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ABS News, the official newsletter of the American Board of Surgery, is published and mailed annually to inform diplomates and training programs about ABS activities and issues related to board certification.
ABS News - 2014 (pdf)
It is an honor to serve as chair of the American Board of Surgery (ABS) during a pivotal time in American surgery. I started my year as chair with two goals in mind — working to elevate general surgery training and making Maintenance of Certification (MOC) a more diplomate-centric program.
General surgery training in the United States has a well-established history of producing some of the finest surgeons in the world. Over the last quarter century, however, many factors, including dramatic advances in technology, the 80-hour workweek, changes in disease management, a greater focus on quality and safety in surgical outcomes, and an explosion in surgical subspecialization have all had a significant impact on the residency experience in surgery. In addition, several studies have suggested that residency graduates are perhaps less prepared for independent practice today than in the past (Mattar et al 2012, Lewis et al 2012, Sandhu et al 2015). These factors, coupled with a greater focus on competency-based training and assessment in undergraduate medical education and residency training, have reinforced the need to redesign surgical education in this country.
These issues have been brought to the forefront before, most notably in 2004 through the work of the American Surgical Association's Blue Ribbon Committee. While several discussions regarding surgical training redesign have occurred within the American Board of Surgery over the last 15 years, until now they have not achieved consensus as to the need for change and the direction of change required. The ABS directors, representing the breadth of general surgery, are in agreement that now is the time to move forward. The challenges are significant and the issues are complex, but can be overcome with deliberate thought, a collaborative mindset, and a clearly defined process for managing such an undertaking.
Over the last 24 months, the ABS has begun gathering stakeholder perspectives, gaining greater insights into innovative surgical education models (such as those of the Royal College of Physicians and Surgeons of Canada), and establishing the momentum to move such an endeavor forward. Several steps have already been taken that provide foundational elements for this redesign effort, such as the implementation of the Milestones Project by the Accreditation Council for Graduate Medical Education (ACGME), the efforts of the Surgical Council on Resident Education (SCORE) to establish a national curriculum for general surgery training, and the requirements put in place by the ABS over the last several years for the assessment of residents' operative skills and performance while in training.
With these elements in place, we can build on this foundation with competency-based training and assessment tools to enhance the effectiveness and efficiency of surgical training, with a structure that encourages learner-dependent education and skill acquisition, as well as greater operative experience. However the ABS does not intend to act alone in this effort. This educational re-engineering will require input and collaboration from all major stakeholders in U.S. surgical education as it moves forward.
Another key priority of the ABS directors is the development of our Maintenance of Certification program to better meet the needs of our diplomates. The goal of the ABS MOC Program is to set a surgeon-defined, national standard for what surgeons should be doing to stay up to date and improve their practice. That said, we are aware that further development of the program is necessary so that it is viewed by diplomates as truly adding value, rather than just another "hoop."
We created our current MOC program with the intent of making it as flexible as possible so surgeons can fulfill its requirements in ways most suited to their practice. We will continue the development of MOC in this vein — the ABS directors are seeking to elevate the program so it builds upon what surgeons are doing every day in their practice, with independent, self-directed, lifelong learning. Toward this end, we will be soliciting ideas and suggestions from diplomates to make MOC as meaningful and user-friendly as possible.
We are examining all aspects of the ABS MOC Program this year, with a special focus on Part 3 (Cognitive Expertise) and Part 4 (Evaluation of Performance in Practice). For example, for Part 3, is an exam every 10 years the optimal way to assess a surgeon's cognitive knowledge and judgment? For Part 4, what should be considered as counting toward this requirement, and how do we capture diplomates' efforts? In addition, for MOC Part 2 (Lifelong Learning and Self-Assessment), are there ways we can facilitate diplomates' access to meaningful CME and self-assessment programs?
The ABS MOC Program allows diplomates to formally demonstrate their commitment to lifelong learning and practice improvement. We are committed to improving MOC so it better serves diplomates as well as patients.
The American public expects and deserves the finest surgical care we can offer. The ABS was founded in 1937 to "improve the specialty and protect the public." Both of the initiatives I have described reflect this purpose. As chair and fellow diplomate, I thank you for your dedication to ABS certification and welcome your thoughts as our work continues.