Association of Program Directors in Surgery Presidential Address

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Association of Program Directors in Surgery
Presidential Address

• Joseph B. Cofer, MD, FACS
• Professor of Surgery
• Program Director
• University of Tennessee College of Medicine
• Chattanooga Campus, Department of Surgery
• Chattanooga, Tennessee

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Thank you very much!
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This is not your Mothers APDS

• Joseph B. Cofer MD, FACS
• University of Tennessee College of
  Medicine-Chattanooga Unit

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Dr. Bob Berry
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A. O. Whipple Society

• Founded in 1952
• To further surgical education
• Initially met with the Society of Surgical
  Chairman

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• Dr. Dominic DeLaurentis becomes Chief of Surgery
  at Springfield Medical Center, Springfield,
  Massachusetts (1966)
• Dr. Paul Friedmann joins him in 1968
• Both eventually join the Whipple Society

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Seminar-Residency Review Committee for Surgery
ACS 24 October, 1974

• Dr. Paul Van Pernis
• Dr. Leonard Fenninger
• Dr. James Humphreys
• Dr. John Beal
• Dr. Tom Shires
• Dr. Donald Mulder
• Dr. Dean Warren

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Second SymposiumACS 12 October,1976

• The RRC and its role in Surgical education
• The role of the LCGME
• The role of the ABS
• Pediatric Surgery Residencies as they pertain to
  General Surgery Residencies
• 383 GS Residencies/1203 Chief spots

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The Whipple Society meets for the last time in
New Orleans in October 1978
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The Educational Context in 1978

• Of the 383 training programs at that time, about
  1/3 were University and 2/3 were Non-University
• The Society of Surgical Chairmen had been meeting
  with the Whipple Society
• No educational forum existed for the
  Non-University programs

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• From October 1978 through the next year,
  extensive discussions were held between Dr.
  DeLaurentis, Dr. Friedmann, and Dr. Rollins
  Hanlon who was the Executive Director of the
  American College of Surgeons
• A decision was made to have an organizing
  meeting for the new group

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Dr. James Hardy

• The ACS should Provide a home for the meeting
  of directors of general surgery training
  programs. In my judgment the proposition is sound
  and the timing is right

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Plans for meeting with ACSOctober, 1979

• Dr. Herman appointed head of the planning
  Committee
• Dr. Padberg of the ACS sent a memorandum to all
  PDs in 8/79
• Decision to hold a panel discussion at the
  initial forum
• Letter from Dr. Herman to all PDs listing
  questions to be put to the panel

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• Do we need an annual forum for GS PDs?
• What are problems unique to university/non-univers
  ity/community/veterans hospitals?
• Should there be a central registry for openings?
• A registry for displaced residents or PDs with an
  opening?
• Should surgical residencies be reduced in number?
• Impact of recent legislation restricting FMGs?
• How much Trauma is ideal?
• How important is pre-op assessment, operative
  decision making, and post-op follow up?

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• First formal Forum for General Surgery Program
  Directors was held in Chicago on Tuesday October
  23, 1979 to a standing room only audience
• Dr. Herman chaired this first forum
• An overwhelming majority of those present voted
  for an annual meeting
• This was the beginning

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Dr. Rashid A. Abdu

• The overwhelming response and enthusiasm made it
  clear as to the need of such a meetingthe
  unanimous vote to have this meeting again next
  year was an indication of the great need and
  desire to discuss the problems which we all have
  in common I feel the meeting in Chicago strongly
  indicated that we should have a well-organized
  association, the American Surgical Association of
  Program Directors. This is different from all
  other educational associations in that membership
  will be to all directors of approved programs,
  regardless of University or medical school
  association

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• Dr. Herman and 15 others have a planning meeting
  on March 20, 1980 in Chicago
• Dr. Friedmann composes a 5 page document in June,
  1980
• The Task Force meets again in Philadelphia, in
  June 1980
• A decision is made to form a new organization
• The Association of Program Directors in Surgery

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• The organization will meet annually
• Funded by modest annual contributions, without
  full time employees
• Goals 1) to assist in the continued improvement
  of the quality of education, 2) to facilitate
  communication among program directors, 3) to
  provide a forum for open discussion of
  educational issues in surgical training

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• The planners decided to have the organization
  report solely to the membership, but to have a
  close working relationship with the ACS, the RRC,
  the ABS, and the Society of Surgical Chairmen
• The members of the APDS would be all Program
  Directors as defined by the AMA Directory of
  Graduate Medical Programs (The Green book)

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Second APDS ForumAtlanta 10/21/1980

• Moderated by Dr. Robert Herman
• RRC and ABS gave a report
• Organizing task force gave their report
• 350-400 members in the audience voted to form the
  APDS
• Dr. Herman elected first Chairman/Secretary
• A steering committee of 26 surgeon educators was
  appointed

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• Steering Committee met 2/16/1981
• Dr. Humphreys published first Newsletter
• APDS next meets as an organization with the ACS
  on October 14, 1981
• Initial dues set at 25.00
• Dr. Sparkman elected second chairman-secretary

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• Steering Committee meets in Dallas, March 20,
  1982
• Only 154 of the 324 programs had paid their dues
• Dues increased to 100.00

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• Steering Committee meets in Dallas, March 19,
  1983, The APDS has 8,887.00 in the bank
• By May of 1983, Dr. DeLaurentis was nominated to
  be the third Chairman-Secretary
• In 1983 a decision is made to hold the first
  Spring meeting of the APDS, separate from the ACS
  Fall meeting

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• Dr. Hiram Polk, then Chair of the RRC, volunteers
  to hold this first Spring Meeting of the APDS in
  conjunction with the RRC
• This act probably supplied a crucial degree of
  legitimacy to the fledgling APDS
• Announcements were sent out promoting this
  two-day meeting to be held in the Spring of 1984
  in Atlanta
• Dues were still 100.00, and all but 64 programs
  had paid up
• Dr. Nyhus, editor of Current Surgery was
  approached about an alliance

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• By January 10, 1984, the program for the meeting
  to be held in Atlanta on 17-18 February was
  assembled
• A registration fee of 65.00 was announced
• The meeting was to be divided into Plenary
  Sessions and Workshops

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Topics-February, 1984

• Dr. Herman-APDS Origins
• Dr. Sparkman-APDS Future
• Dr. Blaisdell-Are we training the correct number
  of general surgeons?
• Dr. Finch-How much of a pyramid is acceptable
• Dr. Berry-ABSITE use and abuse

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Topics-February, 1984

• Dr. Philpott-Research at a resident level-How
  much and what type?
• Dr. Friedmann-The ICU and the general surgery
  residency
• Dr. Nealon-How to assess quality in the surgical
  Residency
• Dr. Cranley-For Super Fellowships
• Dr.Thomas-Against Super Fellowships
• Dr. Furste-Should Program Directors always be
  Department Directors?

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• Prompted by the demise of the Whipple Society in
  1978, The APDS held its first Spring Meeting in
  Atlanta in February, 1984
• Mr. Tom Fise and his organization AGRM was hired
  in 1986 to serve as director, and his contract
  was recently extended for three years in October,
  2005.
• Fast Forward to the Future

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• 1990 - Dr. Arthur Aufses - Advisory Council for
  General Surgery
• 1991 - Dr. Bob Barnes - Board of Governors
• 1994 - Dr. Dan Diamond American Board of
  Surgery
• 2006 Dr. Tim Flynn Current Vice-Chairman of
  the American Board of Surgery

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• Residency Review Committee for Surgery
  responsibility for accrediting programs
• American Board of Surgery responsibility for
  accrediting surgeons
• American College of Surgeons assists in
  education
• Association of Program Directors in Surgery
  responsibility for creating, educating surgeons

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Blue Ribbon Panel

• ASA, ACS, ABS, RRC
• The committee was charged with examining the
  multitude of forces impacting health care and
  making recommendations regarding the changes
  needed in surgical education to enhance the
  training of surgeons to serve all the surgical
  needs of the nation and to keep training and
  research in surgery at the cutting edge in the
  twenty-first century
• The APDS was not formally included

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March 16, 2002We Hit The Bottom!

• General Surgery no longer a competitive choice
• Too much work!
• Too much call!
• Woman consider surgery unfriendly!
• Lifestyle, lifestyle, lifestyle!

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US Senior Medical Students Who Match Into General
Surgery
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US Senior Medical Students Who Match Into General
Surgery
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Categorical PGY-1 Residents USMLE I
(N) Surgery
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Categorical PGY-1 ResidentsUSMLE II
(N) Surgery
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Fundamentals in Surgery Curriculum

• Sponsored by the ACS
• APDS involved from the start
• Expected roll out July, 2007
• Modular curriculum for all categorical and
  preliminary first year surgery residents

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ABS Curricular Initiative

• First meeting November 15, 2004
• APDS involved from the start
• Intention is to develop a standardized, national
  curriculum for all years of General Surgery
• One full time surgical educator hired by the ABS
  to head this up
• APDS first organization in the nation to fund
  with a 20,000 grant
• APDS Curriculum Committee to be integrally
  involved

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A Patient Safety Curriculum for Surgical
Residency Programs

• Joint invitational conference held by ACS and
  ACGME, May 2005
• APDS was there

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Vascular Surgery Primary Certificate

• When the APDVS decided to begin the process of
  writing a curriculum for their newly designated
  primary certificate, they approached the APDS for
  help
• The intention was to do so in a collaborative
  effort, not confrontational
• Conference call, meetings in Chicago and San
  Francisco

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The APDS is now CLEARLY Relevant and Involved

• When a discussion is held regarding surgical
  education, the APDS is there
• The APDS truly appreciates and thanks the ABS,
  ACS, RRC, and ACGME for allowing us to sit at the
  table, asking for our opinion, and listening to
  us!

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APDS Annual Meeting Attendance
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APDS Net Worth
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APDS Strategic Retreat

• Approved by the Board of Directors, charged to
  map out a plan for the future
• Met in Chicago
• Report disseminated
• Committees formed

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New APDS Committees

• Curriculum
• Simulation
• Ethics
• Industry
• Issues
• Financial
• Education/mentorship

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Existing APDS Committees

• Bylaws
• Program
• Nominating

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APDS Needs AssessmentPurpose

• The purpose was to evaluate APDS member needs and
  measure members perception of the value of APDS
  programs and to define future strategies
• A needs assessment survey tool was devised by
  Stiles Healthcare Strategies with input from Drs.
  Potts, Valentine, and Cofer

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Methods

• The study was funded by The Chattanooga Surgical
  Foundation, of The Department of Surgery,
  UTCOM-Chattanooga Campus
• In January 2006, 540 surveys were mailed to all
  540 persons on the APDS with strict instructions
  that they be filled out by the Program Director

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Methods

• Many surveys were sent in error to program
  coordinators and associate program directors
• Multiple e-mails followed to reinforce
  instructions that the surveys were to be filled
  out only by the Program Directors
• 193 surveys were returned, 32 were considered
  invalid

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Methods

• 32 surveys excluded
• 18 from program coordinators or administrators
• 9 from Department Chairmen
• 2 from Associate Program Directors
• 2 from Retired Directors
• 1 received after tabulation

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Results

• 161 surveys (63) from 254 Program Directors were
  analyzed
• 95 confidence level with 4.68 margin of error

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Results

• 91.9-male, 8.1 female nationally 19/254 (7.5)
  names on the list are obviously female
• Age
• lt40 - 3.7
• 40-49 27.3
• 50-59 44.1
• 60-69 21.7
• gt69 2.5

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Results

• Length of membership in APDS
• lt2 years 16
• 2-5 years 21.7
• 5-10 years 28.6
• gt10 years 33.5
• Type of residency program
• University 46.6
• Affiliated 32.3
• Community 37.3

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Results

• Location of Residency Program
• Major Metro (1,000,000 or more) 42.2
• Medium Metro (250K-1,000,000) 34.8
• Small Metro/Rural (lt250,000) 15.5

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Results

• Participation in Meetings
• 71 of Respondents plan to come to Tucson
• 66 Plan to attend the fall meeting in Chicago
• 85 of members lt2 years will attend spring
  meeting vs. 71 overall, and 65 members gt10 years

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Results

• 35 of respondents have been involved as a
  presenter or panel participant (54 of those gt 10
  years)
• Participation in APDS meetings seems to be open
  to all on an equal basis, not dominated by
  university or academic programs or men over
  women, or major metro vs. small metro/rural

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Spring Meeting Activities-Member Value
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Results

• Have you ever served as an Officer or on an APDS
  Committee?
• -Yes 23.6 -No 75.2
• How likely is it you would served if asked?
• - Very 70.2 Somewhat 19.9
  Not 9.3

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Percent of Compensation that comes from PD job

• 0 - 16.1
• 10-20 - 34.8
• 30-40 - 19.3
• 50-70 - 19.2
• 80-100 - 9.2

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Full Time Staff Support

• Zero - 1.9
• One - 37.3
• Two to Four - 52.2
• Five to Nine - 6.8
• Ten or more - 1.9

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Number of Faculty Compared With Type of Program
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Numbers of Masters and Ph.D. Level
Educators/Program
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Do You Anticipate Quitting, Retiring, or Leaving
in the Next 3 Years?

• Yes - 23.6
• No - 59
• Not Sure - 16.8

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Factors Influencing Decisions to Leave

• Desire to reduce workload 41.5
• Unspecified other 33.8
• Anticipated retirement 30.8
• Not happy with role as PD 18.5
• Financial pressures, need more - 15.4
• Timing of next RRC visit 9.2
• Desire to relocate 7.7
• Anticipated cutback or termination of program
  1.5

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Anticipated Changes in Financial Resources

• Growing - 21.7
• Staying about the same 57.1
• Declining 19.9

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Current APDS Services-Value

• Spring Meeting with ASE 4.3
• Networking APDS Members 3.8
• New PD Workshop 3.8
• Fall ACS Meeting 3.6
• Listserve 3.4
• BS Text/CD Rom/Web Mtl 3.3
• Website 3.3
• Current Surgery 2.8

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Potential APDS ServicesInterest

• New Standard Curriculum 4.2
• Skills Lab Curriculum 4.2
• PD Resources Perform/advance 3.6
• Refresher course 3.6
• PD Compensation Survey 3.5
• Representation/Medicare 3.5
• Accreditation program 3.3

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Support Future APDS Strategic Initiatives

• RRC Representation 4.6
• Establish Curriculum Comm. 4.4
• Develop Methods to incorporate Core Competencies
  4.4
• Establish Skills Curriculum 4.2
• Establish Issues Committee 3.8
• Establish APDS Foundation 3.2
• Establish Ethics Committee 3.2

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Conclusions

• The APDS is Relevant on the stage of Surgical
  Education in America
• The opinions of the APDS are solicited, valued,
  and listened to
• The APDS is the leading organization in the world
  whose mission is Surgical Education

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Conclusions

• The APDS is financially sound
• Attendance at meetings is increasing
• Medical students want to become surgeons
• We recruit from the top half of the medical
  school class

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Conclusions

• We are a diverse group, with our training
  programs spread among academic and community
  institutions
• The RRC/ABS/ACS panel and networking are the most
  popular activities at our Spring meeting
• 80 of our membership wishes to be involved in
  formal activities of the group

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Conclusions

• 23.6 of our members are planning on leaving
  their job as PD in the next 3 years, and 16.8
  are not sure
• Desire to reduce workload 41.5, other
  33.8, retirement 31, not happy as PD 18.5
• 50 of our PDs receive less than 20 of their
  compensation for running their program, and 15
  receive nothing
• 40 of PDs have 0-1 staff, and 52 have 2-4

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I think somebody needs to do something about
this!!
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Conclusions

• The spring meeting, the ability to network, and
  the New PD course are perceived as highest value
  for our members
• The development of a standard curriculum, a
  skills lab curriculum, resources to help PDs
  perform better and advance professionally, and a
  refresher course were the highest perceived
  potential values

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Future APDS Strategic Initiatives-Stratified by
Members

• RRC Representation
• Standard Curriculum
• Methods to incorporate core competencies
• Skills Curriculum
• Issues Committee
• APDS Foundation
• Ethics Committee

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The Future

• Get more members involved in a useful way!
• Program Directors are problem solvers, doers,
  leaders!
• It is time that our leadership look at our assets
  and develop a business plan to allow us to
  continue to grow, but to start to fund curriculum
  development and other necessary activities to
  support our membership.

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MISSION STATEMENT

• The mission of the APDS is to prepare the
  surgeons of tomorrow to provide excellence in
  patient care.

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Thank You!
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US Senior Medical Students Who Match Into General
Surgery
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Programs Ranked to Obtain Match