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

The Communication Pulse: Leadership and Member Perspectives

100 Words

As surgical technology and informatics accelerate, it’s good to remember that students and trainees need to learn the basics, if we have the time and patience to teach them; have them palpate the abdomen of a patient with appendicitis. In the ICU, use a stethoscope on a patient with a consolidated lobe. Show them how to use vital signs to identify sick patients and how they change after an operation. By the end of a week on service you’ll have had a real impact on someone’s clinical education.

—Don K. Nakayama, MD, MBA, FACS, Treasurer, American College of Surgeons

Surgeon Voices

From the Frontlines

In this issue, Steven D. Wexner, MD, FACS, FRCSEng, FRCSEd, FRCSI(Hon), FRCSGlasg(Hon), Vice-Chair, American College of Surgeons Board of Regents, and Director, Digestive Disease Institute at Cleveland Clinic Florida in Weston, FL, interviews:

Douglas E. Wood, MD, FACS, FRCSEd, ACS Regent, on the Journal of Thoracic Disease article, “How can men be good allies for women in surgery? #HeForShe”

Girma Tefera, MD, FACS, Medical Director, Operation Giving Back, who discusses the ACS/Pfizer Humanitarian and Volunteerisms Awards, including a new award category for 2021, as well as the critical philanthropic work of OGB.

Diversity, Equity and Inclusion in Surgery

Joshua M. Mammen, MD, PhD, FACS, interviews Madeline B. Torres, MD, coauthor of the January Bulletin of the American College of Surgeons article, “Increasing membership diversity in surgical societies through intentional inclusion,” about the role the ACS and other organizations can play in improving DEI.

Black History Month: Honoring Dr. Louis Tompkins Wright, Who Worked to Diversify the ACS

As Black History Month continues and the College honors history-making Black surgeons and Fellows, this week’s highlighted member is Louis Tompkins Wright, MD, FACS, who worked to have Black surgeons accepted as Fellows in a time that did not value equality.

Dr. Wright was born in LaGrange, GA, in 1891 and grew up in a racially charged time in U.S. history. But he also was exposed to examples of achievement within his own family, specifically through his father and, eventually, stepfather, who both earned medical degrees. Dr. Wright applied to, and was accepted at, Harvard Medical School, Boston, MA, and eventually accepted a position at Freedmen’s Hospital, Washington, DC, now Howard University Hospital. Dr. Wright went on to join the U.S. Army, where he served as first lieutenant in the Army Medical Corps in France.

Dr. Wright had an illustrious career at Harlem Hospital in New York City for more than three decades, from 1919 to 1952 during the height of the Jim Crow era.

Dr. Wright’s affiliation with the ACS began in 1934, when he was admitted as a Fellow of the organization—an admission that brought much debate and division among ACS leadership and members, as issues of race often resulted in controversy and discord. However, the goal of including African-American surgeons into the ACS was a challenge Dr. Wright was willing to face, and he became part of a group that actively worked to admit more Black surgeons into the College. Ultimately, the effort was successful and by the end of 1950, at least 38 Black surgeons had gained ACS Fellowship.

Read more about Dr. Wright’s life and career in the ACS Archives.

Increasing Membership Diversity in Surgical Societies through Intentional Inclusion

January 2021 Bulletin coverThis week—as the Bulletin Brief continues to highlight diversity, equity and inclusion (DEI)-centered articles from the January issue of the ACS Bulletin—the focus is on DEI as it relates to membership diversity in surgical societies. In “Increasing membership diversity in surgical societies through intentional inclusion,” the authors describe disparities facing minorities underrepresented in surgery, and outline solutions to increase diversity within surgical societies; summarize how fostering inclusion in the surgical profession is important for both moral and practical reasons, including improved access to care and enhanced patient-provider communication; describe how professional societies with inclusive policies demonstrate increases in recruitment and retention of members; and identify strategies for increasing diversity within surgical specialties, including focused mentorship programs, alternative compensation models, and customized recruitment programs.

The article begins as follows:

Increasing Membership Diversity in Surgical Societies through Intentional Inclusion

By Madeline B. Torres, MD; Rebecca L. Williams-Karnesky, MD, PhD; Jeremy D. Kauffman, MD; Woodson Smelser, MD; Patricia Martinez Quinones, MD, PhD; Basheer Elsolh, MD; Yewande Alimi, MD, MHS; and Maria S. Altieri, MD, MS

Professional societies play an important role in creating and maintaining a surgical workforce that reflects the populations they serve. To that end, surgical societies must create diverse and inclusive environments that encourage surgeons to achieve their maximum potential. Diversity is defined as the recognition and acceptance of individuals and their different backgrounds, including race, ethnicity, gender, work experience, socioeconomic status, sexual orientation and identity, and other qualities leading to diversity of thought. The concept of inclusion was introduced to the world of education in the 1990s as a means to create a space for students with disabilities, where they are respected and valued for their unique characteristics. The definition of inclusion now extends beyond special needs education and includes the norms and behaviors within an institution that ensure all individuals feel welcome and respected.

The U.S. population is increasingly diverse. In their responses to the 2010 census, nearly 30 percent of the population described themselves as nonwhite, and 50 percent of the respondents were women. Although more women are matriculating into medical school and residency programs, few women hold faculty and leadership positions. As of 2019, less than 4 percent of medical school faculty identified as Hispanic/Latino and only 3.6 percent as African American, a stark example of underrepresentation given that Hispanic/Latino make up 18 percent and African Americans 13 percent of the U.S. general population.

In surgery, the discrepancy in representation is no different. In 2008, Butler and colleagues reported that only 3.6 percent of academic surgery faculty positions were held by Hispanic/Latino surgeons, and only 2.9 percent were held by African Americans. This disparity extends into participation and leadership positions in professional organizations. For example, as of 2016 the Society for Surgery of the Alimentary Tract (SSAT) has had only seven women and eight men of racial and ethnic minority heritage hold officer positions since its establishment in 1960. In addition, a recent study by Kuo and colleagues that evaluated the diversity of the American Association of Endocrine Surgeons (AAES) revealed that, as of 2017, women comprised only 35 percent of the AAES membership, less than 25 percent of its membership identified as nonwhite, and only 11 percent of past-presidents were women or identified as nonwhite.6

Underrepresentation is more notable in subspecialty surgical societies, where only 10 percent of the membership and 4 percent of named lecture speakers are women, and an even smaller percentage are underrepresented in medicine (URiM), a term used to describe populations less visible in the medical professions than in the general population. This article highlights some of the disparities faced by URiMs, specifically in surgery, and offers solutions to increase diversity and inclusion within surgical societies.

Read Increasing Membership Diversity in Surgical Societies through Intentional Inclusion on the Bulletin website.

ACS Fellow Dr. Eduardo Rodriguez Performs Successful Face and Bilateral Hand Transplant at NYU Langone

By Marshall Schwartz, MD, FACS, and L. Scott, Levin, MD, FACS, Chair, ACS Board of Regents

In July 2018, while Joseph DiMeo was driving home after completing his night shift, he fell asleep at the wheel and was involved in a rollover accident in which his car caught on fire. Mr. DiMeo was pulled from the car by two good Samaritans but sustained third-degree burns covering 80 percent of his body, including his face. This began a long and difficult recovery, including at least 20 reconstructive procedures with skin grafts and procedures to release contractures from the scarring that typically occurs following healing skin grafts. Mr. DiMeo’s face was considerably scarred with no lips or eyelids, as were his hands with many fingers amputated as a result of the burns. 

Mr. DiMeo demonstrated not only a remarkable will to live, but also a strong desire to return to a “normal life.” So, when he was offered an option to undergo a face and bilateral hand transplants, he agreed. However, the problem was finding a suitable donor in terms of skin tone, facial features and hand size, as well as immunological compatibility. Mr. DiMeo had undergone multiple blood transfusions during his skin grafts, resulting in his immune system being highly sensitized. A blood test was performed to determine the degree of sensitization, and a panel-reactive antibody test would determine his degree of sensitivity to potential donors and, therefore, whether his body would reject their tissue. Mr. DiMeo’s PRA was 94 percent, indicating a 6 percent chance of finding a compatible donor. The likelihood of finding a donor meeting all of these criteria would be nearly impossible—but it happened! 

The 23-hour procedure was performed on August 12, 2020, by Eduardo D. Rodriguez, MD, DDS, FACS, director of the Face Transplant Program, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, and chair of the Hansjörg Wyss Department of Plastic Surgery at NYU Langone, along with a large team that included six separate surgical teams for the donor and recipient. The complexity of each of the three simultaneous procedures were challenging and fraught with potential major complications. The fact that everything came together so well is a testimony to the extensive pre-planning that apparently began nearly one year in advance of receiving a potential donor. These preparations included cadaver rehearsals and the use of computer tomography and sophisticated 3-D imaging of the patient’s anatomy, which are used to create custom cutting guides for bone cuts and osteosynthesis. These guides ensure that the bones would be aligned perfectly, and that implantable plates and screws would be in the best position to anchor the transplanted hands and face. 

Each surgical team followed a specific predetermined plan to transplant both hands to the mid-forearm, including the radius and ulna, three dominant nerves to the hand, six vessels requiring vascular connections and 21 tendons; full face including the forehead, eyebrows, both ears, nose, eyelids, lips, and underlying skull, cheek, nasal, and chin bone segments.

This is the first known successful combined face and bilateral hand transplant in the world. 

Read more about this incredible surgical accomplishment.