The RAS-ACS: Recruiting medical students and training future leaders

The mission of the Resident and Associate Society of the American College of Surgeons (RAS-ACS) and of the College itself are closely aligned. The ACS Mission Statement explains that members of the ACS are “dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.”¹ Improving the care of the surgical patient is contingent upon residents becoming successful surgeons, leaders, and teachers. It hinges on our mastering the fundamentals of surgery, teaching our junior colleagues, and recruiting our brightest medical students.

Unfortunately, medical students often fear their surgical rotations. They dread the long hours and dealing with the malignant surgical personality—that is, the stereotypical fire-breathing, instrument-throwing surgeon. As the culture of surgical professionalism has evolved over the years, the ACS has worked to encourage the expansion of surgical clerkships as well as recruitment of medical students to general surgery and the surgical subspecialties. The RAS-ACS continues to foster an encouraging learning environment while supporting its members for ongoing success with each knot, each suture, each decision, and each patient.

What is the RAS-ACS?

The RAS-ACS was conceived by former ACS Director of Surgical Education and Research Olga Jonasson, MD, FACS, in 1999. The group’s mission of fostering the College’s relationship with surgical trainees and recent residency graduates remains strong. It has been a continuing goal of the RAS-ACS to recruit residents and young surgeons to have a voice and presence in the ACS, as the future success and responsibilities of the College will eventually be assumed by our young leaders. With more than 9,000 current members, the RAS-ACS continues member recruitment efforts both in the U.S. and internationally by increasing the exposure of the group and promoting the benefits of resident engagement with the ACS.

The mission statement of the RAS-ACS is as follows: “The RAS-ACS will serve to familiarize all surgical trainees and young surgeons with the ACS, its programs, and leadership; provide an avenue for participation in ACS affairs; foster development and use of leadership skills in organized surgery; and give opportunities for the opinions and concerns of young surgeons to be heard by the ACS leadership.”² Initially named the Candidate and Associate Society in 2000, the group evolved into the Resident and Associate Society in 2004 to more accurately reflect the membership.

Resident Members are those trainees who graduated from an Accreditation Council for Graduate Medical Education-accredited medical school or a medical school acceptable to the ACS and who are in an approved surgical residency, surgical research, or surgical fellowship program acceptable to the ACS.² Associate Fellows are defined as surgeons who have graduated from a medical school recognized by the ACS; have completed an accredited surgical residency in the U.S. or Canada; have a full and unrestricted license to practice medicine; are currently engaged in either a second surgical residency, a research program, a fellowship, or in a surgical specialty practice in the U.S. or Canada; and have an interest in pursuing professional excellence.²

National efforts include grassroots recruitment of current and incoming residents as well as involvement in subspecialty conferences. RAS-ACS recruitment efforts begin early in the surgical career and for that reason there is a focus on incoming surgical residents at the intern level. For example, members of the RAS Membership Committee collected contact information for more than 150 incoming surgical interns from 16 programs immediately after Match Day in 2014. The incoming residents were sent a welcome letter and brochure that provided early exposure to the ACS and its member benefits.

There also is a passionate focus on recruitment of members from the surgical subspecialties. At present, the College has 13 specialty Advisory Councils and is an inclusive umbrella organization for all surgical subspecialties. The Advisory Councils include colon/rectal surgery, general surgery, neurosurgery, gynecology and obstetrics, ophthalmology, orthopaedic surgery, otolaryngology, pediatric surgery, plastic and maxillofacial surgery, rural surgery, thoracic surgery, urology, and vascular surgery (see Figure 1). To increase penetrance into the surgical subspecialty groups, RAS has focused attention on having Advisory Council Liaisons promote membership in the RAS-ACS at their respective specialty society meetings. In 2014, the RAS participated in the annual meeting of the American Society of Plastic Surgeons and hosted a pediatric surgery reception at the ACS Clinical Congress.

Figure 1. RAS Structure

The ACS has built a robust presence in the U.S., but perhaps more importantly, its visibility on an international level continues to grow. The RAS-ACS International Exchange Scholarship Program provides selected RAS members with the opportunity to attend a surgical meeting outside North America and, in exchange, hosts a resident- or associate-level surgeon from that country at the ACS Clinical Congress. Interest in this program has grown exponentially since its conception in 2011, with a 400 percent increase in the number of applicants.³ Through collaboration with the ACS international chapters and other societies from Australia/New Zealand, Ireland, Italy, and Lebanon, the International Exchange Scholarship Program has successfully hosted four visiting surgical trainees from around the world. In the coming year, the program will seek to broaden its international visibility through an exchange collaboration with Greece, and possibly South Africa. This program has provided surgical trainees with the unique opportunity to exchange scientific knowledge at the international level.

Besides recruitment of new members into the College, the RAS has a strong focus on maintaining current memberships and building a reliable network of professional and ethical support. Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), in his Presidential Address at the Convocation at the 2013 ACS Clinical Congress, stated, “This College, your College, provides you not only with the best and most comprehensive platform to leverage your quest in shaping your future but also provides you with a set of values that can serve as your moral compass.”⁴ Building on the tenet of professional development through mentorship, leadership, advocacy, and education, the RAS-ACS offers myriad opportunities for young surgeons and trainees in addition to providing invaluable career support and a path toward initiation as an ACS Fellow. These opportunities include participating in leadership positions on the RAS-ACS committees and scholarships for leadership and educational development at various annual meetings, such as the Residents as Teachers and Leaders course and the ACS Leadership & Advocacy Summit. The opportunity to network with leaders and mentors along with influential policymakers at these meetings is a unique educational experience that provides young surgeons with the tools to advocate for quality health care policies. The RAS-ACS continues to challenge its members to remain knowledgeable but also continues to guide their development into honest surgeons who behave with integrity.

These benefits are only a few offered by the RAS-ACS to its members. In an effort to connect with young surgeons and to highlight the numerous benefits of involvement in the ACS, the College launched the Realize the Potential of Your Profession campaign.⁵ One aspect of this initiative was the release of a video identifying “100 reasons” to be involved in the ACS, with brief statements delivered by various members and staff members of the College.⁶ In addition to providing mentorship, unparalleled education, and leadership opportunities, one of the most important reasons to join the RAS-ACS may be its structured path for continuous professional development and its lasting legacy of excellence.

RAS-ACS structure

The RAS-ACS was established in part to encourage the development of future leaders of surgery and to provide them with the tools and opportunities they need to succeed. Therefore, we offer members several opportunities for leadership and involvement. The Executive Committee of the RAS is composed of the Immediate Past-Chair (ex officio), the Chair, the Vice-Chair, and the Secretary, each of whom serves a year in each role.

The Secretary is elected at the annual Clinical Congress, and after one year of service automatically assumes the role of Vice-Chair and subsequently Chair. The RAS also has a Governing Board, which comprises the RAS Executive Committee, the Chair of the four standing committees of the RAS, the RAS Advisory Council Liaisons, and the RAS Liaison to the Board of Governors. The four standing committees of the RAS are the Advocacy & Issues, Communications, Education, and Membership committees. Each committee has a Chairman and a Vice-Chair, with progressive ascendancy. Some standing committees also have a Secretary, who serves a one-year term and does not automatically ascend to Vice-Chair. The RAS has liaisons to each of the 13 Advisory Councils mentioned earlier; these individuals serve three-year terms. There also are RAS representatives on most standing ACS committees and Board of Governors Workgroups; these individuals serve three-year terms.²

There are many pathways to leadership in the RAS-ACS. First, each standing committee has a monthly conference call on a Wednesday night at 9:00 pm ET. During these conference calls, committee members discuss the projects of the committee, provide updates on projects from the previous month, and recommend new initiatives. Most Chairs and Vice-Chairs of standing committees, as well as members of the Executive Committees, initiate their involvement by calling in to the monthly conference calls and then volunteering for a project of interest.

Each committee focuses on specific goals and projects, including the following:

• The Advocacy & Issues Committee collaborates with the ACS Division of Advocacy and Health Policy and the American College of Surgeons Professional Association Political Action Committee (ACSPA-SurgeonsPAC).⁷ The Advocacy and Issues Committee also hosts a debate regarding a controversial topic in surgery during the RAS symposium at the Clinical Congress. The debate occurs among contest winners and national experts in support of, or in opposition to, the issue. First- and second-place essays are published in the Bulletin.
• The Communications Committee publishes a bimonthly e-newsletter, contributes to the RAS theme issue of the Bulletin, maintains the RAS Facebook page and Twitter accounts, and oversees the annual RAS essay contest.^8,9 Each standing committee contributes an article to the RAS issue of the Bulletin, which is chosen by the Communications Committee, with an introductory article by the RAS Chair. Additionally, this committee promotes the ACS Communities, which are an online tool that allows surgeons with common interests to engage in virtual discussions and to share resources.¹⁰
• The Education Committee hosts the annual Surgical Jeopardy competition among residents from programs across the nation at Clinical Congress and has created a Surgical Jeopardy Tool Kit for use by ACS chapters.¹¹
• The Membership Committee helps educate Residents and Associates about the benefits of membership in the RAS and ACS. The efforts have included the development of a brochure and the creation of a top ten list of benefits.^12-14 The Membership Committee also organizes outreach efforts to surgical subspecialties and supports the International Exchange Scholarship Program.^3,14

The ACS also fosters leadership development among residents and provides various educational conferences to that end. Clinical Congress is the flagship meeting of the organization, held every fall, and is free for Resident Members who register in advance. Each spring, the ACS hosts the Leadership & Advocacy Summit in Washington, DC, where residents are encouraged to take political action. The ACS also hosts the Residents as Teachers and Leaders course in Chicago, IL, the Scholars in Residence program (a two-year paid research fellowship in Chicago working on outcomes and health service research using data from the ACS National Surgical Quality Improvement Program), and the Surgeons as Leaders course. The ACS facilitates the transition from medical school into residency with its publication, Successfully Navigating the First Year of Surgical Residency: Essentials for Medical Students and PGY-1 Residents.

The medical student mission

The ACS Committee on Medical Student Education (CMSE) is charged with recruiting and educating medical students, and this committee coordinates the Medical Student Program at the annual Clinical Congress. This three-day program, spearheaded by Andre Campbell, MD, FACS, professor of clinical surgery, University of California, San Francisco, is dedicated to providing future generations with information about a career in surgery.

Although the topics change each year to remain relevant and up-to-date, as well as to appeal to those students who may have previously attended the program, the general format remains the same. The students begin their three-day experience with a lecture from one of the best and brightest minds in the ACS, such as Thomas M. Krummel, MD, FACS, who presented a keynote address in 2014. The afternoon includes a Lifestyles Panel Session, as well as opportunities to meet residents, discuss “the match,” and speak with program directors at residency programs throughout the country. The Lifestyles Panel demonstrates how surgeons maintain work-life balance. This panel has featured surgeons with diverse outside interests, including marathon-enthusiast surgeons, family-oriented surgeons, medical-mission surgeons, make-my-own-schedule surgeons, and so on. Although a life in surgery can certainly be grueling and time-consuming, the Lifestyles Panel urges students to realize that they do not have to permanently forsake hobbies, interests, and goals outside of surgery for the sake of their professional aspirations.

Often medical students believe that a life in general surgery means rarely seeing their families and missing birthdays, weddings, and soccer games. One of the most poignant speakers at the 2014 Medical Student Program provided a very humorous example of how he created work-life balance. At the beginning of every year he requested four very specific days off—his birthday, his wife’s birthday, and their two children’s birthdays. He would stay home, make pancakes, have birthday parties, and every year, ensure “something special” happened. He also made a point of living near the hospital to minimize travel time and so he could sneak away to sporting events. Medical students often lose sight of the big picture because they are focused on details such as step exams, anatomy dissections, and getting “honors” on their clerkship. Unfortunately, they often miss the more important objective of choosing a fulfilling career, which could be in one of the surgical specialties. The Medical Student Program has provided students every year with this big-picture perspective.

One of the newest additions to the Medical Student Program is the Out of the Box SIG—or surgical interest group. This competition among the students encourages innovation and creativity. The students initiate a project at their home institution and submit an application. The students with the most innovative SIG activity are invited to speak at the Medical Student Program and share their ideas with the audience. Program activities include a Great Surgical Games competition in which students participate in suturing and knot-tying, a student trauma call, and medical student surgery research mentoring programs.

Medical SIGs can play a key role in recruitment of students to surgical residency and the profession. Both the Association for Surgical Education and the ACS encourage the development of these groups, which can provide medical students with exposure to both general surgery and surgical subspecialties. Additionally, from the student’s perspective, SIGs can help develop mentors, investigate research opportunities, and may even help students select surgery as a specialty. Nearly half of all U.S. medical schools have established a SIG.¹⁵ There have been concerns in recent years from program directors and other educators about levels of recruitment to the field of general surgery and that the interest in general surgery as a specialty is dwindling. Surveys in the past have identified minimal interaction between surgeons and medical students, resulting in a negative impression of general surgery in a significant number of students.¹⁶ SIGs, with faculty and resident participation, may improve the perception of surgery as a specialty and help convey the positive, exciting, and fulfilling aspects of a surgical career.

The students also participate in knot-tying and suturing sessions with world-renowned surgeons, including (all MD, FACS) Christopher Brandt, Andre Campbell, Rebecca Evangelista, Celeste Hollands, Mary Hooks, Joseph Iocono, Deborah Loeff, Paul Schenarts, Susan Steinemann, and Stephen Yang. This stellar group of surgeons works all year to create the best schedule of events to encourage students to pursue a career in surgery. They travel to Ohio, California, and even Hawaii with this mission in mind. Each year, the CMSE’s Medical Student Program attracts more students from across the country, and with that, seeks to encourage students to join us in this rewarding career.

Conclusion

The culture of surgery thrives on hard work, energy, compassion, and education. During the progression of training, the adage of “see one, do one, teach one” becomes more and more important. The RAS-ACS works to not only help its members thrive in their careers as surgeons, but also to attract the best and brightest minds to surgery—and teach them to strive for success, one knot at a time.

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References

1. American College of Surgeons. Mission Statement. Available at: www.facs.org/about-acs. Accessed June 3, 2015.
2. American College of Surgeons Bylaws for RAS-ACS. Member Services. Available at: www.facs.org/member-services/ras/leadership/bylaws. Accessed April 12, 2015.
3. Mouawad NJ, Iyer P, Grant SB, Spaniolas K. RAS-ACS International Exchange Scholarship Program provides unique opportunity for global collaboration. Bull Am Coll Surg. 2014:99(4):42-45. Available at: bulletin.facs.org/2014/04/ras-acs-international-exchange-scholarship-program-provides-unique-opportunity-for-global-collaboration/. Accessed April 12, 2015.
4. Pellegrini CA. Presidential Address: The surgeon of the future: Anchoring innovation and science with moral values. Bull Am Coll Surg. 2013;98(12):8-14. Available at: bulletin.facs.org/2013/12/presidential-address-the-surgeon-of-the-future-anchoring-innovation-and-science-with-moral-values/. Accessed June 17, 2015.
5. American College of Surgeons. Realize the potential. Member Services. Available at: www.facs.org/member-services/realize. Accessed April 12, 2015.
6. American College of Surgeons. 100 Years, 100 reasons to join. January 6, 2015. Available at: www.youtube.com/watch?v=QnUlChP5KAU. Accessed April 12, 2015.
7. American College of Surgeons. Advocacy and Issues Committee. Available at: www.facs.org/member-services/ras/leadership/advocacy. Accessed April 12, 2015.
8. American College of Surgeons. RAS-ACS News. Available at: www.facs.org/publications/newsletters/ras-news. Accessed April 12, 2015.
9. American College of Surgeons. Communications Committee. Member Services. About RAS. Available at: www.facs.org/member-services/ras/leadership/communications. Accessed April 12, 2015.
10. American College of Surgeons. Help/FAQs. Available at: http://acscommunities.facs.org/faq#whatarecommunities. Accessed April 12, 2015.
11. American College of Surgeons. Education Committee. Member Services. Available at: www.facs.org/member-services/ras/leadership/education. Accessed April 12, 2015.
12. American College of Surgeons. Value of membership. Available at: www.facs.org/~/media/files/member%20services/member%20benefits/residentbenefits.ashx. Accessed April 12, 2015.
13. American College of Surgeons. Top 10 reasons to participate. Member Services. Available at: www.facs.org/member-services/ras/top10. Accessed April 12, 2015.
14. American College of Surgeons. Membership Committee. Member Services. Available at: www.facs.org/member-services/ras/leadership/membership. Accessed April 12, 2015.
15. American College of Surgeons. Surgical interest groups. Available at: www.facs.org/education/resources/medical-students/sigs. Accessed April 12, 2015.
16. Ko CY, Escarce JJ, Baker L, Klein D, Guarino C. Predictors for medical students entering a general surgery residency: National survey results. Surgery. 2004:136(3):567-572.