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 June 7–8 at the College’s headquarters in Chicago, IL. 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 to May 8, the ACSPA and its Political Action Committee, ACSPA-SurgeonsPAC, reported more than $274,000 in receipts from more than 800 ACS members and staff. SurgeonsPAC disbursed $214,000 to more than 60 congressional candidates, leadership PACs, and political campaign committees. Commensurate with congressional party ratios, 52 percent of the amount given went to Democrats, and 48 percent went to Republicans.
In addition to reviewing reports from the ACS division directors, the B/R reviewed and approved the following policy statements:
- Statement on Bullying, Harassment, and Discrimination
- Statement on Older Adult Falls and Falls Prevention
- Revised Statement on Patient Safety Principles for Office-Based Surgery Utilizing Moderate Sedation/Analgesia
The B/R accepted resignations from 12 Fellows and changed the status from Active or Senior to Retired for 90 Fellows.
The Regents also approved the formation of the Iraq Chapter.
Division of Advocacy and Health Policy
The Division of Advocacy and Health Policy (DAHP) has identified 43 health policy and advocacy issues that are important to surgeons. Sixteen of the 43 issues are the focus of the advocacy team based on legislative proposals under congressional consideration.
Legislative activities for this year included the following:
- Testifying before the House Labor, Health and Human Services Appropriations Subcommittee on firearms
- Testifying before the Senate Finance Committee on the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) and payment
- Providing extensive written comments on surprise billing
- Leading the effort to get Congress to pass the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019
DAHP continues to monitor legislative activities, especially the recent introduction of several bills on unanticipated/surprise billing.
In the first five months of 2019, the ACS submitted more than 140 pages of feedback to the U.S. Department of Health and Human Services (HHS).
Division of Education
Academy of Master Surgeon Educators
Established in 2017, the Academy recognizes and assembles a cadre of Master Surgeon Educators™ of national and international renown to work closely with the Division of Education to advance the science and practice of surgical education and training. The initial group of Members and Associate Members were inducted October 2018 in Chicago. Following the Induction Ceremony, the newly inducted Members and Associate Members were invited to submit suggestions regarding high-impact programs and projects the Academy should pursue. Initial steps are under way to pursue the top two priorities for 2019–2020. The Academy will convene a special session October 28 at Clinical Congress 2019 to update attendees on the Academy’s activities.
Committee on Ethics
The Committee on Ethics will sponsor the John J. Conley Ethics and Philosophy Lecture presented by Gretchen M. Schwarze, MD, FACS, What We Talk About When We Talk About Surgery, at Clinical Congress 2019. Additional committee-sponsored events include the 2019 Ethics Colloquium, The Ethics of Extraordinary Care; a Panel Session, Should Surgeons Care for their Family Members?; and a Postgraduate Course, Ethical Issues in Geriatric Surgical Care.
The Fellowship in Surgical Ethics, sponsored by the Division of Education and MacLean Center for Clinical Medical Ethics at the University of Chicago, IL, prepares surgeons for careers that combine clinical surgery with scholarly studies in surgical ethics. Applications for 2019 are under review, and discussions are under way regarding the final selection.
Modules and focused sessions of the ACS Certificate Program in Applied Surgical Education Leadership (CASEL) include the following:
- Creating a Culture of Scholarship
- Evaluating Program Outcomes
- Facilitating a Culture for Individuals to Reach their Professional Potential
- Influencing People
- Leading and Supporting Faculty Development and Advancement
- Managing Yourself as an Educational Leader
- Mentoring a Diverse Workforce
- Navigating Change
- Negotiating for Resources
CASEL is expected to launch in September, and applications are being accepted for the initial cohort of 20 participants.
The ACS Clinical Congress remains the premier annual surgical meeting and is the largest educational program of the Division of Education. It offers a range of outstanding education and training opportunities to practicing surgeons, surgery residents, medical students, and other members of surgical teams. Clinical Congress 2019 will take place October 27−31 in San Francisco, CA, and will include 24 tracks; 11 Named Lectures; 112 Panel Sessions; 19 Didactic Courses; 14 Skills Courses; 45 Meet-the-Expert sessions; and 19 Town Halls. A total of 1,971 scientific abstracts were submitted. Continuing Medical Education (CME) and Self-Assessment Credits will be available for most sessions, and Certificates of Verification provided for didactic and skills courses.
Comprehensive General Surgery Review Course
The ACS Comprehensive General Surgery Review Course offers a 3.5-day intensive review of the essential content areas in general surgery. The course design is novel with online pre- and posttests, and includes a unique, interactive educational model. The 2019 course will take place November 14–17 in Chicago.
Core General Surgery Review for Residents
The ACS Core General Surgery Review for Residents, a new three-day course, took place July 6–8 in Chicago. It was developed specifically for residents interested in an intense review of general surgery but benefits all individuals preparing for the General Surgery Qualifying Examination and residents transitioning to general surgery practice.
Optimizing Perioperative Pain Management: An Evidence-based Approach
Optimizing Perioperative Pain Management: An Evidence-based Approach is a new course that a multidisciplinary committee of surgeons, pharmacists, anesthesiologists, oncologists, and pain specialists is developing. The goals of the program are to support appropriate pain management, improve outcomes, improve patient functionality, reduce opioid prescribing and opioid consumption, and optimize consultative services. The program is scheduled to launch this fall.
The 13th Annual Residents as Teachers and Leaders (RATL) Course was offered March 29–31 in Chicago. More than 130 attendees learned about coaching, teaching in the ambulatory setting and operating room, providing feedback, understanding individual leadership styles, designing effective conferences, and questioning skills.
Resources in Surgical Education (RISE) provides timely and informative peer-reviewed online articles on all aspects of surgical education. A new article is posted every six to eight weeks. From June 2017 through April 2019, 20,538 visitors viewed the web page.
Senior surgeon, pre- and postretirement educational activities
Activities of the Division of Education specifically directed at senior surgeons, pre- and postretirement, include the following:
- The Introduction to Simulation-based Teaching Course has taken place annually for the last three years to help senior surgeons acquire teaching skills in simulation-based education and training.
- A new program of training senior surgeons to serve as coaches for mid-career and junior surgeons is being pursued.
- Courses on effective teaching, assessment, and evaluation founded on principles of contemporary surgical education are being designed.
- A number of other programs focusing on the professional activities of this cohort of senior surgeons also are being planned.
- A program on financial planning and implementation for mid-career and senior surgeons is in development.
An ad hoc committee has provided direction for these programs over the last four years. In October 2018, the B/R approved the appointment of a Standing Committee on Professional Opportunities for Senior Surgeons. The committee has been working with the Division of Education to develop programs and activities for senior surgeons, pre- and postretirement.
The Surgical Education and Self-Assessment Program (SESAP) is now in its 47th year and remains the premier self-assessment and guided cognitive skills education program for practicing surgeons. The education and cognitive learning model of SESAP is designed to promote expertise in surgery. SESAP 17 is expected to be released in October 2019.
Summit on Surgical Training
The Fourth Annual ACS Summit on Surgical Training took place May 22–23 in Chicago and focused on competency-based surgical education and training. A panel on competency-based surgical education and training addressed the perspectives of the College, American Board of Surgery (ABS), Association of Program Directors in Surgery, and Resident and Associate Society of the ACS. Small group discussions focused on cognitive skills, technical skills, nontechnical skills and teamwork, and programmatic and operational issues, within the context of competency-based surgical education and training.
Surgeons as Educators Course
The ACS Surgeons as Educators Course, now in its 26th year, is considered the gold standard for all faculty development courses in surgery. The intense, six-day course addresses curriculum development, teaching skills, educational administration, educational leadership, and performance and program evaluation. The 2019 Surgeons as Educators Course will take place September 7–13 in Atlanta, GA.
Surgeons as Leaders: From Operating Room to Boardroom Course
The Surgeons as Leaders: From Operating Room to Boardroom Course continues to establish new benchmarks. The 15th anniversary of this program was celebrated during the April 2019 course in Durham, NC.
The Division of Research and Optimal Patient Care (DROPC) encompasses the areas of Continuous Quality Improvement, including ACS research and accreditation programs.
Quality and Safety Conference
The 2019 Quality and Safety Conference (QSC) took place July 19–22 in Washington, DC, and focused on putting the patient first. Sessions highlighted techniques to improve quality and safety, leadership, advocacy, communication, and a full track to focus on important clinical topics, such as enhanced recovery, Strong for Surgery, emergency general surgery, and transplant, geriatric, and trauma surgery. More than 500 abstracts were selected to showcase surgical quality improvement initiatives and the implementation or validation of best practices from institutions nationwide. The keynote speaker, Rana L. Awdish, MD, an intensive care physician at Henry Ford Hospital, Detroit, MI, shared her journey from near death to recovery, as well as the passion she has for improving the patient experience. The 2020 QSC will take place July 24–27 in Minneapolis, MN.
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. Pilot visits began last year at targeted hospitals and continue in 2019. The goal is to refine and revise the set of standards based on the findings from the pilot phase. Since its release, nearly 10,000 manuals have been distributed.
A total of 839 hospitals participate in the National Surgical Quality Improvement Program (ACS NSQIP®), with 706 participating in the adult option. The pediatric option represents 16 percent of overall participation, and another 28 hospitals are in the onboarding process. At present, 124 hospitals outside of the U.S. participate in ACS NSQIP—approximately 15 percent of all participating hospitals. Interest from Canada remains strong, and sites in Taiwan and Pakistan recently joined the program.
The ACS NSQIP Geriatric Pilot, launched January 2014 by the Geriatric Task Force, is ongoing, with 23 sites collecting data on 19 geriatric-specific variables. The intent of this initiative is to assess what impact the collection of data relevant to the older population may have on the overall ACS NSQIP dataset and outcomes and to work toward developing strategies to improve the overall surgical care of the geriatric patient. The pilot will continue to inform the development of the Geriatric Surgery Verification (GSV) Quality Improvement Program.
A total of 889 facilities participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP); 829 are fully accredited. MBSAQIP recently released its third version of standards. Important changes include improved direction and support for centers on quality improvement projects, the addition of a patient risk assessment and follow-up protocol, and a medical weight loss accreditation option to recognize centers that offer nonsurgical weight management treatment to their patients. These standards represent the inaugural harmonization of the prescribed nomenclature that all standards for ACS Quality Programs will be using moving forward. This alignment will ensure that ACS Quality Programs can deliver a similar and more unified product.
At the 2019 QSC, MBSAQIP released a Bariatric Risk and Efficacy Calculator, the first of its kind, with more than four years of data and millions of patients to drive the tool’s analytics. The tool functions similarly to the Adult NSQIP Surgical Risk Calculator. The Bariatrics Calculator will support clinician and patient decision making preoperatively, with the added ability to allow patients to select a particular procedure and estimate its risk of complications, body mass index reduction, and co-morbidity resolution postoperatively.
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. The program comprises 133 active children’s surgery centers. Approximately 45 of these centers are in the various stages of verification, a 16 percent increase from 2018. 15 active sites are fully verified as Level I children’s surgery centers, a 60 percent increase from 2018.
Plans are under way to create CSV standards for children’s specialty hospitals, which provide a limited range of services specific to various conditions or related to a specific disease process. Program leadership has met with leaders from oncology and musculoskeletal specialty hospitals to assess how these facilities can apply for CSV. The need for standards specific to specialty hospitals will be addressed by adjusting CSV standards to fit the narrow scope of these specialty hospitals. The modified Level I standards will be applied to allow specialty hospitals to apply to the CSV program and achieve a designation of Level I specialty oncology or Level I specialty musculoskeletal hospital. The designation of specialty hospitals is expected to launch this summer.
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 old by establishing a verification program. Work from the Coalition has culminated in the development of the GSV Quality Improvement Program. The GSV formally launched at the 2019 QSC with 30 new surgical standards designed to systematically improve surgical care and outcome for the aging adult population.
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 the ACS NSQIP and 40 percent are not NSQIP participants. Several health systems have enrolled in the ISCR program to drive quality improvement efforts throughout their member hospitals. A new opportunity for enrollment, cohort 3B, has been introduced and is scheduled to start September 2019 to allow hospitals to join and implement enhanced recovery pathways for colorectal, total joints, hip fractures, and 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. As of April 2019, the program grew from 178 sites to 538 sites after the release of the tool kit. The program now comprises eight checklists, including new ones on delirium, prehabilitation, advance directives, and safe and effective pain control. The new checklists were developed in collaboration with the CQGS project. Future plans are for S4S to complement the standards developed for CQGS and other quality programs at the ACS.
The Surgeon Specific Registry (SSR™) 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 1.6 million cases have been entered into the SSR by a user base of 5,500 surgeons. The SSR has been refined to continue addressing many of the regulatory requirements for surgeons. The system supports the ABS Continuous Certification requirements, including the transmittal of cases to the Board. The SSR also continues to work closely with the Centers for Medicare & Medicaid Services (CMS) to implement the Quality Payment Program (QPP) Merit-Based Incentive Payment System (MIPS).
Quality Data Platform Project
The ACS Quality Data Platform Project began in 2015 with the goal of consolidating and improving all ACS clinical registries by moving them to a common platform hosted by QuintilesIMS, now known as IQVIA. The project will create a consolidated platform for data collection, data warehousing, and reporting for existing ACS quality programs, as well as the integration of educational and programmatic resources to be housed within the platform for each program. Efforts for the remainder of the year include preparing to integrate the MBSAQIP and Cancer registries into the new platform.
In 2018 the ACS Committee on Trauma (COT) Executive Committee initiated a strategic planning process to create a five-year plan to serve as a blueprint to guide the priorities and activities of the committee. The process used project management principles to define, accept, operationalize, implement, and evaluate each program element. This summer, staff and leaders will collaborate on the development of formal project plans, with the intent to begin a structured process of communication and reporting by late fall.
Stop the Bleed® training is being provided in more than 100 countries. As of April 30, 2019, bleedingcontrol.org had more than 49,000 registered classes, 50,000 instructors, and 790,000 individuals trained worldwide.
As of May 14, a total of 825 hospitals were participating in ACS Trauma Quality Improvement Program (TQIP), including 145 participating in Pediatric TQIP; 14 percent of Adult TQIP programs also participate in Pediatric TQIP.
The 2019 TQIP Annual Scientific Meeting and Training is set for November 16–18 in Dallas, TX. The conference will focus on error management and high-functioning teams.
Earlier this year, the Advancing Leadership in Trauma Center Management Course content experts began creating course materials. This course is designed to provide insight and direction on the critical infrastructure and organizational processes needed to develop and lead a successful trauma center. The course will launch November 2019.
The College hosted a Medical Summit on Firearm Injury Prevention in Chicago February 10–11. Representatives of 43 professional medical and injury prevention organizations, as well as the American Bar Association, participated. The purpose of the conference was to identify a consensus-based, apolitical approach to firearm injury prevention. Summit presenters focused on understanding and addressing the root causes of firearm violence, while making firearm ownership as safe as possible. Following the meeting, the planning committee compiled consensus statements and brought them to the attention of attendees for further internal consideration by their organizations. Recently released Summit proceedings identified a comprehensive public health approach to addressing this problem that 42 of the participating organizations have formally agreed to support via a road map that can be implemented through collaboration among medical, legal, and community organizations. The consensus-based points for potential action address the need to do the following:
- Recognize firearm injury as a U.S. public health crisis, and take a comprehensive public health and medical approach to address it
- Research this public health crisis using a disease model, and call for research funding at federal and philanthropic levels commensurate with the burden of the disease on society
- Engage firearm owners and communities at risk as stakeholders to develop firearm injury programs
- Empower the medical community across all health care settings to act in the best interests of their patients in a variety of palpable ways: counsel patients on safe firearm storage; screen patients at risk for firearm injury or death; and engage the community in addressing the social determinants of disease through hospitals and health care systems
- Commit professional stakeholder organizations to ensure that these statements lead to constructive actions to improve the health and well-being of our nation