The next time you sit in an airplane you might spend a moment thinking about how the flight crew incorporates the new technology that is added to the aircraft from time to time.  Certainly the advent of GPS occurred in the midst of the careers of many senior pilots as well as the evolution of more sophisticated instrument landing systems.  As a passenger you have the general expectation that the pilots were trained on these new systems long before you walked into the cabin that day.  As a pilot, each time I planned to fly a new aircraft I was required to take a check ride with a flight instructor in order to be certain I was able to manage the systems in the aircraft,  such as the new GPS,  in order to avoid a potential fatality – mine.  Is certainly been said many times in the aviation industry that the lessons pilots learn are too often written in their own blood. As surgeons, that’s not quite true for us, (think about whose blood) but that shouldn’t change our commitment to be the masters of all the new technology that enters into the operating room.  I suppose I’m dating myself when I confess that I finished my training prior to the advent of the ultrasonic dissector, argon beam, and sophisticated radio frequency coagulators. It was mostly the good ole Bovie in my training days. New energy devices that came along in the 1990s such as ultrasonic dissectors clearly enabled us to do more advanced minimally invasive surgical procedures than ever before.  Even recent graduates are confronted with new devices that deliver significant energy to tissue on a frequent basis.  In your own practice, how did you learn to use the latest tool that you added to your energy armamentarium?  Do you even know generally how it works? Can you assemble it? Could you (or your circulating nurse) successfully troubleshoot a malfunction? Do you know your responsibilities if it malfunctions? The answers to these questions are often disappointing from a patient safety point of view.  I found this troubling and initiated a series of discussions within the SAGES Executive Committee and the SAGES Board of Governors hoping to persuade my colleagues that in the footsteps of FLS and FES, our third fundamentals program could be born.  Like all new ideas that promote potential change a variety of responses were encountered.  Some were wildly enthusiastic while others questioned the need to devote financial resources and a lot of human surgeon volunteer capital for such a curriculum. After all “we are the experts aren’t we?”  But not unlike the new word you learn that you start to see it everywhere, the realization that there is a legitimate need for this curriculum began to emerge. Just in the last two months I have become aware of 4 recent OR fires.  Still unconvinced? Check out https://www.outpatientsurgery.net/search/?sQ=fire.

Our past president, Jo Buyske, appointed Dan Jones to head the newly created task force charged with developing the curriculum and validated assessment methodology in the area of surgical energy. True to form Dan immediately went to work on the first order of business – the project needed a name.  Blessed with a true inspiration, the FUSE project was launched.  Pascal Fuchshuber and Liane Feldman were named co-chairs and the team went to work developing the FUSE taskforce. The Fundamental Use of Surgical Energy is currently under rapid development.  FUSE Taskforce and PG Course Leaders members include Atul Madan, Brian Dunkin, Dana Portenier, Dan Herron, Danny Scott, Dean Mikami, Esteban Varela, Gerry Fried, Gretchen Purcell Jackson, Leena Khaitan, Sharon Bachman, Suvranu De, Thomas Robinson, Scott Melvin, Warren Grundfest, William Richardson, Stephanie Jones, Malcolm Munro, Randy Voyles, Mike Brunt, James Choi, Scott Helton, Jeff Hazey,  David Iannitti,  James Ulchaker, and  Carla Bryant and Jessica Mischna (SAGES staff) – my sincere thanks to all of you  for you hard work!

A pilot postgraduate course developed by the FUSE task force was rolled out at the SAGES annual meeting in San Antonio with didactic and hands-on components. These didactics are the basis for the upcoming SAGES FUSE manual to be published by Springer later this year. The task force which represents a multidisciplinary effort by general surgeons, gynecologists, anesthesiologists, urologists, nurses as well as others is hard at work refining the curriculum and developing validated assessment tools similar to those seen in FLS and FES.  In addition to the manual, the curriculum will be available as a web-based tool and will be designed to meet surgical residency training needs and MOC requirements in the area of patient safety. 

The challenges of providing specific tool-based training are formidable but not insurmountable.  The current climate designed to protect operating room personnel from excessive sales based interactions also raises barriers to very important informal in-servicing an instrument instruction.  SAGES’ positions concerning relationships with industry as a surgical professional society are stated in our white paper: https://www.sages.org/publication/id/COI/   ( see also Surg Endosc. 2010 Apr;24(4):742-4.)  This document goes on to describe why a transparent relationship of surgical societies working with device makers as education partners is in the best interests of patient safety and high-quality surgical outcomes.  The FUSE task force will work under this rubric with the makers of the most commonly used energy devices (who admittedly know the most about their specific devices) to independently create high-quality education modules designed to fill the tool specific knowledge gap. 

Our goal is to help each surgical team perform at the most efficient and safest level, kind of like what you would expect from your pilots and flight crew and next time you step into in a plane. The WHO got it right with the Checklist mantra: safe surgery saves lives.

If you have suggestions for the FUSE project or wish to participate, please write me at [email protected]. 

Steve Schwaitzberg

This month I am writing to all current SAGES members and those of you in the general surgical community thinking about “how many societies do I need to belong to?” In this day and age of declining reimbursements and dramatic economic “belt-tightening”, this becomes an ever increasingly important question. In my mind a professional society has to be a good value proposition for its members. Clearly this can be achieved in a number of ways. Access to educational materials, Surgical Endoscopy subscription, terrific annual meetings, committee participation, networking with friends and colleagues are but a few. However, I would like to focus on what I hope you will find beginning this summer to be a key benefit of membership and a real plus to the value proposition of belonging to SAGES.

As many of you know the process of maintaining certification by the American Board of Surgery has evolved from a one-time exam, through an every 10 year examination process, to what we have today:  the Maintenance of Certification Program (MOC). Part 2 of this MOC program is: Lifelong learning and self-assessment, which is achieved through practice relevant continuing education and periodic self-assessment.

This summer SAGES will be launching its newest educational program, SAGES University. This program will enable participants to receive Part 2 MOC credits as an included benefit of SAGES membership. There will be no additional charge for participating in this program. SAGES members could earn all of their MOC credits without additional expense in the SAGES University program.

This program was developed by SAGES’ Continuing Education Committee which is chaired by Dr. Danny Scott and co-chaired by Drs. Tim M. Farrell and Simon Bergman. SAGES University will offer SAGES members online educational materials packaged with methods for self assessment. The educational content is incremental, with activities ranging from 15 minutes to 1 hour. All activities are linked not only to CME credit, but also to Self Assessment (SA) credit, which is required by the ABS for MOC Part II.

SAGES University will use an electronic learning management system (LMS) which will include a “My CME/My MOC” page to track all activities. These credits will be tracked according to specific disease-based content areas, such as hernia or bariatrics and by key designated areas including ethics, patient safety, etc. These activities will be directly downloadable to the ABS database for MOC purposes.

SAGES University will roll out with 2 programs: Journal Club and the Online Self Assessment Program (OSAP). Surgical Endoscopy articles (free to SAGES members) will be selected by the Editor-in-Chief, Dr. Mark Talamini. The articles will be accessible through SAGES University website or other online access through SpringerLink and identified as “SAGES University – CME/SA Credits offered”. Four multiple choice questions with a 75% minimum passing score is required to receive credit. 1.0 hr CME/SA credit per article. SAGES Journal Club has been coordinated by Dr. Don Selzer along with task force members: Rose Chan, David Crawford, Rajesh Aggarwal, Steven Bowers, Teodor Grantcharov, Niazy Selim, and Kent R. Van Sickle.

The Online Self Assessment Program (OSAP) is based on existing online SAGES content. This can be accessed via SAGES University or via random access during review of online content (Flagged with link for “SAGES University – CME/SA Credits offered”). The initial content will be based on 30 videos featured on SAGES TV. The will be a 15 minute content review and 1 multiple choice question per .25 credit. New content will be added every six months. OSAP is coordinated by Danny Scott along with taskforce members: John Sweeney, Nicole Fearing, Limaris Barrios, Paul Hansen, Elisabeth McLemore, Michael Cahalane, and Marina Kurian.

SAGES University began from ideas generated at the 2008 leadership retreat. Lead by the Continuing Education Committee and supported with internal investments authorized by the SAGES Board of Governors for the development of the Learning Management System, SAGES University represents a commitment to SAGES members to provide CME/MOC for recertification in general surgery as a value benefit of SAGES membership. In addition, all CME earned at the SAGES annual meeting from 2011 onward will also qualify for Part 2 MOC if the surgeon replies to the self assessment questions that will be emailed after the meeting.

If you are wondering where you are in the MOC cycle (like I was recently), go to https://home.absurgery.org/. Log in to your account and examine your MOC timeline listed in the MOC section. You might discover (like I did) that you have some Part 2 MOC to earn and a form to fill out. Fortunately you will be able to use SAGES University to meet those Part 2 needs right from your desk.

I would like to congratulate the entire Continuing Education Committee and the SAGES University team along with the SAGES staffers like Yumi Hori, Erin Schwarz and Vanessa Cheung who have worked hard to bring this project online. Their efforts are just one of the many reasons why more than 6,500 general surgeons are SAGES members. If you are not member, there has never been a better time to join. If you are already member, check out SAGES University when the doors open this summer.

See you in class!

If you have ideas how together we might make SAGES an even stronger value proposition for membership, or if you have concerns, please write me at [email protected] .

Steve Schwaitzberg, MD

Like many of you I recently returned from the SAGES annual meeting in San Antonio marking our 30th anniversary. More than 2000 surgeons and allied health professionals registered for this year’s meeting. I would like to personally congratulate Brian Dunkin, this year’s program chair and his whole team for an extraordinarily engaging series of post graduate courses and scientific sessions. Many sessions were packed and a few were standing room only. There was so much great information it was like trying to drink from a fire-hose – you could not possibly take it all in! It was exciting to follow the SAGES Twits, our own version of the digerati who sent Tweets via the SAGES Meeting Twitter application alerting attendees to what was hot and where to find it in real time. If you could not make to the meeting, all is not lost. You can catch many parts of the meeting as well as more than 700 other videos on SAGES TV – check it out.

Despite all of the technologic advances the virtual meeting, is not (yet) ready to replace the real thing. Clearly our HD televisions provide the most granular view of any sporting event you can imagine, yet stadiums, arenas, and parks are still packed for the “big game.” Nothing beats being there. If you want to feel the energy of the crowd, you still have to go there in person. I will admit to being biased, but in general surgery, the SAGES annual meeting is one of the few “big games”. You just have to be there. Whether it was training time in the Learning Center, a hands-on course, a trip through the exhibit hall, rooting for your favorite Top Gun contestant, watching us sing, catching up with an old friend, or a chance to debate the presenter in person, the live meeting is still a singular experience. Moreover, as I sat with more than a thousand people during Jo Buyske’s Presidential address “Those to Whom Much is Given, Much is Required” you could actually feel the power of inspiration moving through the room. When coupled with the Marks Lecture that followed delivered by Cameron Wright” describing the nature of service rendered by the American military surgeon, we left the room thunderstruck.

If you are a regular attendee, you know what I mean. Dan Jones and Danny Scott, the program chairs for the 2012 meeting have given me a sneak peak of what’s in store for 2012. I can assure you there will be unique opportunities unseen before in a surgical meeting. If you have never been or have not been recently, it might be time to plan a trip to San Diego for the annual meeting March 7-10, 2012. There is nothing like a SAGES meeting.

If you want to find out how to participate or have comments, questions, concerns, or ideas how SAGES might continue to improve patient care or surgical education, please write me at [email protected].

Steve Schwaitzberg