landstuhl Regional Medical Center, Germany, from 2006 to 2013.
Operation Giving Back (OGB) seeks to leverage the passion, skills, and humanitarian ethos of the surgical community to meet the needs of medically underserved populations. OGB provides the tools to facilitate humanitarian outreach among surgeons of all specialties at all stages of their careers and with an emphasis on both domestic and international service. Domestic efforts of the last year have focused on the Health Career Academy’s intent to create a pipeline for high school students from minority communities to explore health careers and health education topics. OGB also has sought to respond to Puerto Rico’s insufficient access to surgeons and surgery centers in the aftermath of Hurricane Maria. In collaboration with the Puerto Rico Department of Health and various nongovernmental organizations, OGB is mobilizing surgeon volunteers to address this gap.
Global efforts have included awarding five women trainees from the College of Surgeons of Eastern, Central, and Southern Africa (COSECSA) region with scholarships from the ACS-COSECSA Women Scholars Program (more information in the related story). The scholarship aims to promote gender equity in the surgical workforce in Africa.
The ACS-COSECSA Surgical Training Collaborative will launch its pilot surgery training hub at Hawassa University, Ethiopia. In all, 13 U.S. institutions have committed to be involved in this initiative and plan to provide consistent staffing to the site with the goal of developing workforce capacity and training opportunities for students, residents, and faculty.
The Resident and Associate Society (RAS-ACS) serves to familiarize resident members with ACS programs and provides an avenue for participation in ACS affairs, fosters development and use of leadership skills, and provides opportunities for opinions and concerns of young surgeons and trainees to be heard by the ACS. The August issue of the Bulletin featured articles by RAS members on the theme of Resident Autonomy. The RAS JACS Journal Club hosted five online journal clubs with more than 1 million impressions on social media. A second series of chapter Surgical Jeopardy games launched, and the RAS hosted the second So You Think You Can Operate: The RAS-ACS Surgical Skills Competition at Clinical Congress 2018. Eight teams competed in this team-based skills competition testing surgical technique and communication. To increase interaction between Resident and Medical Student Members, several hangouts have taken place. These one-hour phone conversations allow medical students to call in and ask questions and talk with residents about the various aspects of a surgical residency.
The fourth annual Young Fellows Association (YFA) advocacy essay contest was offered to encourage and facilitate participation in the 2018 Leadership & Advocacy Summit. Communications efforts have focused on informing the membership of the benefits and value of ACS across social media channels, quarterly YFA newsletters, collaboration with RAS on webinars, and the ACS Communities. Mentorship remains a primary focus, and two successful mentoring programs took place in 2018: a one-hour Speed Mentoring program at Clinical Congress for Residents and Associate Fellows and the YFA Annual Mentor Program, which pairs an Associate Fellow, young Fellow, and experienced Fellow.
Chapter Services continues to provide guidance and assistance to the College’s 67 domestic and 45 international chapters. The Regents approved the formation of a chapter in South Africa.
Other Chapter Services activities include the following:
- Issued the 2017 Annual Report, which contains information about the efforts of chapters in administration and management, membership recruitment and retention, communications, finances, educational programming and events, and advocacy (domestic chapters only). The leadership of each chapter received a personalized report, which compared their responses to the chapter aggregate. Efforts for the 2018 Annual Report are under way.
- Hosted the second annual Chapter Officer Leadership Program in May 2018.
- Arranged for four chapters to present their success stories at the 2018 Leadership & Advocacy Summit.
- Provided several recruitment resources, such as template letters, to the chapters.
- Began development of an online recruitment toolbox to assist chapters in the recruitment of Fellows and non-ACS members who are eligible to join the College. The toolbox will include images for social media, brochures, e-mail templates, and a timeline for various marketing campaigns.
DROPC encompasses the areas of Continuous Quality Improvement, including ACS research and accreditation programs.
Quality and Safety Conference
The 2019 Quality and Safety Conference will take place July 19–22 in Washington, DC, and will focus on putting the patient first.
In 2017, the ACS published Optimal Resources for Surgical Quality and Safety (the Red Book). The development of adjunctive and integrated resources/standards based on this manual are near completion and ultimately will be used to launch a Surgical Quality Verification Program. The principal areas of focus for the standards are rooted within the foundational elements of the manual and include the domains and phases of surgical care, the Surgical Quality Officer, program and committee infrastructure, peer and case review, disease-based management, and components of data capture and surveillance.
A total of 828 hospitals participate in ACS NSQIP, with 705 participating in the adult option. The pediatric option represents 15 percent of overall participation, and another 29 hospitals are in various stages of the onboarding process. At present, 118 hospitals outside of the U.S. participate in ACS NSQIP—approximately 14 percent of all participating hospitals. Interest from international sites continues to build, particularly in Asia, Australia, Europe, the Middle East, and South America.
A total of 894 facilities participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), and 64 surgeon surveyors are expected to complete 250 site visits in 2019. A total of 804 participating centers are fully accredited—an increase of more than 5 percent from 2017. MBSAQIP’s national enhanced recovery initiative, Employing New Enhanced Recovery Goals to Bariatric SurgerY (ENERGY), concluded with 36 participating centers. The ENERGY project was focused on enhancing patient experience through improved pain management, fewer opioid side effects (nausea, vomiting, ileus), decreased readmissions, and quicker return to normal activity for the three principal bariatric operations.
The Children’s Surgery Verification (CSV) Quality Improvement Program launched in 2017 with the goal of ensuring access to high-quality care for pediatric surgical patients. At present, the program has 123 active children’s surgery centers. Approximately 45 of these centers are in the various stages of verification, a significant increase from previous years—and 11 of the active sites are fully verified as Level I children’s surgery centers.
The ACS NSQIP Pediatric Process Measures Pilot project concluded last year. The pilot was developed with the intent of expanding beyond the typical morbidity and mortality outcomes and prompting local cross-disciplinary quality improvement at individual institutions. A total of 40 sites participated and a comprehensive report was provided to all participating hospitals.
The Coalition for Quality in Geriatric Surgery (CQGS) Project, funded by the John A. Hartford Foundation, aims to systematically improve surgical care for patients older than 65 years of age by establishing a verification program. As part of the CQGS Beta Pilot, the team conducted and completed eight site visits last year to better understand the feasibility of centers implementing the standards. The CQGS will launch at the 2019 ACS Quality and Safety Conference.
The Agency for Healthcare Research and Quality Improving Surgical Care and Recovery (ISCR) Program, a collaborative effort between the ACS and the Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, is under way. The program continues to attract hospitals throughout the nation that are interested in partnering with the ISCR national program team to implement enhanced recovery practices. Approximately 60 percent of enrolled hospitals also participate in ACS NSQIP. A comprehensive marketing and recruitment plan is being finalized to engage hospitals to participate in the third cohort scheduled to begin in March 2019. The third cohort will allow hospitals to concentrate on colorectal, orthopaedic, and/or gynecologic surgery.
Strong for Surgery
Strong for Surgery (S4S), a joint program between the ACS and the University of Washington, Seattle, is aimed at identifying and evaluating evidence-based practices to optimize the health of patients before surgery. The program empowers hospitals and clinics to integrate checklists into the preoperative phase of clinical practice for elective operations. The S4S checklists are used to screen patients for potential risk factors that can lead to surgical complications and to provide appropriate interventions to ensure better surgical outcomes. Four new checklists on delirium, prehabilitation, advance directives, and safe and effective pain control were introduced at Clinical Congress 2018. As of September 2018, the program grew from 110 sites to 373 sites after the release of the tool kit.
The Surgeon Specific Registry (SSR), which launched on the new ACS Quality Data platform (IQVIA) in 2017, continues to evolve with more features as an online software application and database that allows individual surgeons to track their cases and outcomes from their computer or mobile device. Since its launch, more than 1.1 million cases have been entered into the SSR by a user base of 5,300 surgeons.
The B/R approved new members and leadership for the Commission on Cancer (CoC). Heidi Nelson, MD, FACS, a colorectal surgeon, has assumed the role of Medical Director, ACS Cancer Programs, succeeding David P. Winchester, MD, FACS, as he transitions from the position in which he has served for more than 30 years. Dr. Nelson is department chair and vice-chair for research, department of surgery, Mayo Clinic; and professor of surgery, Mayo Clinic College of Medicine and Sciences, Rochester, MN.
The COT is developing a three- to five-year strategic plan to establish a thoughtful, purposeful approach to identifying and planning COT initiatives through a transparent and inclusive methodology that will ensure clear accountability for both leaders and staff. As the COT looks forward to its 100th anniversary in 2022, the membership of the COT will be expanded to 100 positions, including a dedicated specialty spot for ophthalmic trauma surgery. A total of 803 hospitals participate in the COT’s Trauma Quality Improvement Program (TQIP®), and 503 hospitals have ACS verification.
The 2018 TQIP Annual Scientific Meeting took place November 16–18 in Anaheim, CA, and featured keynote speaker John B. Holcomb, MD, FACS, who spoke on high-performing teams. Kristina Anderson, the trauma survivor speaker, described being shot in April 2007 during the active shooting at Virginia Polytechnic Institute and State University, Blacksburg, VA. In addition, the program included 30 oral abstract presentations and more than 100 posters. The 2019 TQIP Annual Scientific Meeting and Training will take place November 16–18, in Dallas, TX. See the related story for more information on the conference.
Best Practices Guidelines on Imaging were released in November. The guidelines were developed by an expert panel with representation from TQIP; Verification, Review, and Consultation; and the Performance Improvement and Patient Safety programs. Development of the Intentional Trauma Guidelines began last year and will be divided into three sections: interpersonal violence, elder abuse, and child abuse.
The Firearm Injury Prevention Strategic Workgroup has begun implementation of the Firearm Injury Prevention Action Plan for the following firearm-related activities:
- Development and dissemination of a confidential web-based survey to all U.S. ACS members on topics related to firearms and firearm injury prevention
- Establishment of the Firearm Strategy Team (FAST) workgroup, which comprises firearm owners to help ensure that all perspectives are considered in the development of firearm injury prevention strategies and advocacy efforts
- Promotion of safe storage and counseling resources for physician-patient interactions, including a firearm safety brochure for patients
- Dissemination of a tablet-based survey piloted at 10 pediatric centers to assess attitudes and practices on firearm safe storage among the guardians of pediatric patients
- Development of a research agenda for firearm injury prevention focused on the epidemiology of violence and identification of evidence-based interventions that prevent or reduce firearm injuries
The Bleeding Control program has experienced rapid growth since its inception in January 2017. Stop the Bleed® is now located in all 50 states and more than 77 countries. The program has offered more than 26,000 classes, approved more than 30,000 instructors, and trained more than 400,000 individuals worldwide.
The ACS Foundation had a strong year in obtaining financial support for the charitable and educational work of the ACS. It experienced a 40 percent increase in individual contributions over the previous year while lowering its cost per dollar by 30 percent. Examples of programs supported by these contributions in 2018 include the following:
- 13 Skills Courses at Clinical Congress
- International Scholarship Travel Awards
- Fellowship Research Awards
- First Annual Residents Surgical Skills Competition
- Materials for Stop the Bleed Training in Rural Communities
- Patient Education Materials
- Sponsor a Medical Student Program