American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Approval of Courses in New Skills

The Committee on Emerging Surgical Technologies has previously published "Guidelines for Evaluation of Credentials of Individuals for the Purpose of Awarding Surgical Privileges in New Technologies." In that statement, which was approved by the American College of Surgeons' Board of Regents and published in 1994, the completion of a defined educational program in the technology, including didactic and practical elements, was recommended. The following statement, which was approved by the Board of Regents in October 1997, defines standards for courses in new technology that are designed to prepare the practicing surgeon to apply the technology to the care of patients.


Most new surgical techniques are learned informally, through courses given commercially by experts or by the manufacturers of the new equipment, through mini-preceptorships, or simply by observing and/or assisting surgeons who have begun to use the techniques. Informal learning is irregular in quality, often expensive, and tends to be largely technique oriented without a solid theoretical and evidence-based cognitive component. Acquisition of knowledge and skills is rarely documented. Surgeons seek high-quality courses, and health care institutions need to know if the course taken by an applicant for privileges is of high quality and if the surgeon has acquired the knowledge and skills needed to safely apply the new technology to patients.

Beginning with a course in flexible colonoscopy/sigmoidoscopy approximately 20 years ago, the American College of Surgeons has responded on occasion to the need to educate practicing surgeons in technology that has become available following completion of a residency. The College is now offering the following courses with didactic and practical components: “Advanced Trauma Life Support,” "Image-Guided Breast Biopsy," "Ultrasound for General Surgeons," and a variety of trauma and critical care techniques and skills. Courses in new techniques and skills, offered by organizations or individuals not associated with the College, are widely available.

The establishment of standards for courses in new technology that will include the testing of acquisition of knowledge and skills will provide a mechanism for surgeons to choose courses that will meet their educational needs and a method for institutions to use determining if a surgeon applying for privileges in a new technology has obtained the expected level of knowledge and skills.

Standards for Advanced Courses in New Technology

1. A Program Goal(s) is announced.

Detailed course learning objectives are listed, including concepts and principles, indications and contraindications for the procedure, anticipated complications and outcomes and subsequent management.

The procedural skills that are needed to apply the technique safely and effectively are listed.

2. Content of the course addresses each of the listed course objectives and the method to be used to teach the listed skills.

3. Acquisition of the cognitive materials is assessed by a method described in advance by the course developers. Such assessment will frequently involve pre-and post-course testing; other validated methods may be used when appropriate.

4. Acquisition of the listed skills is assessed by the individual student based on comparison of his/her performance relative to established standards available at each skill station (time, accuracy, successful completion of task, correct interpretation of data displayed, and so on).
Acquisition of the listed skills is assessed by the instructor who observes and assesses the global and individual level of skill demonstrated by the student. The method of assessing skills should be validated (for example, by repeated measurements or independent assessors) at the outset of the course.

5. A syllabus is provided containing representative references to the pertinent literature on the technique, indications and contraindications for the procedure, complications, outcome, and subsequent management, as well as a written outline or text addressing the course goal and objectives.

Documentation to be Provided by the Course Director for Courses Sponsored by the American College of Surgeons

Level 1. Verification of Attendance:
The surgeon has attended and completed a course.

Level 2. Verification of Satisfactory Completion of Course Objectives:
The surgeon has satisfactorily met the specified learning objectives.

Level 3. Instructor Level:
The surgeon has had monitored practice experience with the technology and has documented satisfactory patient outcomes; the surgeon has participated in development of goals and objectives for educational programs in the technology and is experienced in teaching these skills to others.

Reprinted from Bulletin of the American College of Surgeons
Vol.83, No. 03, March 1998