Bulletin "We Suffer in Silence" - Surgeons as Second Victims - American College of Surgeons
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Bulletin
N OV E MB E R- DEC E MB E R 2 02 2 | VO LUME 107 NUMB E R 11
“We Suffer in Silence”
Surgeons as
Second Victims
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2023
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Contents
FEATURES
7 COVER STORY: “We Suffer in Silence”:
The Challenge of Surgeons as Second Victims
Matthew Fox, MSHC
14 Generations of Giving: Philanthropy Is
a Family Affair for These Father-Son Surgeons
Tony Peregrin
7
18 Clinical Congress 2022 Highlights
25 E. Christopher Ellison, MD, FACS, Is Installed as ACS
President
27 Dr. E. Christopher Ellison Urges Surgeons to Unite for
the Profession, Patients
29 Sherry M. Wren, MD, FACS, FCS(ECSA), Is Elected ACS
Secretary
30 One Mace to Rule Them All
14 Tyler G. Hughes, MD, FACS
34 Henri R. Ford, MD, MHA, FACS, FRCS, FAAP, Is ACS
President-Elect
38 Honorary Fellowship Is Conferred on 12 Eminent
International Surgeons
43 Governors Survey Probes Telehealth, Microaggressions,
Training, Private Practice
Danielle A. Katz, MD, FACS, John P. Kirby, MD, MS, FACS,
and David J. Welsh, MD, FACS
27
continued on next page
NOV-DEC 2022 BULLETIN American College of Surgeons |1
Contents continued
DEPARTMENTS
COMMENTARY Boughey, MD, FACS
5 Executive Director’s Update: FOR YOUR PRACTICE
Charting Our Course
61 Coding and Practice
for the Year Ahead
Management: Coming in
Patricia L. Turner, MD, MBA, FACS 2023: Extensive Changes
for Reporting Anterior
FOR YOUR PATIENTS
Abdominal Hernia Repair
52 ACS Quality and Safety Case
Megan McNally, MD, FACS,
71 Studies: Reduction in PONV
Jayme Lieberman, MD, FACS,
Leads to Decrease in Emesis,
and Jan Nagle, MS
Length of Stay, and Opioid Use
in Bariatric Surgery Patients 67 A Look at The Joint
Ginny Ledbetter, MSN, APRN, Commission: Joint Commission
ACNS-BC, CBN, Kaitlin O’Brien, Changes Reviews of Hospitals
DNP, RN, Hilliary Goode, BS, Lenworth M. Jacobs Jr., MD,
MSN, CRNA, Patrick D. Walker, MPH, FACS
PharmD, BCCCP, Alison Partridge,
PhD, RN, CPAN, Charles K. FOR YOUR PROFESSION
Mitchell Jr., MD, FACS, FASMBS, 69 From the Archives: Trepanation
and Bryan K. Thomas, MD Reveals the Success of the Incas
59 ACS Cancer Research Program: Tiffany R. Sanchez and Angel D.
New Standards Offer Glimpse of Chavez-Rivera
72 Multidisciplinary Care through
the “Lens of the Breast Cancer
Patient”
Jill R. Dietz, MD, MHCM, FACS,
Scott H. Kurtzman, MD, FACS,
Kathy Yao, MD, FACS, and Judy C.
NEWS
71 In Memoriam: Dr. Sean 75 ACS Launches Emergency
Grondin, ACS Regent General Surgery Verification
72 In Memoriam: Dr. William Program
Sasser, ACS Past-Second Vice- 77 Call for Nominations for ACS
79 President Officers-Elect and Board of
73 ACS Unveils New “Power of Regents
Quality” Campaign 79 Report on ACSPA/ACS Activities,
74 ACS Releases Free Clinical October 2022
Readiness Curriculum for Danielle Saunders Walsh, MD,
Military, Civilian Surgeons FACS
2| V107 No 11 BULLETIN American College of Surgeons
The American College of Surgeons is dedicated
to improving the care of the surgical patient
and safeguarding standards of care in an Surgeons
optimal and ethical practice environment. Sowing
Hope
SENIOR MANAGER, EDITOR-IN-CHIEF Letters to the Editor
Jennifer Bagley, MA should be sent with the
writer’s name, address,
DIRECTOR, DIVISION OF email address, and
INTEGRATED COMMUNICATIONS daytime telephone
Natalie Boden, MBA number via email to
jbagley@facs.org, or via
SENIOR GRAPHIC DESIGNER/
CLINICAL
mail to Jennifer Bagley,
PRODUCTION MANAGER/
FRONT COVER DESIGN Bulletin, American
Tina Woelke College of Surgeons,
CONGRESS
633 N. Saint Clair St.,
MANAGING EDITOR, SPECIAL Chicago, IL 60611.
PROJECTS Letters may be edited
Tony Peregrin
2022
for length or clarity.
Permission to publish
DIGITAL MANAGING EDITOR letters is assumed
Matthew Fox, MSHC unless the author
indicates otherwise.
EDITORIAL & PRODUCTION ASSOCIATE
Jen Moran, MPP
Now On
EDITORIAL ADVISORS
Danielle A. Katz, MD, FACS
Dhiresh Rohan Jeyarajah, MD, FACS
Crystal N. Johnson-Mann, MD, FACS
Mark W. Puls, MD, FACS
Bryan K. Richmond, MD, FACS
Demand
Marshall Z. Schwartz, MD, FACS
Anton N. Sidawy, MD, FACS
Gary L. Timmerman, MD, FACS
Douglas E. Wood, MD, FACS
Access Clinical Congress
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©2022 by the American College of Surgeons, all rights reserved. Contents
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Library of Congress number 45-49454. Printed in the
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ACS Leaders and Executive Staff*
*Titles and locations current at press time.
James W. Fleshman Jr., MD, FACS AMERICAN COLLEGE OF
Officers Dallas, TX Advisory Council SURGEONS FOUNDATION
Shane Hollett
E. Christopher Ellison, MD, FACS
Andrea A. Hayes
Dixon, MD, FACS to the Board Executive Director
Powell, OH
PRESIDENT
Washington, DC of Regents CONVENTION AND MEETINGS
Cindy Kennedy Airhart, CAE
Julie A. Freischlag, MD, FACS Fabrizio Michelassi, MD, FACS (Past-Presidents) Director
Winston-Salem, NC New York, NY
Kathryn D. Anderson, MD, FACS OFFICE OF DIVERSITY,
IMMEDIATE PAST-PRESIDENT Lena M. Napolitano, MD, FACS San Gabriel, CA EQUITY, AND INCLUSION
Mary E. Fallat, MD, FACS Ann Arbor, MI Cie Armstead, MPA, DBA
Barbara Lee Bass, MD, FACS
Louisville, KY Linda G. Phillips, MD, FACS Houston, TX Director
FIRST VICE-PRESIDENT Galveston, TX
L. D. Britt, MD, MPH, FACS, FCCM Bonnie Simpson Mason, MD
Anne G. Rizzo, MD, FACS Sarwat Salim, MD, FACS Norfolk, VA Medical Director
Sayre, PA Boston, MA
SECOND VICE-PRESIDENT John L. Cameron, MD, FACS DIVISION OF EDUCATION
Mark T. Savarise, MD, FACS Baltimore, MD Ajit K. Sachdeva, MD, FACS, FRCSC
Sherry M. Wren, MD, FACS Salt Lake City, UT Director
Palo Alto, CA Edward M. Copeland III, MD, FACS
SECRETARY Kenneth W. Sharp, MD, FACS Gainesville, FL EXECUTIVE SERVICES
Nashville, TN Connie Bura
Don K. Nakayama, MD, MBA, FACS A. Brent Eastman, MD, FACS
Chapel Hill, NC Anton N. Sidawy, MD, FACS San Diego, CA Chief of Staff
TREASURER Washington, DC Lynese Kelley
Gerald B. Healy, MD, FACS
Patricia L. Turner, MD, MBA, FACS Steven C. Stain, MD, FACS Boston, MA Director, Leadership Operations
Chicago, IL Burlington, MA FINANCE AND FACILITIES
EXECUTIVE DIRECTOR & CEO R. Scott Jones, MD, FACS
Gary L. Timmerman, MD, FACS Charlottesville, VA Gay L. Vincent, CPA, MBA
Gay L. Vincent, CPA, MBA Sioux Falls, SD Chief Financial Officer
Chicago, IL Edward R. Laws, MD, FACS
Shelly D. Timmons, MD, FACS Boston, MA HUMAN RESOURCES
CHIEF FINANCIAL OFFICER
Indianapolis, IN AND OPERATIONS
Ronald V. Maier, MD, FACS Michelle R. McGovern,
David J. Welsh, MD, MBA, FACS Seattle, WA
Batesville, IN MSHRIR, CPSP
Officers-Elect Philip R. Wolinsky, MD, FACS
LaMar S. McGinnis Jr., MD, FACS Director, Strategic Operations,
Atlanta, GA People & Culture
(take office October 2023) Lebanon, NH
J. Wayne Meredith, MD, FACS INFORMATION TECHNOLOGY
Henri R. Ford, MD, MHA, FACS Douglas E. Wood, MD, Winston-Salem, NC Brian Harper
Miami, FL FACS, FRCSEd Director
PRESIDENT-ELECT Seattle, WA David G. Murray, MD, FACS
Syracuse, NY DIVISION OF INTEGRATED
Tyler G. Hughes, MD, FACS
Patricia J. Numann, MD, FACS COMMUNICATIONS
Salina, KS
Natalie Boden, MBA
FIRST VICE-PRESIDENT-ELECT
Board of Syracuse, NY
Director, Internal Communications
Deborah A. Kuhls, MD, FACS Carlos A. Pellegrini, MD, FACS
Las Vegas, NV Governors/ Seattle, WA Brian K. Edwards, MBA
SECOND VICE-PRESIDENT-ELECT Executive Valerie W. Rusch, MD, FACS
Chief, External Communications
Committee New York, NY JOURNAL OF THE AMERICAN
COLLEGE OF SURGEONS
Richard R. Sabo, MD, FACS
Board of Regents Ross F. Goldberg, MD, FACS
Phoenix, AZ
Bozeman, MT
Timothy J. Eberlein, MD, FACS
Editor-in-Chief
Timothy J. Eberlein, MD, FACS CHAIR Courtney M. Townsend Jr., DIVISION OF MEMBER SERVICES
Saint Louis, MO Lillian S. Kao, MD, FACS MD, FACS Michael J. Sutherland, MD, FACS
CHAIR Galveston, TX
Houston, TX Director
Anthony Atala, MD, FACS VICE-CHAIR Andrew L. Warshaw, MD, FACS
Winston-Salem, NC M. Margaret Knudson, MD, FACS
Marion Curtiss Henry, MD, FACS Boston, MA Medical Director, Military Health
VICE-CHAIR
Chicago, IL Systems Strategic Partnership
Carol L. Brown, MD, FACS SECRETARY
New York, NY Cherisse D. Berry, MD, FACS Executive Staff Girma Tefera, MD, FACS
Director, Operation Giving Back
Francoise P. Chagnon, New York, NY EXECUTIVE DIRECTOR & CEO
MD, FACS, FRCSC DIVISION OF RESEARCH AND
Shannon M. Foster, MD, FACS Patricia L. Turner, MD, MBA, OPTIMAL PATIENT CARE
Montreal, QC Reading, PA FACS Clifford Y. Ko, MD,
Annesley W. Copeland, MD, FACS Amit R. Joshi, MD, FACS DIVISION OF ADVOCACY MS, MSHS, FACS
Bethesda, MD Moorestown, NJ AND HEALTH POLICY Director
James C. Denneny III, MD, FACS Maie A. St. John, MD, PhD, FACS Frank G. Opelka, MD, FACS
Medical Director, Quality Heidi Nelson, MD, FACS
Alexandria, VA Los Angeles, CA
and Health Policy Medical Director, Cancer
Diana L. Farmer, MD, Don J. Selzer, MD, FACS
FACS, FRCS Patrick V. Bailey, MD, MLS, Eileen M. Bulger, MD, FACS
Indianapolis, IN Medical Director, Trauma
Sacramento, CA FACS
Medical Director, Advocacy
Christian Shalgian
4| V107 No 11 BULLETIN American College of Surgeons Director
EXECUTIVE DIRECTOR’S UPDATE
Charting Our Course for the Year Ahead
by Patricia L. Turner, MD, MBA, FACS
I
t is hard to believe that 2022 is almost in the rear- Moving into 2023, the ACS is being particularly
view mirror. As I near the end of my first year strategic with program development and more inno-
as Executive Director and CEO, I want to take a vative with technology. For example, we recognize that
moment to celebrate our accomplishments and out- not every member can attend the full Clinical Con-
line the road ahead as we continue to move our spe- gress, we would all benefit from a more individualized
cialty forward and strengthen the House of Surgery approach to specialty content, and we know that every-
together. one wants to be able to access high-quality and inno-
First, I want to thank everyone who participated vative education close to home and when convenient.
in our recent Clinical Congress in San Diego. It was Your ACS staff and surgeon leaders have been
amazing to be back together for the first time in 3 working diligently to bring best in class to you. Webi-
years, and the camaraderie, enthusiasm, and energy nars, toolkits, virtual seminars, in-person lectures,
were extraordinary. and skills-based courses are all part of what the ACS
We welcomed world-renowned experts, featured offers. Education in every format for all career stages
cutting-edge innovations, and presented exciting is designed to help you excel, advance, and grow.
new research and educational programming. Thank Additional developments will occur over the next
you, sincerely, to the dedicated staff, leaders, sur- few years, and they will deepen the value proposition
geon faculty, and subject matter experts—you made for surgeons of all specialties. We currently have more
it possible! than 84,000 members around the world, and our ACS
More than 9,600 people joined us in person, with chapters continue to grow in number and strength. We
more than 2,000 others taking advantage of the vir- now have 119 chapters, including our newest chapters
tual option. Altogether, registrants represented indi- in the UK, Costa Rica, Bahrain, and the Kurdistan
viduals from all surgical specialties, from all career Region of Iraq.
levels, and from 116 countries. Through a new pilot launched this year to waive
You can read more about the sessions, learn how resident dues for the 2022–2023 academic year, we also
to access the on-demand content, see an assortment expect to increase resident participation in the ACS—
of photos, and get additional factoids about the meet- and we are confident that residents of every surgical
ing in a special Clinical Congress recap on pages specialty, who are exposed to the career development
18–42. resources, education, quality programs, and schol-
arship and grants opportunities that we offer—will
become ACS members for life.
Shifting Gears Helping our members provide the highest quality
For nearly 3 years, surgeons, frontline workers, and patient care has been the top priority for the ACS for
their teams made remarkable sacrifices to treat the past 110 years, and it will continue to be the top
patients during the COVID-19 pandemic. Many priority.
experienced stress and burnout, while at the same This past year, we celebrated the centennials and
time realizing just how resilient and resourceful outstanding accomplishments of the Committee on
we can be. Trauma and the Commission on Cancer. They have
As we emerge from the pandemic, individuals both helped transform clinical care and significantly
and organizations—including the ACS—are refin- improved outcomes for trauma and cancer patients
ing their priorities and recalibrating tactics. around the world.
NOV-DEC 2022 BULLETIN American College of Surgeons |5
EXECUTIVE DIRECTOR’S UPDATE
Learn more about the numerous and impressive
accomplishments of the ACS staff and volunteers
on behalf of the House of Surgery in the
ACS 2021–2022 Annual Report. Access the
report at facs.org/about-acs/governance/annual-
report or scan the QR code on this page.
quality among hospitals, lawmakers, regulatory agen-
Productive Partnerships cies, payers, and the public.
One key to the strength, durability, and success of the An integrated, multiyear campaign launches early
ACS is our partnerships with other organizations. next year aimed at increasing participation in our
In September, the ACS welcomed professionals Quality Programs and leading to inclusion of quality
from 47 multidisciplinary medical societies and health measures in healthcare reform legislation, a greater
organizations for a Medical Summit on Firearm Inju- adoption of ACS quality metrics in CMS and private
ry Prevention (see the October Bulletin). In October, payer formulas, and a greater demand from the pub-
through our long-term collaboration with the military, lic to be cared for by a quality verified facility. More
we launched a Military Clinical Readiness Curriculum, details about the campaign are on page 73 and forth-
which is a free online resource that provides valuable coming.
education for all surgeons who treat trauma victims (see You can read more about the numerous and
page 74); and in November, the ACS, American Acad- impressive accomplishments of the ACS staff and
emy of Family Physicians, and American College of volunteers on behalf of the House of Surgery in my
Physicians jointly authored an opinion piece in Modern annual report to the membership (see sidebar).
Healthcare about the urgent need for Congress to halt As always, I look forward to hearing from you,
Medicare payment cuts that take effect on January 1 and I hope to see you at upcoming events, including
and fix the broken Medicare payment system. the Leadership & Advocacy Summit (April 15–18)
If you practice in the US and haven’t yet contacted in Washington, DC, the Quality & Safety Confer-
your lawmakers on this issue that affects our patients’ ence (July 7–13) in Minneapolis, MN, and Clinical
access to care, please do so today at facs.org/surgeons- Congress 2023 (October 22–26) in Boston, MA. A
voice. new hotel just opened adjacent to the Boston meet-
We know activism works. We know that our voices ing space, which will lead to a fantastic experience
matter. in the city.
As I wrote in my October column, surgeon advo- Thank you for your membership in the ACS. I wish
cacy led to recent wins in two states. Based on the ACS you, your colleagues, and your family happy holidays
STOP THE BLEED® program, California became the and a healthy, safe, and productive new year. Please
first state in the nation to require installation of trauma look for a fresh and redesigned Bulletin in January
bleeding control kits in new buildings where people and engage with us on all of the new fronts in store
congregate; in New York, fellows and residents who ini- for our organization. ♦
tially did not qualify for that state’s $1.2 billion health-
care worker bonus program related to care of COVID
patients now can collect the bonus.
The Power of Quality
Together, we accomplished a lot in 2022, and I am
confident that we can achieve even more in 2023, If you have comments or suggestions, please send them to Dr. Turner at
including increasing awareness about the power of executivedirector@facs.org.
6| V107 No 11 BULLETIN American College of Surgeons
SECOND VICTIM SYNDROME
“We Suffer in Silence”
Surgeons as
Second Victims
by Matthew Fox, MSHC
NOV-DEC 2022 BULLETIN American College of Surgeons |7
SECOND VICTIM SYNDROME
HIGHLIGHTS
• Explains the second victim phenomenon—feelings
of guilt, sadness, and anxiety a surgeon may
experience after an intraoperative adverse event
• Shares a story from a surgeon affected by treating
patients early in the COVID-19 pandemic
• Describes how strong peer and institutional
support can help surgeons recover
O
ne December, early in his time as an attending experienced and less tired, would he have debrided the
trauma surgeon, Haytham M. Kaafarani, MD, wound? Would the patient still be alive?
MPH, FACS, treated a young man involved in a “It stayed with me for days, weeks, and maybe
factory crash. The victim had been crushed by a fork- months. No one else doubted my heroic efforts to save
lift. He arrived to Dr. Kaafarani and the trauma bay the patient. It was in my own mind that I had failed,”
in grave condition, and he was operated on over the Dr. Kaafarani said.
following 72 hours to address pelvis, rectal, and blad- That internal struggle reveals an important truth
der injuries, and the wound itself. for healthcare workers and, emphatically, for surgeons.
The patient had teenage children and his mother at When a patient experiences an intraoperative adverse
the hospital, and each day, Dr. Kaafarani, associate pro- event (iAE) during care and suffers a complication—
fessor of surgery at Harvard Medical School and Mas- or worse, death—the patient and his or her family are
sachusetts General Hospital (MGH) in Boston, would undoubtedly the victims. But the surgeons involved
talk with them to express that their loved one was in in the care, who experience the mental and emotional
critical condition, and the surgical team was trying its suffering of feeling that they made a mistake or could
best to save his life. have done more, can be victims as well—the second
Shortly before Christmas, the major operations were victims.
completed, and the patient was in better condition,
waking up when sedation was lightened and giving the
thumbs up in the intensive care unit (ICU). Dr. Kaafa- Surgeons as Second Victims
rani went to the family and said, “We did it. He’s going Dr. Kaafarani’s experience likely will ring familiar.
to live. He’s going to be fine.” They were grateful, and As he points out, almost all surgeons will have their
the mother went home that day and made some Christ- own stories. With the recent increased focus on phy-
mas cookies for Dr. Kaafarani and the care team. sician and surgeon well-being, more attention now is
But things changed that night. After Dr. Kaafarani being paid to this constellation of traumatic feelings and
had gone home for the first time in days, he received suffering, referred to as the second victim syndrome
a call that the patient was deteriorating. The severe or phenomenon, which can manifest after a medical
wounds had led to a massive infection, and he died error or other significant adverse event occurs during
because of them. It was Christmas Day. Dr. Kaaf- patient care.1
arani sat with the family and delivered the news. The second victim phenomenon has been a part of
Dr. Kaafarani’s daughter kept the decorated cookie the wellness discussion in healthcare for more than 20
box in her room for years, serving as a reminder of the years and has received moderate academic attention,
patient and his family every day. and research specifically focusing on surgeons’ experi-
As a trauma surgeon, Dr. Kaafarani is familiar with ences has been even less represented.
patient death. “I tell this story not because I can’t deal with Dr. Kaafarani, who earlier in 2022 was appointed as
difficult cases—I’ve experienced worse—but this one was The Joint Commission’s chief patient safety officer and
different. In the back of my mind, I recalled that in the medical director, spent years focusing on the impact
last surgery, the fat in his wound didn’t look as shiny as of iAEs on patients. But after his experience and the
one expects it to be—it looked a little dull,” Dr. Kaafarani prompting of a trainee, he transitioned his focus toward
said. He struggled with the thoughts of self-doubt and his colleagues.
guilt for potentially missing the sign of infection, and he In a 2017 study published in the Journal of the Ameri-
internalized his pain. He wondered, if he had been more can College of Surgeons,2 Dr. Kaafarani and colleagues
8| V107 No 11 BULLETIN American College of SurgeonsSECOND VICTIM SYNDROME
examined the effects of iAEs on surgeons from three anxiety about our patients. It’s normal. You should
major teaching hospitals in Boston, which revealed have some anxiety about your patients that drives you
some staggering numbers. The study showed that to do your best, but you need to be able to manage it.”
84% of respondents to a questionnaire who had expe- In fact, a second victim crisis can be the disease
rienced at least one iAE in the previous year reported that causes the symptom of burnout, according to
a combination of anxiety, guilt, sadness, shame, and Gregory D. Pearson, MD, FACS, director, Center for
anger. Complex Craniofacial Disorders, associate professor of
Some of the most impactful information came plastic surgery at Ohio State, and surgeon at Nation-
from the freeform comments, in which respondents wide Children’s Hospital. An iAE, left unexamined
could relay messages directly about their experiences. and unresolved, can lead to burnout by affecting a
One surgeon wrote that, after experiencing an iAE, surgeon’s connection to his or her work.
“We all hide our grief, suffer in silence. The pain can “Burnout is really about job satisfaction. You can
be close to debilitating.” work 10 hours or 100 hours. If you’re satisfied with
Beyond grappling with the reality of playing a part your work and it has meaning, the hour differential
in a surgical error, blame was common, and some- doesn’t tend to matter,” Dr. Pearson said. “But second
times debilitating mental and emotional anguish was victim syndrome can lead to surgeons feeling like
the result of suboptimal institutional support mecha- we’ve failed our patients and we’ve failed ourselves.”
nisms. Something needed to change.
“If this isn’t about surgeon well-being,” Dr. Kaafa- Potential Long-Term Consequences for Residents
rani said, “then what is?” That feeling of failure can have lasting consequences
for surgeons. Commonly, second victims experience
A Core Well-Being Issue increased anxiety about future errors, decreased job
There are commonly discussed determinants of a sur- confidence, increased sleeplessness, worries about
geon’s well-being, such as economic pressures, admin- harm to professional reputation, and, most ubiqui-
istrative burden, workplace discrimination, and struc- tously, the avoidance of similar patterns of care that
tural bias in race or gender in the workplace. But the precipitated the iAE.
second victim syndrome speaks to what may be the “For a surgeon, that might mean they are now
defining burden that can weigh on a practitioner— sending more cases to the interventional radiologist
feeling like they have failed to provide optimal care who seeks other ways of addressing an issue or looking
in a direct, one-to-one relationship with a patient. for other medical solutions at the expense of surgery,
While each of these determinants can lead to burnout, so they don’t need to live with the fear of experienc-
responding to an iAE sometimes is ignored. ing another error,” Dr. Kaafarani said.
“When leadership talks about burnout, they rarely And while the implications of shifted decision-
mention how adverse events are related,” said Ibra- making and in-surgery behavior can be significant
him Khansa, MD, FACS, assistant professor of plas- at all levels of a surgical career, there are specific
tic surgery at The Ohio State University and a plastic challenges for residents and trainees. Drs. Khansa
and reconstructive surgeon at Nationwide Children’s and Pearson coauthored a survey-based study earlier
Hospital, both in Columbus. “They talk about mind- in 2022 that looked at how surgical residents cope
fulness, meditation, work hours, pay, how much call and recover after experiencing an iAE.3 For context,
you take, which are all factors that are important. But Dr. Pearson was the residency program director at
we’re ignoring a big part about well-being, which is Ohio State while Dr. Khansa was a resident, and
NOV-DEC 2022 BULLETIN American College of Surgeons |9SECOND VICTIM SYNDROME
“It stayed with me for days, weeks, and maybe months.
No one else doubted my heroic efforts to save the
patient. It was in my own mind that I had failed.”
—Haytham Kaafarani, MD, MPH, FACS
he offered support when Dr. Khansa experienced a high-stress, intense pathophysiology, where patients
second victim event. had woken up that day thinking it would be normal.”
According to Dr. Khansa, “Published literature Death and complicated treatment were a part of her
shows residents are especially vulnerable to second professional life.
victim syndrome. Not only are they feeling anxious But nothing could prepare her for the COVID-19
or guilty about the experience with patients, but they pandemic. At MGH, Dr. Bankhead took on the role of
might feel anxious about their performance, their job, ICU physician in the early crush of COVID-19 cases,
and their future.” which grew rapidly, all while she and her colleagues
The findings were familiar—most respondents were struggling to learn more about the virus.
experienced guilt, anxiety, or insomnia, consistent Dr. Bankhead described the strangeness of han-
with the second victim phenomenon. And, importantly, dling it firsthand and then learning about it through
more than 15% of those residents said it affected their other channels.
job performance. For a surgeon at the beginning of his “Every night in that first week, I’d go to work and
or her career, these feelings can have long-lasting con- experience the surrealism of seeing this condition I’d
sequences that extend beyond a single patient. only seen on the news before, and then I’d walk home
“Not only does the adverse event affect the patient and see new outlets reporting to all the world what
first and the resident second, it potentially affects future my colleagues and I were dealing with on a minute-
patients,” Dr. Pearson said. “If I experience an adverse to-minute basis,” she said.
event today, and I’m carrying it with me 3 months down It was a much different experience than interacting
the road and it’s still affecting my job performance, with trauma victims, both in terms of treating the dis-
then it’s an issue. How is it affecting my patients or my ease, as well as in watching extremely ill individuals
interactions with my team and other faculty going for- face their death. “These patients were dying alone, ter-
ward? It’s a potential domino effect for residents who rified both of being there and not being there,” she said.
don’t recover early on.” As surgeons and physicians around the world were
For residents or attending surgeons, recovery from grappling with patient care, they were living through
experiencing an iAE can be difficult in the best of cir- fear, anxiety, and uncertainty in their own lives.
cumstances, and how does second victim syndrome Dr. Bankhead, a mother of two, was confronted
manifest during a world-altering healthcare crisis, and with the need to make difficult choices regarding inter-
what are the potential long-term effects? actions with her children. It was a profound struggle,
Dr. Bankhead said, to cope with being a good parent
while managing wildly increased work hours, sick
Second Victims, COVID-19, and patients, and uncertainty. She ultimately made the
Post-Traumatic Stress difficult decision to have her children stay with her
In March 2020, Brittany Bankhead, MD, FACS, assis- parents for their safety, but it all took a severe toll on
tant professor of surgery, trauma/acute surgical care her mental health: “I felt like the ultimate failure as
at Texas Tech University Health Sciences Center in a mom, for not being able to take care of them and
Lubbock, was practicing at MGH during her fellow- patients at the same time.”
ship in surgical critical care. All the while, she was afraid that a hole in her glove
As a trauma surgeon, she participated in the care or an ill-fitting mask might lead her to the same fate
of many gravely injured patients. As she said, “Every as so many of her patients—on a ventilator, alone,
day, every shift, my work is fraught with high-acuity, leaving her children without a mother.
10 | V107 No 11 BULLETIN American College of SurgeonsSECOND VICTIM SYNDROME
“We like to think as surgeons and scientists we can how dangerous they could be to her health, family,
completely compartmentalize emotions from adverse and career. She needed time and space away from
or ongoing health events, but you inherently have a work, and she increased individual counseling ses-
tie to them,” Dr. Bankhead said. “You always want the sions, which aided in her healing and return to a new
best for your patients, but this was different because normal. She continues to succeed as a trauma surgeon,
you had the added component of wondering, ‘Am I researcher, and in her personal life. But without a clear
going to spread this to my family? Am I going to get definition of healing, recovery from her experience
it myself? Can I take care of my patients while taking with PTSD is an ongoing story.
care of myself?’”
As with an iAE, the patients suffering and dying
from COVID-19 were the primary victims. But like Supporting Second Victims
many of her colleagues on the frontlines of the pan- Second victim syndrome and PTSD—suffered by many
demic in those early days, Dr. Bankhead was caught healthcare practitioners throughout the acute phases of
in a seemingly unending second victim cycle of fear, the COVID-19 pandemic—developed in unique, chaotic
anxiety, sadness, and guilt, even though no one at the work circumstances. In a typical practice environment,
time would find fault with her for any potential error. research has found that healthcare workers involved in
All the same, “I would have the feeling of guilt a second victim event are likely to progress through six
about decisions I made for patients and realizing it stages in the aftermath, including chaos and accident
was wrong—not because I made a clinical mistake, response, intrusive reflections, fear of colleague and
but because no one knew better,” she said. leadership perceptions, and enduring the internal and
As her time treating COVID-19 during the initial external investigations into the incident.5
waves wore on and eventually passed, and she moved But the final two stages take on particular impor-
with her family to practice in Texas, Dr. Bankhead tance for surgeons:
could tell that she was not recovering as she expected
from the many adverse patient events she faced. There • Emotional first aid: Provider connects with colleague,
were certain sensory experiences that would trigger mentor, or mental health professional for assistance in
flashbacks and familiar feelings of panic—news head- processing the event
lines from March 2020, the beeping of ventilators, the
smell of an N95 mask. • Final disposition: Provider may “drop out,” “survive,”
“I knew these triggers bothered me and they or “thrive” after the event
weren’t normal, but I felt it was my job to power for-
ward and, quite frankly, suppress it,” she said. Surgeons experiencing the second victim phenom-
But it would not be simple, because Dr. Bank- enon can suffer in myriad ways—emotionally, mentally,
head was experiencing post-traumatic stress disorder and, potentially, in their careers. But, as surgeons have
(PTSD) due to the barrage of illness and death she started to show in recent years, a strong institutional
experienced, all associated with the ongoing event. support system can make all the difference in getting to
Research has suggested that severe second victim syn- recovery, and a lack of such a system can be damaging.
drome can lead to a diagnosis of PTSD.4 “The problem is that we as surgeons are not taught
Dr. Bankhead would struggle with sometimes how to support each other,” Dr. Khansa said. “Histori-
disturbing thoughts stemming from her post-trau- cally, we tend to beat each other down, which is what
matic stress. Fortunately, she was able to recognize commonly happens during morbidity and mortality
NOV-DEC 2022 BULLETIN American College of Surgeons | 11SECOND VICTIM SYNDROME
“[During the pandemic] I would have the feeling of guilt about
decisions I made for patients and realizing it was wrong—not
because I made a clinical mistake, but because no one knew better.”
—Brittany Bankhead, MD, FACS
conferences. It’s an old school approach. But there’s a participants in the program believed that it had a “posi-
better way—support each other and build systems to tive impact on the department’s ‘safety and support’
encourage that support.” culture by raising awareness of the need to support
colleagues going through difficult patient situations.”6
The Power of Peer Support The program design and its positive results could
Dr. Kaafarani and his team in Boston sought to estab- have implications for surgery programs that want to
lish a support system using the most empathetic group bolster intradepartmental support for surgeon well-
of individuals who could understand a surgeon’s com- being. Other surgeons have found in their own expe-
plex relationship to managing an adverse event—their riences, at all career levels and in all practice environ-
peers. Among the key data from his initial study on ments, that peer support matters and it works.
how surgeons responded to iAEs,2 his team saw that “What we found in our study is that support from
it was a surgeon’s colleagues, above all other sources, peer residents should be stressed,” Dr. Pearson said.
who were a second victim’s most frequently used sup- “It really can start a snowball effect, in a positive way,
port system. by building camaraderie, which encourages residents
Based on these findings and other data show- to use each other as resources, and improving team-
ing the effectiveness of peer support, they designed work. It gets residents talking to each other, about both
a formal, surgery-specific peer support program at patient-related matters and more personal ones, which
MGH for surgeons who experienced iAEs and cat- has a positive spillover effect with communication.”
astrophic outcomes.6 The design of the program According to Dr. Bankhead, during the early days
focused on identifying and training peer supporters, of the COVID-19 pandemic, when few institutional
identifying iAEs quickly after they occurred, initiat- resources were available to aid physicians as they coped
ing follow-up to the affected surgeon, and starting a with the spike of patients, even informal peer support
discussion between peers to help the individual work was critical.
through the event. “Unofficially, we were using peer support every
Although the impetus was data-driven, Dr. Kaafa- day—at check in, at sign out. There was a built-in com-
rani had doubts about how effective such a program munity of mutual understanding, and we were check-
would be among surgeons, who are stereotypically ing in on each other, asking how our families were,” she
seen as uninterested in engaging with the emotions said. “It was a necessary release for anyone who took
of patient care. care of COVID-19 patients in the first waves.”
“My expectation, understanding the culture of sur- Ultimately, the goal of a peer support group for
gery, was that the program would be perceived as fluff second victims is found in the final stage progression
and not meaningful. But I couldn’t have been more described previously. No hospital wants their surgeons
wrong,” he said. “As soon as I got the courage to estab- to drop out due to an unresolved second victim event,
lish it, to talk about second victim syndrome and the and even simple “survival” falls short. It’s important to
program in the open, and say, ‘This is what we need get surgeons into the stage where they thrive, become
to do,’ the reception was unbelievable.” more interested in quality improvement, and can rec-
The numbers from the study were highly posi- ognize issues in others, while promoting improved
tive. In the first year of the second victim program’s recovery processes for their colleagues and improved
operations, the peer team performed nearly 50 out- patient outcomes.
reach interventions after significant surgical mis- According to Dr. Khansa, “There’s a really good
haps or unexpected patient deaths. More than 80% of opportunity for growth after a surgeon experiences an
12 | V107 No 11 BULLETIN American College of SurgeonsSECOND VICTIM SYNDROME
adverse event and for them to become safety advocates REFERENCES
who work to prevent future occurrences.” 1. Wu AW. Medical error: The second victim. The
While second victim-specific support programs are doctor who makes the mistake needs help too. BMJ.
only beginning to be implemented in hospitals, most 2000;320(7237):726-727.
institutions do offer support systems such as employee 2. Han K, Bohnen JD, Peponis T, et al. The surgeon as
the second victim? Results of the Boston intraoperative
assistance programs. But these resources often struggle adverse events surgeons’ attitude (BISA) Study. J Am Coll
to build awareness. Surg. 2017;224(6):1048-1056.
“The challenge is that not enough people realize 3. Khansa I, Pearson GD. Coping and recovery in surgical
resources are available,” Dr. Pearson said. “For people residents after adverse events: The second victim
interested in surgeon wellness, knowing what resources phenomenon. Plastic and Reconstructive Surgery–Global
Open. 2022;10(3):e4203.
are available and knowing how to guide staff and resi- 4. Sachs CJ, Wheaton N. Second Victim Syndrome. [Updated
dents, and for institutions to promote those resources, 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island
is a change that needs to happen.” (FL): StatPearls Publishing; 2022. Available at: https://
www.ncbi.nlm.nih.gov/books/NBK572094. Accessed
November 1, 2022.
5. Scott SD, Hirschinger LE, Cox KR, McCoig M,
A Steadfast Focus Brandt J, Hall LW. The natural history of recovery for the
Nascent programs that are dedicated to addressing healthcare provider “second victim” after adverse patient
surgeons as second victims show promise, and health- events. Qual Saf Health Care. 2009;18(5):325-330.
care culture in the US is slowly adapting to meet the 6. El Hechi MW, Bohnen JD, Westfal M, et al. Design and
holistic well-being needs of practitioners. It is the hope impact of a novel surgery-specific second victim peer
support program. J Am Coll Surg. 2020;230(6):926-933.
that eventually all surgeons will have the support they
need if, one day, they experience a complication, an
outcome, or a patient death that they carry in their
heads or hearts for longer, and more heavily, than
expected.
But even as work toward that goal continues, sur-
geons will remain dedicated to patient care and com-
passionate in the face of difficulty. Second victims
should not and cannot be ignored, but the focal point
of surgical care will always be on the first victim of
an adverse event.
“For better or worse, it is my job to ensure that
the care that patients get—the high acuity needs,
the technical skills, the follow-up—are top notch,”
Dr. Bankhead said. “They deserve every bit of that,
every bit of explanation, understanding, and empathy,
and my hope is that is and always will be steadfast, no
matter what happens to me as the second victim.” ♦
MATTHEW FOX is Digital Managing Editor, Division
of Integrated Communications, Chicago IL.
NOV-DEC 2022 BULLETIN American College of Surgeons | 13ACS FOUNDATION AT WORK
Dr. Generoso Duremdes
(left) and Dr. Gene
Duremdes
Generations
of Giving:
Philanthropy Is
a Family Affair for These
Father-Son Surgeons
by Tony Peregrin
14 | V107 No 11 BULLETIN American College of SurgeonsACS FOUNDATION AT WORK
Dr. Gene Duremdes
(left) and Dr. Generoso
Duremdes (right)
performing a laparoscopy
F
or nearly 3 decades, visitors to Princeton Com- continued her practice as a surgeon and became an
munity Hospital in West Virginia would likely inspiration, not only to her colleagues, but also to
hear a page for “Dr. Dad” or “Dr. Gene” sum- her patients.”
moning either Generoso Duremdes, MD, FACS, or During the meeting, Dr. Dalmacio was able to see
his son, Gene Duremdes, MD, FACS, to care for a her mentor, ACS Past-President Patricia J. Numann,
patient or, perhaps, participate in a meeting. MD, FACS, honored with the ACS Lifetime Achieve-
“These nicknames are terms of endearment,” said ment Award. Their interactions during Clinical Con-
the junior Dr. Duremdes. “And I think they show the gress were especially compelling as Dr. Numann was
loyalty, love, and support that we’ve had all these years the spark that inspired the Duremdes family to create
from our community and the people at our hospital.” this traveling fellowship.
The father-son duo recently answered a different “When I was serving as the President of the ACS
kind of call to action. West Virginia Chapter in 2013—which was actually 20
Together with their spouses—Janelle Duremdes, years after dad served in that same position—we had
MD, and Mary Duremdes, RN—they are sponsoring the privilege of having Dr. Numann as the represen-
the Duremdes Family Travel Award, an ACS fund that tative from the College to the chapter,” explained
provides international physicians, specifically Filipino Dr. Gene Duremdes. “While we were sharing a won-
surgeons, with the opportunity to attend and partici- derful evening of dinner and fellowship, we found out
pate in the annual Clinical Congress. that Dr. Numann had spent a lot of time in the Philip-
“My parents came from a very rural area in the pines and that she loved her visits there. My parents
Philippines, and they want to provide an opportunity were touched by her fondness for their birthplace and
for some of the young surgeons—who might not have how she spoke about the need for the College to reach
the resources to make it to Clinical Congress—to be out to the international surgical community and share
exposed to the latest research and trends in surgery,” the wealth of information and resources that the ACS
explained Dr. Gene Duremdes. has to offer. So, from that brief encounter was born
“Karen Hope A. Dalmacio, MD, FACS, the inau- the idea of the traveling fellowship—it literally began
gural recipient of the award, sent us this short letter just as a conversation during dinner.”
describing her journey to Clinical Congress as not In the ACS Foundation 2019 Annual Report,
only a highlight of her career as a surgeon, gaining Dr. Dalmacio described her experience observing
knowledge by attending the lectures, but also as some- Dr. Numann receive the College’s Lifetime Achieve-
thing that helped her personally fight her own breast ment Award: “It was through that recognition that
cancer,” said the senior Dr. Duremdes. “Dr. Dalmacio I was inspired by her work, her persistence as a
NOV-DEC 2022 BULLETIN American College of Surgeons | 15ACS FOUNDATION AT WORK
Dr. Generoso
Duremdes (left) and
Dr. Gene Duremdes
(right) in the OR
doing an exploratory
laparotomy
physician, her strength as a female surgeon, and, above It’s almost like we’re friends. We know each other’s
all, her excellence. The experience of witnessing such techniques to the point that we didn’t even talk to each
a momentous event for her was more than enough to other much in the operating room because we knew
inspire me to strive more in doing my part as a member exactly what we were going to do. It’s almost like that
of my surgical community.” sixth sense, that other unwritten language, that we
Following Dr. Dalmacio, the second recipient of knew each other so well.”
the Duremdes Family Travel Award was Leah Ruth The senior Dr. Duremdes added, “I consider it a
Failagutan Porras, MD, in 2020. Due to the pandemic, blessing and an honor to be able to work with and teach
Dr. Porras’s scholarship was deferred to Clinical Con- my son and to help him grow and develop into the sur-
gress 2023. geon that he has become today.”
Father-Son Surgeons Distinguished Philanthropist Award
The Duremdes family arrived in the US in 1962 at St. Since 1989, the ACS has acknowledged individuals who
Elizabeth Hospital in Elizabeth, NJ. Dr. Duremdes have distinguished themselves through their exem-
senior and his wife later trained in New York City— plary investments in the mission of the College and
at Albert Einstein Medical Center and Fordham Hos- in philanthropy with the Distinguished Philanthro-
pital, respectively. pist Award.
Dr. Duremdes senior took a job at Princeton Com- The Board of Directors of the ACS Foundation pre-
munity Hospital in 1969 and is the longest-serving phy- sented the 2020 and 2021 Distinguished Philanthropist
sician at that center. His son joined him in 1993 as a Awards to the Duremdes Family and Charles E. Lucas,
general surgeon, and for many years he performed tra- MD, FACS, at its annual donor recognition luncheon
ditional laparoscopy alongside his father. on Monday, October 17, at the Manchester Grand Hyatt
“When I first started showing an interest in sur- in San Diego. The award recognizes the Duremdes
gery, Dad said, ‘If you’re interested, you really need to Family and Dr. Lucas for their philanthropic endeav-
see what it’s like to be a surgeon.’ So, I started scrub- ors, service to the surgical profession, and long-lasting
bing with him in high school, back in the days when contributions to the medical community and the ACS.
you were allowed to do that. I learned so much, even For Dr. Duremdes senior, looking back at his life
by the time I was out of high school and college, from experiences has made him realize the importance of
a surgical standpoint. It’s been a wonderful work- giving back in order to support other surgeons’ oppor-
ing relationship—and it’s almost not even father-son. tunities for education and training.
16 | V107 No 11 BULLETIN American College of SurgeonsACS FOUNDATION AT WORK
From left: Mary Duremdes,
RN, Dr. Gene Duremdes,
Dr. Generoso Duremdes,
and Janelle Duremdes,
MD, at the 2022 ACS
Foundation Donor
Recognition Luncheon
“Pearl Harbor was bombed on December 7, 1941; laparoscopic cholecystectomy in the US. That lecture
Manila, in the Philippines, was bombed and destroyed kindled his interest in the once controversial new pro-
the following day on December 8, along with the Amer- cedure, and in June 1989, Dr. Duremdes senior became
ican and Filipino armed forces,” recalled Dr. Duremdes. the first surgeon in southern West Virginia to operate
“My parents were teachers, and we were all interred using this new technology.
in the schools and forced to learn Japanese in order to
teach the younger generation. My father, along with
two other ROTC [Reserve Officers’ Training Corps] ACS Foundation
men, secretly built a boat, which took over a year. In The Duremdes Family Travel Award is a recent exam-
the middle of the night our families escaped into the ple of the family’s long and generous contributions to
Davao Gulf only to be caught in a typhoon that capsized the ACS Foundation, which began in 1992 with finan-
the boat. For 5 days and 4 nights, we were stranded on cial contributions to the College’s International Guest
the capsized boat in shark-infested waters. We were Scholarship fund.
all saved, praise the Lord, except my mother suffered “I think philanthropy starts locally,” said Dr. Gene
from pneumonia and, without adequate antibiotics, she Duremdes. “Working with your local community is
passed away. This experience inspired me to work hard, a great way to start giving back. If you want to make
go to college and medical school, become a doctor, and a larger impact, use some of the resources provided
to give back to my rural Philippine community.” by the College. The staff at the ACS Foundation were
Dr. Gene Duremdes added: “Receiving the Dis- instrumental in developing the Duremdes Family
tinguished Philanthropist Award is an honor for our Travel Award. From our standpoint, it was relatively
family. With our traveling scholarship, we want to help easy—we just let the ACS Foundation guide us and
rural surgeons in an underdeveloped country learn show us what to do.”
new information and technology and have the oppor- “The ACS Foundation is there for the members at
tunity to meet and network with other surgeons at whatever capacity they need,” added Dr. Gene Durem-
Clinical Congress who they never would have been des. “They are very receptive to working with each
able to meet otherwise.” individual surgeon at any level of engagement.”
The Duremdes family has had its own remarkable To date, 387 international scholarships have been
experiences during Clinical Congress. In the fall of funded by the ACS Foundation to Fellows from more
1988, the senior Dr. Duremdes attended a lecture pre- than 80 countries worldwide. ♦
sented by Eddie J. Reddick, MD, FACS, and William B. TONY PEREGRIN is Managing Editor, Special Projects,
Saye, MD, FACS, who were among the first to perform Division of Integrated Communications, Chicago IL.
NOV-DEC 2022 BULLETIN American College of Surgeons | 17CLINICAL CONGRESS 2022
Clinical Congress 2022
Highlights
18 | V107 No 11 BULLETIN American College of SurgeonsCLINICAL CONGRESS 2022
Convocation: New Initiates recite the Fellowship Pledge
T
he ACS Clinical Congress 2022 in San Diego, The 2022 Honorary Fellows are:
CA, provided opportunities for surgeons,
residents, medical students, and other health- • Mohammad M. Al-Qattan, Riyadh, Saudi Arabia
care professionals from around the world to
sharpen and test their surgical skills and interact • Ines Buccimazza, MBChB, FCS(SA), FACS, Durban,
with their peers and ACS leaders and staff. It was South Africa
the first time in 3 years that Clinical Congress con-
vened in person. • Reinhold Ganz, MD, Gümligen, Switzerland
More than 9,600 individuals traveled to San Diego,
and thousands more participated virtually and have • Marco Montorsi, MD, Milan, Italy
accessed the conference’s content on demand. All
registrants can view on demand content through • Graham L. Newstead, MBBS, FACS, FRACS,
May 1, 2023, and registration remains open for new FRCS, Randwick, Australia
participants.
This article summarizes some of the conference • Fernando Rodriguez Montalvo, MD, PhD, FACS,
highlights. Caracas, Venezuela
• Paulina Salminen, MD, PhD, Turku, Finland
Convocation
A record 2,355 surgeons were initiated into ACS Fel- • Samuel Shuchleib Chaba, MD, FACS, Mexico City, Mexico
lowship this year, and following a joyful proces-
sion of ACS leaders, invited guests, and Initiates • Antonio Jose Torres, MD, PhD, FACS, Madrid, Spain
from 2020, 2021, and 2022, then-Secretary Tyler G.
Hughes, MD, FACS, presented the Great Mace (see • Petr Tsarkov, MD, PhD, Moscow, Russia
pages 30–32).
During the hour-long program, 12 international • Laura G. Viani, BA, BCh, BAO, DMMD, MSc,
surgeons were conferred Honorary Fellowship, sev- FRCSI, Dublin, Ireland
eral of the College’s most prestigious awards were
presented, and 2021–2022 ACS President Julie A. • Peter-John Wormald, MD, MBChB, FAHMS, FRACS,
Freischlag, MD, FACS, DFSVS, MAMSE, led the FCS(SA), FRCSEd, North Adelaide, Australia
installation of new officers, including E. Christo-
pher Ellison, MD, FACS, MAMSE, as President (see See pages 38–41 for more information.
pages 25–28), Mary E. Fallat, MD, FACS, as First Vice-
President, and Anne G. Rizzo, MD, FACS, as Second The 2022 Owen H. Wangensteen Scientific
Vice-President. Forum Award was presented to Henri R. Ford, MD,
NOV-DEC 2022 BULLETIN American College of Surgeons | 19CLINICAL CONGRESS 2022
Convocation: Distinguished Service Award recipient Dr. Mark In the Convention Center: A giant ACS hashtag photo op
Malangoni delivers his acceptance speech via video
MHA, FACS, FRCS, FAAP, who is renowned for his significant advances during the past 100 years. In
groundbreaking research in necrotizing enterocoli- this comprehensive talk, Dr. Feliciano described
tis, significant history of extramural funding, and the evolution of trauma surgery for liver, spleen,
his reputation for mentorship and sponsorship. duodenum, pancreas, and abdominal vascular
Mark A. Malangoni, MD, FACS, received the 2022 injuries.
Distinguished Service Award for his various leader- In the inaugural Metabolic and Bariatric Surgery
ship roles in the ACS and other medical organiza- Lecture, Don’t Stop Now, Bruce D. Schirmer, MD,
tions, including the American Board of Surgery (see FACS, MAMSE, discussed the long road that the
September Bulletin), and Ernestine Hambrick, MD, field of bariatric surgery has taken toward main-
FACS, an esteemed colon-rectal surgeon received stream practice, and he urged surgeons to learn
the Dr. Mary Edwards Walker Inspiring Women in about obesity.
Surgery Award (see October Bulletin). “Our biggest challenge is that we’re only now
beginning to understand the disease of obesity and
how to work in conjunction with medical colleagues
Named Lectures to provide lifelong ways for patients to keep the
Clinical Congress featured 12 Named Lectures, weight off,” Dr. Schirmer said. “More importantly,
which provided attendees with opportunities to hear there are still only 1% of patients each year who elect
internationally renowned surgeons and healthcare to have metabolic and bariatric surgery. What we
experts share their insights on medicine and surgery. really need to do is figure out what is wrong with
Past ACS-Executive Director David B. Hoyt, MD, our marketing and public education.”
FACS, delivered the Martin Memorial Lecture and
participated in a meet and greet after the presenta-
tion. In his talk, Dr. Hoyt provided an overview of Noteworthy Academic Programming
how the ACS’s historical commitment to patient care Each year, Clinical Congress is anchored by expansive
and quality has served as a pillar in the foundation academic, scientific, and educational programming.
of the modern organization, which has maintained In addition to Didactic and Skills Postgraduate
significance and success in a rapidly evolving medi- Courses, Clinical Congress 2022 provided attend-
cal environment. At all times, he said, the ACS uses ees access to more than 100 expert-led Panel Ses-
data, science, and surgeon experiences to move the sions. These included well-attended sessions such
College and field forward. as the 10 Hot Topics in General Surgery, hosted
“We need to use outcomes and science to deter- by Dr. Ellison and ACS Regent Kenneth W. Sharp,
mine how we treat patients going forward, and we MD, FACS, MAMSE; Diverticulitis 2022: What’s
need to be transparent with the public,” Dr. Hoyt New, What’s Old and What You Need to Know!;
said. Structural Racism: What It Is and What It Means
In the Excelsior Surgical Society/Edward D. for Surgeons and Their Patients; and much more.
Churchill Lecture, The Extraordinary Evolu- Three Special Sessions once again were offered at
tion of Surgery for Abdominal Trauma, lecturer Clinical Congress. These sessions provided attend-
David V. Feliciano, MD, FACS, MAMSE, discussed ees with an in-depth look at important ACS topics
how the high quality of modern civilian and mili- in surgery, including reports from US surgeons who
tary trauma surgery is built on the foundation of have provided care and education in Ukraine since
20 | V107 No 11 BULLETIN American College of SurgeonsYou can also read
