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

The Communication Pulse: Leadership and Member Perspectives

100 Words

Whatever your practice situation, your CV needs an update. Let it speak to you. When's the last time you reflected on the milestones of your career? Read the CV and remember: the person who encouraged you to try for med school...the one who didn't laugh when you said you wanted to be a surgeon...the professor who listed you first author on the paper you wrote together...the colleague who put you up for that prestigious surgical society...the surgeon friend who wrote a letter recommending you for an honor you never expected.... Pause to say thank you.

Beth H. Sutton, MD, FACS, Immediate Past-Chair, American College of Surgeons Board of Regents

Surgeon Voices

From the Frontlines

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

Lawrence Shulman, MD, MACP, FASCO, deputy director, clinical services, Abramson Cancer Center, University of Pennsylvania, Philadelphia, and Immediate Past-Chair, Commission on Cancer, on COVID-19’s impact on cancer screening and treatment.

Brian J. Dunkin, MD, FACS, chief medical officer, Boston Scientific Endoscopy (Global), on his career in academic surgery that led to being CMO in an industry position, some of his current responsibilities, and how the COVID-19 pandemic has affected the activities of Boston Scientific.

Diversity, Equity and Inclusion in Surgery

Joshua M. Mammen, MD, PhD, FACS, interviews Meghana V. Kashyap, MD, DIM&PH, coauthor of the Bulletin article, “Mirror, mirror: How current societal issues reflect changes arising in surgery.”

Practice Protection Committee

Also in this issue, Patrick V. Bailey, MD, FACS, ACS Medical Director of Advocacy, interviews Mark Aeder, MD, MS, FACS, on lessons learned about insurance, particularly in light of the life and career changes that the COVID-19 pandemic has brought to many surgeons.

The Success of West Virginia’s COVID-19 Vaccine Distribution Program

by Bryan K. Richmond, MD, MBA, FACS

West Virginia’s success in efficiently distributing the COVID-19 vaccine has been featured in the national media in recent weeks. As of January 7, West Virginia had successfully delivered vaccines to many health care workers and completed the first round of vaccines to all its long-term care facilities. By January 25, WV heath officials had administered 83 percent of their available vaccines—this at a time when many states were struggling to roll out their distribution programs. I had the opportunity to discuss WV’s success with Clay Marsh, MD, executive dean of the WV University School of Medicine and the state’s Governor-appointed coronavirus “czar.” Dr. Marsh has referred to the COVID-19 pandemic as a “Black Swan” event, which describes a catastrophic and rare event that places huge stresses on societal systems.

Dr. Marsh believes that a number of factors, both cultural and technical, helped WV succeed in their efforts. The cultural factors primarily involved team dynamics. All team members involved in the vaccine distribution effort maintained a consistent clarity of purpose: to work together to save lives as West Virginians. This principle and its successful application required that competitors become collaborators in pursuit of this higher purpose.

The second cultural factor was that of clarity in priorities. At the state level, the rollout maintained clear priorities: health care workers first, followed by long-term care residents, then the elderly and those with comorbidities. These priority categories and only these categories, which were assigned by risk, would serve to define the individuals eligible to be vaccinated.

Still another cultural factor was that of always seeking counsel from the best advisers available to aid in solving a particular problem, without regard of their rank, title or place in the hierarchy. Ad-hoc experts routinely were engaged for their expertise in a specific area. Egos were checked at the door in pursuit of the best plan of action.

Several technical aspects of the WV plan also aided in the state’s successful program. The leaders maintained an adaptable, agile approach to team management that stressed open communication and group consensus. An example of the team’s use of critical thinking to solve problems is the decision that WV would not join the federal government’s agreement to use CVS and Walgreens as their preferred vaccine distributors. This decision was made because the leaders realized that WV had fewer than 150 such stores, and that these were clustered in larger areas of the state and not in many rural areas. Because this geographic distribution would have hindered access for many WV residents, the state instead partnered with locally owned community pharmacies with great success.

WV leadership also placed a priority on maintaining transparency and access to information for its residents as well. Televised press briefings delivered by the Governor and the state’s COVID-19 task force were delivered almost daily. Experts in social media and behavioral communications were tapped to assist in disseminating credible and reliable information to the WV people. Distribution hubs were developed in five strategic locations to minimize transport distances, and all transports were monitored by GPS and continuous thermal monitoring. Most recently, the state initiated use of the EverBridge™ app, which allows registration for the vaccine online.

As a native West Virginian, I applaud these efforts and their success and hope that this can provide insight into the resolution of system problems plaguing similar efforts across our great nation.

Black History Month: Honoring Dr. Kenneth A. Forde, Pioneer in Advancing Colorectal Cancer Screening

As Black History Month comes to a close, this week the ACS highlights the achievements of Black surgeon and Fellow Kenneth A. Forde, MD, FACS, FASCRS, FACG, FCCS(Hon), an ACS Governor who advanced the practice of coloscopy and became a fixture of public education on the procedures importance in detecting colon cancer.

Dr. Forde, who passed away in 2019, worked for 40 years teaching clinical surgery at the Columbia University Vagelos College of Physicians and Surgeons (formerly the College of Physicians and Surgeons), where for the majority of his career he was the only Black member of the medical faculty.

His achievements were myriad, in the broader field and at Columbia. Dr. Forde was a founding member of the American Trauma Society and the first Black president of the New York Surgical Society and American Gastrointestinal Endoscopic Surgeons; at Columbia, he was the first Black surgeon to have an endowed chair established in his name, he was the first Black president of the John Jones Surgical Society, among many other achievements and firsts.

Dr. Forde promoted colonoscopy as a routine way to detect signs of gastrointestinal and colorectal cancer and to remove polyps and helped to make surgical endoscopy a commonly taught element of the medical curriculum. But he is best remembered as a consummate figure in the public consciousness for raising awareness of cancer screening by his prominent appearance on Katie Couric’s 2000 “Confront Colon Cancer” series, where he explained the importance of colon cancer screening in an informative, compassionate manner. The series was watched by millions of Americans and led to a significant increase in colonoscopies.

Dr. Forde’s commitment to overcoming racial discrimination as a medical student and in his professional career, as well as his tangible impact on colon cancer detection, led to him being named an ACS Icon in Surgery in 2018—watch the video to see Dr. Forde discussing his career in his own words.

How Current Societal Issues Reflect Changes Arising in Surgery

Continuing the exploration of diversity, equity and inclusion (DEI)-focused articles in the Bulletin of the American College of Surgeons by members of the Resident and Associate Society of the ACS, this week examines the parallels between DEI issues that have developed in broader society with the changes occurring in the field of surgery. In “Mirror, mirror: How current societal issues reflect changes arising in surgery,” the authors compare the challenges facing LGBTQ+ individuals, minorities, and women in surgery with emerging societal issues; describe lessons learned in other industries that could be used to improve diversity and equity in the surgical workforce; and highlight the importance of intersectionality.

The article begins as follows:

Mirror, mirror: How current societal issues reflect changes arising in surgery

by Meghana V. Kashyap, MD, DIM&PH; Terence J. Jackson, MBBS; Crystal N. Johnson-Mann, MD; and Melissa Red Hoffman, MD, ND

At one time, # meant “number” or was called the pound sign. Since the advent of social media, this symbol now is referred to as a “hashtag” and has come to represent societal trends and movements. In fact, hashtags such as #MeToo and #BlackLivesMatter have transcended social media movements and now are used to support victims of sexual harassment and assault and racial profiling. These movements are slowly affecting professional settings, with an increased awareness and calls to action for diversity and inclusion in the workforce.

A search of recent news with the terms “diversity, equity, and inclusion” results in numerous articles published on a daily basis about the new appointments of diversity officers, sensitivity training programs, awards, and other initiatives in the business sector, academia, sports, and medicine. Unfortunately, the search also results in multiple articles citing a recent national survey of U.S. general surgery residents reporting a prevalent experience of racial, ethnic, and gender discrimination.

Furthermore, the effects of national diversity movements are just beginning to be realized in academic surgery. A review of the most recent Association of American Medical Colleges (AAMC) demographic data shows that a gender and racial gap persists in the numbers of active surgical academic faculty across the U.S. Of the 16,221 total academic surgical faculty as of December 31, 2018, 23 percent were women, and only 7 percent were underrepresented minorities (URM). Additional breakdowns of gender and race are summarized in Table 1.

Change is inevitable, and medicine and surgery are lagging behind other sectors of society. This article delves into the parallels between ongoing public battles for equity and inclusion to struggles facing various professionals with lesbian, gay, bisexual, transgender, queer, and other sexual identities (LGBTQ+); minorities; and women.

Read the article on the Bulletin of the American College of Surgeons website.