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

Advanced Skills Course for Rural Surgeons

The mission of the Nora Institute is to support surgeons in their pursuit of exceptional patient care. One path to this goal is to support surgeons in maintaining knowledge and excellent technical skills. The Nora Institute identified a need among rural surgeons for increased access to continuing professional development that matches the rural surgeons’ broad scope of practice. Unlike their urban colleagues, rural surgeons often have a broader scope of practice that requires them to address a wider array of clinical problems, including emergency gynecology, emergency urology, orthopedics, and more.

The Nora Institute Advanced Skills Course for Rural Surgeons brings together rural surgeons from all over the country and provides them with expert mentoring in a variety of disciplines. The course uses a blended learning format that consists of an e-learning component for knowledge acquisition followed by a hands-on mentored skills session. Amy Halverson, MD, FACS, and a team of rural surgeons and adult learning experts have developed 11 distinct learning modules.

The 2014 Nora Advanced Skills Course for Rural Surgeons was held October 25 in San Francisco in conjunction with the American College of Surgeons Clinical Congress. This year’s course welcomed 38 participants, the highest enrollment in a Nora Institute skills course to date. The curriculum focused on endoscopic procedures including foreign body removal, advanced polypectomy and stricture dilation and stent placement. We also presented a session on endoscopic management of hemorrhoids. 

Looking forward

The 2015 Nora Advanced Skills Course for Rural Surgeons will cover the topics of laparoscopic common bile duct exploration and facial plastic surgery.

Jaime Sanchez, MD, FACS
Retrieving a foreign body with Jaime Sanchez, MD, FACS. 

Scott Steele, MD, FACS
Practicing advanced polypectomy techniques with Scott Steele, MD, FACS.

Jaime Sanchez, MD, FACS
How to use the Blakemore tube for the management of upper gastrointestinal hemorrhage with Jaime Sanchez, MD, FACS.

Rural Surgery Learning Modules

  1. Leadership and communication
  2. Advanced endoscopy
  3. Emergency gynecology
  4. Emergency urology
  5. Facial plastic surgery—lesion excision
  6. Facial plastic surgery—laceration repair
  7. Breast ultrasound
  8. Ultrasound for central line insertion
  9. Management of fingertip amputation
  10. Laparoscopic common bile duct exploration
  11. Anesthesia skills

What Surgical Skills Rural Surgeons Need to Master
Halverson AL, Hughes TG, Borgstrom DC, et al. J Am Coll Surg 2013, Nov; 217(5):919-23.

Participant Comments

“I have applied the skills I learned in my working relationships as well as my personal relationships.”

“I never used the ultrasound until recently. At this time I feel that it is probably bad practice not to use it.”

“I had a patient with a neglected avulsion of the tip. I used the technique of dyeing the matrix to be certain I removed it all. I found this very helpful, as the anatomy was distorted. Yet with this technique, I was able to identify and remove the entire matrix and got an excellent functional result. Thanks!”

“I reconstructed a huge facial lac/scalping injury from the eyelid across the forehead to the back of the scalp, which turned out beautifully!”

“Not only did I gain a couple of useful techniques, especially ultrasound for central line placement and the trick with the nail matrix, but, more importantly, I had knowledgeable people watch how I was doing things and either affirm that what I was doing was correct or make helpful suggestions. I have been in solo practice most of my career with no other surgeons on staff. It is always great to have a proctor look over your shoulder and make useful suggestions. I wish I had had this course available to me 34 years ago when I started my practice. Thank you.”