Reprint of: History of specialty training and board certification in colon and rectal surgery

Colon and rectal surgery as a separate and identifiable specialty dates back to the early 1900s. Development of training programs, beginning as proctology preceptorships and evolving to residency programs recognized by the Accreditation Council for Graduate Medical Education, demonstrate the value of the unwavering dedication of the founders of the field. Similarly, creation of an independent Board with its own certification procedures has maintained the independence and integrity of the specialty despite external pressures to return to general surgery. Both the development of the board and training programs are reviewed in detail.     

The history of the American boards of surgery and colon and rectal surgery

This chapter will cover the history of the American Boards of Surgery and Colon and Rectal Surgery, the importance and purpose of the boards, and lifelong learning. Specifics for continuing medical education and maintenance of certification will be detailed. Lastly, opportunities for getting involved in this educational process will be described .     

Evolution of the specialty of colon and rectal surgery: Historical perspective

The field of Colon and Rectal Surgery has a rich history which has significantly evolved over the years from its beginnings as the American Board of Proctology to what is now the American Society of Colon and Rectal Surgery with over 3000 members. Although the training requirements have changed dramatically, the interest of graduating General Surgery Residents for Colon and Rectal Surgery continues to soar. The rising popularity of the field is reflected in the increasing number of fellowship programs as well as the greater number of practicing Colon and Rectal Surgeons.     

Evolving practice patterns in colon and rectal surgery

BACKGROUND: Minimum numbers of cases required for certification by the American Board of Colon and Rectal Surgery (ABCRS) have been determined from a prospective database of all applicants applying for examination since 1989. These data represent the longitudinal evolution of practice patterns in tertiary colorectal training programs. STUDY DESIGN: After obtaining permission from the ABCRS, access to the database was obtained and data from the 12-year period 1994 to 2005 were analyzed. RESULTS: The database contains the operative and endoscopic case numbers of 673 residents. The number of training programs increased from 28 to 39 (28%) and the number of residency positions from 50 to 66 (24%). Median numbers of anorectal patients per resident remained remarkably constant over the period of study. Both rigid sigmoidoscopy (67 to 44 per resident) and flexible sigmoidoscopy (135.5 to 39 per resident) decreased substantially; colonoscopy volume increased (209 to 264 per resident). Perineal procedures for rectal prolapse consistently comprise 50% to 60% of the total procedures for prolapse. Low anterior resection for rectal cancer outnumber abdominoperineal resections by a 3/1 ratio. Coloanal anastomoses have steadily increased. Laparoscopic approaches for all abdominal operations have increased substantially, with the greatest increase being in diverticular resections (6.5% to 44.7%). CONCLUSIONS: Prospective data collection by ABCRS has permitted calculation of minimum numbers of operative cases for training colorectal surgeons, with the advantage of a rolling average that reflects evolving practice patterns in teaching programs. Analysis of these data allows planning of needs-based educational programs and may ultimately be involved in designing the maintenance of certification process.     

American board of vascular surgery: the first 7 years

The American Board of Vascular Surgery (ABVS) was incorporated in 1996 with a vision of improved training standards and certification of vascular surgeons. At that time, 91% of those holding American Board of Surgery Certificates of Added Qualifications in Vascular Surgery supported the formation of the ABVS. Subsequent events have led to a clear definition of specific educational issues important to the vascular surgery community. Unresolved issues relate to the need to complete a general surgery residency before beginning a vascular surgery fellowship, the continued inclusion of vascular surgery as a primary component of general surgery training, and the absence of a designated Residency Review Committee for Vascular Surgery. These issues have persisted since the inception of the ABVS. An application for the ABVS to become an American Board of Medical Specialties (ABMS) primary board was submitted in 2002 with a preliminary hearing before a liaison committee composed of American Medical Association and ABMS members. The American Board of Surgery (ABS) and a minority of the vascular surgery community vigorously opposed the application. The perceived divisiveness created by their actions contributed to the application's initial rejection and the necessity for an appeal. Certain ABS directors have recently stated that they would consider approving multiple track-type training that could allow single certification in vascular surgery, following 5 to 6 years of postgraduate training after medical school. The ABVS cautiously supports this action, recognizing that this radical change for the ABS may not be feasible given the broad-ranging interests of general surgery and restrictive ABMS guidelines for certifying medical specialists. The impact of not resolving the critical issues facing vascular surgery in a timely manner is that there will be inadequate numbers of competent vascular surgeons to provide for society's needs. An independent ABMS-approved ABVS provides a clear opportunity to resolve the recognized failings of the status quo.     

Patient-reported outcomes in colon and rectal surgery: The best is yet to come

As part of the continuous effort to improve the quality of surgical care across its many facets, our patients can provide invaluable insight into how interventions impact their health and well-being. Patient-reported outcomes (PROs) complement traditional objective surgical outcomes—such as surgical site infection or length of stay—by accounting for the patient's perspective. The value of PROs was previously reviewed in Seminars in Colon and Rectal Surgery in 2018;¹ herein we report on the current status of PROs in colon and rectal surgery.     

Laparoscopic colon and rectal surgery at a VA hospital

Background: Laparoscopic techniques were utilized for all colon and rectal procedures undertaken by a single surgeon at the West Haven VA Hospital beginning in August of 1991. Methods: All patients were entered into a registry, and data was gathered prospectively. This report comprises the first 50 patients. These patients were compared with 34 consecutive patients undergoing open operations during the same time period. Results: Overall, 33 patients (66%) were completed laparoscopically. This increased to 87% after the first 20 patients. Patients undergoing laparoscopic procedures showed significant improvement over the open and converted patients in several areas. Operative blood loss was decreased. They ate sooner (3.7 days) and required less postoperative pain medication. Major complications were less common after laparoscopic operations. Average length of stay was 8.3 days, compared with 13.9 days and 14.5 days in the converted and open groups, respectively. There was no difference in the operative time between laparoscopic and open cases; time for converted cases was significantly longer. There was no difference in lymph node counts among the three groups in patients with resections for cancer. Conclusions: Laparoscopic colorectal surgery is safe and effective, although its efficacy in malignant disease is uncertain. Patients enjoy the same benefits derived from other laparoscopic procedures. Although there appears to be a longer learning curve associated with the procedure, minimally invasive techniques should become utilized more frequently for patients with colorectal disease.