News From the College

The American College of Surgeons Committee on Trauma (ACS COT) announced the 15 winners of the 36th annual Residents Trauma Papers Competition at its March 21-23 meeting in San Diego, CA. Each winner received a $500 prize, with an additional $500 awarded to the second-place winners in each category, and an extra $1,000 to the two first-place winners.

The competition is open to surgical residents and trauma fellows. Submissions describe original research in the area of trauma care and/or prevention in one of two categories: basic laboratory research or clinical investigation. The Eastern and Western States COTs, Region 7 (Iowa, Kansas, Missouri, and Nebraska) and the ACS are funding the competition.

Submissions begin at the state or provincial level, and winners are then judged at regional competitions. Each region is then eligible to submit two abstracts to a panel of COT judges, who make the final selection for presentation at the Scientific Session of the COT meeting. This year, Raul Coimbra, MD, PhD, FACS, San Diego, CA, Vice-Chair of the COT and Chair of the COT Regional Committees, moderated the session.

The surgical residents and trauma fellows who presented are listed in the sidebar on page 81.

The 2013 final winners are as follows (see photo, this page):

First Place, Basic Laboratory Research: Abubaker A. Ali, MD, Dearborn, MI (Region 5): The Stress Hormone Epinephrine Increases IgA Transport across Respiratory Epithelial Cells

First Place, Clinical Investigation: Eiman Zargaran, MD, Vancouver, BC (Region 11): Development and Evaluation of an Electronic Trauma Health Record to Support Trauma Care and Population-Based Injury Surveillance in Low-Resource Settings

Second Place, Basic Laboratory Research (tied): Kristin L. Long, MD, Lexington, KY, (Region 4): Fresh Red Blood Cells Mitigate Human T-Cell Suppression Seen with Stored Blood Bank Red Cells

Second Place, Basic Laboratory Research (tied): Isaiah R. Turnbull, MD, PhD, St. Louis, MO (Region 7): Severe Multisystem Injury Alters Immune Cell Expression of TLR-4 in a Novel Mouse Model of Adult Trauma

Second Place, Clinical Investigation: David A. Hampton, MD, MEng, Portland, OR (Region 10): Cryopreserved Red Blood Cells Are Superior to Standard Liquid Blood Cells

The American College of Surgeons Committee on Trauma (ACS COT) announced the 15 winners of the 36th annual Residents Trauma Papers Competition at its March 21-23 meeting in San Diego, CA. Each winner received a $500 prize, with an additional $500 awarded to the second-place winners in each category, and an extra $1,000 to the two first-place winners.

The competition is open to surgical residents and trauma fellows. Submissions describe original research in the area of trauma care and/or prevention in one of two categories: basic laboratory research or clinical investigation. The Eastern and Western States COTs, Region 7 (Iowa, Kansas, Missouri, and Nebraska) and the ACS are funding the competition.

Submissions begin at the state or provincial level, and winners are then judged at regional competitions. Each region is then eligible to submit two abstracts to a panel of COT judges, who make the final selection for presentation at the Scientific Session of the COT meeting. This year, Raul Coimbra, MD, PhD, FACS, San Diego, CA, Vice-Chair of the COT and Chair of the COT Regional Committees, moderated the session.

The surgical residents and trauma fellows who presented are listed in the sidebar on page 81.

The 2013 final winners are as follows (see photo, this page):

First Place, Basic Laboratory Research: Abubaker A. Ali, MD, Dearborn, MI (Region 5): The Stress Hormone Epinephrine Increases IgA Transport across Respiratory Epithelial Cells

First Place, Clinical Investigation: Eiman Zargaran, MD, Vancouver, BC (Region 11): Development and Evaluation of an Electronic Trauma Health Record to Support Trauma Care and Population-Based Injury Surveillance in Low-Resource Settings

Second Place, Basic Laboratory Research (tied): Kristin L. Long, MD, Lexington, KY, (Region 4): Fresh Red Blood Cells Mitigate Human T-Cell Suppression Seen with Stored Blood Bank Red Cells

Second Place, Basic Laboratory Research (tied): Isaiah R. Turnbull, MD, PhD, St. Louis, MO (Region 7): Severe Multisystem Injury Alters Immune Cell Expression of TLR-4 in a Novel Mouse Model of Adult Trauma

Second Place, Clinical Investigation: David A. Hampton, MD, MEng, Portland, OR (Region 10): Cryopreserved Red Blood Cells Are Superior to Standard Liquid Blood Cells

The American College of Surgeons Committee on Trauma (ACS COT) announced the 15 winners of the 36th annual Residents Trauma Papers Competition at its March 21-23 meeting in San Diego, CA. Each winner received a $500 prize, with an additional $500 awarded to the second-place winners in each category, and an extra $1,000 to the two first-place winners.

The competition is open to surgical residents and trauma fellows. Submissions describe original research in the area of trauma care and/or prevention in one of two categories: basic laboratory research or clinical investigation. The Eastern and Western States COTs, Region 7 (Iowa, Kansas, Missouri, and Nebraska) and the ACS are funding the competition.

Submissions begin at the state or provincial level, and winners are then judged at regional competitions. Each region is then eligible to submit two abstracts to a panel of COT judges, who make the final selection for presentation at the Scientific Session of the COT meeting. This year, Raul Coimbra, MD, PhD, FACS, San Diego, CA, Vice-Chair of the COT and Chair of the COT Regional Committees, moderated the session.

The surgical residents and trauma fellows who presented are listed in the sidebar on page 81.

The 2013 final winners are as follows (see photo, this page):

First Place, Basic Laboratory Research: Abubaker A. Ali, MD, Dearborn, MI (Region 5): The Stress Hormone Epinephrine Increases IgA Transport across Respiratory Epithelial Cells

First Place, Clinical Investigation: Eiman Zargaran, MD, Vancouver, BC (Region 11): Development and Evaluation of an Electronic Trauma Health Record to Support Trauma Care and Population-Based Injury Surveillance in Low-Resource Settings

Second Place, Basic Laboratory Research (tied): Kristin L. Long, MD, Lexington, KY, (Region 4): Fresh Red Blood Cells Mitigate Human T-Cell Suppression Seen with Stored Blood Bank Red Cells

Second Place, Basic Laboratory Research (tied): Isaiah R. Turnbull, MD, PhD, St. Louis, MO (Region 7): Severe Multisystem Injury Alters Immune Cell Expression of TLR-4 in a Novel Mouse Model of Adult Trauma

Second Place, Clinical Investigation: David A. Hampton, MD, MEng, Portland, OR (Region 10): Cryopreserved Red Blood Cells Are Superior to Standard Liquid Blood Cells

The Centers for Medicare & Medicaid Services (CMS) on April 26 released the fiscal year (FY) 2014 Inpatient Prospective Payment System (IPPS) proposed rule, which would increase average inpatient payments by 0.8 percent starting when FY2014 begins on October 1, 2013. This reimbursement update is contingent upon hospitals reporting data as specified in the Inpatient Quality Reporting program, which requires hospitals to report on a specified list of quality measures in order to receive the full annual update to their payment rates.

The proposed rule also would reduce disproportionate share hospital payments to 25 percent of the amount that Medicare currently pays. The remaining 75 percent would be distributed to hospitals based on their share of uncompensated care provided to Medicare patients.

In addition, the proposed rule would make a number of changes aimed at quality improvement, such as increasing the percentage of Medicare payments that hospitals would lose due to excessive readmissions under the Hospital Readmissions Reduction Program from the current 1 percent to 2 percent; increasing the reduction in hospital Medicare payment to fund the Hospital Value-Based Purchasing program from the current 1 percent to 1.25 percent; and reducing Medicare payments by 1 percent for hospitals that are in the highest quartile with respect to their rates of hospital-acquired conditions.

Another significant provision calls for revising the definition of inpatient. The new definition would presume that hospital inpatient admissions are reasonable and necessary for patients receiving medically necessary services who require more than one Medicare use day, which would be defined as a hospital stay crossing two midnights.

ACS regulatory staff is evaluating the proposed rule to determine the potential impact on surgery and will submit a comment letter to CMS. View a copy of the proposed rule at http://www.ofr.gov/OFRUpload/OFRData/2013-10234_PI.pdf] -13=10234.PI.pdf. View fact sheets on the payment and quality aspects of the proposal, both released April 26, at http://www.cms.gov/apps/media/fact_sheets.asp.

The Centers for Medicare & Medicaid Services (CMS) on April 26 released the fiscal year (FY) 2014 Inpatient Prospective Payment System (IPPS) proposed rule, which would increase average inpatient payments by 0.8 percent starting when FY2014 begins on October 1, 2013. This reimbursement update is contingent upon hospitals reporting data as specified in the Inpatient Quality Reporting program, which requires hospitals to report on a specified list of quality measures in order to receive the full annual update to their payment rates.

The proposed rule also would reduce disproportionate share hospital payments to 25 percent of the amount that Medicare currently pays. The remaining 75 percent would be distributed to hospitals based on their share of uncompensated care provided to Medicare patients.

In addition, the proposed rule would make a number of changes aimed at quality improvement, such as increasing the percentage of Medicare payments that hospitals would lose due to excessive readmissions under the Hospital Readmissions Reduction Program from the current 1 percent to 2 percent; increasing the reduction in hospital Medicare payment to fund the Hospital Value-Based Purchasing program from the current 1 percent to 1.25 percent; and reducing Medicare payments by 1 percent for hospitals that are in the highest quartile with respect to their rates of hospital-acquired conditions.

Another significant provision calls for revising the definition of inpatient. The new definition would presume that hospital inpatient admissions are reasonable and necessary for patients receiving medically necessary services who require more than one Medicare use day, which would be defined as a hospital stay crossing two midnights.

ACS regulatory staff is evaluating the proposed rule to determine the potential impact on surgery and will submit a comment letter to CMS. View a copy of the proposed rule at http://www.ofr.gov/OFRUpload/OFRData/2013-10234_PI.pdf] -13=10234.PI.pdf. View fact sheets on the payment and quality aspects of the proposal, both released April 26, at http://www.cms.gov/apps/media/fact_sheets.asp.

The Centers for Medicare & Medicaid Services (CMS) on April 26 released the fiscal year (FY) 2014 Inpatient Prospective Payment System (IPPS) proposed rule, which would increase average inpatient payments by 0.8 percent starting when FY2014 begins on October 1, 2013. This reimbursement update is contingent upon hospitals reporting data as specified in the Inpatient Quality Reporting program, which requires hospitals to report on a specified list of quality measures in order to receive the full annual update to their payment rates.

The proposed rule also would reduce disproportionate share hospital payments to 25 percent of the amount that Medicare currently pays. The remaining 75 percent would be distributed to hospitals based on their share of uncompensated care provided to Medicare patients.

In addition, the proposed rule would make a number of changes aimed at quality improvement, such as increasing the percentage of Medicare payments that hospitals would lose due to excessive readmissions under the Hospital Readmissions Reduction Program from the current 1 percent to 2 percent; increasing the reduction in hospital Medicare payment to fund the Hospital Value-Based Purchasing program from the current 1 percent to 1.25 percent; and reducing Medicare payments by 1 percent for hospitals that are in the highest quartile with respect to their rates of hospital-acquired conditions.

Another significant provision calls for revising the definition of inpatient. The new definition would presume that hospital inpatient admissions are reasonable and necessary for patients receiving medically necessary services who require more than one Medicare use day, which would be defined as a hospital stay crossing two midnights.

ACS regulatory staff is evaluating the proposed rule to determine the potential impact on surgery and will submit a comment letter to CMS. View a copy of the proposed rule at http://www.ofr.gov/OFRUpload/OFRData/2013-10234_PI.pdf] -13=10234.PI.pdf. View fact sheets on the payment and quality aspects of the proposal, both released April 26, at http://www.cms.gov/apps/media/fact_sheets.asp.

A total of 102 hospitals now are participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) and the Centers for Medicare & Medicaid Services (CMS) collaborative pilot project that allows ACS NSQIP hospitals to voluntarily report surgical performance measures on the CMS Hospital Compare website. On April 18, the results of the second reporting period were posted to the Hospital Compare website. Since the initial reporting period ended in October 2012, 23 additional hospitals have volunteered to publicly report their ACS NSQIP performance measures. View the results for the 102 hospitals.

Participating hospitals may report results for one or any combination of three National Quality Forum (NQF)–endorsed surgical measures: elderly surgical outcomes, colon surgical outcomes, and lower-extremity bypass surgical outcomes.

Registration is open for the next reporting period scheduled for October 2013. View additional information at http://site.acsnsqip.org/ regarding this initiative and registration procedures.

A total of 102 hospitals now are participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) and the Centers for Medicare & Medicaid Services (CMS) collaborative pilot project that allows ACS NSQIP hospitals to voluntarily report surgical performance measures on the CMS Hospital Compare website. On April 18, the results of the second reporting period were posted to the Hospital Compare website. Since the initial reporting period ended in October 2012, 23 additional hospitals have volunteered to publicly report their ACS NSQIP performance measures. View the results for the 102 hospitals.

Participating hospitals may report results for one or any combination of three National Quality Forum (NQF)–endorsed surgical measures: elderly surgical outcomes, colon surgical outcomes, and lower-extremity bypass surgical outcomes.

Registration is open for the next reporting period scheduled for October 2013. View additional information at http://site.acsnsqip.org/ regarding this initiative and registration procedures.

A total of 102 hospitals now are participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) and the Centers for Medicare & Medicaid Services (CMS) collaborative pilot project that allows ACS NSQIP hospitals to voluntarily report surgical performance measures on the CMS Hospital Compare website. On April 18, the results of the second reporting period were posted to the Hospital Compare website. Since the initial reporting period ended in October 2012, 23 additional hospitals have volunteered to publicly report their ACS NSQIP performance measures. View the results for the 102 hospitals.

Participating hospitals may report results for one or any combination of three National Quality Forum (NQF)–endorsed surgical measures: elderly surgical outcomes, colon surgical outcomes, and lower-extremity bypass surgical outcomes.

Registration is open for the next reporting period scheduled for October 2013. View additional information at http://site.acsnsqip.org/ regarding this initiative and registration procedures.

The practice of surgery provides significant privileges and rewards, but with accompanying responsibilities and challenges. As surgeons become more experienced and mature professionally, some of the most difficult issues they face fall outside the realm of patient care and medical knowledge. At times, behavioral, physical, judgment and impairment issues may damage and derail a surgeon’s ability to practice safely and effectively. Most surgeons know colleagues whose careers have been limited by these issues; some have personal experience. To help surgeons develop a better understanding of these problems, the American College of Surgeons (ACS) Board of Governors Committee on Physician Competency and Health has posted Being Well and Staying Competent: Challenges for the Surgeon on the members-only Web portal at www.efacs.org.

Ongoing concern

In the past, the expectation was that surgeons dealing with fatigue, illness, and other issues that can lead to impairment could, and should, "tough it out". The occasional acknowledgement of human frailty was mostly limited to cautionary tales of surgeons who were considered not resilient enough to meet the demands of surgical practice. Impairment and how to address it is rarely a component of surgical training; hence, most surgeons are far more comfortable managing a bowel obstruction than an impaired colleague. Additionally, surgeons may not realize that some of the personality traits we value in ourselves and our colleagues (compulsiveness, a heightened sense of responsibility, perfectionism) may predispose them to dysfunction and impairment. Consequently, situations and behaviors that are detrimental to patient care and surgeon wellbeing are sometimes ignored and rationalized.

The Governors’ Committee on Competency and Health has been studying these issues since 2008, when, with the support of the College, the committee commissioned a survey of the Fellows, asking about personal characteristics, practice situations, quality of life, professional satisfaction, issues relating to fatigue, and other topics. Most surgeons described good quality of life, and nearly three-quarters stated that, given the choice, they would again choose surgery as a career. Nonetheless, the large-scale response of nearly 8,000 Fellows reflected significant rates of burnout, depression, and other issues related to professional satisfaction and work-life balance.

Another survey performed in 2010 had a somewhat different focus, with questions addressing interpersonal relationships, work-life balance, coping mechanisms, and substance abuse. Responses to this study corroborated previous findings but also demonstrated high rates of substance abuse. Surgeons who reported making a major medical mistake in the three months prior to completing the survey were much more likely to offer responses indicating burnout, particularly emotional exhaustion and depersonalization, regardless of whether the patient was harmed.

A new resource

The committee examined the survey results carefully and solicited feedback, questions, and concerns from Fellows and decided to develop a readily available resource that Fellows could use to both identify and address these concerns. A previous pamphlet on The Impaired Surgeon was published in 1992 through the ACS Committee on Physicians’ Health (the precursor to the current committee) and revised in 1995. This resource primarily dealt with impairment due to alcohol or substance abuse. The evidence from the surveys and our personal experience suggested that the challenges facing surgeons are more wide-ranging. Discussion among committee members about the complexities of the identified problems led to the topic selections for Being Well and Staying Competent: Challenges for the Surgeon.

The committee members who contributed to this resource acknowledge that few of them are experts in these areas, but are surgeons with practical experience who are aware of the challenges and seek to offer assistance. Topics explored in the document include surgeon burnout, substance abuse, sleep deprivation, age impairment, the disruptive physician, boundaries, and credentialing issues.

The committee chose to post the document on ACS Portal to provide rapid access to this resource in a digital format. In addition, select sections of the resource are serving as the basis of a series of article in the ACS Bulletin, http://bulletin.facs.org/.

The practice of surgery provides significant privileges and rewards, but with accompanying responsibilities and challenges. As surgeons become more experienced and mature professionally, some of the most difficult issues they face fall outside the realm of patient care and medical knowledge. At times, behavioral, physical, judgment and impairment issues may damage and derail a surgeon’s ability to practice safely and effectively. Most surgeons know colleagues whose careers have been limited by these issues; some have personal experience. To help surgeons develop a better understanding of these problems, the American College of Surgeons (ACS) Board of Governors Committee on Physician Competency and Health has posted Being Well and Staying Competent: Challenges for the Surgeon on the members-only Web portal at www.efacs.org.

Ongoing concern

In the past, the expectation was that surgeons dealing with fatigue, illness, and other issues that can lead to impairment could, and should, "tough it out". The occasional acknowledgement of human frailty was mostly limited to cautionary tales of surgeons who were considered not resilient enough to meet the demands of surgical practice. Impairment and how to address it is rarely a component of surgical training; hence, most surgeons are far more comfortable managing a bowel obstruction than an impaired colleague. Additionally, surgeons may not realize that some of the personality traits we value in ourselves and our colleagues (compulsiveness, a heightened sense of responsibility, perfectionism) may predispose them to dysfunction and impairment. Consequently, situations and behaviors that are detrimental to patient care and surgeon wellbeing are sometimes ignored and rationalized.

The Governors’ Committee on Competency and Health has been studying these issues since 2008, when, with the support of the College, the committee commissioned a survey of the Fellows, asking about personal characteristics, practice situations, quality of life, professional satisfaction, issues relating to fatigue, and other topics. Most surgeons described good quality of life, and nearly three-quarters stated that, given the choice, they would again choose surgery as a career. Nonetheless, the large-scale response of nearly 8,000 Fellows reflected significant rates of burnout, depression, and other issues related to professional satisfaction and work-life balance.

Another survey performed in 2010 had a somewhat different focus, with questions addressing interpersonal relationships, work-life balance, coping mechanisms, and substance abuse. Responses to this study corroborated previous findings but also demonstrated high rates of substance abuse. Surgeons who reported making a major medical mistake in the three months prior to completing the survey were much more likely to offer responses indicating burnout, particularly emotional exhaustion and depersonalization, regardless of whether the patient was harmed.

A new resource

The committee examined the survey results carefully and solicited feedback, questions, and concerns from Fellows and decided to develop a readily available resource that Fellows could use to both identify and address these concerns. A previous pamphlet on The Impaired Surgeon was published in 1992 through the ACS Committee on Physicians’ Health (the precursor to the current committee) and revised in 1995. This resource primarily dealt with impairment due to alcohol or substance abuse. The evidence from the surveys and our personal experience suggested that the challenges facing surgeons are more wide-ranging. Discussion among committee members about the complexities of the identified problems led to the topic selections for Being Well and Staying Competent: Challenges for the Surgeon.

The committee members who contributed to this resource acknowledge that few of them are experts in these areas, but are surgeons with practical experience who are aware of the challenges and seek to offer assistance. Topics explored in the document include surgeon burnout, substance abuse, sleep deprivation, age impairment, the disruptive physician, boundaries, and credentialing issues.

The committee chose to post the document on ACS Portal to provide rapid access to this resource in a digital format. In addition, select sections of the resource are serving as the basis of a series of article in the ACS Bulletin, http://bulletin.facs.org/.

The practice of surgery provides significant privileges and rewards, but with accompanying responsibilities and challenges. As surgeons become more experienced and mature professionally, some of the most difficult issues they face fall outside the realm of patient care and medical knowledge. At times, behavioral, physical, judgment and impairment issues may damage and derail a surgeon’s ability to practice safely and effectively. Most surgeons know colleagues whose careers have been limited by these issues; some have personal experience. To help surgeons develop a better understanding of these problems, the American College of Surgeons (ACS) Board of Governors Committee on Physician Competency and Health has posted Being Well and Staying Competent: Challenges for the Surgeon on the members-only Web portal at www.efacs.org.

Ongoing concern

In the past, the expectation was that surgeons dealing with fatigue, illness, and other issues that can lead to impairment could, and should, "tough it out". The occasional acknowledgement of human frailty was mostly limited to cautionary tales of surgeons who were considered not resilient enough to meet the demands of surgical practice. Impairment and how to address it is rarely a component of surgical training; hence, most surgeons are far more comfortable managing a bowel obstruction than an impaired colleague. Additionally, surgeons may not realize that some of the personality traits we value in ourselves and our colleagues (compulsiveness, a heightened sense of responsibility, perfectionism) may predispose them to dysfunction and impairment. Consequently, situations and behaviors that are detrimental to patient care and surgeon wellbeing are sometimes ignored and rationalized.

The Governors’ Committee on Competency and Health has been studying these issues since 2008, when, with the support of the College, the committee commissioned a survey of the Fellows, asking about personal characteristics, practice situations, quality of life, professional satisfaction, issues relating to fatigue, and other topics. Most surgeons described good quality of life, and nearly three-quarters stated that, given the choice, they would again choose surgery as a career. Nonetheless, the large-scale response of nearly 8,000 Fellows reflected significant rates of burnout, depression, and other issues related to professional satisfaction and work-life balance.

Another survey performed in 2010 had a somewhat different focus, with questions addressing interpersonal relationships, work-life balance, coping mechanisms, and substance abuse. Responses to this study corroborated previous findings but also demonstrated high rates of substance abuse. Surgeons who reported making a major medical mistake in the three months prior to completing the survey were much more likely to offer responses indicating burnout, particularly emotional exhaustion and depersonalization, regardless of whether the patient was harmed.

A new resource

The committee examined the survey results carefully and solicited feedback, questions, and concerns from Fellows and decided to develop a readily available resource that Fellows could use to both identify and address these concerns. A previous pamphlet on The Impaired Surgeon was published in 1992 through the ACS Committee on Physicians’ Health (the precursor to the current committee) and revised in 1995. This resource primarily dealt with impairment due to alcohol or substance abuse. The evidence from the surveys and our personal experience suggested that the challenges facing surgeons are more wide-ranging. Discussion among committee members about the complexities of the identified problems led to the topic selections for Being Well and Staying Competent: Challenges for the Surgeon.

The committee members who contributed to this resource acknowledge that few of them are experts in these areas, but are surgeons with practical experience who are aware of the challenges and seek to offer assistance. Topics explored in the document include surgeon burnout, substance abuse, sleep deprivation, age impairment, the disruptive physician, boundaries, and credentialing issues.

The committee chose to post the document on ACS Portal to provide rapid access to this resource in a digital format. In addition, select sections of the resource are serving as the basis of a series of article in the ACS Bulletin, http://bulletin.facs.org/.

The American College of Surgeons (ACS) Division of Education has introduced the new ACS Transition to Practice Program in General Surgery. Through this program, residents making the transition to independent practice will:

• Obtain enhanced autonomous experience in broad-based general surgery

• Increase their competence and confidence in clinical matters

• Gain exposure to aspects of practice management

• Experience mentoring with notable practicing surgeons

• Participate in experiential learning tailored to individual needs

The following institutions will offer the ACS Transition to Practice Program starting in July 2013:

Gundersen Lutheran Health System, LaCrosse, WI

Mercer University School of Medicine/Medical Center of Central Georgia, Macon

Ohio State University Wexner Medical Center, Columbus

University of Louisville School of Medicine, KY

University of Tennessee College of Medicine, Chattanooga

ACS Executive Director David B. Hoyt, MD, FACS, offers an overview of the ACS Transition to Practice Program in his "Looking Forward" column in the February 2013 Bulletin of the American College of Surgeons. To view the article, go to http://bulletin.facs.org/2013/02/looking-forward-february-2013. For additional information, please contact the Division of Education at 312-202-5491 or [email protected].

The American College of Surgeons (ACS) Division of Education has introduced the new ACS Transition to Practice Program in General Surgery. Through this program, residents making the transition to independent practice will:

• Obtain enhanced autonomous experience in broad-based general surgery

• Increase their competence and confidence in clinical matters

• Gain exposure to aspects of practice management

• Experience mentoring with notable practicing surgeons

• Participate in experiential learning tailored to individual needs

The following institutions will offer the ACS Transition to Practice Program starting in July 2013:

Gundersen Lutheran Health System, LaCrosse, WI

Mercer University School of Medicine/Medical Center of Central Georgia, Macon

Ohio State University Wexner Medical Center, Columbus

University of Louisville School of Medicine, KY

University of Tennessee College of Medicine, Chattanooga

ACS Executive Director David B. Hoyt, MD, FACS, offers an overview of the ACS Transition to Practice Program in his "Looking Forward" column in the February 2013 Bulletin of the American College of Surgeons. To view the article, go to http://bulletin.facs.org/2013/02/looking-forward-february-2013. For additional information, please contact the Division of Education at 312-202-5491 or [email protected].

The American College of Surgeons (ACS) Division of Education has introduced the new ACS Transition to Practice Program in General Surgery. Through this program, residents making the transition to independent practice will:

• Obtain enhanced autonomous experience in broad-based general surgery

• Increase their competence and confidence in clinical matters

• Gain exposure to aspects of practice management

• Experience mentoring with notable practicing surgeons

• Participate in experiential learning tailored to individual needs

The following institutions will offer the ACS Transition to Practice Program starting in July 2013:

Gundersen Lutheran Health System, LaCrosse, WI

Mercer University School of Medicine/Medical Center of Central Georgia, Macon

Ohio State University Wexner Medical Center, Columbus

University of Louisville School of Medicine, KY

University of Tennessee College of Medicine, Chattanooga

ACS Executive Director David B. Hoyt, MD, FACS, offers an overview of the ACS Transition to Practice Program in his "Looking Forward" column in the February 2013 Bulletin of the American College of Surgeons. To view the article, go to http://bulletin.facs.org/2013/02/looking-forward-february-2013. For additional information, please contact the Division of Education at 312-202-5491 or [email protected].

The American College of Surgeons (ACS) recently released the Surgeons and Bundled Payment Models: A Primer for Understanding Alternative Physician Payment Approaches, which summarizes the concept of bundled payment and the effect bundled payment policies could have on surgical practices.

Given the increased focus on bundled payment as an approach to payment reform, the ACS General Surgery Coding and Reimbursement Committee formed a workgroup to develop a process for creating clinically coherent bundled payment models and analyzing the potential opportunities and barriers. The workgroup was composed of surgeon experts in quality and coding and reimbursement and was tasked with: (1) determining the resources and expertise necessary for developing clinically coherent surgical bundles; (2) developing general principles regarding the selection, optimal structure, and function of surgical bundles; (3) providing robust guidelines about which procedures or condition characteristics must be present to construct a usable bundle; and (4) providing insight about which characteristics might make a procedure or condition a poor candidate for a bundled payment model.

In addition to the workgroup findings, the primer provides an overview of existing bundled payment programs at Geisinger Health System in Pennsylvania and BlueCross BlueShield of Massachusetts, as well as common issues to consider when developing a bundle. To access this members-only resource, go to http://efacs.org/advocacy and use your ACS issued username and password.

The American College of Surgeons (ACS) recently released the Surgeons and Bundled Payment Models: A Primer for Understanding Alternative Physician Payment Approaches, which summarizes the concept of bundled payment and the effect bundled payment policies could have on surgical practices.

Given the increased focus on bundled payment as an approach to payment reform, the ACS General Surgery Coding and Reimbursement Committee formed a workgroup to develop a process for creating clinically coherent bundled payment models and analyzing the potential opportunities and barriers. The workgroup was composed of surgeon experts in quality and coding and reimbursement and was tasked with: (1) determining the resources and expertise necessary for developing clinically coherent surgical bundles; (2) developing general principles regarding the selection, optimal structure, and function of surgical bundles; (3) providing robust guidelines about which procedures or condition characteristics must be present to construct a usable bundle; and (4) providing insight about which characteristics might make a procedure or condition a poor candidate for a bundled payment model.

In addition to the workgroup findings, the primer provides an overview of existing bundled payment programs at Geisinger Health System in Pennsylvania and BlueCross BlueShield of Massachusetts, as well as common issues to consider when developing a bundle. To access this members-only resource, go to http://efacs.org/advocacy and use your ACS issued username and password.

The American College of Surgeons (ACS) recently released the Surgeons and Bundled Payment Models: A Primer for Understanding Alternative Physician Payment Approaches, which summarizes the concept of bundled payment and the effect bundled payment policies could have on surgical practices.

Given the increased focus on bundled payment as an approach to payment reform, the ACS General Surgery Coding and Reimbursement Committee formed a workgroup to develop a process for creating clinically coherent bundled payment models and analyzing the potential opportunities and barriers. The workgroup was composed of surgeon experts in quality and coding and reimbursement and was tasked with: (1) determining the resources and expertise necessary for developing clinically coherent surgical bundles; (2) developing general principles regarding the selection, optimal structure, and function of surgical bundles; (3) providing robust guidelines about which procedures or condition characteristics must be present to construct a usable bundle; and (4) providing insight about which characteristics might make a procedure or condition a poor candidate for a bundled payment model.

In addition to the workgroup findings, the primer provides an overview of existing bundled payment programs at Geisinger Health System in Pennsylvania and BlueCross BlueShield of Massachusetts, as well as common issues to consider when developing a bundle. To access this members-only resource, go to http://efacs.org/advocacy and use your ACS issued username and password.

A study published in the March issue of the Journal of the American College of Surgeons (JACS) shows that data collected through the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP^®) may be more useful than administrative records in accurately tracking and evaluating information on hospital readmissions. Accurate monitoring of the causes of readmissions is becoming increasingly relevant as The Centers for Medicare & Medicaid Services (CMS) seeks to publicly report on readmission rates and has even begun withholding payment for readmissions involving certain hospital-acquired complications.

"If we’re going to try to reduce readmissions and improve care for surgical patients, we have to know why they are being readmitted," said the study’s senior author, Karl Y. Bilimoria, MD, FACS, assistant professor of surgery and director of the surgical outcomes and quality improvement center at Northwestern University, Chicago, IL. "The CMS readmission data do not reliably offer that [information] to hospitals, and the more granular you can get with the information, the more actionable it will be locally for quality improvement and reduction of readmissions."

Currently, more than one in 10 surgical patients experiences complications requiring hospital readmission, according to a 2012 study also published in JACS.*

Comparisons of data

Most hospitals use their own clinical patient records and administrative data to determine how patients fare after a surgical procedure. However, this approach has its limitations. Clinical patient records are considered the gold standard of patient tracking because the treating physician or other health care professional records the information in real time. However, internal review of patient records does not allow hospitals to compare their results with those of other institutions.

Administrative data are provided for billing purposes only and usually by someone with no clinical training. Furthermore, administrative records do not provide reasons for readmissions or indicate whether a readmission was planned or unplanned.

Hospitals participating in ACS NSQIP may review clinical patient data and compare their outcomes with those at other hospitals in the database, and in January 2011, ACS NSQIP began collecting key data on the frequency and causes of readmissions.

In their study, Dr. Bilimoria and the Northwestern research team sought to determine whether the information in ACS NSQIP accurately reflected patient medical records and how the information compared with administrative data.

Data analysis

The surgeons examined data on 1,748 patients in Northwestern Memorial Hospital’s ACS NSQIP database. Nearly 70 percent of the patients had operations that required a hospital stay, and nearly all came to the hospital able to function independently. Approximately 7.5 percent were readmitted within 30 days of their operations.

The investigators then assessed the accuracy of the ACS NSQIP data by comparing it with the readmission data in the patients’ medical records—a comparison that yielded a rate of 99.8 percent agreement with the patients’ charts. Only two readmissions were not captured in the ACS NSQIP data.

Additionally, two readmissions were misclassified because the patients were readmitted through the emergency department (ED), and patients who come through the ED are not always recognized as a readmission. The difference highlights the need for comparing sources of information in order to improve the quality of surgical patient care and tracking. "Since seeing that inconsistency, we’ve been able to correct it," Dr. Bilimoria said.

ACS NSQIP also had a 95.7 percent agreement with the patient charts on tracking whether the readmission was planned or unplanned and nearly 80 percent agreement on the cause of the readmissions.

Whereas the study found 99.5 percent agreement between the administrative data and patient charts on recording readmissions, agreement was significantly lower on the reasons behind the readmission (55.1 percent).

"Historically, the most used source of readmission data has been administrative data," the authors wrote. However, Dr. Bilimoria said, "ACS NSQIP is as reliable as going through a chart. It’s certainly a better source than administrative data.

"It’s the type of data you can use to identify opportunities for improvement," Dr. Bilimoria added.

Data at work

Surgeons at Northwestern Memorial Hospital have used the data to improve their surgical site infection and urinary tract infection rates for surgical patients. "We keep an eye on all outcomes," Dr. Bilimoria said. "If we’re average on one quality of care standard, we can recognize it and work toward becoming excellent."

Other study participants are all affiliated with Northwestern Memorial Hospital and include Morgan M. Sellers; Ryan P. Merkow, MD; Amy Halverson, MD, FACS; Keiki Hinami, MD; Rachel R. Kelz, MD, MSCE, FACS; and David J. Bentrem, MD, FACS.

*Kassin, MT, Owen RM, Perez, SD. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;Sep:215(3):322-330.

A study published in the March issue of the Journal of the American College of Surgeons (JACS) shows that data collected through the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP^®) may be more useful than administrative records in accurately tracking and evaluating information on hospital readmissions. Accurate monitoring of the causes of readmissions is becoming increasingly relevant as The Centers for Medicare & Medicaid Services (CMS) seeks to publicly report on readmission rates and has even begun withholding payment for readmissions involving certain hospital-acquired complications.

"If we’re going to try to reduce readmissions and improve care for surgical patients, we have to know why they are being readmitted," said the study’s senior author, Karl Y. Bilimoria, MD, FACS, assistant professor of surgery and director of the surgical outcomes and quality improvement center at Northwestern University, Chicago, IL. "The CMS readmission data do not reliably offer that [information] to hospitals, and the more granular you can get with the information, the more actionable it will be locally for quality improvement and reduction of readmissions."

Currently, more than one in 10 surgical patients experiences complications requiring hospital readmission, according to a 2012 study also published in JACS.*

Comparisons of data

Most hospitals use their own clinical patient records and administrative data to determine how patients fare after a surgical procedure. However, this approach has its limitations. Clinical patient records are considered the gold standard of patient tracking because the treating physician or other health care professional records the information in real time. However, internal review of patient records does not allow hospitals to compare their results with those of other institutions.

Administrative data are provided for billing purposes only and usually by someone with no clinical training. Furthermore, administrative records do not provide reasons for readmissions or indicate whether a readmission was planned or unplanned.

Hospitals participating in ACS NSQIP may review clinical patient data and compare their outcomes with those at other hospitals in the database, and in January 2011, ACS NSQIP began collecting key data on the frequency and causes of readmissions.

In their study, Dr. Bilimoria and the Northwestern research team sought to determine whether the information in ACS NSQIP accurately reflected patient medical records and how the information compared with administrative data.

Data analysis

The surgeons examined data on 1,748 patients in Northwestern Memorial Hospital’s ACS NSQIP database. Nearly 70 percent of the patients had operations that required a hospital stay, and nearly all came to the hospital able to function independently. Approximately 7.5 percent were readmitted within 30 days of their operations.

The investigators then assessed the accuracy of the ACS NSQIP data by comparing it with the readmission data in the patients’ medical records—a comparison that yielded a rate of 99.8 percent agreement with the patients’ charts. Only two readmissions were not captured in the ACS NSQIP data.

Additionally, two readmissions were misclassified because the patients were readmitted through the emergency department (ED), and patients who come through the ED are not always recognized as a readmission. The difference highlights the need for comparing sources of information in order to improve the quality of surgical patient care and tracking. "Since seeing that inconsistency, we’ve been able to correct it," Dr. Bilimoria said.

ACS NSQIP also had a 95.7 percent agreement with the patient charts on tracking whether the readmission was planned or unplanned and nearly 80 percent agreement on the cause of the readmissions.

Whereas the study found 99.5 percent agreement between the administrative data and patient charts on recording readmissions, agreement was significantly lower on the reasons behind the readmission (55.1 percent).

"Historically, the most used source of readmission data has been administrative data," the authors wrote. However, Dr. Bilimoria said, "ACS NSQIP is as reliable as going through a chart. It’s certainly a better source than administrative data.

"It’s the type of data you can use to identify opportunities for improvement," Dr. Bilimoria added.

Data at work

Surgeons at Northwestern Memorial Hospital have used the data to improve their surgical site infection and urinary tract infection rates for surgical patients. "We keep an eye on all outcomes," Dr. Bilimoria said. "If we’re average on one quality of care standard, we can recognize it and work toward becoming excellent."

Other study participants are all affiliated with Northwestern Memorial Hospital and include Morgan M. Sellers; Ryan P. Merkow, MD; Amy Halverson, MD, FACS; Keiki Hinami, MD; Rachel R. Kelz, MD, MSCE, FACS; and David J. Bentrem, MD, FACS.

*Kassin, MT, Owen RM, Perez, SD. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;Sep:215(3):322-330.

A study published in the March issue of the Journal of the American College of Surgeons (JACS) shows that data collected through the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP^®) may be more useful than administrative records in accurately tracking and evaluating information on hospital readmissions. Accurate monitoring of the causes of readmissions is becoming increasingly relevant as The Centers for Medicare & Medicaid Services (CMS) seeks to publicly report on readmission rates and has even begun withholding payment for readmissions involving certain hospital-acquired complications.

"If we’re going to try to reduce readmissions and improve care for surgical patients, we have to know why they are being readmitted," said the study’s senior author, Karl Y. Bilimoria, MD, FACS, assistant professor of surgery and director of the surgical outcomes and quality improvement center at Northwestern University, Chicago, IL. "The CMS readmission data do not reliably offer that [information] to hospitals, and the more granular you can get with the information, the more actionable it will be locally for quality improvement and reduction of readmissions."

Currently, more than one in 10 surgical patients experiences complications requiring hospital readmission, according to a 2012 study also published in JACS.*

Comparisons of data

Most hospitals use their own clinical patient records and administrative data to determine how patients fare after a surgical procedure. However, this approach has its limitations. Clinical patient records are considered the gold standard of patient tracking because the treating physician or other health care professional records the information in real time. However, internal review of patient records does not allow hospitals to compare their results with those of other institutions.

Administrative data are provided for billing purposes only and usually by someone with no clinical training. Furthermore, administrative records do not provide reasons for readmissions or indicate whether a readmission was planned or unplanned.

Hospitals participating in ACS NSQIP may review clinical patient data and compare their outcomes with those at other hospitals in the database, and in January 2011, ACS NSQIP began collecting key data on the frequency and causes of readmissions.

In their study, Dr. Bilimoria and the Northwestern research team sought to determine whether the information in ACS NSQIP accurately reflected patient medical records and how the information compared with administrative data.

Data analysis

The surgeons examined data on 1,748 patients in Northwestern Memorial Hospital’s ACS NSQIP database. Nearly 70 percent of the patients had operations that required a hospital stay, and nearly all came to the hospital able to function independently. Approximately 7.5 percent were readmitted within 30 days of their operations.

The investigators then assessed the accuracy of the ACS NSQIP data by comparing it with the readmission data in the patients’ medical records—a comparison that yielded a rate of 99.8 percent agreement with the patients’ charts. Only two readmissions were not captured in the ACS NSQIP data.

Additionally, two readmissions were misclassified because the patients were readmitted through the emergency department (ED), and patients who come through the ED are not always recognized as a readmission. The difference highlights the need for comparing sources of information in order to improve the quality of surgical patient care and tracking. "Since seeing that inconsistency, we’ve been able to correct it," Dr. Bilimoria said.

ACS NSQIP also had a 95.7 percent agreement with the patient charts on tracking whether the readmission was planned or unplanned and nearly 80 percent agreement on the cause of the readmissions.

Whereas the study found 99.5 percent agreement between the administrative data and patient charts on recording readmissions, agreement was significantly lower on the reasons behind the readmission (55.1 percent).

"Historically, the most used source of readmission data has been administrative data," the authors wrote. However, Dr. Bilimoria said, "ACS NSQIP is as reliable as going through a chart. It’s certainly a better source than administrative data.

"It’s the type of data you can use to identify opportunities for improvement," Dr. Bilimoria added.

Data at work

Surgeons at Northwestern Memorial Hospital have used the data to improve their surgical site infection and urinary tract infection rates for surgical patients. "We keep an eye on all outcomes," Dr. Bilimoria said. "If we’re average on one quality of care standard, we can recognize it and work toward becoming excellent."

Other study participants are all affiliated with Northwestern Memorial Hospital and include Morgan M. Sellers; Ryan P. Merkow, MD; Amy Halverson, MD, FACS; Keiki Hinami, MD; Rachel R. Kelz, MD, MSCE, FACS; and David J. Bentrem, MD, FACS.

*Kassin, MT, Owen RM, Perez, SD. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;Sep:215(3):322-330.

American College of Surgeons (ACS) members and subscribers to the Journal of the American College of Surgeons (JACS) have free access to the JACS iPad® Edition. You need only register for the free app to activate access to JACS contents at http://www.journalacs.org/content/mobileaccessinstructions. The JACS iPad app and digital journals can then be downloaded at the iTunes® app store at https://itunes.apple.com/us/app/ jacs-official-scientific-journal/id491332618?mt=8 and accessed through the new iPad Newstand interface. The app allows users to access JACS content wherever and whenever it is needed.

The app automatically downloads new issues and allows users to interact with the Journal by tapping links to content. Users may bookmark their favorite articles, take notes and highlight items within articles, save the material to their favorite electronic reading device, and quickly access articles and issues.

American College of Surgeons (ACS) members and subscribers to the Journal of the American College of Surgeons (JACS) have free access to the JACS iPad® Edition. You need only register for the free app to activate access to JACS contents at http://www.journalacs.org/content/mobileaccessinstructions. The JACS iPad app and digital journals can then be downloaded at the iTunes® app store at https://itunes.apple.com/us/app/ jacs-official-scientific-journal/id491332618?mt=8 and accessed through the new iPad Newstand interface. The app allows users to access JACS content wherever and whenever it is needed.

The app automatically downloads new issues and allows users to interact with the Journal by tapping links to content. Users may bookmark their favorite articles, take notes and highlight items within articles, save the material to their favorite electronic reading device, and quickly access articles and issues.

American College of Surgeons (ACS) members and subscribers to the Journal of the American College of Surgeons (JACS) have free access to the JACS iPad® Edition. You need only register for the free app to activate access to JACS contents at http://www.journalacs.org/content/mobileaccessinstructions. The JACS iPad app and digital journals can then be downloaded at the iTunes® app store at https://itunes.apple.com/us/app/ jacs-official-scientific-journal/id491332618?mt=8 and accessed through the new iPad Newstand interface. The app allows users to access JACS content wherever and whenever it is needed.

The app automatically downloads new issues and allows users to interact with the Journal by tapping links to content. Users may bookmark their favorite articles, take notes and highlight items within articles, save the material to their favorite electronic reading device, and quickly access articles and issues.

The American College of Surgeons (ACS) is offering International Guest Scholarships in 2014 to outstanding young surgeons from countries other than the U.S. or Canada who have demonstrated strong interests in teaching and research. The $10,000 scholarships will provide the International Guest Scholars with an opportunity to visit clinical, teaching, and research institutions in North America and to attend and participate fully in the educational opportunities and activities of the ACS Clinical Congress in San Francisco, CA, October 26-30, in 2014.

A legacy left to the College by Paul R. Hawley, MD, FACS (Hon), former Director of the College, originally funded the scholarship endowment. More recently, gifts from Fellows and their families and associates have expanded the roster of International Guest Scholarships. The ACS Foundation website features additional information about these benefactors and the awards they support.

The scholarship requirements are as follows:

• Applicants must be medical school graduates.

• Applicants must be at least 35 years of age, but younger than 45, on the filing date of the completed application.

• Applicants must submit their applications from their intended permanent location. The College will accept applications for processing only when the applicants have been in surgical practice, teaching, or research for a minimum of one 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 their respective home country.

• Applicants whose careers are in the developing stage are deemed more suitable for receipt of this scholarship than those who are serving in senior academic appointments.

• Applicants must submit a fully completed application form provided by the College on its website. The application and accompanying materials must be submitted in English. Submission of a curriculum vitae without a completed application is not acceptable.

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

• Applicants must submit letters of recommendation from three colleagues. One letter must be from the chair of the department in which the applicant holds academic appointment or a Fellow of the ACS residing in the applicant’s country. The letter from the chair or Fellow must include a specific statement detailing the nature and extent of the teaching and other academic involvement of the applicant.

• The International Guest Scholarships must be used in their designated year. Recipients cannot postpone the scholarship.

• Applicants who receive scholarships are expected to 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 current application form provided by the College, together with new supporting documentation.

International Guest Scholarships provide successful applicants with the privilege of participating in the College’s annual Clinical Congress in October, with public recognition of their presence. They will receive gratis admission to selected postgraduate courses, plus admission to all lectures, demonstrations, and exhibits, which are integral to the Clinical Congress. Assistance will be provided in arranging visits (following the Clinical Congress) to various clinics and universities of the scholars’ choosing.

To qualify for consideration by the selection committee, applicants must fulfill all of the requirements. The application form for the ACS International Guest Scholarship is available online on the College’s website at http://www.facs.org/memberservices/igs.html. Questions should be directed to:Kate Early, International Liaison, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611-3211 USA; [email protected].

The ACS must receive all completed applications, including all the supporting documentation for the 2013 International Guest Scholarships, no later than July 1, 2013. All applicants will be notified of the selection committee’s decision in November 2013. The College urges applicants to submit their completed application package as early as possible in order to provide sufficient time for processing.

The American College of Surgeons (ACS) is offering International Guest Scholarships in 2014 to outstanding young surgeons from countries other than the U.S. or Canada who have demonstrated strong interests in teaching and research. The $10,000 scholarships will provide the International Guest Scholars with an opportunity to visit clinical, teaching, and research institutions in North America and to attend and participate fully in the educational opportunities and activities of the ACS Clinical Congress in San Francisco, CA, October 26-30, in 2014.

A legacy left to the College by Paul R. Hawley, MD, FACS (Hon), former Director of the College, originally funded the scholarship endowment. More recently, gifts from Fellows and their families and associates have expanded the roster of International Guest Scholarships. The ACS Foundation website features additional information about these benefactors and the awards they support.

The scholarship requirements are as follows:

• Applicants must be medical school graduates.

• Applicants must be at least 35 years of age, but younger than 45, on the filing date of the completed application.

• Applicants must submit their applications from their intended permanent location. The College will accept applications for processing only when the applicants have been in surgical practice, teaching, or research for a minimum of one 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 their respective home country.

• Applicants whose careers are in the developing stage are deemed more suitable for receipt of this scholarship than those who are serving in senior academic appointments.

• Applicants must submit a fully completed application form provided by the College on its website. The application and accompanying materials must be submitted in English. Submission of a curriculum vitae without a completed application is not acceptable.

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

• Applicants must submit letters of recommendation from three colleagues. One letter must be from the chair of the department in which the applicant holds academic appointment or a Fellow of the ACS residing in the applicant’s country. The letter from the chair or Fellow must include a specific statement detailing the nature and extent of the teaching and other academic involvement of the applicant.

• The International Guest Scholarships must be used in their designated year. Recipients cannot postpone the scholarship.

• Applicants who receive scholarships are expected to 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 current application form provided by the College, together with new supporting documentation.

International Guest Scholarships provide successful applicants with the privilege of participating in the College’s annual Clinical Congress in October, with public recognition of their presence. They will receive gratis admission to selected postgraduate courses, plus admission to all lectures, demonstrations, and exhibits, which are integral to the Clinical Congress. Assistance will be provided in arranging visits (following the Clinical Congress) to various clinics and universities of the scholars’ choosing.

To qualify for consideration by the selection committee, applicants must fulfill all of the requirements. The application form for the ACS International Guest Scholarship is available online on the College’s website at http://www.facs.org/memberservices/igs.html. Questions should be directed to:Kate Early, International Liaison, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611-3211 USA; [email protected].

The ACS must receive all completed applications, including all the supporting documentation for the 2013 International Guest Scholarships, no later than July 1, 2013. All applicants will be notified of the selection committee’s decision in November 2013. The College urges applicants to submit their completed application package as early as possible in order to provide sufficient time for processing.

The American College of Surgeons (ACS) is offering International Guest Scholarships in 2014 to outstanding young surgeons from countries other than the U.S. or Canada who have demonstrated strong interests in teaching and research. The $10,000 scholarships will provide the International Guest Scholars with an opportunity to visit clinical, teaching, and research institutions in North America and to attend and participate fully in the educational opportunities and activities of the ACS Clinical Congress in San Francisco, CA, October 26-30, in 2014.

A legacy left to the College by Paul R. Hawley, MD, FACS (Hon), former Director of the College, originally funded the scholarship endowment. More recently, gifts from Fellows and their families and associates have expanded the roster of International Guest Scholarships. The ACS Foundation website features additional information about these benefactors and the awards they support.

The scholarship requirements are as follows:

• Applicants must be medical school graduates.

• Applicants must be at least 35 years of age, but younger than 45, on the filing date of the completed application.

• Applicants must submit their applications from their intended permanent location. The College will accept applications for processing only when the applicants have been in surgical practice, teaching, or research for a minimum of one 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 their respective home country.

• Applicants whose careers are in the developing stage are deemed more suitable for receipt of this scholarship than those who are serving in senior academic appointments.

• Applicants must submit a fully completed application form provided by the College on its website. The application and accompanying materials must be submitted in English. Submission of a curriculum vitae without a completed application is not acceptable.

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

• Applicants must submit letters of recommendation from three colleagues. One letter must be from the chair of the department in which the applicant holds academic appointment or a Fellow of the ACS residing in the applicant’s country. The letter from the chair or Fellow must include a specific statement detailing the nature and extent of the teaching and other academic involvement of the applicant.

• The International Guest Scholarships must be used in their designated year. Recipients cannot postpone the scholarship.

• Applicants who receive scholarships are expected to 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 current application form provided by the College, together with new supporting documentation.

International Guest Scholarships provide successful applicants with the privilege of participating in the College’s annual Clinical Congress in October, with public recognition of their presence. They will receive gratis admission to selected postgraduate courses, plus admission to all lectures, demonstrations, and exhibits, which are integral to the Clinical Congress. Assistance will be provided in arranging visits (following the Clinical Congress) to various clinics and universities of the scholars’ choosing.

To qualify for consideration by the selection committee, applicants must fulfill all of the requirements. The application form for the ACS International Guest Scholarship is available online on the College’s website at http://www.facs.org/memberservices/igs.html. Questions should be directed to:Kate Early, International Liaison, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611-3211 USA; [email protected].

The ACS must receive all completed applications, including all the supporting documentation for the 2013 International Guest Scholarships, no later than July 1, 2013. All applicants will be notified of the selection committee’s decision in November 2013. The College urges applicants to submit their completed application package as early as possible in order to provide sufficient time for processing.

The International Relations Committee of the American College of Surgeons (ACS) announces two Community Surgeons Travel Awards for surgeons ages 30 to 50. These $4,000 awards allow international surgeons to participate in the annual ACS Clinical Congress. Surgeons who work in community or regional hospitals or clinics in countries other than the U.S. and Canada or who are from struggling academic departments of surgery in low- or middle-income countries are eligible for the awards. Candidates from Southeast Asia will receive preference in this cycle. The office of the International Liaison must receive all applications and supporting documents for these awards before July 1, 2013.

Each awardee will receive gratis registration to the Clinical Congress and to one available Clinical Congress postgraduate course. The College will help awardees find affordable hotel in the Clinical Congress host city. The 2014 Clinical Congress will take place in San Francisco, CA, October 26-30.The scholarship requirements are:

• Applicants must be graduates of medical schools.

• Age requirement refers to the date of the filing of the completed application.

• 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 a minimum of one year at their intended permanent location, following completion of all formal training (including fellowships and scholarships).

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

• Applicants must submit an online fully completed application form provided by the College. The application and accompanying materials must be typewritten and in English. Submission of a curriculum vitae only is insufficient

Preference will be given to applicants who have not already experienced training or surgical fellowships in North America.

Applicants must submit independently prepared letters of recommendation from three (3) of their colleagues. One letter must be from the chair of the department in which they hold a clinical or academic appointment or an ACS Fellow residing in their country. The letter from the chair or Fellow should directly address the applicant’s commitment to high-quality surgery, surgical teaching, improved access to surgical care locally. Letters of recommendation should be submitted by the persons making the recommendations.

The Community Surgeons Travel Awards must be used in the year for which they are designated. They cannot be postponed.

Awardees must provide a written report upon their return home, specifically focusing on the value of the visit to the awardee and the potential beneficial effect to patients in the country of origin.

Unsuccessful applicants may reapply only twice and only by completing and submitting a current application form provided by the College, together with new supporting documentation.

To be considered by the selection committee, applicants must fulfill all requirements.

Find the application for the Community Surgeons Travel Award on the ACS website at http://www.facs.org/memberservices/community-travel.html.

Direct supporting materials and questions to:

Administrator

International Liaison Section

American College of Surgeons

633 N. Saint Clair St.

Chicago, IL 60611-3211

USA

[email protected] or 312-202-5021 (facsimile)

All applicants will be notified of the selection committee’s decision in November 2013. Please submit completed applications and supporting documents early to allow time for processing.

The International Relations Committee of the American College of Surgeons (ACS) announces two Community Surgeons Travel Awards for surgeons ages 30 to 50. These $4,000 awards allow international surgeons to participate in the annual ACS Clinical Congress. Surgeons who work in community or regional hospitals or clinics in countries other than the U.S. and Canada or who are from struggling academic departments of surgery in low- or middle-income countries are eligible for the awards. Candidates from Southeast Asia will receive preference in this cycle. The office of the International Liaison must receive all applications and supporting documents for these awards before July 1, 2013.

Each awardee will receive gratis registration to the Clinical Congress and to one available Clinical Congress postgraduate course. The College will help awardees find affordable hotel in the Clinical Congress host city. The 2014 Clinical Congress will take place in San Francisco, CA, October 26-30.The scholarship requirements are:

• Applicants must be graduates of medical schools.

• Age requirement refers to the date of the filing of the completed application.

• 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 a minimum of one year at their intended permanent location, following completion of all formal training (including fellowships and scholarships).

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

• Applicants must submit an online fully completed application form provided by the College. The application and accompanying materials must be typewritten and in English. Submission of a curriculum vitae only is insufficient

Preference will be given to applicants who have not already experienced training or surgical fellowships in North America.

Applicants must submit independently prepared letters of recommendation from three (3) of their colleagues. One letter must be from the chair of the department in which they hold a clinical or academic appointment or an ACS Fellow residing in their country. The letter from the chair or Fellow should directly address the applicant’s commitment to high-quality surgery, surgical teaching, improved access to surgical care locally. Letters of recommendation should be submitted by the persons making the recommendations.

The Community Surgeons Travel Awards must be used in the year for which they are designated. They cannot be postponed.

Awardees must provide a written report upon their return home, specifically focusing on the value of the visit to the awardee and the potential beneficial effect to patients in the country of origin.

Unsuccessful applicants may reapply only twice and only by completing and submitting a current application form provided by the College, together with new supporting documentation.

To be considered by the selection committee, applicants must fulfill all requirements.

Find the application for the Community Surgeons Travel Award on the ACS website at http://www.facs.org/memberservices/community-travel.html.

Direct supporting materials and questions to:

Administrator

International Liaison Section

American College of Surgeons

633 N. Saint Clair St.

Chicago, IL 60611-3211

USA

[email protected] or 312-202-5021 (facsimile)

All applicants will be notified of the selection committee’s decision in November 2013. Please submit completed applications and supporting documents early to allow time for processing.

The International Relations Committee of the American College of Surgeons (ACS) announces two Community Surgeons Travel Awards for surgeons ages 30 to 50. These $4,000 awards allow international surgeons to participate in the annual ACS Clinical Congress. Surgeons who work in community or regional hospitals or clinics in countries other than the U.S. and Canada or who are from struggling academic departments of surgery in low- or middle-income countries are eligible for the awards. Candidates from Southeast Asia will receive preference in this cycle. The office of the International Liaison must receive all applications and supporting documents for these awards before July 1, 2013.

Each awardee will receive gratis registration to the Clinical Congress and to one available Clinical Congress postgraduate course. The College will help awardees find affordable hotel in the Clinical Congress host city. The 2014 Clinical Congress will take place in San Francisco, CA, October 26-30.The scholarship requirements are:

• Applicants must be graduates of medical schools.

• Age requirement refers to the date of the filing of the completed application.

• 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 a minimum of one year at their intended permanent location, following completion of all formal training (including fellowships and scholarships).

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

• Applicants must submit an online fully completed application form provided by the College. The application and accompanying materials must be typewritten and in English. Submission of a curriculum vitae only is insufficient

Preference will be given to applicants who have not already experienced training or surgical fellowships in North America.

Applicants must submit independently prepared letters of recommendation from three (3) of their colleagues. One letter must be from the chair of the department in which they hold a clinical or academic appointment or an ACS Fellow residing in their country. The letter from the chair or Fellow should directly address the applicant’s commitment to high-quality surgery, surgical teaching, improved access to surgical care locally. Letters of recommendation should be submitted by the persons making the recommendations.

The Community Surgeons Travel Awards must be used in the year for which they are designated. They cannot be postponed.

Awardees must provide a written report upon their return home, specifically focusing on the value of the visit to the awardee and the potential beneficial effect to patients in the country of origin.

Unsuccessful applicants may reapply only twice and only by completing and submitting a current application form provided by the College, together with new supporting documentation.

To be considered by the selection committee, applicants must fulfill all requirements.

Find the application for the Community Surgeons Travel Award on the ACS website at http://www.facs.org/memberservices/community-travel.html.

Direct supporting materials and questions to:

Administrator

International Liaison Section

American College of Surgeons

633 N. Saint Clair St.

Chicago, IL 60611-3211

USA

[email protected] or 312-202-5021 (facsimile)

All applicants will be notified of the selection committee’s decision in November 2013. Please submit completed applications and supporting documents early to allow time for processing.