News From the College

Approximately 300 surgeons and surgical residents participated in the advocacy portion of the 2016 American College of Surgeons (ACS) Leadership & Advocacy Summit. The event provided participants with an opportunity to develop their advocacy skills, learn about legislative and health policy priorities, and advocate in meetings with members of Congress and their staffs.

Surgeons asked lawmakers to use their oversight authority to encourage the Centers for Medicare & Medicaid Services to adopt meaningful quality measures, and physician-developed Alternative Payment Models. ACS members also asked their elected officials to support the Responsible Data Transparency Act, legislation that is being developed by Rep. Bill Flores (R-Tex.). The College is committed to maintaining transparency in the Medicare system to promote high-quality patient care. At issue, however, are third-party groups that are evading established, accurate, valid, and transparent pathways to sensitive Medicare data by using Freedom of Information Act requests to obtain raw physician claims data. This legislation would prevent groups from using questionable, non–risk-adjusted methodologies to conduct performance analyses and publish potentially misleading physician performance ratings on public websites.

Other issues discussed at the Capitol Hill meetings include promotion of the Ensuring Access to General Surgery Act of 2016, legislation being developed that would require that a study be conducted to designate general surgery Health Professional Shortage Areas (HPSAs); cancer-related concerns, including education on the importance of Commission on Cancer accreditation; and improved access to trauma care. Details about the ACS Leadership & Advocacy Summit will be published in the May SurgeonsVoice Monthly and the July issue of the Bulletin at http://bulletin.facs.org/.

Approximately 300 surgeons and surgical residents participated in the advocacy portion of the 2016 American College of Surgeons (ACS) Leadership & Advocacy Summit. The event provided participants with an opportunity to develop their advocacy skills, learn about legislative and health policy priorities, and advocate in meetings with members of Congress and their staffs.

Surgeons asked lawmakers to use their oversight authority to encourage the Centers for Medicare & Medicaid Services to adopt meaningful quality measures, and physician-developed Alternative Payment Models. ACS members also asked their elected officials to support the Responsible Data Transparency Act, legislation that is being developed by Rep. Bill Flores (R-Tex.). The College is committed to maintaining transparency in the Medicare system to promote high-quality patient care. At issue, however, are third-party groups that are evading established, accurate, valid, and transparent pathways to sensitive Medicare data by using Freedom of Information Act requests to obtain raw physician claims data. This legislation would prevent groups from using questionable, non–risk-adjusted methodologies to conduct performance analyses and publish potentially misleading physician performance ratings on public websites.

Other issues discussed at the Capitol Hill meetings include promotion of the Ensuring Access to General Surgery Act of 2016, legislation being developed that would require that a study be conducted to designate general surgery Health Professional Shortage Areas (HPSAs); cancer-related concerns, including education on the importance of Commission on Cancer accreditation; and improved access to trauma care. Details about the ACS Leadership & Advocacy Summit will be published in the May SurgeonsVoice Monthly and the July issue of the Bulletin at http://bulletin.facs.org/.

Approximately 300 surgeons and surgical residents participated in the advocacy portion of the 2016 American College of Surgeons (ACS) Leadership & Advocacy Summit. The event provided participants with an opportunity to develop their advocacy skills, learn about legislative and health policy priorities, and advocate in meetings with members of Congress and their staffs.

Surgeons asked lawmakers to use their oversight authority to encourage the Centers for Medicare & Medicaid Services to adopt meaningful quality measures, and physician-developed Alternative Payment Models. ACS members also asked their elected officials to support the Responsible Data Transparency Act, legislation that is being developed by Rep. Bill Flores (R-Tex.). The College is committed to maintaining transparency in the Medicare system to promote high-quality patient care. At issue, however, are third-party groups that are evading established, accurate, valid, and transparent pathways to sensitive Medicare data by using Freedom of Information Act requests to obtain raw physician claims data. This legislation would prevent groups from using questionable, non–risk-adjusted methodologies to conduct performance analyses and publish potentially misleading physician performance ratings on public websites.

Other issues discussed at the Capitol Hill meetings include promotion of the Ensuring Access to General Surgery Act of 2016, legislation being developed that would require that a study be conducted to designate general surgery Health Professional Shortage Areas (HPSAs); cancer-related concerns, including education on the importance of Commission on Cancer accreditation; and improved access to trauma care. Details about the ACS Leadership & Advocacy Summit will be published in the May SurgeonsVoice Monthly and the July issue of the Bulletin at http://bulletin.facs.org/.

Save the date for the American College of Surgeons Clinical Congress 2016, October 16−20 in Washington, DC, at the Walter E. Washington Convention Center. The Marriot Marquis Washington, DC, located next to the convention center, will serve as the headquarters hotel.

The theme of this year’s meeting, Challenges for the Second Century, recognizes the College’s second 100 years of ensuring quality surgical patient care. Clinical Congress 2016 will present hundreds of educational sessions, including Panel Sessions, Postgraduate Didactic and Skills-Oriented Courses, Meet-the-Expert Luncheons, Names Lectures, Scientific Paper Sessions, and Poster Presentations. View an ACS press release at https://www.facs.org/media/press-releases/2016/clincon0316#sthash.SnHNsOJB.dpuf for more information on Clinical Congress 2016.

Save the date for the American College of Surgeons Clinical Congress 2016, October 16−20 in Washington, DC, at the Walter E. Washington Convention Center. The Marriot Marquis Washington, DC, located next to the convention center, will serve as the headquarters hotel.

The theme of this year’s meeting, Challenges for the Second Century, recognizes the College’s second 100 years of ensuring quality surgical patient care. Clinical Congress 2016 will present hundreds of educational sessions, including Panel Sessions, Postgraduate Didactic and Skills-Oriented Courses, Meet-the-Expert Luncheons, Names Lectures, Scientific Paper Sessions, and Poster Presentations. View an ACS press release at https://www.facs.org/media/press-releases/2016/clincon0316#sthash.SnHNsOJB.dpuf for more information on Clinical Congress 2016.

Save the date for the American College of Surgeons Clinical Congress 2016, October 16−20 in Washington, DC, at the Walter E. Washington Convention Center. The Marriot Marquis Washington, DC, located next to the convention center, will serve as the headquarters hotel.

The theme of this year’s meeting, Challenges for the Second Century, recognizes the College’s second 100 years of ensuring quality surgical patient care. Clinical Congress 2016 will present hundreds of educational sessions, including Panel Sessions, Postgraduate Didactic and Skills-Oriented Courses, Meet-the-Expert Luncheons, Names Lectures, Scientific Paper Sessions, and Poster Presentations. View an ACS press release at https://www.facs.org/media/press-releases/2016/clincon0316#sthash.SnHNsOJB.dpuf for more information on Clinical Congress 2016.

An article in the March 16 issue of JAMA Surgery summarizes the research and funding priorities for addressing health care disparities in the United States, which were identified at the inaugural National Institutes of Health (NIH)–American College of Surgeons (ACS) Symposium on Surgical Disparities Research.¹ The ACS and the National Institute on Minority Health and Disparities (NIMHD) cohosted the conference, which took place in May 2015 at the NIH campus, Bethesda, MD.²

“The goal of the symposium was to create a national research agenda that could be used to prioritize funding for research. We conducted an extensive literature review of existing research, organized the results by theme, and asked attendees to identify what they saw as the top priorities for each theme,” said Adil Haider, MD, MPH, FACS. Dr. Haider is the lead author of the JAMA Surgery article; Vice-Chair, ACS Committee on Health Care Disparities; and Kessler Director, Center for Surgery and Public Health, a joint initiative of Brigham and Women’s Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health, Boston.

Defining themes and priorities

The themes discussed at the symposium were as follows: patient and host factors, systemic factors and access issues, clinical care and quality, provider factors, and postoperative care and rehabilitation. The leading research and funding priorities – identified by the more than 60 researchers, surgeon-scientists, and federal leaders who attended the symposium, and articulated in the JAMA Surgery article – are as follows:

• Improve patient-provider communication by teaching providers to deliver culturally dexterous care and measuring its impact on elimination of surgical disparities.

• Foster engagement and community outreach and use technology to optimize patient education, health literacy, and shared decision making in a culturally relevant way; disseminate these techniques; and evaluate their impact on reducing surgical disparities.

• Evaluate regionalization of care versus strengthening safety-net hospitals within the context of differential access and surgical disparities.

• Gauge the long-term impact of intervention and rehabilitation support within the critical period on functional outcomes and patient-defined perceptions of quality of life.

• Improve patient engagement and identify patient expectations for postoperative and postinjury recovery, as well as their values regarding advanced health care planning and palliative care.

The authors of the JAMA Surgery article concluded that “The NIH-ACS Symposium on Surgical Disparities Research succeeded in identifying a comprehensive research agenda.” In particular, they noted that future research is needed in the areas of patients’ perspectives, workforce diversification and training, and systematic evaluation of health technologies to reduce surgical disparities. Within the context of the larger literature focused on disparity-related research, results also call for ongoing evaluation of evidence-based practice, rigorous research methodologies, incentives for standardization of care, and building on existing infrastructure to support these advances.

Just the beginning

The ACS is “confident that this is just the beginning of a much larger effort and hopeful that the National Institutes of Health and the NIMHD will continue to work with the ACS to build upon the foundation that was set during the symposium by establishing a funding stream to support this important research. Together, we can foster systemic change, effectively eliminating surgical and other health care disparities,” said L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), ACS Past-President and Chair, ACS Committee on Health Care Disparities. Dr. Britt is the Brickhouse Professor of Surgery, Eastern Virginia Medical School, Norfolk, and played a critical role in the creation of the committee and in defining the committee’s deliverables, which included a national symposium.

1. Haider AH, Dankwa-Mullan I, Maragh-Bass, et al. Setting a national agenda for surgical disparities research: Recommendations from the National Institutes of Health and American College of Surgeons Summit. JAMA Surg. March 16, 2016. Available at http://archsurg.jamanetwork.com/article.aspx?articleid=2503437. Accessed March 28, 2016.

2. Schneidman D. No quality without access: ACS and NIH collaborate to ensure access to optimal care. Bull Am Coll Surg. 2015;100(8):52-62. Available at: bulletin.facs.org/2015/08/no-quality-without-access-acs-and-nih-collaborate-to-ensure-access-to-optimal-care. Accessed March 28, 2016.

An article in the March 16 issue of JAMA Surgery summarizes the research and funding priorities for addressing health care disparities in the United States, which were identified at the inaugural National Institutes of Health (NIH)–American College of Surgeons (ACS) Symposium on Surgical Disparities Research.¹ The ACS and the National Institute on Minority Health and Disparities (NIMHD) cohosted the conference, which took place in May 2015 at the NIH campus, Bethesda, MD.²

“The goal of the symposium was to create a national research agenda that could be used to prioritize funding for research. We conducted an extensive literature review of existing research, organized the results by theme, and asked attendees to identify what they saw as the top priorities for each theme,” said Adil Haider, MD, MPH, FACS. Dr. Haider is the lead author of the JAMA Surgery article; Vice-Chair, ACS Committee on Health Care Disparities; and Kessler Director, Center for Surgery and Public Health, a joint initiative of Brigham and Women’s Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health, Boston.

Defining themes and priorities

The themes discussed at the symposium were as follows: patient and host factors, systemic factors and access issues, clinical care and quality, provider factors, and postoperative care and rehabilitation. The leading research and funding priorities – identified by the more than 60 researchers, surgeon-scientists, and federal leaders who attended the symposium, and articulated in the JAMA Surgery article – are as follows:

• Improve patient-provider communication by teaching providers to deliver culturally dexterous care and measuring its impact on elimination of surgical disparities.

• Foster engagement and community outreach and use technology to optimize patient education, health literacy, and shared decision making in a culturally relevant way; disseminate these techniques; and evaluate their impact on reducing surgical disparities.

• Evaluate regionalization of care versus strengthening safety-net hospitals within the context of differential access and surgical disparities.

• Gauge the long-term impact of intervention and rehabilitation support within the critical period on functional outcomes and patient-defined perceptions of quality of life.

• Improve patient engagement and identify patient expectations for postoperative and postinjury recovery, as well as their values regarding advanced health care planning and palliative care.

The authors of the JAMA Surgery article concluded that “The NIH-ACS Symposium on Surgical Disparities Research succeeded in identifying a comprehensive research agenda.” In particular, they noted that future research is needed in the areas of patients’ perspectives, workforce diversification and training, and systematic evaluation of health technologies to reduce surgical disparities. Within the context of the larger literature focused on disparity-related research, results also call for ongoing evaluation of evidence-based practice, rigorous research methodologies, incentives for standardization of care, and building on existing infrastructure to support these advances.

Just the beginning

The ACS is “confident that this is just the beginning of a much larger effort and hopeful that the National Institutes of Health and the NIMHD will continue to work with the ACS to build upon the foundation that was set during the symposium by establishing a funding stream to support this important research. Together, we can foster systemic change, effectively eliminating surgical and other health care disparities,” said L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), ACS Past-President and Chair, ACS Committee on Health Care Disparities. Dr. Britt is the Brickhouse Professor of Surgery, Eastern Virginia Medical School, Norfolk, and played a critical role in the creation of the committee and in defining the committee’s deliverables, which included a national symposium.

1. Haider AH, Dankwa-Mullan I, Maragh-Bass, et al. Setting a national agenda for surgical disparities research: Recommendations from the National Institutes of Health and American College of Surgeons Summit. JAMA Surg. March 16, 2016. Available at http://archsurg.jamanetwork.com/article.aspx?articleid=2503437. Accessed March 28, 2016.

2. Schneidman D. No quality without access: ACS and NIH collaborate to ensure access to optimal care. Bull Am Coll Surg. 2015;100(8):52-62. Available at: bulletin.facs.org/2015/08/no-quality-without-access-acs-and-nih-collaborate-to-ensure-access-to-optimal-care. Accessed March 28, 2016.

An article in the March 16 issue of JAMA Surgery summarizes the research and funding priorities for addressing health care disparities in the United States, which were identified at the inaugural National Institutes of Health (NIH)–American College of Surgeons (ACS) Symposium on Surgical Disparities Research.¹ The ACS and the National Institute on Minority Health and Disparities (NIMHD) cohosted the conference, which took place in May 2015 at the NIH campus, Bethesda, MD.²

“The goal of the symposium was to create a national research agenda that could be used to prioritize funding for research. We conducted an extensive literature review of existing research, organized the results by theme, and asked attendees to identify what they saw as the top priorities for each theme,” said Adil Haider, MD, MPH, FACS. Dr. Haider is the lead author of the JAMA Surgery article; Vice-Chair, ACS Committee on Health Care Disparities; and Kessler Director, Center for Surgery and Public Health, a joint initiative of Brigham and Women’s Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health, Boston.

Defining themes and priorities

The themes discussed at the symposium were as follows: patient and host factors, systemic factors and access issues, clinical care and quality, provider factors, and postoperative care and rehabilitation. The leading research and funding priorities – identified by the more than 60 researchers, surgeon-scientists, and federal leaders who attended the symposium, and articulated in the JAMA Surgery article – are as follows:

• Improve patient-provider communication by teaching providers to deliver culturally dexterous care and measuring its impact on elimination of surgical disparities.

• Foster engagement and community outreach and use technology to optimize patient education, health literacy, and shared decision making in a culturally relevant way; disseminate these techniques; and evaluate their impact on reducing surgical disparities.

• Evaluate regionalization of care versus strengthening safety-net hospitals within the context of differential access and surgical disparities.

• Gauge the long-term impact of intervention and rehabilitation support within the critical period on functional outcomes and patient-defined perceptions of quality of life.

• Improve patient engagement and identify patient expectations for postoperative and postinjury recovery, as well as their values regarding advanced health care planning and palliative care.

The authors of the JAMA Surgery article concluded that “The NIH-ACS Symposium on Surgical Disparities Research succeeded in identifying a comprehensive research agenda.” In particular, they noted that future research is needed in the areas of patients’ perspectives, workforce diversification and training, and systematic evaluation of health technologies to reduce surgical disparities. Within the context of the larger literature focused on disparity-related research, results also call for ongoing evaluation of evidence-based practice, rigorous research methodologies, incentives for standardization of care, and building on existing infrastructure to support these advances.

Just the beginning

The ACS is “confident that this is just the beginning of a much larger effort and hopeful that the National Institutes of Health and the NIMHD will continue to work with the ACS to build upon the foundation that was set during the symposium by establishing a funding stream to support this important research. Together, we can foster systemic change, effectively eliminating surgical and other health care disparities,” said L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), ACS Past-President and Chair, ACS Committee on Health Care Disparities. Dr. Britt is the Brickhouse Professor of Surgery, Eastern Virginia Medical School, Norfolk, and played a critical role in the creation of the committee and in defining the committee’s deliverables, which included a national symposium.

1. Haider AH, Dankwa-Mullan I, Maragh-Bass, et al. Setting a national agenda for surgical disparities research: Recommendations from the National Institutes of Health and American College of Surgeons Summit. JAMA Surg. March 16, 2016. Available at http://archsurg.jamanetwork.com/article.aspx?articleid=2503437. Accessed March 28, 2016.

2. Schneidman D. No quality without access: ACS and NIH collaborate to ensure access to optimal care. Bull Am Coll Surg. 2015;100(8):52-62. Available at: bulletin.facs.org/2015/08/no-quality-without-access-acs-and-nih-collaborate-to-ensure-access-to-optimal-care. Accessed March 28, 2016.

The American College of Surgeons (ACS) is now accepting applications for the 2016 Claude H. Organ, Jr., MD, FACS, Traveling Fellowship. The deadline for all application materials is June 1.

The family and friends of the late Dr. Organ established an endowment through the ACS Foundation to provide funding for this fellowship, which is awarded annually to an outstanding young surgeon from the Society of Black Academic Surgeons, the Association of Women Surgeons, or the Surgical Section of the National Medical Association. The fellowship, in the amount of $5,000, enables a U.S. or Canadian Fellow or Associate Fellow younger than age 45 who is a member of one of these societies to attend an educational meeting or participate in an extended visit to an institution of his or her choice, tailored to his or her research interests.

Past awardees have used their fellowships to develop their careers in creative ways. The most recent fellow, Kathie-Ann Joseph, MD, MPH, FACS, associate professor of surgery, New York University School of Medicine, and chief of surgery, Bellevue Hospital Center, New York, NY, is researching how health care systems work in a major metropolitan area, with a focus on the ways that large hospitals systems manage care for underserved women.

The full requirements for the Claude H. Organ, Jr., MD, FACS, Traveling Fellowship are posted at facs.org/member-services/scholarships/special/organ. The 2016 awardee will be informed of the College’s decision by August 2016. Questions and application materials should be submitted to the attention of Kate Early, ACS Scholarships Administrator, at [email protected].

The American College of Surgeons (ACS) is now accepting applications for the 2016 Claude H. Organ, Jr., MD, FACS, Traveling Fellowship. The deadline for all application materials is June 1.

The family and friends of the late Dr. Organ established an endowment through the ACS Foundation to provide funding for this fellowship, which is awarded annually to an outstanding young surgeon from the Society of Black Academic Surgeons, the Association of Women Surgeons, or the Surgical Section of the National Medical Association. The fellowship, in the amount of $5,000, enables a U.S. or Canadian Fellow or Associate Fellow younger than age 45 who is a member of one of these societies to attend an educational meeting or participate in an extended visit to an institution of his or her choice, tailored to his or her research interests.

Past awardees have used their fellowships to develop their careers in creative ways. The most recent fellow, Kathie-Ann Joseph, MD, MPH, FACS, associate professor of surgery, New York University School of Medicine, and chief of surgery, Bellevue Hospital Center, New York, NY, is researching how health care systems work in a major metropolitan area, with a focus on the ways that large hospitals systems manage care for underserved women.

The full requirements for the Claude H. Organ, Jr., MD, FACS, Traveling Fellowship are posted at facs.org/member-services/scholarships/special/organ. The 2016 awardee will be informed of the College’s decision by August 2016. Questions and application materials should be submitted to the attention of Kate Early, ACS Scholarships Administrator, at [email protected].

The American College of Surgeons (ACS) is now accepting applications for the 2016 Claude H. Organ, Jr., MD, FACS, Traveling Fellowship. The deadline for all application materials is June 1.

The family and friends of the late Dr. Organ established an endowment through the ACS Foundation to provide funding for this fellowship, which is awarded annually to an outstanding young surgeon from the Society of Black Academic Surgeons, the Association of Women Surgeons, or the Surgical Section of the National Medical Association. The fellowship, in the amount of $5,000, enables a U.S. or Canadian Fellow or Associate Fellow younger than age 45 who is a member of one of these societies to attend an educational meeting or participate in an extended visit to an institution of his or her choice, tailored to his or her research interests.

Past awardees have used their fellowships to develop their careers in creative ways. The most recent fellow, Kathie-Ann Joseph, MD, MPH, FACS, associate professor of surgery, New York University School of Medicine, and chief of surgery, Bellevue Hospital Center, New York, NY, is researching how health care systems work in a major metropolitan area, with a focus on the ways that large hospitals systems manage care for underserved women.

The full requirements for the Claude H. Organ, Jr., MD, FACS, Traveling Fellowship are posted at facs.org/member-services/scholarships/special/organ. The 2016 awardee will be informed of the College’s decision by August 2016. Questions and application materials should be submitted to the attention of Kate Early, ACS Scholarships Administrator, at [email protected].

HOLLYWOOD, FLA. – The National Comprehensive Cancer Network has issued new guidelines for the diagnosis and management of vulvar cancer.

Vulvar cancers are rare neoplasms, with an estimated U.S. annual incidence of 5,950 cases, and 1,110 deaths. The majority of cases (about 90%) are of squamous cell histology.

Treatment of vulvar cancer has evolved from en bloc resections used throughout most of the 20th century, to more refined techniques, said Dr. Benjamin E. Greer, professor of gynecological oncology at the University of Washington in Seattle.

“In the 1980s, we started to modify treatment to reduce morbidity,” he said at the annual conference of the National Comprehensive Cancer Network.

With older, more radical techniques, groin breakdown, leg edema, and impaired sexual function were common post-surgery consequences. Current practice, however, is to perform regional lymph node management for unilateral cancers, radical local excision rather than en bloc resections, separate groin incisions, lymphatic mapping, radiation, chemotherapy, and, if necessary, exenteration, Dr. Greer noted.

The guidelines note that adequate surgical margins – 1 to 2 cm – at the time of primary surgery appear to be essential for reducing risk of local recurrence, and that if margins are within 8 mm of tumor, the surgeon should consider re-excision or adjuvant radiation.

Lymph node status is the most important determinant of survival, with historical reports showing overall survival following surgery of 70% to 80% among patients with negative nodes, compared with 30% to 40% of those with positive nodes, he said.

Evaluation of bilateral inguinofemoral groin nodes should be performed in patients with lesions in the vulvar midline, and ipsilateral groin node evaluation should be performed for those with lateral lesions lying more than 2 cm from the vulvar midline. Additionally, select patients may require sentinel lymph node biopsy, the guidelines state.

Unilateral carcinomas of the vulva can be treated with limited radical vulvectomy and ipsilateral inguinal femoral node dissection. Lymph node dissection can be performed through a separate incision. For patients with positive nodes, adjuvant radiation may aid in disease control. Patients with inoperable carcinomas are recommended to receive radiation and chemotherapy.

Radiation for vulvar cancer

“For early stage tumors, adjuvant radiotherapy is an effective treatment modality that significantly decreases recurrence, especially in surgically resected groins, and it leads to improvement in relapse-free and overall survival,” said Dr. Wui-Jin Koh, medical director for radiation oncology at the Fred Hutchinson Cancer Research Center in Seattle.

Concurrent chemotherapy and radiation may provide additional therapeutic benefit, especially for patients with advanced, unresectable tumors, and it may help to address systemic risk in patients with multiple positive lymph nodes, Dr. Koh said.

The guidelines state that radiation can be given with external beam radiation delivered via a 3D-conformal or intensity modulated (IMRT) technique, with brachytherapy boost for some tumors where the anatomy permits.

“Careful attention should be taken to ensure adequate tumor coverage by combining clinical examination, imaging findings, and appropriate nodal volumes at risk to define the target volume,” the guideline states.

For adjuvant therapy, doses of 50.4 Gy divided in 1.8 Gy fractions should be delivered once daily 5 days per week, with minimal treatment breaks.

For treatment of unresectable tumors, doses range from 59.4 Gy to 64.8 Gy in 1.8 Gy fractions, with a boost dose to approximately 70 Gy for large lymph nodes in select cases.

Residual disease

The decision to provide additional treatment following surgery is based on whether the patient is clinically negative for residual tumor at the primary site and nodes.

“If one has negative margins and negative nodes? Observation, absolutely,” Dr. Koh said. “If one has positive margins for invasive disease, our recommendation is to re-excise and not go straight to radiation, and if one can do it and get negative margins, again observe the majority of them.”

“Use radiation very judiciously,” he added. “Only if patients have positive margins or have unresectable primary disease do we routinely recommend radiation.”

Locally advanced disease

For patients who cannot be treated with conventional or sphincter-sparing, organ preserving surgery upfront, the recommendation is to provide chemoradiation, with initial radiation to the primary site, groins, and pelvis, and concurrent week cisplatin at a dose of 30-40 mg/m² per week. The recommended radiation doses are 45 Gy to at-risk, microscopic clinical tumor volume, and 57.6 to 60 Gy to gross tumor volume (primary site and nodes).

“If one uses IMRT, you need to be very generous with the volumes,” Dr. Koh said.

The panelists also recommend re-imaging and re-evaluating patients 6 to 8 weeks after the completion of chemoradiation, with possible resection or biopsy of the primary tumor site, and limited groin resection of imaged residual disease.

For patients with clearly node-positive disease, “my general preference is to give upfront chemoradiation therapy to avoid delay of primary therapy, and then resect residual nodes after the chemoradiation is done,” he said.

HOLLYWOOD, FLA. – The National Comprehensive Cancer Network has issued new guidelines for the diagnosis and management of vulvar cancer.

Vulvar cancers are rare neoplasms, with an estimated U.S. annual incidence of 5,950 cases, and 1,110 deaths. The majority of cases (about 90%) are of squamous cell histology.

Treatment of vulvar cancer has evolved from en bloc resections used throughout most of the 20th century, to more refined techniques, said Dr. Benjamin E. Greer, professor of gynecological oncology at the University of Washington in Seattle.

“In the 1980s, we started to modify treatment to reduce morbidity,” he said at the annual conference of the National Comprehensive Cancer Network.

With older, more radical techniques, groin breakdown, leg edema, and impaired sexual function were common post-surgery consequences. Current practice, however, is to perform regional lymph node management for unilateral cancers, radical local excision rather than en bloc resections, separate groin incisions, lymphatic mapping, radiation, chemotherapy, and, if necessary, exenteration, Dr. Greer noted.

The guidelines note that adequate surgical margins – 1 to 2 cm – at the time of primary surgery appear to be essential for reducing risk of local recurrence, and that if margins are within 8 mm of tumor, the surgeon should consider re-excision or adjuvant radiation.

Lymph node status is the most important determinant of survival, with historical reports showing overall survival following surgery of 70% to 80% among patients with negative nodes, compared with 30% to 40% of those with positive nodes, he said.

Evaluation of bilateral inguinofemoral groin nodes should be performed in patients with lesions in the vulvar midline, and ipsilateral groin node evaluation should be performed for those with lateral lesions lying more than 2 cm from the vulvar midline. Additionally, select patients may require sentinel lymph node biopsy, the guidelines state.

Unilateral carcinomas of the vulva can be treated with limited radical vulvectomy and ipsilateral inguinal femoral node dissection. Lymph node dissection can be performed through a separate incision. For patients with positive nodes, adjuvant radiation may aid in disease control. Patients with inoperable carcinomas are recommended to receive radiation and chemotherapy.

Radiation for vulvar cancer

“For early stage tumors, adjuvant radiotherapy is an effective treatment modality that significantly decreases recurrence, especially in surgically resected groins, and it leads to improvement in relapse-free and overall survival,” said Dr. Wui-Jin Koh, medical director for radiation oncology at the Fred Hutchinson Cancer Research Center in Seattle.

Concurrent chemotherapy and radiation may provide additional therapeutic benefit, especially for patients with advanced, unresectable tumors, and it may help to address systemic risk in patients with multiple positive lymph nodes, Dr. Koh said.

The guidelines state that radiation can be given with external beam radiation delivered via a 3D-conformal or intensity modulated (IMRT) technique, with brachytherapy boost for some tumors where the anatomy permits.

“Careful attention should be taken to ensure adequate tumor coverage by combining clinical examination, imaging findings, and appropriate nodal volumes at risk to define the target volume,” the guideline states.

For adjuvant therapy, doses of 50.4 Gy divided in 1.8 Gy fractions should be delivered once daily 5 days per week, with minimal treatment breaks.

For treatment of unresectable tumors, doses range from 59.4 Gy to 64.8 Gy in 1.8 Gy fractions, with a boost dose to approximately 70 Gy for large lymph nodes in select cases.

Residual disease

The decision to provide additional treatment following surgery is based on whether the patient is clinically negative for residual tumor at the primary site and nodes.

“If one has negative margins and negative nodes? Observation, absolutely,” Dr. Koh said. “If one has positive margins for invasive disease, our recommendation is to re-excise and not go straight to radiation, and if one can do it and get negative margins, again observe the majority of them.”

“Use radiation very judiciously,” he added. “Only if patients have positive margins or have unresectable primary disease do we routinely recommend radiation.”

Locally advanced disease

For patients who cannot be treated with conventional or sphincter-sparing, organ preserving surgery upfront, the recommendation is to provide chemoradiation, with initial radiation to the primary site, groins, and pelvis, and concurrent week cisplatin at a dose of 30-40 mg/m² per week. The recommended radiation doses are 45 Gy to at-risk, microscopic clinical tumor volume, and 57.6 to 60 Gy to gross tumor volume (primary site and nodes).

“If one uses IMRT, you need to be very generous with the volumes,” Dr. Koh said.

The panelists also recommend re-imaging and re-evaluating patients 6 to 8 weeks after the completion of chemoradiation, with possible resection or biopsy of the primary tumor site, and limited groin resection of imaged residual disease.

For patients with clearly node-positive disease, “my general preference is to give upfront chemoradiation therapy to avoid delay of primary therapy, and then resect residual nodes after the chemoradiation is done,” he said.

HOLLYWOOD, FLA. – The National Comprehensive Cancer Network has issued new guidelines for the diagnosis and management of vulvar cancer.

Vulvar cancers are rare neoplasms, with an estimated U.S. annual incidence of 5,950 cases, and 1,110 deaths. The majority of cases (about 90%) are of squamous cell histology.

Treatment of vulvar cancer has evolved from en bloc resections used throughout most of the 20th century, to more refined techniques, said Dr. Benjamin E. Greer, professor of gynecological oncology at the University of Washington in Seattle.

“In the 1980s, we started to modify treatment to reduce morbidity,” he said at the annual conference of the National Comprehensive Cancer Network.

With older, more radical techniques, groin breakdown, leg edema, and impaired sexual function were common post-surgery consequences. Current practice, however, is to perform regional lymph node management for unilateral cancers, radical local excision rather than en bloc resections, separate groin incisions, lymphatic mapping, radiation, chemotherapy, and, if necessary, exenteration, Dr. Greer noted.

The guidelines note that adequate surgical margins – 1 to 2 cm – at the time of primary surgery appear to be essential for reducing risk of local recurrence, and that if margins are within 8 mm of tumor, the surgeon should consider re-excision or adjuvant radiation.

Lymph node status is the most important determinant of survival, with historical reports showing overall survival following surgery of 70% to 80% among patients with negative nodes, compared with 30% to 40% of those with positive nodes, he said.

Evaluation of bilateral inguinofemoral groin nodes should be performed in patients with lesions in the vulvar midline, and ipsilateral groin node evaluation should be performed for those with lateral lesions lying more than 2 cm from the vulvar midline. Additionally, select patients may require sentinel lymph node biopsy, the guidelines state.

Unilateral carcinomas of the vulva can be treated with limited radical vulvectomy and ipsilateral inguinal femoral node dissection. Lymph node dissection can be performed through a separate incision. For patients with positive nodes, adjuvant radiation may aid in disease control. Patients with inoperable carcinomas are recommended to receive radiation and chemotherapy.

Radiation for vulvar cancer

“For early stage tumors, adjuvant radiotherapy is an effective treatment modality that significantly decreases recurrence, especially in surgically resected groins, and it leads to improvement in relapse-free and overall survival,” said Dr. Wui-Jin Koh, medical director for radiation oncology at the Fred Hutchinson Cancer Research Center in Seattle.

Concurrent chemotherapy and radiation may provide additional therapeutic benefit, especially for patients with advanced, unresectable tumors, and it may help to address systemic risk in patients with multiple positive lymph nodes, Dr. Koh said.

The guidelines state that radiation can be given with external beam radiation delivered via a 3D-conformal or intensity modulated (IMRT) technique, with brachytherapy boost for some tumors where the anatomy permits.

“Careful attention should be taken to ensure adequate tumor coverage by combining clinical examination, imaging findings, and appropriate nodal volumes at risk to define the target volume,” the guideline states.

For adjuvant therapy, doses of 50.4 Gy divided in 1.8 Gy fractions should be delivered once daily 5 days per week, with minimal treatment breaks.

For treatment of unresectable tumors, doses range from 59.4 Gy to 64.8 Gy in 1.8 Gy fractions, with a boost dose to approximately 70 Gy for large lymph nodes in select cases.

Residual disease

The decision to provide additional treatment following surgery is based on whether the patient is clinically negative for residual tumor at the primary site and nodes.

“If one has negative margins and negative nodes? Observation, absolutely,” Dr. Koh said. “If one has positive margins for invasive disease, our recommendation is to re-excise and not go straight to radiation, and if one can do it and get negative margins, again observe the majority of them.”

“Use radiation very judiciously,” he added. “Only if patients have positive margins or have unresectable primary disease do we routinely recommend radiation.”

Locally advanced disease

For patients who cannot be treated with conventional or sphincter-sparing, organ preserving surgery upfront, the recommendation is to provide chemoradiation, with initial radiation to the primary site, groins, and pelvis, and concurrent week cisplatin at a dose of 30-40 mg/m² per week. The recommended radiation doses are 45 Gy to at-risk, microscopic clinical tumor volume, and 57.6 to 60 Gy to gross tumor volume (primary site and nodes).

“If one uses IMRT, you need to be very generous with the volumes,” Dr. Koh said.

The panelists also recommend re-imaging and re-evaluating patients 6 to 8 weeks after the completion of chemoradiation, with possible resection or biopsy of the primary tumor site, and limited groin resection of imaged residual disease.

For patients with clearly node-positive disease, “my general preference is to give upfront chemoradiation therapy to avoid delay of primary therapy, and then resect residual nodes after the chemoradiation is done,” he said.

Surgery volunteerism has been on the rise for several decades. The American College of Surgeons is increasing its role in organizing and facilitating these programs via Operation Giving Back (OGB). And many ACS members are prominent participants in this endeavor.

A leader in global surgery is Michael L. Bentz, M.D., FAAP, FACS, professor of surgery, pediatrics, and neurosurgery, and chairman of the Division of Plastic and Reconstructive Surgery at the University of Wisconsin School of Medicine and Public Health. Dr. Bentz has led international missions in many countries of the world over nearly 20 years and has helped a team develop a long-term program of clinical care and training in Nicaragua. We talked with him about his experiences.

Q: You have been involved in international surgical missions for many years. Can you tell us something about your early projects?

I was first exposed to international work at the University of Pittsburgh. My mentor J. William Futrell, M.D., FACS, was a veteran of over 30 international surgical trips. I went on the first trip with him to Vietnam in the 1997 and have been going ever since. For that initial trip, we worked with a nonprofit organization called Interplast. I went with a large group of 20 people from the University that included plastic surgery attendings, plastic surgery residents, pediatric attendings, pediatric residents, and nursing and anesthesia staff.

In those days, many trips were based predominantly on clinical care – adult care and pediatric care. Teams would do a certain number of operations and then go home. We did cleft lip repairs, cleft palate repairs, burn reconstruction, congenital hand deformity surgery, and tumor management.

That would result in good outcomes for those who actually had a procedure done. But in any place I have ever worked overseas – Vietnam, China, Russia, Nicaragua – the need is overwhelming. The need far outstripped what surgical missions can provide in isolated, single trips back and forth.

Q: The years have brought changes to these missions. What are the most significant changes over the years in how these missions are conducted?

The scope and direction of global health is moving toward sustainable, long-term, and longitudinal education. In those earlier trips where there was an emphasis on doing as many operations as possible, people meant well – we meant well! But the real impact comes with the longitudinal education investment.

I have never been anywhere around the world where there weren’t interested, very capable, excellent surgeons committed to taking care of their patients who only need some support and facilitation.

If you compare the cases we are able to do on a trip with our partners with the cases they are able to do independently, it’s a logarithmic curve – they are far more productive than we could ever be on any number of trips. There is a multiplier effect that allows many more patients to be taken care of.

Q: Your institution has a long-term relationship with a hospital in Nicaragua. How does this work and what is the role of your team in the program?

The University of Wisconsin Division of Plastic Surgery and the Eduplast Foundation has a team of about 10 that goes to Nicaragua twice a year. Most importantly, we support a residency program in there. We move residents through a 3-year modular program much like programs in the U.S. and then examine them. We facilitate this educational process with trips there and we bring them to our institution in the U.S.

Over the past 10 years, we have been doing a weekly live webcast of our Plastic Surgery Grand Rounds which is received on several continents. This creates a very valuable bidirectional, and even tridirectional conversation. This webcast is simple, incredibly inexpensive, and has provided hundreds of hours of education over the years in addition to the on-site work we do.

There can be a language barrier in some cases, but we broadcast in English, with occasional translation support. In addition to Nicaragua, our webcast has been received in institutions in Thailand, China, Ecuador and across the United States. We keep records of cases performed. Our plastic surgery residents can get credit for the cases they do under faculty supervision at our international sites if we meet specific criteria set by our Resident Review Committee.

It is important to note that we take care of the patients in our partner institutions in Nicaragua exactly as we would care for patients in our institution in Wisconsin. There is no “practicing” as all operations are done by surgeons appropriately credentialed and trained for the task.

Q: Do you find that there is a cultural gap that you must bridge in working with colleagues and patients in Nicaragua?

Our program has an orientation session for team participants in advance of each trip, where we talk about the mechanics of the trip – safety, medical issues. We also talk about cultural considerations of each site. It is very important that the residents embed in the culture in which we are working. They also need to know the cultural norms of how to communicate with patients, parents, and children. Some of it is simply good manners – acting like your mother taught you!

The team can reside in a local hotel, but often stays in the homes of local hosts, and this can be a beautiful opportunity to learn about local norms and communication.

Q: What is your favorite part of these missions?

I have so many favorite parts! I like caring for people who otherwise might not receive medical care. This is “giving back” and I think all of the participants would agree that we come home feeling like we received much more than we gave. These experiences remind you of why you went to medical school. It is an opportunity to provide something in return for all the investment that has been made in us for our education. In working with colleagues from other countries, I learn as much as I teach. I come back a better surgeon.

The benefits to residents from our institution are many. They learn how to operate in a resource-limited setting, and they return with a greater appreciation for the equipment and supplies we have available at our institution in Madison. The cultural competence and awareness they also learn is an invaluable life skill.

I want to stress that the friendships with our fellow surgeons are what makes this work. We achieve a degree of continuity and even watch our pediatric patients grow up over the years because of our long-term relationship with the hospital in León and our dedicated colleagues there. This is a truly a partnership among friends.

Q: Do you have some advice for a surgeon interested in participating in an international program?

For those surgeons who were not exposed to these programs during residency, finding a mentor or mentoring organization is the way to begin. A beginner should consider making the first couple of trips with someone who knows the ropes in terms of understanding cultural competency, practical issues of safety, and relevant clinical issues. Almost every surgery discipline has an organization with the capability of identifying volunteer surgery groups in their specialty. ACS’ Operation Giving Back is a particularly important resource for helping Fellows find the right international program.

If you would like to learn more about global surgery programs, contact Operation Giving Back at [email protected]. Or if you would like to share your experiences as an international surgical volunteer, please email this publication at [email protected].

Surgery volunteerism has been on the rise for several decades. The American College of Surgeons is increasing its role in organizing and facilitating these programs via Operation Giving Back (OGB). And many ACS members are prominent participants in this endeavor.

A leader in global surgery is Michael L. Bentz, M.D., FAAP, FACS, professor of surgery, pediatrics, and neurosurgery, and chairman of the Division of Plastic and Reconstructive Surgery at the University of Wisconsin School of Medicine and Public Health. Dr. Bentz has led international missions in many countries of the world over nearly 20 years and has helped a team develop a long-term program of clinical care and training in Nicaragua. We talked with him about his experiences.

Q: You have been involved in international surgical missions for many years. Can you tell us something about your early projects?

I was first exposed to international work at the University of Pittsburgh. My mentor J. William Futrell, M.D., FACS, was a veteran of over 30 international surgical trips. I went on the first trip with him to Vietnam in the 1997 and have been going ever since. For that initial trip, we worked with a nonprofit organization called Interplast. I went with a large group of 20 people from the University that included plastic surgery attendings, plastic surgery residents, pediatric attendings, pediatric residents, and nursing and anesthesia staff.

In those days, many trips were based predominantly on clinical care – adult care and pediatric care. Teams would do a certain number of operations and then go home. We did cleft lip repairs, cleft palate repairs, burn reconstruction, congenital hand deformity surgery, and tumor management.

That would result in good outcomes for those who actually had a procedure done. But in any place I have ever worked overseas – Vietnam, China, Russia, Nicaragua – the need is overwhelming. The need far outstripped what surgical missions can provide in isolated, single trips back and forth.

Q: The years have brought changes to these missions. What are the most significant changes over the years in how these missions are conducted?

The scope and direction of global health is moving toward sustainable, long-term, and longitudinal education. In those earlier trips where there was an emphasis on doing as many operations as possible, people meant well – we meant well! But the real impact comes with the longitudinal education investment.

I have never been anywhere around the world where there weren’t interested, very capable, excellent surgeons committed to taking care of their patients who only need some support and facilitation.

If you compare the cases we are able to do on a trip with our partners with the cases they are able to do independently, it’s a logarithmic curve – they are far more productive than we could ever be on any number of trips. There is a multiplier effect that allows many more patients to be taken care of.

Q: Your institution has a long-term relationship with a hospital in Nicaragua. How does this work and what is the role of your team in the program?

The University of Wisconsin Division of Plastic Surgery and the Eduplast Foundation has a team of about 10 that goes to Nicaragua twice a year. Most importantly, we support a residency program in there. We move residents through a 3-year modular program much like programs in the U.S. and then examine them. We facilitate this educational process with trips there and we bring them to our institution in the U.S.

Over the past 10 years, we have been doing a weekly live webcast of our Plastic Surgery Grand Rounds which is received on several continents. This creates a very valuable bidirectional, and even tridirectional conversation. This webcast is simple, incredibly inexpensive, and has provided hundreds of hours of education over the years in addition to the on-site work we do.

There can be a language barrier in some cases, but we broadcast in English, with occasional translation support. In addition to Nicaragua, our webcast has been received in institutions in Thailand, China, Ecuador and across the United States. We keep records of cases performed. Our plastic surgery residents can get credit for the cases they do under faculty supervision at our international sites if we meet specific criteria set by our Resident Review Committee.

It is important to note that we take care of the patients in our partner institutions in Nicaragua exactly as we would care for patients in our institution in Wisconsin. There is no “practicing” as all operations are done by surgeons appropriately credentialed and trained for the task.

Q: Do you find that there is a cultural gap that you must bridge in working with colleagues and patients in Nicaragua?

Our program has an orientation session for team participants in advance of each trip, where we talk about the mechanics of the trip – safety, medical issues. We also talk about cultural considerations of each site. It is very important that the residents embed in the culture in which we are working. They also need to know the cultural norms of how to communicate with patients, parents, and children. Some of it is simply good manners – acting like your mother taught you!

The team can reside in a local hotel, but often stays in the homes of local hosts, and this can be a beautiful opportunity to learn about local norms and communication.

Q: What is your favorite part of these missions?

I have so many favorite parts! I like caring for people who otherwise might not receive medical care. This is “giving back” and I think all of the participants would agree that we come home feeling like we received much more than we gave. These experiences remind you of why you went to medical school. It is an opportunity to provide something in return for all the investment that has been made in us for our education. In working with colleagues from other countries, I learn as much as I teach. I come back a better surgeon.

The benefits to residents from our institution are many. They learn how to operate in a resource-limited setting, and they return with a greater appreciation for the equipment and supplies we have available at our institution in Madison. The cultural competence and awareness they also learn is an invaluable life skill.

I want to stress that the friendships with our fellow surgeons are what makes this work. We achieve a degree of continuity and even watch our pediatric patients grow up over the years because of our long-term relationship with the hospital in León and our dedicated colleagues there. This is a truly a partnership among friends.

Q: Do you have some advice for a surgeon interested in participating in an international program?

For those surgeons who were not exposed to these programs during residency, finding a mentor or mentoring organization is the way to begin. A beginner should consider making the first couple of trips with someone who knows the ropes in terms of understanding cultural competency, practical issues of safety, and relevant clinical issues. Almost every surgery discipline has an organization with the capability of identifying volunteer surgery groups in their specialty. ACS’ Operation Giving Back is a particularly important resource for helping Fellows find the right international program.

If you would like to learn more about global surgery programs, contact Operation Giving Back at [email protected]. Or if you would like to share your experiences as an international surgical volunteer, please email this publication at [email protected].

Surgery volunteerism has been on the rise for several decades. The American College of Surgeons is increasing its role in organizing and facilitating these programs via Operation Giving Back (OGB). And many ACS members are prominent participants in this endeavor.

A leader in global surgery is Michael L. Bentz, M.D., FAAP, FACS, professor of surgery, pediatrics, and neurosurgery, and chairman of the Division of Plastic and Reconstructive Surgery at the University of Wisconsin School of Medicine and Public Health. Dr. Bentz has led international missions in many countries of the world over nearly 20 years and has helped a team develop a long-term program of clinical care and training in Nicaragua. We talked with him about his experiences.

Q: You have been involved in international surgical missions for many years. Can you tell us something about your early projects?

I was first exposed to international work at the University of Pittsburgh. My mentor J. William Futrell, M.D., FACS, was a veteran of over 30 international surgical trips. I went on the first trip with him to Vietnam in the 1997 and have been going ever since. For that initial trip, we worked with a nonprofit organization called Interplast. I went with a large group of 20 people from the University that included plastic surgery attendings, plastic surgery residents, pediatric attendings, pediatric residents, and nursing and anesthesia staff.

In those days, many trips were based predominantly on clinical care – adult care and pediatric care. Teams would do a certain number of operations and then go home. We did cleft lip repairs, cleft palate repairs, burn reconstruction, congenital hand deformity surgery, and tumor management.

That would result in good outcomes for those who actually had a procedure done. But in any place I have ever worked overseas – Vietnam, China, Russia, Nicaragua – the need is overwhelming. The need far outstripped what surgical missions can provide in isolated, single trips back and forth.

Q: The years have brought changes to these missions. What are the most significant changes over the years in how these missions are conducted?

The scope and direction of global health is moving toward sustainable, long-term, and longitudinal education. In those earlier trips where there was an emphasis on doing as many operations as possible, people meant well – we meant well! But the real impact comes with the longitudinal education investment.

I have never been anywhere around the world where there weren’t interested, very capable, excellent surgeons committed to taking care of their patients who only need some support and facilitation.

If you compare the cases we are able to do on a trip with our partners with the cases they are able to do independently, it’s a logarithmic curve – they are far more productive than we could ever be on any number of trips. There is a multiplier effect that allows many more patients to be taken care of.

Q: Your institution has a long-term relationship with a hospital in Nicaragua. How does this work and what is the role of your team in the program?

The University of Wisconsin Division of Plastic Surgery and the Eduplast Foundation has a team of about 10 that goes to Nicaragua twice a year. Most importantly, we support a residency program in there. We move residents through a 3-year modular program much like programs in the U.S. and then examine them. We facilitate this educational process with trips there and we bring them to our institution in the U.S.

Over the past 10 years, we have been doing a weekly live webcast of our Plastic Surgery Grand Rounds which is received on several continents. This creates a very valuable bidirectional, and even tridirectional conversation. This webcast is simple, incredibly inexpensive, and has provided hundreds of hours of education over the years in addition to the on-site work we do.

There can be a language barrier in some cases, but we broadcast in English, with occasional translation support. In addition to Nicaragua, our webcast has been received in institutions in Thailand, China, Ecuador and across the United States. We keep records of cases performed. Our plastic surgery residents can get credit for the cases they do under faculty supervision at our international sites if we meet specific criteria set by our Resident Review Committee.

It is important to note that we take care of the patients in our partner institutions in Nicaragua exactly as we would care for patients in our institution in Wisconsin. There is no “practicing” as all operations are done by surgeons appropriately credentialed and trained for the task.

Q: Do you find that there is a cultural gap that you must bridge in working with colleagues and patients in Nicaragua?

Our program has an orientation session for team participants in advance of each trip, where we talk about the mechanics of the trip – safety, medical issues. We also talk about cultural considerations of each site. It is very important that the residents embed in the culture in which we are working. They also need to know the cultural norms of how to communicate with patients, parents, and children. Some of it is simply good manners – acting like your mother taught you!

The team can reside in a local hotel, but often stays in the homes of local hosts, and this can be a beautiful opportunity to learn about local norms and communication.

Q: What is your favorite part of these missions?

I have so many favorite parts! I like caring for people who otherwise might not receive medical care. This is “giving back” and I think all of the participants would agree that we come home feeling like we received much more than we gave. These experiences remind you of why you went to medical school. It is an opportunity to provide something in return for all the investment that has been made in us for our education. In working with colleagues from other countries, I learn as much as I teach. I come back a better surgeon.

The benefits to residents from our institution are many. They learn how to operate in a resource-limited setting, and they return with a greater appreciation for the equipment and supplies we have available at our institution in Madison. The cultural competence and awareness they also learn is an invaluable life skill.

I want to stress that the friendships with our fellow surgeons are what makes this work. We achieve a degree of continuity and even watch our pediatric patients grow up over the years because of our long-term relationship with the hospital in León and our dedicated colleagues there. This is a truly a partnership among friends.

Q: Do you have some advice for a surgeon interested in participating in an international program?

For those surgeons who were not exposed to these programs during residency, finding a mentor or mentoring organization is the way to begin. A beginner should consider making the first couple of trips with someone who knows the ropes in terms of understanding cultural competency, practical issues of safety, and relevant clinical issues. Almost every surgery discipline has an organization with the capability of identifying volunteer surgery groups in their specialty. ACS’ Operation Giving Back is a particularly important resource for helping Fellows find the right international program.

If you would like to learn more about global surgery programs, contact Operation Giving Back at [email protected]. Or if you would like to share your experiences as an international surgical volunteer, please email this publication at [email protected].

The American College of Surgeons (ACS) Division of Education and the International Relations Committee have announced the availability of two international scholarships focused on surgical education for 2016. These awards will offer faculty members from countries other than the U.S. and Canada the opportunity to participate in a variety of faculty development activities that will result in acquisition of new knowledge and skills in surgical education and training. The intent of the program is to help scholars improve surgical education and training in their home institutions and countries. All application materials and supporting documents are due no later than May 2 for attendance at the ACS Clinical Congress 2016, October 16−20 in Washington, DC.

About the program

The two scholars will participate in the annual Clinical Congress, including the Surgical Education: Principles and Practice course, as well as other plenary sessions and Postgraduate Courses that address surgical education and training needs across the continuum of professional development. This continuum may include the needs of practicing surgeons through their entire careers, as well as the needs of surgery residents, medical students, and other members of the surgical team.

After the Clinical Congress, each scholar will visit two Level I ACS Accredited Education Institutes (ACS-AEIs) selected in advance based on the scholars’ interest areas in surgical education and training. At the conclusion of the Clinical Congress and the scholars’ visits to the ACS-AEIs, each recipient will send to the International Relations Committee and the Division of Education a brief report outlining the outcomes that have been achieved as a result of their scholarship; this report should focus specifically on the objectives outlined in their application for the scholarship. The scholarships will facilitate the scholars’ involvement in subsequent collaborative ventures in education and training under the aegis of the ACS Division of Education.

Each scholarship provides a stipend of $10,000, supporting travel and per diem in North America and the cost of Postgraduate Courses undertaken at the Clinical Congress and at the ACS-AEIs to be visited. Clinical Congress registration and fees for attendance at the Surgical Education: Principles and Practices course will be provided. Assistance will be offered to reserve affordable housing in Washington, DC, during the Clinical Congress.

Application requirements

Applicants must document prior experience in surgical education and training, such as involvement in the development and evaluation of education modules, use of novel teaching and assessment strategies, or curriculum design. In addition, applicants must submit a one-paragraph description of their education philosophies, a list of specific educational goals and objectives for their visits, and evidence of support of these goals and objectives from the leadership at their home institutions. These documents will be reviewed by the Division of Education as part of the selection process. At least 5 years of experience beyond completion of all training and fellowships is required. Scholarships must be used in the year awarded; they may not be postponed.

Full scholarship requirements for this program may be reviewed at facs.org/member-services/scholarships/international/issurged. The application for the scholarship may be accessed at the bottom of the requirements page. Questions should be directed to Kate Early, ACS International Liaison, at [email protected].

The American College of Surgeons (ACS) Division of Education and the International Relations Committee have announced the availability of two international scholarships focused on surgical education for 2016. These awards will offer faculty members from countries other than the U.S. and Canada the opportunity to participate in a variety of faculty development activities that will result in acquisition of new knowledge and skills in surgical education and training. The intent of the program is to help scholars improve surgical education and training in their home institutions and countries. All application materials and supporting documents are due no later than May 2 for attendance at the ACS Clinical Congress 2016, October 16−20 in Washington, DC.

About the program

The two scholars will participate in the annual Clinical Congress, including the Surgical Education: Principles and Practice course, as well as other plenary sessions and Postgraduate Courses that address surgical education and training needs across the continuum of professional development. This continuum may include the needs of practicing surgeons through their entire careers, as well as the needs of surgery residents, medical students, and other members of the surgical team.

After the Clinical Congress, each scholar will visit two Level I ACS Accredited Education Institutes (ACS-AEIs) selected in advance based on the scholars’ interest areas in surgical education and training. At the conclusion of the Clinical Congress and the scholars’ visits to the ACS-AEIs, each recipient will send to the International Relations Committee and the Division of Education a brief report outlining the outcomes that have been achieved as a result of their scholarship; this report should focus specifically on the objectives outlined in their application for the scholarship. The scholarships will facilitate the scholars’ involvement in subsequent collaborative ventures in education and training under the aegis of the ACS Division of Education.

Each scholarship provides a stipend of $10,000, supporting travel and per diem in North America and the cost of Postgraduate Courses undertaken at the Clinical Congress and at the ACS-AEIs to be visited. Clinical Congress registration and fees for attendance at the Surgical Education: Principles and Practices course will be provided. Assistance will be offered to reserve affordable housing in Washington, DC, during the Clinical Congress.

Application requirements

Applicants must document prior experience in surgical education and training, such as involvement in the development and evaluation of education modules, use of novel teaching and assessment strategies, or curriculum design. In addition, applicants must submit a one-paragraph description of their education philosophies, a list of specific educational goals and objectives for their visits, and evidence of support of these goals and objectives from the leadership at their home institutions. These documents will be reviewed by the Division of Education as part of the selection process. At least 5 years of experience beyond completion of all training and fellowships is required. Scholarships must be used in the year awarded; they may not be postponed.

Full scholarship requirements for this program may be reviewed at facs.org/member-services/scholarships/international/issurged. The application for the scholarship may be accessed at the bottom of the requirements page. Questions should be directed to Kate Early, ACS International Liaison, at [email protected].

The American College of Surgeons (ACS) Division of Education and the International Relations Committee have announced the availability of two international scholarships focused on surgical education for 2016. These awards will offer faculty members from countries other than the U.S. and Canada the opportunity to participate in a variety of faculty development activities that will result in acquisition of new knowledge and skills in surgical education and training. The intent of the program is to help scholars improve surgical education and training in their home institutions and countries. All application materials and supporting documents are due no later than May 2 for attendance at the ACS Clinical Congress 2016, October 16−20 in Washington, DC.

About the program

The two scholars will participate in the annual Clinical Congress, including the Surgical Education: Principles and Practice course, as well as other plenary sessions and Postgraduate Courses that address surgical education and training needs across the continuum of professional development. This continuum may include the needs of practicing surgeons through their entire careers, as well as the needs of surgery residents, medical students, and other members of the surgical team.

After the Clinical Congress, each scholar will visit two Level I ACS Accredited Education Institutes (ACS-AEIs) selected in advance based on the scholars’ interest areas in surgical education and training. At the conclusion of the Clinical Congress and the scholars’ visits to the ACS-AEIs, each recipient will send to the International Relations Committee and the Division of Education a brief report outlining the outcomes that have been achieved as a result of their scholarship; this report should focus specifically on the objectives outlined in their application for the scholarship. The scholarships will facilitate the scholars’ involvement in subsequent collaborative ventures in education and training under the aegis of the ACS Division of Education.

Each scholarship provides a stipend of $10,000, supporting travel and per diem in North America and the cost of Postgraduate Courses undertaken at the Clinical Congress and at the ACS-AEIs to be visited. Clinical Congress registration and fees for attendance at the Surgical Education: Principles and Practices course will be provided. Assistance will be offered to reserve affordable housing in Washington, DC, during the Clinical Congress.

Application requirements

Applicants must document prior experience in surgical education and training, such as involvement in the development and evaluation of education modules, use of novel teaching and assessment strategies, or curriculum design. In addition, applicants must submit a one-paragraph description of their education philosophies, a list of specific educational goals and objectives for their visits, and evidence of support of these goals and objectives from the leadership at their home institutions. These documents will be reviewed by the Division of Education as part of the selection process. At least 5 years of experience beyond completion of all training and fellowships is required. Scholarships must be used in the year awarded; they may not be postponed.

Full scholarship requirements for this program may be reviewed at facs.org/member-services/scholarships/international/issurged. The application for the scholarship may be accessed at the bottom of the requirements page. Questions should be directed to Kate Early, ACS International Liaison, at [email protected].

The American College of Surgeons (ACS) offers International Guest Scholarships to young surgeons from countries other than the U.S. or Canada who have demonstrated a strong interest in teaching and research. Twelve scholarships are available for 2017, in the amount of $10,000 each, and will provide the scholars with an opportunity to engage in clinical, teaching, and research activities in the U.S. and Canada and to attend and participate fully in the educational opportunities and activities of the ACS Clinical Congress. For consideration by the Selection Committee, completed applications for the 2017 International Guest Scholarships and all supporting documentation must be received at the office of the International Liaison Section by June 30, 2016.

Paul R. Hawley, MD, FACS(Hon), Past-ACS Executive Director (1950−1961), left a legacy to the College for the scholarship endowment. More recently, gifts to the International Guest Scholarship endowment from the family of Abdol Islami, MD, FACS, and Joan Islami; the Stavros Niarchos Foundation; and others have enabled the College to increase the number of these scholarship awards.

The scholarship requirements are as follows:

• Applicants must be medical school graduates who have completed their surgical training.

• Applicants must be between 35 and 50 years old on the date that the completed application is filed.

• Applicants must submit their applications from their intended permanent location. Applications will be accepted for processing only if the applicants have been in surgical practice, teaching, or research for a minimum of 1 year at their intended permanent location, following completion of all formal training (including fellowships and scholarships).

• Applicants must have demonstrated a commitment to teaching and/or research in accordance with the standards of the applicant’s country.

• Applicants early in their careers are deemed more suitable than those surgeons who are in senior academic positions.

• Applicants must submit a fully completed application form available on the ACS website at facs.org/member-services/scholarships/international/igs. The application and accompanying materials must be submitted in English. Submission of a curriculum vitae without a completed application is unacceptable.

• Applicants must provide a list of all of their publication credits and must submit three complete reprints or manuscripts from that list.

• Preference may be given to applicants who have not already experienced training or surgical fellowships in the U.S. or Canada.

• Applicants must submit independently prepared letters of recommendation from three of their colleagues. One letter must be from the chair of the department in which the applicant holds an academic appointment or an ACS Fellow residing in the applicant’s country. This letter must include a statement regarding the nature and extent of the teaching and other academic involvement of the applicant. Letters of recommendation should be submitted by the person making the recommendation.

• The online application form is structured to assist the Scholarship Selection Subcommittee and assists the applicant in submitting a structured curriculum vitae.

• The International Guest Scholarships must be used in the year for which they are designated. They may not be postponed.

• Applicants who are awarded scholarships will provide a full written report of the experiences provided through the scholarships upon completion of their tours.

• An unsuccessful applicant may reapply only twice and only by completing and submitting a new application and new supporting documentation.

The scholarships will provide successful applicants with public recognition of their presence. Assistance will be provided in arranging visits, following the Clinical Congress, to various clinics and universities of their choice.

For consideration by the Selection Committee, applicants must fulfill all of the requirements. Applicants are urged to submit their completed applications and supporting documents as early as possible to provide sufficient time for processing.

Send supporting materials to International Liaison Section, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL, 60611-3211; or via fax to 312-202-5021. Questions should be directed to Kate Early, International Liaison, at [email protected].

The American College of Surgeons (ACS) offers International Guest Scholarships to young surgeons from countries other than the U.S. or Canada who have demonstrated a strong interest in teaching and research. Twelve scholarships are available for 2017, in the amount of $10,000 each, and will provide the scholars with an opportunity to engage in clinical, teaching, and research activities in the U.S. and Canada and to attend and participate fully in the educational opportunities and activities of the ACS Clinical Congress. For consideration by the Selection Committee, completed applications for the 2017 International Guest Scholarships and all supporting documentation must be received at the office of the International Liaison Section by June 30, 2016.

Paul R. Hawley, MD, FACS(Hon), Past-ACS Executive Director (1950−1961), left a legacy to the College for the scholarship endowment. More recently, gifts to the International Guest Scholarship endowment from the family of Abdol Islami, MD, FACS, and Joan Islami; the Stavros Niarchos Foundation; and others have enabled the College to increase the number of these scholarship awards.

The scholarship requirements are as follows:

• Applicants must be medical school graduates who have completed their surgical training.

• Applicants must be between 35 and 50 years old on the date that the completed application is filed.

• Applicants must submit their applications from their intended permanent location. Applications will be accepted for processing only if the applicants have been in surgical practice, teaching, or research for a minimum of 1 year at their intended permanent location, following completion of all formal training (including fellowships and scholarships).

• Applicants must have demonstrated a commitment to teaching and/or research in accordance with the standards of the applicant’s country.

• Applicants early in their careers are deemed more suitable than those surgeons who are in senior academic positions.

• Applicants must submit a fully completed application form available on the ACS website at facs.org/member-services/scholarships/international/igs. The application and accompanying materials must be submitted in English. Submission of a curriculum vitae without a completed application is unacceptable.

• Applicants must provide a list of all of their publication credits and must submit three complete reprints or manuscripts from that list.

• Preference may be given to applicants who have not already experienced training or surgical fellowships in the U.S. or Canada.

• Applicants must submit independently prepared letters of recommendation from three of their colleagues. One letter must be from the chair of the department in which the applicant holds an academic appointment or an ACS Fellow residing in the applicant’s country. This letter must include a statement regarding the nature and extent of the teaching and other academic involvement of the applicant. Letters of recommendation should be submitted by the person making the recommendation.

• The online application form is structured to assist the Scholarship Selection Subcommittee and assists the applicant in submitting a structured curriculum vitae.

• The International Guest Scholarships must be used in the year for which they are designated. They may not be postponed.

• Applicants who are awarded scholarships will provide a full written report of the experiences provided through the scholarships upon completion of their tours.

• An unsuccessful applicant may reapply only twice and only by completing and submitting a new application and new supporting documentation.

The scholarships will provide successful applicants with public recognition of their presence. Assistance will be provided in arranging visits, following the Clinical Congress, to various clinics and universities of their choice.

For consideration by the Selection Committee, applicants must fulfill all of the requirements. Applicants are urged to submit their completed applications and supporting documents as early as possible to provide sufficient time for processing.

Send supporting materials to International Liaison Section, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL, 60611-3211; or via fax to 312-202-5021. Questions should be directed to Kate Early, International Liaison, at [email protected].

The American College of Surgeons (ACS) offers International Guest Scholarships to young surgeons from countries other than the U.S. or Canada who have demonstrated a strong interest in teaching and research. Twelve scholarships are available for 2017, in the amount of $10,000 each, and will provide the scholars with an opportunity to engage in clinical, teaching, and research activities in the U.S. and Canada and to attend and participate fully in the educational opportunities and activities of the ACS Clinical Congress. For consideration by the Selection Committee, completed applications for the 2017 International Guest Scholarships and all supporting documentation must be received at the office of the International Liaison Section by June 30, 2016.

Paul R. Hawley, MD, FACS(Hon), Past-ACS Executive Director (1950−1961), left a legacy to the College for the scholarship endowment. More recently, gifts to the International Guest Scholarship endowment from the family of Abdol Islami, MD, FACS, and Joan Islami; the Stavros Niarchos Foundation; and others have enabled the College to increase the number of these scholarship awards.

The scholarship requirements are as follows:

• Applicants must be medical school graduates who have completed their surgical training.

• Applicants must be between 35 and 50 years old on the date that the completed application is filed.

• Applicants must submit their applications from their intended permanent location. Applications will be accepted for processing only if the applicants have been in surgical practice, teaching, or research for a minimum of 1 year at their intended permanent location, following completion of all formal training (including fellowships and scholarships).

• Applicants must have demonstrated a commitment to teaching and/or research in accordance with the standards of the applicant’s country.

• Applicants early in their careers are deemed more suitable than those surgeons who are in senior academic positions.

• Applicants must submit a fully completed application form available on the ACS website at facs.org/member-services/scholarships/international/igs. The application and accompanying materials must be submitted in English. Submission of a curriculum vitae without a completed application is unacceptable.

• Applicants must provide a list of all of their publication credits and must submit three complete reprints or manuscripts from that list.

• Preference may be given to applicants who have not already experienced training or surgical fellowships in the U.S. or Canada.

• Applicants must submit independently prepared letters of recommendation from three of their colleagues. One letter must be from the chair of the department in which the applicant holds an academic appointment or an ACS Fellow residing in the applicant’s country. This letter must include a statement regarding the nature and extent of the teaching and other academic involvement of the applicant. Letters of recommendation should be submitted by the person making the recommendation.

• The online application form is structured to assist the Scholarship Selection Subcommittee and assists the applicant in submitting a structured curriculum vitae.

• The International Guest Scholarships must be used in the year for which they are designated. They may not be postponed.

• Applicants who are awarded scholarships will provide a full written report of the experiences provided through the scholarships upon completion of their tours.

• An unsuccessful applicant may reapply only twice and only by completing and submitting a new application and new supporting documentation.

The scholarships will provide successful applicants with public recognition of their presence. Assistance will be provided in arranging visits, following the Clinical Congress, to various clinics and universities of their choice.

For consideration by the Selection Committee, applicants must fulfill all of the requirements. Applicants are urged to submit their completed applications and supporting documents as early as possible to provide sufficient time for processing.

Send supporting materials to International Liaison Section, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL, 60611-3211; or via fax to 312-202-5021. Questions should be directed to Kate Early, International Liaison, at [email protected].

Applications and supporting documentation for two 2017 Community Surgeon Travel Awards, sponsored by the International Relations Committee of the American College of Surgeons (ACS), are due July 1, 2016. The travel awards, $4,000 each and available to surgeons ages 30–50 years, allow international surgeons to attend and participate in the educational activities of the annual ACS Clinical Congress. The awards are intended specifically to assist surgeons who work in community or regional hospitals or clinics in countries other than the United States and Canada, or who are from under-resourced academic departments of surgery in under-resourced countries.

The College will cover each awardee’s registration fees for Clinical Congress 2017, October 22−26, in San Diego, CA, as well as the cost of one Postgraduate Course at the meeting. The ACS also will assist the recipients in finding preferential housing in an economical hotel. All applicants will be notified of the Selection Committee’s decision in November 2016.

Application requirements are as follows:

• Applicants must be medical school graduates who have completed their surgical training.

• Applicants must be between 30 and 50 years old on the date that the application is filed.

• Applicants must submit their applications from their intended permanent location. Applications will be accepted for processing only when the applicants have been in surgical practice, teaching, or research for at least 1 year at their intended permanent location and following completion of all formal training (including fellowships and scholarships).

• Applicants must show evidence of commitment to quality care, surgical teaching, and improving access to surgical care in their community.

• Applicants must submit a fully completed application form provided on the ACS website at facs.org/member-services/scholarships/international/communitytravel. The application and accompanying materials must be submitted in English. Submission of a curriculum vitae without a completed application is unacceptable.

• Applicants who have not already experienced training or surgical fellowships in the U.S. or Canada will receive preference for the awards.

• Applicants must submit independently prepared letters of recommendation from three colleagues. One letter must be from the chair of the department in which the applicant holds a clinical or academic appointment or from an ACS Fellow residing in their country. The recommendation letter must directly address the applicant’s commitment to quality care, surgical teaching, and improving access to surgical care locally. Letters of recommendation should be submitted by the individuals making the recommendations.

• The Community Surgeon Travel Awards must be used in the year for which they are designated. They may not be postponed.

• Awardees are expected to provide a written report upon their return home, specifically focusing on the value of the visit to the awardee and the potentially beneficial effect for patients in the country of origin.

• Unsuccessful applicants may reapply only twice and only by completing and submitting a new application together with new supporting documentation.

To qualify for consideration by the Selection Committee, all of the requirements must be fulfilled.

Supporting materials and questions should be directed to Kate Early, International Liaison, at [email protected] or faxed to 312-202-5021.

Applications and supporting documentation for two 2017 Community Surgeon Travel Awards, sponsored by the International Relations Committee of the American College of Surgeons (ACS), are due July 1, 2016. The travel awards, $4,000 each and available to surgeons ages 30–50 years, allow international surgeons to attend and participate in the educational activities of the annual ACS Clinical Congress. The awards are intended specifically to assist surgeons who work in community or regional hospitals or clinics in countries other than the United States and Canada, or who are from under-resourced academic departments of surgery in under-resourced countries.

The College will cover each awardee’s registration fees for Clinical Congress 2017, October 22−26, in San Diego, CA, as well as the cost of one Postgraduate Course at the meeting. The ACS also will assist the recipients in finding preferential housing in an economical hotel. All applicants will be notified of the Selection Committee’s decision in November 2016.

Application requirements are as follows:

• Applicants must be medical school graduates who have completed their surgical training.

• Applicants must be between 30 and 50 years old on the date that the application is filed.

• Applicants must submit their applications from their intended permanent location. Applications will be accepted for processing only when the applicants have been in surgical practice, teaching, or research for at least 1 year at their intended permanent location and following completion of all formal training (including fellowships and scholarships).

• Applicants must show evidence of commitment to quality care, surgical teaching, and improving access to surgical care in their community.

• Applicants must submit a fully completed application form provided on the ACS website at facs.org/member-services/scholarships/international/communitytravel. The application and accompanying materials must be submitted in English. Submission of a curriculum vitae without a completed application is unacceptable.

• Applicants who have not already experienced training or surgical fellowships in the U.S. or Canada will receive preference for the awards.

• Applicants must submit independently prepared letters of recommendation from three colleagues. One letter must be from the chair of the department in which the applicant holds a clinical or academic appointment or from an ACS Fellow residing in their country. The recommendation letter must directly address the applicant’s commitment to quality care, surgical teaching, and improving access to surgical care locally. Letters of recommendation should be submitted by the individuals making the recommendations.

• The Community Surgeon Travel Awards must be used in the year for which they are designated. They may not be postponed.

• Awardees are expected to provide a written report upon their return home, specifically focusing on the value of the visit to the awardee and the potentially beneficial effect for patients in the country of origin.

• Unsuccessful applicants may reapply only twice and only by completing and submitting a new application together with new supporting documentation.

To qualify for consideration by the Selection Committee, all of the requirements must be fulfilled.

Supporting materials and questions should be directed to Kate Early, International Liaison, at [email protected] or faxed to 312-202-5021.

Applications and supporting documentation for two 2017 Community Surgeon Travel Awards, sponsored by the International Relations Committee of the American College of Surgeons (ACS), are due July 1, 2016. The travel awards, $4,000 each and available to surgeons ages 30–50 years, allow international surgeons to attend and participate in the educational activities of the annual ACS Clinical Congress. The awards are intended specifically to assist surgeons who work in community or regional hospitals or clinics in countries other than the United States and Canada, or who are from under-resourced academic departments of surgery in under-resourced countries.

The College will cover each awardee’s registration fees for Clinical Congress 2017, October 22−26, in San Diego, CA, as well as the cost of one Postgraduate Course at the meeting. The ACS also will assist the recipients in finding preferential housing in an economical hotel. All applicants will be notified of the Selection Committee’s decision in November 2016.

Application requirements are as follows:

• Applicants must be medical school graduates who have completed their surgical training.

• Applicants must be between 30 and 50 years old on the date that the application is filed.

• Applicants must submit their applications from their intended permanent location. Applications will be accepted for processing only when the applicants have been in surgical practice, teaching, or research for at least 1 year at their intended permanent location and following completion of all formal training (including fellowships and scholarships).

• Applicants must show evidence of commitment to quality care, surgical teaching, and improving access to surgical care in their community.

• Applicants must submit a fully completed application form provided on the ACS website at facs.org/member-services/scholarships/international/communitytravel. The application and accompanying materials must be submitted in English. Submission of a curriculum vitae without a completed application is unacceptable.

• Applicants who have not already experienced training or surgical fellowships in the U.S. or Canada will receive preference for the awards.

• Applicants must submit independently prepared letters of recommendation from three colleagues. One letter must be from the chair of the department in which the applicant holds a clinical or academic appointment or from an ACS Fellow residing in their country. The recommendation letter must directly address the applicant’s commitment to quality care, surgical teaching, and improving access to surgical care locally. Letters of recommendation should be submitted by the individuals making the recommendations.

• The Community Surgeon Travel Awards must be used in the year for which they are designated. They may not be postponed.

• Awardees are expected to provide a written report upon their return home, specifically focusing on the value of the visit to the awardee and the potentially beneficial effect for patients in the country of origin.

• Unsuccessful applicants may reapply only twice and only by completing and submitting a new application together with new supporting documentation.

To qualify for consideration by the Selection Committee, all of the requirements must be fulfilled.

Supporting materials and questions should be directed to Kate Early, International Liaison, at [email protected] or faxed to 312-202-5021.

Save the date for the American College of Surgeons (ACS) Surgeons as Leaders: From Operating Room to Boardroom course, June 5–8 in Durham, NC. Surgeons who aspire to meet the challenges of exemplary leadership across all settings are encouraged to join senior surgical leaders in the three-day course.

Faculty will include the following:

• Course Chair Andrew L. Warshaw, MD, FACS, FRCSEd(Hon), senior consultant, international and regional clinical relations, Massachusetts General Hospital and Partners HealthCare, Boston, MA, and Immediate Past-President of the ACS.

• Julie A. Freischlag, MD, FACS, vice-chancellor, human health sciences, and dean, school of medicine; University of California-Davis Health System, and Past-Chair of the ACS Board of Regents.

• Matthew M. Hutter, MD, MPH, FACS, director, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, and associate professor of surgery, Harvard Medical School, Boston.

• Larry R. Kaiser, MD, FACS, president and chief executive officer, Temple University Health System, and dean, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.

• Fabrizio Michelassi, MD, FACS, Lewis Atterbury Stimson Professor and chairman, department of surgery, Weill Cornell Medical College; surgeon in chief, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Chair, ACS Board of Governors.

• Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), chief medical officer, UW Medicine; vice-president for medical affairs, University of Washington, Seattle; and ACS Past-President.

• Nathaniel J. Soper, MD, FACS, Loyal and Edith Davis Professor and chair, department of surgery, and surgeon in chief, Northwestern Medicine, Chicago, IL, and a Past-Governor of the ACS.

• Beth H. Sutton, MD, FACS, general surgeon, Wichita Falls, TX; clinical professor of surgery, University of Texas Southwestern Medical School, Dallas; and ACS Regent.

• Michael Useem, PhD, William and Jacalyn Egan Professor of Management and director, Center for Leadership and Change Management, Wharton School of University of Pennsylvania, Philadelphia.

• The keynote speaker will be David F. Torchiana, MD, FACS, president and chief executive officer, Partners HealthCare System, Boston

Organized by the ACS Division of Education, the course will help surgeons exhibit leadership attributes; use consensus development and vision to set, align, and achieve goals; build and maintain effective teams; identify factors that hamper the ability to lead; change culture, resolve conflict, and balance demands within the larger environment; and translate the principles of leadership into action. For additional information, e-mail [email protected], or call 312-202-5018. ♦

Save the date for the American College of Surgeons (ACS) Surgeons as Leaders: From Operating Room to Boardroom course, June 5–8 in Durham, NC. Surgeons who aspire to meet the challenges of exemplary leadership across all settings are encouraged to join senior surgical leaders in the three-day course.

Faculty will include the following:

• Course Chair Andrew L. Warshaw, MD, FACS, FRCSEd(Hon), senior consultant, international and regional clinical relations, Massachusetts General Hospital and Partners HealthCare, Boston, MA, and Immediate Past-President of the ACS.

• Julie A. Freischlag, MD, FACS, vice-chancellor, human health sciences, and dean, school of medicine; University of California-Davis Health System, and Past-Chair of the ACS Board of Regents.

• Matthew M. Hutter, MD, MPH, FACS, director, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, and associate professor of surgery, Harvard Medical School, Boston.

• Larry R. Kaiser, MD, FACS, president and chief executive officer, Temple University Health System, and dean, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.

• Fabrizio Michelassi, MD, FACS, Lewis Atterbury Stimson Professor and chairman, department of surgery, Weill Cornell Medical College; surgeon in chief, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Chair, ACS Board of Governors.

• Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), chief medical officer, UW Medicine; vice-president for medical affairs, University of Washington, Seattle; and ACS Past-President.

• Nathaniel J. Soper, MD, FACS, Loyal and Edith Davis Professor and chair, department of surgery, and surgeon in chief, Northwestern Medicine, Chicago, IL, and a Past-Governor of the ACS.

• Beth H. Sutton, MD, FACS, general surgeon, Wichita Falls, TX; clinical professor of surgery, University of Texas Southwestern Medical School, Dallas; and ACS Regent.

• Michael Useem, PhD, William and Jacalyn Egan Professor of Management and director, Center for Leadership and Change Management, Wharton School of University of Pennsylvania, Philadelphia.

• The keynote speaker will be David F. Torchiana, MD, FACS, president and chief executive officer, Partners HealthCare System, Boston

Organized by the ACS Division of Education, the course will help surgeons exhibit leadership attributes; use consensus development and vision to set, align, and achieve goals; build and maintain effective teams; identify factors that hamper the ability to lead; change culture, resolve conflict, and balance demands within the larger environment; and translate the principles of leadership into action. For additional information, e-mail [email protected], or call 312-202-5018. ♦

Save the date for the American College of Surgeons (ACS) Surgeons as Leaders: From Operating Room to Boardroom course, June 5–8 in Durham, NC. Surgeons who aspire to meet the challenges of exemplary leadership across all settings are encouraged to join senior surgical leaders in the three-day course.

Faculty will include the following:

• Course Chair Andrew L. Warshaw, MD, FACS, FRCSEd(Hon), senior consultant, international and regional clinical relations, Massachusetts General Hospital and Partners HealthCare, Boston, MA, and Immediate Past-President of the ACS.

• Julie A. Freischlag, MD, FACS, vice-chancellor, human health sciences, and dean, school of medicine; University of California-Davis Health System, and Past-Chair of the ACS Board of Regents.

• Matthew M. Hutter, MD, MPH, FACS, director, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, and associate professor of surgery, Harvard Medical School, Boston.

• Larry R. Kaiser, MD, FACS, president and chief executive officer, Temple University Health System, and dean, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.

• Fabrizio Michelassi, MD, FACS, Lewis Atterbury Stimson Professor and chairman, department of surgery, Weill Cornell Medical College; surgeon in chief, New York-Presbyterian/Weill Cornell Medical Center, New York, NY; and Chair, ACS Board of Governors.

• Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon), chief medical officer, UW Medicine; vice-president for medical affairs, University of Washington, Seattle; and ACS Past-President.

• Nathaniel J. Soper, MD, FACS, Loyal and Edith Davis Professor and chair, department of surgery, and surgeon in chief, Northwestern Medicine, Chicago, IL, and a Past-Governor of the ACS.

• Beth H. Sutton, MD, FACS, general surgeon, Wichita Falls, TX; clinical professor of surgery, University of Texas Southwestern Medical School, Dallas; and ACS Regent.

• Michael Useem, PhD, William and Jacalyn Egan Professor of Management and director, Center for Leadership and Change Management, Wharton School of University of Pennsylvania, Philadelphia.

• The keynote speaker will be David F. Torchiana, MD, FACS, president and chief executive officer, Partners HealthCare System, Boston

Organized by the ACS Division of Education, the course will help surgeons exhibit leadership attributes; use consensus development and vision to set, align, and achieve goals; build and maintain effective teams; identify factors that hamper the ability to lead; change culture, resolve conflict, and balance demands within the larger environment; and translate the principles of leadership into action. For additional information, e-mail [email protected], or call 312-202-5018. ♦