Frank R. Lewis, Jr., MD, FACS, has just completed a 15-year term (2002–2017) as executive director of the American Board of Surgery (ABS), with numerous remarkable accomplishments during his tenure. At the winter ABS meeting, Dr. Lewis also announced his retirement effective at the end of 2017. Hence, it is fitting to chronicle the life and career of this surgical leader, who has played such an important and dominant role in surgical education, training, and certification in the U.S. and around the world.
Education and training
Dr. Lewis graduated cum laude with a bachelor of physics from Princeton University, NJ, and was inducted into Sigma Xi, the Scientific Research Honor Society. He received his medical degree in 1965 from the University of Maryland Medical School, Baltimore.
His initial goal was to be an internist. However, a one-year internship (six months medicine, six months surgery) at San Francisco General Hospital, CA, resulted in a change of heart. After a few weeks on the internal medicine service at San Francisco General, he recognized that managing chronic disease was not what he really wanted to do. During Dr. Lewis’ surgical training under the leadership of J. Englebert Dunphy, MD, FACS, chairman, department of surgery, and F. William Blaisdell, MD, FACS, chief of trauma and founder of the first U.S. trauma program in 1968, he was drawn to the excitement of the nascent field of acute care surgery, caring for patients with acute surgical issues and traumatic injuries.
It was too late to apply for surgical residency that year, but he was accepted into the surgical residency program at the University of California, San Francisco (UCSF), the following year in 1966. After completing his residency training in 1972, Dr. Lewis completed a National Institutes of Health trauma research fellowship with his mentor, Dr. Blaisdell, at San Francisco General.
Dr. Lewis served on the faculty of the UCSF from 1973 to 1992, rising from assistant professor to professor and vice-chair, department of surgery, and to chief of surgery at San Francisco General Hospital. For his overall teaching efforts, Dr. Lewis received the UCSF Surgery Residents’ Excellence in Teaching Award in 1990 and 1991, as well as the 1991 Alpha Omega Alpha Honor Medical Society Chapter Award for Outstanding UCSF Faculty Teacher.
He then moved east, and from 1992 to 2002, he served as chair, department of surgery, Henry Ford Hospital, Detroit, MI, and professor of surgery, Case Western Reserve University, Cleveland, OH.
Dr. Lewis’ clinical interests have centered on trauma and critical care, and his research has focused on cardiopulmonary physiology, cardiopulmonary effects of sepsis, and acute respiratory failure. He collaborated with Virgil Elings, MD, University of California, Santa Barbara, to develop the lung water computer, which allowed the quantitation of pulmonary edema using the double indicator technique. They established the validity of the technique in both human and animal models.
Dr. Lewis’ more recent work has focused on critical care physiology and specifically the cardiopulmonary effects of sepsis and of vascular resistance on cardiac output. In the course of more than 40 years, Dr. Lewis has published more than 175 articles in peer-reviewed journals.
Dr. Lewis has served in numerous leadership roles in the course of his surgical career. In addition to his roles as chief of surgery at San Francisco General from 1986 to 1992 and chair of surgery at Henry Ford Hospital for a decade, he has held many national leadership roles in surgery. Most notably, he served as Chair of the American College of Surgeons (ACS) Board of Governors, ACS First Vice-President, president of the American Association for the Surgery of Trauma, president of the Shock Society, and chair of both the ABS and the Residency Review Committee for Surgery (RRC-Surgery). The highlight of his career in surgery has been the last 15 years, during which he served as executive director of the ABS, promoting pivotal changes in surgical training and certification and lifelong learning.
Dr. Lewis’ accomplishments during his tenure as ABS executive director are numerous, and all of the ABS directors hold Dr. Lewis in high esteem. According to ABS chair John G. Hunter, MD, FACS, “There are not enough words in the English language to describe the service and contributions made by Dr. Lewis to American surgery over his 15 years as ABS executive director. We are deeply indebted to him for his visionary guidance and dedication to the mission of the board.” The following summarizes some of the numerous advances and major developments that occurred at the ABS during Dr. Lewis’ tenure.
At-large ABS director positions
Dr. Lewis is an advocate for surgeons in clinical practice. In 2005, Dr. Lewis and the ABS announced the creation of three at-large director positions to better reflect the diversity of the surgical community in the U.S. These positions were in addition to the ABS board of directors’ representation from 26 U.S. surgical organizations. This change has allowed surgeons in private or group practice to have greater representation on the board and, thereby, ensure its standards align with the needs of today’s practicing surgeons and myriad practice environments. The inclusion of ABS at-large directors has been highly successful in further broadening the board’s representation.
The first ABS public member role
Under Dr. Lewis’ leadership, a public member was added to the ABS board of directors to represent the public in its deliberations. In 2010, the first ABS public member, William Scanlon, PhD, a consultant and commissioner for the Medicare Payment Advisory Commission, was added to provide a public voice in all ABS deliberations. Dr. Scanlon just completed his term on the ABS, with Nancy M. Schlichting, MBA, immediate past-president and chief executive officer, Henry Ford Health System, succeeding him as public member this past July.
The first ABS mission statement
As a means to further focus the goals and future direction of the ABS, Dr. Lewis and ABS leaders sought to develop a mission statement for the organization. In 2014, the first mission statement of the ABS was introduced, with a focus on the board’s duty to the public. It reads as follows: “The American Board of Surgery serves the public and the specialty of surgery by providing leadership in surgical education and practice, by promoting excellence through rigorous evaluation and examination, and by promoting the highest standards for professionalism, lifelong learning, and the continuous certification of surgeons in practice.”
An unwavering advocate for surgical residents and residency education, Dr. Lewis led an important effort as ABS executive director in the establishment of the Surgical Council on Resident Education (SCORE).
On November 20, 2006, the ABS hosted the inaugural meeting of SCORE, to examine the state of surgical training and develop a new national curriculum for general surgery residency training in the U.S. SCORE is composed of representatives from the principal organizations involved in surgical education: the ACS, the American Surgical Association (ASA), the Association of Program Directors in Surgery, the Association for Surgical Education, the RRC-Surgery, the Society of American Gastrointestinal and Endoscopic Surgeons, and the ABS. The meeting was organized by Dr. Lewis and ABS assistant executive director Richard H. Bell, Jr., MD, FACS, as a first step toward developing a comprehensive program to improve the training of U.S. surgeons.
SCORE emerged from the growing concern among the leadership of the ABS and other organizations that traditional surgical training no longer could respond sufficiently to the pressures of the modern health care environment and that the quality of graduate surgical education and the overall attractiveness of surgery as a specialty were threatened. The rapid growth of new technology and surgical knowledge, along with limits on residency work hours and a projected shortage of surgeons in the near future, were all factors that prompted the creation of SCORE and inspired its objective of a new, innovative curriculum for surgery residency training. The ABS had seen firsthand an undesirable high degree of variability in the knowledge of graduated surgery residents, particularly regarding complex trauma and gastrointestinal cases.
At the November 2006 meeting, SCORE representatives reviewed the efforts of member organizations in improving surgical education and the attractiveness of surgery as a career choice. They also reviewed the proposals of the ASA Blue Ribbon Panel (2005) regarding the restructuring of surgical training and ultimately decided that SCORE would focus on opportunities for improving the traditional five-year surgery curriculum. The members of SCORE also agreed to move ahead with the development of a website dedicated to the provision of comprehensive, high-quality educational materials that would be available at a reasonable cost to all surgical residents.
The SCORE curriculum is now a national standard for defining what a surgeon should know and be able to do by the end of general surgery residency, and SCORE is a critical element in shaping the future of general surgery residency training. The SCORE portal (www.surgicalcore.org) comprises more than 750 learning modules and is used by 98 percent of the general surgery residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).
Dr. Lewis has led many initiatives that have shaped U.S. surgical training and certification, including the design and implementation of the FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees) Trial, which Dr. Lewis initiated in partnership with ACS Executive Director David B. Hoyt, MD, FACS, and Ajit K. Sachdeva, MD, FACS, FRCSC, Director, ACS Division of Education. The study was funded by the ABS, the ACS, and ACGME, and was organized and directed by Karl Y. Bilimoria, MD, MS, FACS, John Benjamin Murphy Professor of Surgery, Northwestern University, Chicago, IL. The trial went from conception to initiation in seven months and to initial results 18 months later. The findings of the study led directly to changes in resident work hours as announced by the ACGME in March 2017.
Under Dr. Lewis’ leadership, the ABS has worked with all major organizations engaged in surgical education and quality improvement to foster education, training, and assessment that reflects best practices. A central focus of the ABS since 2013 has been to critically evaluate general surgery residency training, related to renewed concern about lack of autonomy afforded to general surgery residents, and to ensure that residents are fully prepared to enter independent practice at the completion of residency.
The ABS has convened multiple daylong retreats to review associated issues in surgical training, including resident work-hour limits, the reduction in open operative procedures performed during training, and the dramatic growth of post-residency fellowships. This critical evaluation led to a recommendation to pursue competency-based training as the ultimate goal, similar to the plan for implementation across all Canadian training programs by the Royal College of Physicians and Surgeons of Canada.
When asked in an interview with the AAST what advice he would give to students and residents interested in surgery as a career goal, Dr. Lewis said, “The most important thing is to really have a passionate interest in what you do. When you figure that out, jump into it and do it as well as possible to advance the science of it wherever you can, to constantly look at how you can do things in the best way. If you do that, it’s hard for anything else to be a problem.”
Maintenance of Certification
With Dr. Lewis’ guidance, the ABS has sought to optimize lifelong learning and certification to best serve both diplomates and the public. In a memorandum sent July 7 to all diplomates from ABS chair Mary E. Klingensmith, MD, FACS, and Dr. Lewis, the ABS announced that Maintenance of Certification (MOC) reporting requirements would be changed to require reporting only every five years instead of three, and that the required Self-Assessment Continuing Medical Education credits would be reduced by 50 percent. The ABS also announced that in 2018 diplomates would be offered alternatives to the traditional 10-year recertification exam. The ABS MOC Program will continue to evolve in response to diplomate feedback under Jo Buyske, MD, FACS, who assumed the role of ABS executive director September 1.
As ABS executive director, Dr. Lewis has been a visionary leader in many areas of surgical training and certification, including the development of a primary certificate in vascular surgery, the establishment of “flexible rotations” in surgical residency training, and the restructuring of the ABS to encompass advisory councils and component boards covering all areas of general surgery. His numerous accomplishments during his tenure as ABS executive director have clearly changed the landscape of general surgery in the U.S.
The authors would like to thank Dr. Lewis’ wife, Janet Christensen, and the American Board of Surgery for contributing the photos published with this article.
American Association for the Surgery of Trauma. Past presidents. Frank R. Lewis MD 1999–2000. Available at: www.aast.org/About/PastPresidents.aspx. Accessed September 8, 2017.
The American Board of Surgery. Available at: www.absurgery.org. Accessed September 8, 2017.