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


Clinical Congress 2020 Dates Extended - October 3-7Virtually Unlimited Education, Entirely Free: Register for Clinical Congress 2020!

Registration for the FREE Virtual Clinical Congress 2020, October 3–7, is open!

The five-day program will include Named Lectures, Panel Sessions, the Symposium of the ACS Academy of Master Surgeon Educators, Special Sessions, Scientific Forum Sessions, Video-Based Education Sessions, and Meet-the-Expert Sessions. Experts from a variety of fields will address important and timely topics through these effective presentations.

View the Program-At-A-Glance to plan out your sessions of interest!

And don’t forget to take advantage of the more than 200 free AMA PRA Category 1 Credits™ available for claiming after the conference and that will remain available through the end of January 2021. The Continuing Medical Education credits also will satisfy regulatory mandates, including state requirements for re-licensure.

Register today!

Residency Training at an Inflection Point: Academy Symposium at Clinical Congress 2020

The Annual Symposium of the ACS Academy of Master Surgeon Educators will be held 12:00–1:00 pm Central time October 5 at the upcoming Virtual Clinical Congress. The symposium, “Transformation of Residency Training in Surgery: COVID-19 Pandemic and Beyond,” will highlight the major activities of the Academy that have focused on residency training during the pandemic and on opportunities to transform residency training in surgery for the future. Activities of the Special Committee of the Academy and its three Subcommittees appointed to address this important and timely topic will be highlighted.

The co-moderators for the symposium will be L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), and Ajit Sachdeva, MD, FACS, FRCSC, FSACME. Speakers will include E. Christopher Ellison, MD, FACS; Mohsen Shabahang, MD, PhD, FACS; and Anton Sidawy, MD, FACS, ACS Regent. Dr. Ellison will address the activities of the Survey Subcommittee, Dr. Shabahang will outline the activities of the Subcommittee on Novel Teaching and Assessment Methods and Innovative Educational Resources, and Dr. Sidawy will focus on the activities of the Subcommittee on Sharing and Documenting Experiences from Institutions in the Midst of the COVID-19 Surge. The latter Subcommittee has recently evolved into the Editorial Review Group of the Academy’s new Resources web page. There will be an interactive discussion co-led by Drs. Britt and Sachdeva following these three sessions.

All Clinical Congress registrants are invited to attend this Symposium. We look forward to an exciting session.

For additional information, contact Dr. Sachdeva at; Alisa Nagler, JD, MA, EdD, at; or Susan Newman, MPH, at

A Brave New World: Resident Selection in a Pass-Fail Environment

By Brian R. Smith, MD, FACS; Timothy M. Farrell, MD, FACS; and Andre R. Campbell, MD, FACS; for the Surgical Training Workgroup, ACS Board of Governors

THe Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) announced that the USMLE Step 1 examination will change to pass/fail reporting after January 1, 2022. The decision came after the 2019 Invitational Conference on USMLE Scoring (InCUS) and an extensive national conversation. In the announcement, the USMLE cosponsors noted an overemphasis on Step 1 performance during the transition from undergraduate to graduate medical education. The American Medical Association and the American Association of Medical Colleges (AAMC), which were represented at InCUS, also support this plan, citing the benefits for student educational focus and wellness. However, medical students and residency programs have come to depend on the traditional three-digit score reporting as a reliable and the only objective standard for comparing and distinguishing applicants coming from a wide range of medical schools with varying curricula and grading strategies.

USMLE leaders chartered a medical student advisory committee and InCUS to address the issues with the Step 1 examination. These separate student and faculty groups were charged with making recommendations about changing what was considered a flawed process. Many students were spending considerable resources on exam preparation, and yet not attending medical school classes. Educational leaders felt that medical school curricula were becoming too focused on Step 1 preparation. Additionally, Step 1 is focused on basic science and is considered less relevant than the Step 2 Clinical Knowledge (CK) exam. The USMLE Board felt compelled to make a change since residency programs were using Step 1 scores to screen out residency applicants, despite the test never having been designed for this purpose. They discussed the options at a series of meetings and decided to make it pass/fail. They also felt that since Step 2 was more clinically relevant, it would be a better indicator of clinical knowledge and student performance. The student committee had a mixed opinion regarding the use of Step 1 as a screening tool.

A recent online poll suggests many students oppose this decision, citing concerns that there will be an increased emphasis on USMLE Step 2 and a resultant disadvantage to those from less prestigious and international medical schools. Those who drive medical school curricula likely will feel pressure to modify course content from basic science teaching to better prepare their students for Step 2 CK. Students undoubtedly will be looking for new strategies to distinguish themselves from their peers.

Residency program directors also will need to find alternative ways to replace the loss of Step 1.

Potential solutions include the following:

  • Electronic Residency Application Service limitation of applications to no more than 30 applications (10 “reach” programs, 10 appropriate programs, 10 “safe” programs) per student
  • Renewed efforts to truly standardize letters of recommendation (based on an index of key words/descriptors) to objectify them and allow for quantification analysis
  • AAMC/LCME-mandated strict standardization of Medical Student Performance Evaluation with consistent stratification of students within their medical class into quintiles
  • Create an additional, specialty-specific exam for students to take in preparation for their applications (perhaps designed and administered by specialty societies)
  • Shift to USMLE Step 2 CK as the predominate screening tool to narrow down qualified residency applications, as this likely is a better indicator of clinical knowledge
  • Mandate Shelf exam grade reporting in ERAS or on MSPE
  • Expand residency positions with a goal of match rates of 90 percent to 98 percent for every specialty to increase capacity in high-demand specialties
  • AAMC and LCME mandate medical schools revert to letter grades for GPA calculation
  • Surgery withdraws from ERAS/National Resident Matching Program and construct its own match process with new rules under the guidance and ownership of ACS (much like the Fellowship Council model)

In summary, this change is coming in 2022, and we all must be prepared. However, opportunities abound for multiple stakeholders to come together and accomplish meaningful change. With ACS Educational leadership, the balance between holistic application review and meaningful selection criteria for programs can be achieved.