American Board of Surgery - Southwestern Surgical Congress
American Board of Surgery
Meeting Summary
January 7-11, 2012
Introduction
The American Board of Surgery held its winter meeting for the first time in a cold location, at Jackson Hole, Wyoming. Although snow has been sparse in the Rockies this year, an 18” snowfall the week before the meeting provided acceptable conditions for the skiers present. Dr. Stan Ashley, our current Chair, presided. This was the first meeting conducted with the new format, beginning on Saturday afternoon with examination committee meetings, and with advisory councils/component boards beginning their meetings on Sunday afternoon. It worked well, and provided for more efficient use of advisory council members’ time, as well as resolving previous conflicts between standing committees and component boards.
Retreat – Reentry into Clinical Practice
A retreat was held on Sunday from 8:00am-1:00pm to examine the issue of reentry into practice for surgeons who have taken time off from practice, either voluntarily or involuntarily, after completion of training. The number of surgeons seeking reentry has increased in recent years, and no clear guidelines exist for the various circumstances which arise. The Board felt it needed to examine the issues thoroughly and begin crafting policies to deal with these. The principal categories creating the need for reentry are (1) voluntary absences taken for family or professional reasons, (2) involuntary absences for health reasons, and (3) involuntary absences for disciplinary or professional reasons. Periods of absence range from a few months to multiple years. Many factors have to be considered in determining what is necessary for reentry; among these are: extent of basic residency training; number of years and breadth after residency before leaving practice; number of years out of practice, and nature of work during the absence; intended type of practice after return; setting in which practice is to take place after return; and availability of professional collaboration or support after reentry. Excellent presentations were given by Elizabeth Grace, M.D., of the Center for Personalized Education for Physicians in Colorado; Roberta Lilly, M.D., a transplant surgeon who has just gone through a reentry process after approximately 12 years away from practice; Kevin Behrns, M.D., Chair of the Department of Surgery in Gainesville and a new ABS director; as well as ABS directors Stan Ashley, M.D., and Rick Thirlby, M.D., and Jo Buyske, M.D., the Associate Executive Director.
Final guidelines are in preparation, but the Board felt that the MOC process could be adapted to the development of reentry plans for diplomates, and that an individual remediation/proctoring plan would be needed which was customized for each diplomate seeking reentry. It was agreed that such a plan was needed for anyone who had been out of practice more than 24 months, and that the primary goal of such plans was to protect patients and ensure the competence of the reentering surgeon in whatever area they planned to practice.
Surgical Critical Care Certification for ABEM Diplomates
ABS directors voted at the January meeting to begin certifying American Board of Emergency Medicine diplomates in surgical critical care as soon as it is approved by the American Board of Medical Specialties. Discussions between ABS and ABEM have been ongoing for five years around this issue, and were resolved this past year by the agreement of ABEM that their diplomates would take a year of customized surgical residency training to become familiar with surgical management issues in complex surgical patients prior to undertaking the surgical critical care fellowship. Thus, ABEM diplomates who wish to undertake this would need two years of training, the second an accredited year of SCC fellowship, and upon successful completion of the SCC Certifying Examination, would be certified by the ABS in Surgical Critical Care. There has been skepticism among directors in the past regarding the ability of ABEM diplomates, who often have little formal surgical training, to understand and manage surgical patients in a critical care environment. However, significant experience over the last decade at three different institutions has now been generated with the training of ABEM diplomates in surgical critical care, and is universally positive. Members of the Trauma, Burns, Critical Care Board met with representatives of ABEM in December to agree on the specifics of the additional year training which would be necessary, and it was agreed that this training would have to be done in the same institution where the SCC fellowship is to be served. These agreements were accepted by the full Board at the January meeting. The agreement now has to go before the ABMS at their April meeting and be approved by the Assembly in order to be implemented. As with the recent certificate in Advanced General Surgical Oncology which was approved by the ABS, the Board did not approve any grandfathering for certification of ABEM diplomates in SCC, so only those who complete fellowships after the approval process will be eligible for certification.
Advanced General Surgical Oncology Certificate
Approval by the ACGME of training programs for the Advanced General Surgical Oncology certificate is in process, and it is anticipated it will be approved by the ACGME board at the June meeting of that group. Following that, site visits for accreditation of training programs will begin and it is anticipated some number of these will be completed in 2012-13. Since there is no grandfathering for this certificate, only surgeons who are fellows in these programs at the time of accreditation will be eligible to enter the certification process. The Surgical Oncology Board of the ABS, under the direction of Dr. Fabrizio Michelassi, has begun work on the development of the written and oral examinations which will be used for certification in this new subspecialty area.
SCORE Website Update
All residency programs which previously subscribed to SCORE renewed their yearly subscriptions during the summer, and the participation stands at 92% of all ACGME surgical residencies. In addition several Canadian surgical programs have subscribed during the last year, as well as a majority of the osteopathic surgical residencies. Dr. Mary Klingensmith and the Editorial Board of SCORE are in the process of adding approximately 120 new modules of higher level content to SCORE from the focused diagnosis and complex surgical categories. This will bring the total number of modules up to approximately 500. In addition, the ABS has contracted with a new vendor to develop a more advanced platform for SCORE, which will significantly simplify the process of adding and editing modules, and will also provide a number of advanced features for the user, including the use of the website on hand-held devices. It is anticipated that the new platform will be operational by October 2012, and the transition will be made shortly after this.
New Directors
Nominees to replace seven directors from sponsoring societies whose terms expire in June were discussed at the January meeting, and the new directors for each were selected by secret ballot following the meeting. In addition, the nomination process for the at-large director to replace Dr. Nathalie Johnson was concluded, and four finalists were presented to the full Board; one of these was also elected in the ballot process. (It should be noted that 67 nominations were submitted for the vacant at-large position, and the selection process for these was carried out by the Executive Committee during the fall, with the vote on the final four by the full Board.) The directors elected are the following:
American Association for the Surgery of Trauma
Martin A. Croce, M.D.
American College of Surgeons
Margaret (Margo) C. Shoup, M.D.
American Surgical Association
Karen J. Brasel, M.D.
Association for Academic Surgery
Fizan Abdullah, M.D.
Association of Pediatric Surgery Training Program Directors
Kenneth S. Azarow, M.D.
Central Surgical Association
Christopher R. McHenry, M.D.
New England Surgical Society
James F. Whiting, M.D.
At-Large Director
Tyler G. Hughes, M.D.
AMERICAN BOARD OF SURGERY
SUMMARY OF 2011 EXAMINATIONS
| |# of |# |# |Pass |Fail |Total # |
|Examination |Examinees |Pass |Fail |Rate |Rate |Diplomates |
| | | | | | | |
|Qualifying |1, 378 |1100 |278 |79.8% |20.2% | |
| | | | | | | |
|Recertification |1,895 |1,805 |90 |95.3% |4.7% |20,845 |
| | | | | | | |
|Vascular Surgery QE |146 |142 |4 |97.3% |2.7% | |
| |186 |174 |12 |93.6% |6.4% |1,946 |
|Vascular Surgery Rct. | | | | | | |
|Surgical Principles Exam |21 |13 |8 |61.9% |38.1% | |
| | | | | | | |
|Surgical Critical Care |161 |150 |11 |93.2% |6.8% |2,963 |
| | | | | | | |
|SCC Recertification |186 |174 |12 |93.6% |6.4% |1,407 |
| | | | | | | |
|Pediatric Surgery QE |48 |44 |4 |91.7% |8.3% | |
| |87 |82 |5 |94.3% |5.8% |768 |
|Pediatric Surgery Rct. | | | | | | |
|Hand Surgery |10 |7 |3 |70.0% |30.0% |267 |
| | | | | | | |
|Hand Surgery Recert. |10 |9 |1 |90.0% |10.0% |152 |
| | | | | | | |
|Hospice & Palliative Care* |21 |16 |5 |76.2% |23.8% |25 |
| | | | | | | |
|Vascular Surgery ITE |322 |--- |--- |N.A. |N.A. | |
| | | | | | | |
|Pediatric Surgery ITE |100 |--- |--- |N.A. |N.A. | |
| | | | | | | |
|ITE – Junior Level |3,958 |--- |--- |N.A. |N.A. | |
| | | | | | | |
|ITE – Senior Level |3,815 |--- |--- |N.A. |N.A. | |
| | | | | | | |
|ITE – International |198 |--- |--- |N.A. |N.A. | |
| | | | | | | |
|Certifying** |1,128 |863 |265 |76.5% |23.5% |56,997 |
| | | | | | | |
|Vascular Surgery CE |129 |108 |21 |83.7% |16.3% |3,104 |
| | | | | | | |
|Pediatric Surgery CE |30 |26 |4 |86.7% |13.3% |1,156 |
| | | | | | | |
|TOTAL |13,829 | | | | | |
N.A. = Not applicable.
5,436 examinees, excluding the ITE, VSITE and PSITE.
*2010 Hospice/Palliative Care examination
**Certifying Examination totals for 2010-2011 academic year.
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