In February 2013, this column announced the launch of the American College of Surgeons’ (ACS) Transition to Practice (TTP) Program in General Surgery. I am pleased to report that the program is off to a successful start. The ACS TTP Steering Committee, led by J. David Richardson, MD, FACS, Past-Chair of the Board of Regents, has reviewed and given preliminary approval to 14 sites (see sidebar). Perhaps most importantly, two of these institutions are making excellent progress in pilot testing the program: the Mercer University School of Medicine, Macon, GA, and the University of Tennessee Health Science Center College of Medicine-Chattanooga.
Program design and purposes
The TTP Program is designed to help residents successfully transition to independent practice in general surgery. Young surgeons who participate in the one-year program, known as Associates, are given the opportunity to experience increasing autonomy in a broad-based clinical setting, build their competence and confidence in general surgery, develop practice management skills, and gain practical experience for the next phase of their careers.
Each program has a TTP Chief, who provides overall program leadership and quality and oversight—typically the chair of the department of surgery or the surgery residency program director. Each institution also has one or more Senior Associate(s) who are in full-time surgical practice at the facility and who serve as clinical mentors.
Institutions are afforded a great deal of flexibility in how they design each Associate’s program, but all programs focus on honing surgical skills through hands-on involvement in a general surgery service.
Thus far, the Senior Associates and Associates who have been participating in the TTP pilot programs have been very satisfied with the experience. William P. Pannell, MD, FACS, is the Senior Associate for the program run through Mercer Medical College and a general surgeon at Crisp Regional Hospital in Cordele, GA. For many years, Crisp Regional has partnered with state medical schools to provide medical students and residents with opportunities to be exposed to clinical practice. Then, in the summer of 2012, Dr. Pannell was approached regarding the possibility of pilot testing the TTP program. In the summer of 2013, Heidi Haun, MD, became Crisp’s first Associate.
“Dr. Haun basically wanted one thing,” Dr. Pannell said. “She wanted to do cases. She wanted experience.”
Since starting the program in July 2013, Dr. Haun has participated in rounds and in-house consultations with the Senior Associates. Soon she was allowed to start taking cases, barring any objections from the patients. The Senior Associates have been available for immediate assistance whenever necessary, including her call times. “Gradually we have withdrawn to the ‘shadows’ and watched her become the great surgeon we knew she could be,” Dr. Pannell said.
Dr. Haun plans to practice in rural Ghana, where she will have very limited access to other surgeons and, therefore, will need to feel at ease working autonomously. “While I felt my skills were sufficient for starting practice, I believe my confidence was not quite up to par, as I had few opportunities to operate solo during residency,” she said. “I have been operating solo since the beginning, but have assisted my Senior Associates with their more complex cases and continue to invite their assistance for my larger cases.”
In addition to performing general surgery operations, Dr. Haun has assisted the obstetrician-gynecologists at the hospital with many procedures, including cesarean sections, hysterectomies, and removal of ovarian cysts. “I believe that I will be well prepared for rural surgery in West Africa at the end of this year,” Dr. Haun said.
University of Tennessee’s experience
Like Dr. Haun, Benjamin E. Kellogg, MD, TTP Associate at the University of Tennessee-Chattanooga since August 2013, was interested in participating in the program so that he could work with mentors who would guide him toward more autonomous practice.
“I learned all the technical skills in surgery during residency, but I didn’t feel completely ready to practice autonomously. ‘Transition to practice’ really is the best way to describe this experience. It has allowed me to more gradually start operating on my own,” Dr. Kellogg said. The first few months, he was rotating with three or four general surgeons with broad-based practices and becoming more familiar with breast, colon-rectal, and endocrine operations.
At press time, Dr. Kellogg was mostly providing care to patients at a satellite office of the University of Tennessee in the rural town of Dayton. In the three months he had been there, he was handling many cases on his own under the mentorship of Craig Swafford, MD, FACS, a general surgeon and assistant professor of surgery at the University of Tennessee. Dr. Kellogg and Dr. Swafford have formed a close, positive working relationship through this experience. In fact, Dr. Kellogg, a Tennessee native, has signed a contract to begin practicing in the Dayton office.
R. Phillip Burns, MD, FACS, professor and chair of the department of surgery at the University of Tennessee, and the TTP Chief at that institution, said that “almost all of the work he’s done is in areas where we have faculty but don’t have residents.” Dr. Kellogg has helped to fill those gaps, making the program mutually beneficial to the Associate and the sponsoring institution. “We look forward to him completing the program and then becoming a faculty member,” Dr. Burns said.
“The program is going great. It has achieved what I thought it would,” which is to provide the opportunity for a young surgeon to experience firsthand the practice of general surgery, added Dr. Burns, Past-First Vice-President of the ACS and a member of the TTP Program Steering Committee.
Need your help
The TTP Program is off to a fantastic start, and the College looks forward to hearing more success stories next year as other institutions initiate their programs. I encourage the chairs of departments of surgery and residency program directors at medical schools and training programs not yet participating in the TTP Program to explore this opportunity. I also encourage attending surgeons to offer graduating residents the benefit of their mentorship by serving as Senior Associates.
We all are acutely aware of the problems facing the general surgery workforce and surgical education and training. The TTP Program addresses these concerns in a proactive manner. With your help and participation we can ensure that surgical patients will continue to have access to the care they need for years to come