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 26 at the Hilton San Francisco Union Square, CA. The following is a summary of key activities discussed. The information provided was current as of the date of the meeting.
From January 1 through September 16, 2019, the ACSPA and its political action committee, ACSPA-SurgeonsPAC, collected $360,000 in contributions from more than 900 ACS members and staff. SurgeonsPAC also disbursed more than $300,000 to 95 congressional candidates and political campaign committees. Commensurate with congressional party ratios, 50 percent of the amount given went to Republican and 50 percent to Democratic campaigns.
The Board reviewed reports from the ACS division directors.
Convention and Meetings
The B/R approved the dates of October 30–November 4 for Clinical Congress 2033 in Boston, MA, and October 26–30 for Clinical Congress 2036 in Washington, DC.
The ACS continues to extend association management services to domestic chapters and is contracted with 10 chapters. An additional 18 clients are contracted for services.
Division of Education
The Division of Education presented the proposed program for Clinical Congress 2020 for comment and review by the B/R.
The Committee on Ethics, housed in the Division of Education, selected three recipients for the Fellowship in Surgical Ethics, which prepares surgeons for careers that combine clinical surgery with scholarly studies in surgical ethics.
Division of Member Services
A record number of Initiates—a total of 1,992, with 1,337 from the U.S. and its territories and Canada, and 655 from 73 other countries—were welcomed into the ACS at the 2019 Convocation. This year also marked the highest number of women Initiates in ACS history at 578 (29 percent of the class). Nearly 1,000 Initiates attended the Convocation. During the Convocation ceremonies, the Initiate classes of 1969 and 1994 celebrated their 50 and 25 years of Fellowship, respectively.
The B/R accepted resignations from 12 Fellows and changed the status from Active or Senior to Retired for 75 Fellows. As of September 1, 2019, the College had 81,910 members: 64,414 Fellows, 2,673 Associate Fellows, 11,120 Resident Members, 3,121 Medical Student Members, and 582 Affiliate Members.
In 2019, the Division of Member Services identified opportunities for recruitment among lapsed members in the Resident, Associate, and former Fellow categories and marketed membership to more than 4,500 former Resident Members. A marketing plan was developed for nonmember surgeons who have attended meetings, purchased products from the College, used the ACS Surgery Career Connection, or submitted an article for publication in the Journal of the American College of Surgeons (JACS). Additional efforts focused on the development of ongoing communication campaigns for graduating resident members, as well as the distribution of a survey to senior and retired Fellows to determine the types of services and resources they need from the ACS, their interest in assisting with the development of programs and resources related to preparing for retirement, and to assess their overall satisfaction.
In 2019, a series of in-person meetings with the leadership of surgical specialties was initiated to further explore opportunities for strategic alignment and collaboration on key issues affecting surgeons. The first of these meetings took place with the American Urological Association. Additional meetings are scheduled for 2020.
The ACS has 14 Advisory Councils representing every ACS specialty category. The Advisory Councils engaged in several activities in 2019, such as assisting with the review of expert witness testimony for the ACS Central Judiciary Committee, nominating members for boards and specialty review committees, recommending members to represent the ACS on specialty guidelines writing and review panels, and providing input to specialty society guidelines.
Advisory Councils submitted 123 proposals for Panel Sessions for Clinical Congress 2020. Electronic newsletters continue to be produced to communicate with specialty colleagues on ACS activities and specialty-specific issues and programming. The Advisory Council Pillars and Board of Governors (B/G) Pillars began holding joint meetings at the Leadership and Advocacy Summit and Clinical Congress to explore other opportunities for collaboration.
The Archives serves as the historical memory of the ACS by collecting and preserving inactive records of enduring value and making them available for research. In 2019, the Archives responded to 104 research requests, including eight in-person research visits. The Archives also received 35 new accessions, including records from the Division of Integrated Communications, Information Technology, College administration, Clinical Congress, scholarships, and various College committee records.
In addition to physically moving the Archives to its new space in the headquarters building, the Archives led several projects to increase the accessibility and use of the collections, including professionally photographing all of the presidential portraits. Other art and artifacts also were photographed for future use in displays.
The second Archives Fellowship was awarded in 2019 to Cynthia Tang, a PhD candidate, to conduct research on her project, An Explosion of Interest: Spreading and Controlling the Laparoscopic Revolution through Surgical Training, 1990–2000.
Members of the ACS B/G serve as the official, direct communications link between the B/R and the Fellows. The ACS has 290 Governors: 154 Governors at-Large, representing each U.S. state and Canadian province and territory; 87 specialty society Governors; and 49 international Governors.
In 2019, the B/G Executive Committee focused on three priorities: helping chapters grow membership by providing access to recruitment tools and resources, as well as establishing a competition to increase membership; increasing collaboration with ACS Divisions, Advisory Councils, B/R, and so on by holding Joint Pillar meetings with the Advisory Councils at the Leadership & Advocacy Summit and Clinical Congress, as well as expanding joint programming with the B/R for the 2019 B/G Annual Business Meeting; and strengthening communication efforts by exploring additional efforts via ACS communication vehicles.
Key projects and activities for 2019 included conducting the B/G Annual Survey on regulatory burden, surgical workforce, work-life balance, and ACS communication and representation efforts; developing a paper for JACS on perioperative pain management in the ambulatory setting; revising the ACS Statement on Patient Safety Principles for Office-Based Surgery Utilizing Moderate Sedation/Analgesia, and publishing several articles in the Bulletin on the results of the 2018 B/G Annual Survey. Educational efforts focused on the development of several joint sessions on topics, such as gender inequality, health literacy, mass casualty events, opioids, and surgical informatics for Clinical Congress 2019.
ACS chapters work with the College to provide members with benefits, such as the opportunity to network with surgical peers locally, to participate in advocacy efforts, and to offer Continuing Medical Education opportunities. Chapter Services provides guidance and assistance in these areas to the College’s 67 domestic and 47 international chapters. Several new chapters were established recently, including the South Africa Chapter in 2018 and the Iraq Chapter in 2019.
The third annual Chapter Officer Leadership Program for domestic chapter officers provided skills to help chapters build sustainable success through strong volunteer leadership. The next Chapter Officer Leadership Program is scheduled for March 28, 2020.
International Governors and chapter officers met at Clinical Congress 2019 to discuss resources available to international chapters, the new International Fellowship Applicant Interview Process, updates from ACS international regions, and best practices and success stories.
The ACS international presence continues to grow, and 2019 international Initiates comprised more than 30 percent of all new Fellows. In 2018, international efforts across the College were cataloged and the information was expanded in 2019 to coordinate international efforts across divisions, evaluate and improve current programs and services, and enhance outreach.
The ACS also updated its benchmark analysis of its international offerings against other surgical organizations. The analysis included an evaluation of requirements for Fellowship, membership benefits, dues structure, and annual meeting dates.
International scholarships and travel awards
The ACS International Relations Committee (IRC) provides scholarships to international surgeons to attend major meetings of the College. Scholars attend courses, lectures, and panel sessions, give presentations, and develop collegial networks with other Fellows. Current programs include International Guest Scholarships, Community Surgeon Travel Awards, International Surgical Education Scholarships, and International ACS National Surgical Quality Improvement Program (ACS NSQIP®) Scholarships. The College also cosponsors programs with the American Society of Breast Surgeons and the American Association for the Surgery of Trauma. The number of applicants for the International Guest Scholarship and Community Surgeon Travel Awards increased in 2019, alongside applicants’ geographic and gender diversity.
Additional emphasis on the recruitment of nonmember applicants to become Fellows is under way. The application and corresponding review portals for scholarships are being redesigned to improve user experience and overall functionality.
IPV Task Force
An Intimate Partner Violence (IPV) Task Force was formed 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, 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. Recent accomplishments include an ACS Statement on Intimate Partner Violence; articles in the Bulletin to raise awareness; an Intimate Partner Violence Toolkit; online resources on the ACS website; a case scenario in the ACS Fundamentals of Surgery Curriculum; a Town Hall Session at Clinical Congress 2018; distribution of a member survey; development of a grand rounds presentation slide set; a presentation during a Resident and Associate Society of the ACS (RAS-ACS) grand rounds webinar; and a Panel Session at Clinical Congress 2019.
Leadership & Advocacy Summit
More than 560 ACS leaders—a 6 percent increase from 2018—attended the Leadership portion of the eighth annual Leadership & Advocacy Summit. Attendees heard presentations from notable speakers in the medicine and academia on advancing your surgical career, leading and coaching for better performance, using information technology to advance patient care, avoiding error traps in mentoring, and effectively negotiating contracts.
More than 350 attendees participated in the Advocacy Summit, which focused on ACS health policy priorities, as well as the overall political environment. Panelists addressed Medicare physician reimbursement, measuring surgical quality, surprise billing, administrative burnout, and firearm injury prevention research. The program incorporated comprehensive advocacy training and legislative issue briefings in preparation for congressional visits. The 2020 Leadership & Advocacy Summit is scheduled for March 28–31 in Washington, DC.
The Military Health System Strategic Partnership ACS (MHSSPACS) was formalized in 2014 between the ACS and the U.S. Department of Defense (DOD) to share knowledge about surgical quality care, trauma systems, education and training of military surgeons, and military-relevant trauma research. With assistance from the MHSSPACS and the Division of Research and Optimal Patient Care, a system-wide Military NSQIP Consortium was formed to include all Military Treatment Facilities (MTF) in the U.S., along with a few located outside of the U.S. The surgeon champions and research staff from these MTFs meet twice a year. In conjunction with the publication of the ACS Optimal Resources for Surgical Quality and Safety manual, a prereview questionnaire was developed for quality verification and an initial site visit was conducted at Walter Reed National Military Medical Center, Bethesda, MD. Additional MTFs are undergoing consultation visits.
The Military Clinical Readiness Program (also known as the Knowledge Skills and Abilities [KSA] Project) includes all members of the combat casualty care team and has resulted in each group formulating the essential knowledge points and skill sets needed for their specialty. Among the surgical specialties, the most immediate need was to define the KSA for expeditionary surgeons. More than 500 knowledge point questions were developed based on the military’s clinical practice guidelines and actual cases performed. A beta test was distributed to 138 military surgeons with excellent results. A hands-on skills assessment course for the expeditionary surgeon was developed, including additional elements for damage control orthopaedics, neurosurgery, ophthalmology, and obstetrics. The course was offered three times in 2019. The development of an aligned multi-model curriculum is under way.
Identifying areas of trauma research relevant to combat casualty care in civilian centers is another mission of MHSSPACS. Funding was secured from the DOD/Combat Casualty Care Research Project to study post-traumatic pulmonary embolism at 17 U.S. trauma centers.
In the aftermath of Hurricane Maria in 2017, a partnership with the Puerto Rico Department of Health, Puerto Rico’s local ACS chapter, and various local nongovernmental organizations (NGOs) was established through Operation Giving Back (OGB) to provide a continuous mobilization of volunteer surgeons on a rotating, weekly basis. As of August 2019, 13 Fellows have participated in this program.
The six-month pilot of the ACS-College of Surgeons of East, Central and Southern Africa (COSECSA) Surgical Training Collaborative at Hawassa University in Ethiopia, which included two-week rotations by each of the 13 participating U.S. academic institutions, concluded in July 2019. In 2020, each institution will send a faculty member to Hawassa for a month-long rotation to enhance system and faculty capacity in the following areas: education, clinical care, research, and quality. In 2019, the ACS-COSECSA Women Scholars Program expanded to include a historic five scholarships in addition to up to 20 scholarships for women to enter specialty training tracks (three years) upon completion of their basic surgical training (two years). These awards are co-funded by the Association of Women Surgeons Foundation.
OGB presented two panel sessions at the 2019 ACS Quality and Safety Conference. The speakers discussed identifying quality indicators and research priorities in global surgery to spark future conversations on the role of quality in global health and global surgery. OGB’s volunteer database continues to grow, with 73 registered partner organizations providing ongoing volunteerism opportunities and 721 registered volunteer surgeons.
The August issue of the Bulletin featured articles written by members of the RAS-ACS on the theme of Resident Wellness and Resiliency. In the 2018–2019 academic year, the RAS JACS Journal Club hosted seven online journal clubs with more than 1 million impressions on social media. The RAS-ACS also initiated an Outstanding Mentor of the Year Award to honor mentors who have been instrumental in helping a resident become a leader in ACS. The inaugural recipient, Danielle Saunders Walsh, MD, FACS, was honored at Convocation.
The fifth annual Young Fellows Association (YFA) Advocacy Essay Contest was held to encourage and facilitate participation in the 2019 Leadership & Advocacy Summit. Communications efforts have focused on informing the membership of the benefits and value of ACS across social media channels, the quarterly YFA newsletters, collaboration with RAS on webinars, and on the ACS Communities.
YFA further enhanced the breadth of Clinical Congress proposals by partnering with numerous other ACS committees, resulting in 36 session proposals for Clinical Congress 2020. More than 60 ACS members participated in a one-hour Speed Mentoring program at Clinical Congress 2019. The YFA Annual Mentor Program, in its sixth year, is intended to better equip young surgeons for leadership positions in the College. Eight triads of Associate Fellows, young Fellows, and seasoned Fellows met at Clinical Congress 2019.
The Division of Research and Optimal Patient Care (DROPC) encompasses the areas of Continuous Quality Improvement, including ACS research and the accreditation programs.
Quality and Safety Conference
The 2019 Quality and Safety Conference focused on putting the patient first. More than 2,100 attendees participated in the conference. The keynote speaker, Rana L. Awdish, MD, shared lessons learned from being both a physician and a patient. The 2020 Conference will take place July 24–27 in Minneapolis, MN.
ACS THRIVE (Transforming Healthcare Resources to Increase Value and Efficiency) was announced at the 2019 Quality and Safety Conference. The program, a collaborative effort between the ACS and the Harvard Business School Institute for Strategy, aims to help hospitals and surgical practices improve value-based care. The program will be piloted at U.S. hospitals and will focus on measuring the full cycle of care for three surgical conditions. Once the program has defined participation criteria, the process of recruiting for the pilot phase of the project will begin.
Optimal Resources for Surgical Quality and Safety
The development of adjunctive and integrated resources/standards based on Optimal Resources for Surgical Quality and Safety is near completion. These standards will ultimately be used to launch a Surgical Quality Verification Program. Pilot site visits began with a group of targeted hospitals in the summer of 2018 and continued throughout 2019. The goal is to refine and revise the standards based on the findings from the site visits and to launch the program later this year.
A total of 852 hospitals participate in ACS NSQIP—714 in the adult option. The pediatric option represents 16 percent of overall participation. Another 22 hospitals are in various stages of the onboarding process. At present, 129 hospitals outside of the U.S. participate in ACS NSQIP—approximately 15 percent of all participating hospitals. Growth in Canada remains strong and additional sites in Australia have recently joined the program.
A total of 912 facilities participate in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), and 61 surgeon surveyors are expected to complete 275 site visits in 2020. MBSAQIP’s second national enhanced recovery initiative, Employing New Enhanced Recovery Goals to Bariatric SurgerY (E.N.E.R.G.Y.), concluded in 2018 and a publication from this work has been accepted by Surgery for Obesity and Related Diseases. MBSAQIP plans to share tools and key learnings from the project by developing an enhanced recovery toolkit, including an interactive video, as well as written materials for centers.
MBSAQIP also launched its third national collaborative project, Bariatric Surgery Targeting Opioid Prescriptions, focused on opioid reduction in bariatric surgery. Data will be collected until the conclusion of the project in 2021 and will examine centers’ practices relative to opioid use.
The Children’s Surgery Verification (CSV) Quality Improvement Program launched in 2017 with the goal of ensuring that pediatric surgical patients have access to quality care. In all, 138 centers participate in CSV. Approximately 45 of these centers are in the various stages of verification. 20 active sites are fully verified as Level I children’s surgery centers—an 81 percent increase from 2018.
GSV Quality Improvement Program
The Geriatric Surgery Verification (GSV) Quality Improvement Program was unveiled at the 2019 ACS Quality and Safety Conference. The program is composed of 30 required, and two optional, patient-centered standards designed to systematically improve surgical care and outcomes for the aging adult population. The GSV program was developed through the Coalition for Quality in Geriatric Surgery project, which took place over a four-year period and was funded by the John A. Hartford Foundation. Hospitals were able to enroll in the GSV program at Clinical Congress 2019.
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, continues to attract hospitals interested in implementing enhanced recovery practices. Approximately 60 percent of enrolled hospitals also participate in ACS NSQIP. The final cohort will launch in March 2020 with a concentration on emergency general surgery—specifically appendectomy, cholecystectomy, and laparotomy. The final cohort also will allow participating hospitals to track opioids prescribed for the ISCR patient population in the ACS data platform.
Strong for Surgery
Strong for Surgery, a joint program of the ACS and the University of Washington, Seattle, is a quality initiative 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. Since its release in 2017, Strong for Surgery has more than 500 participating sites. Newly added topics include chronic disease management, mental health, and substance abuse. Strong for Surgery is currently recruiting new sites to pilot the first phase of the new comprehensive checklists. The first phase will allow hospitals to implement the comprehensive checklists in paper form, with the goal of having a second pilot program that will be in electronic format.
The Surgeon Specific Registry (SSR) allows surgeons to track their cases, measure outcomes, and comply with changing regulatory requirements. The SSR can be used to meet the requirements of the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program Merit-based Incentive Payment System (MIPS), as well as the American Board of Surgery Continuous Certification Program requirements. The SSR was approved by CMS to provide MIPS participation through registry-based reporting for the 2019 Performance Year. Several new MIPS 2019 educational opportunities were created, including videos and online hands-on instructional guides.
The FTL100 Fundraising Campaign was established to generate financial support for 100 Future Trauma Leaders (FTL) to coincide with the 100th anniversary of the Committee on Trauma (COT) in 2022. FTL’s mission is to help foster the advancement of future leaders in trauma. The FTL aims to recruit, mentor, provide program support, and reimburse travel to various trauma meetings for eight participants annually. The COT is seeking funding from previous donors and targeted individuals, independent corporations, not-for-profit organizations, and individual trauma leader groups, with a target goal of $1 million to help support the program and make it self-sustaining.
The COT offered a Research Methods Course in 2019. Topics covered included implementation science, pragmatic and adaptive clinical trials, and patient-centered outcomes research. In partnership with the Coalition for National Trauma Research, the COT is exploring opportunities to submit grant applications to leverage the Trauma Quality Improvement Program (TQIP) infrastructure for high-quality research.
The 2019 TQIP Annual Scientific Meeting and Training took place November 16–18 and focused on error management and high-functioning teams. The keynote address was delivered by Robert Todd Maxson, MD, FACS, who spoke on his experience as a patient in the Arkansas trauma system he helped build. The Best Practice Guidelines on Non-Accidental Trauma, covering pediatric, geriatric, and IPV patients, were released at the meeting (see story, page 61).
The Stop the Bleed® (STB) program’s primary focus is to provide training in the techniques of basic bleeding control and to inform individuals of the importance of learning the skills to become immediate responders in the event of a bleeding emergency. STB’s goal is to train 200 million immediate responders. The STB initiative continues to grow exponentially, and through strategic partnerships with National Stop the Bleed Month, National Stop the Bleed Day, and the American College of Emergency Physicians awareness of STB has increased and has led to a dramatic increase in registered instructors and courses. As of September 13, 2019, STB had registered more than 62,000 classes, approved more than 60,000 instructors, and combined created training for more than 1 million individuals worldwide. A redesigned public-facing website debuted this fall to better focus on the general public.
The ACS Foundation remains focused on securing and growing financial support for the College’s charitable, educational, and patient-focused initiatives. In fiscal year (FY) 2019, the number of individual contributors to the Foundation increased by 14 percent from FY 2018. The annual Fall Appeal generated $147,481, a 21.5 percent increase from FY 2018, including a 17.3 percent increase in individual donor numbers. National Doctors’ Day donations also have experienced strong growth, with contributions increasing 433 percent since its inception in 2016.
The Foundation continues to build its portfolio of projects and initiatives to create a broader menu of giving opportunities.
OGB, STB training in rural communities, international scholarship travel awards, fellowship research awards, and the ACS Greatest Needs Fund continue to be supported by generous philanthropic gifts from Fellows.