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American Board of Thoracic Surgery Spring Meeting

American Board of Thoracic Surgery Spring Meeting. ABTS, Past and Present. October 2013. William A. Baumgartner, M.D . Executive Director, ABTS (2009-2016). ABTS Mission Statement.

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American Board of Thoracic Surgery Spring Meeting

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  1. American Board of Thoracic SurgerySpring Meeting ABTS, Past and Present October 2013 William A. Baumgartner, M.D.Executive Director, ABTS (2009-2016)

  2. ABTSMission Statement The mission of the American Board of Thoracic Surgery is to protect the public by promoting effective, safe and ethical thoracic surgical practice by maintaining high standards for education, training and knowledge through examination, certification and maintenance of certification.

  3. ABTSOrigin • In 1925, AATS met with National Board of Medical Examiners to discuss certification Conclusion: • No need for separate thoracic specialty certification • In 1928, Dr. John Alexander at the University of Michigan began the first thoracic surgery training program

  4. ABTSOrigin • In 1936 questionnaire sent to AATS members • 94% response rate Conclusion: • Thoracic surgery should be practiced as a part of general surgery • At a 1937 AATS meeting a resolution was passed stating that the ABS “was, and should remain, the parent organization of all matters dealing with training and certification of surgeons and surgical specialties.”

  5. ABTSWWII: The Tipping Point • Special expertise was gained for handling thoracic trauma • Several advances in the treatment of thoracic injuries emanated from the war experience • Letter from Dr. Robert Shaw to Dr. John Alexander (1946) • Dr. Claude Beck, President of the AATS in 1946, re-commissioned a committee

  6. ABTSGreen Light from AATS Committee • AATS Committee performed second survey to its members • Thoracic surgery should be a specialty • Thoracic surgeons should be certified • However, Thoracic Board would be an affiliate to ABS • Consist of members from: • AATS (4) • ASA (3) • ACS (2) • AMA (2)

  7. ABTSNew Board of Thoracic Surgery Requirements for certification included: • ABS certification • Two years of training in ABTS approved residency program • Successful completion of written, oral and practical examinations

  8. ABTSBoard of Thoracic Surgery • Founders Group • Carl Eggers, Chairman • Cameron Haight, Vice-Chairman • William Tuttle, Secretary-Treasurer • William Adams • Frank Berry • Brian Blades • Thomas Burford • Michael DeBakey • Emile Holman • George Humphreys • Richard Sweet

  9. ABTSBoard of Thoracic Surgery • 1948 – officially established • 1949 – first booklet of information • 1949 (August 1st) – first written exam • Pass rate: 78% (22/28) • 1949 (October 15th) – first oral exam in Chicago • Pass rate: 75% (15/20)

  10. ABTSBoard of Thoracic Surgery • First office was in Detroit, MI • Dr. Tuttle was a member of a group of surgeons in town • Louise Sper was the former secretary of the group (resigned due to the birth of her son) • Asked Louise Sper to be responsible for correspondence and record keeping • Initially work was done in Louise’s kitchen • Established in Herman Kiefer Hospital in Detroit

  11. ABTSLouise Sper • First administrative assistant • During the 1950’s, she was given authority to sign checks • Establishment of a $100 per month annuity after the age 60 • Bond of $5000 established

  12. ABTSFounding Members • Dr. Carl Eggers received certificate #1 • Others received their certificates in order of their election to membership in AATS • Notable exception: Dr. Edward Churchill • Received #174, rather than #13 because he had delayed so long in applying • Dr. Evarts Graham also had a high # • Held #1 certificate from ABS

  13. ABTSTraditions • Prominent and promising thoracic surgeons selected to be guest oral examiners“This was also a testing ground for future board membership” • Original Board members realized the Board would be a lasting organization, long after they departed“Thus the custom of obtaining a photograph of each member as they came on the Board was established”

  14. ABTSTraditions • The practice of eating dinner together the evening before a Board meeting began early in the Board’s history • One custom was to remove a label from one of the wine bottles and have it signed by each member, often with a message • Provided a fascinating history • Louise Sper collected and saved them • Dr. Tuttle noted “flexed arm syndrome” in many of the photographs • Emeritus Dinner • “invited all present and past Board members together with their wives or friends” • Every five years • Black tie

  15. ABTSTraditions • Having each Board member sign each certificate became problematic • Decided to only include chair, vice-chair, and secretary • Members would be reimbursed for travel and living expenses, whether or not the meetings were held in conjunction with another meeting • Credentials committee established • AATS decided to require candidates for membership to be certified by ABTS • In 1959, The Journal of Thoracic Surgery changed its name to The Journal of Thoracic and Cardiovascular Surgery • The Board deliberated on whether it should change its name • Decided that it was not the appropriate time to change the name, due to a struggle in the surgical section of the AMA

  16. ABTSAmenities • Ben Roe designed the original Board tie in 1981 • Pen Faber initiated the Board pin in 1992 • John Ochsner designed the second Board tie in 1994 • John Ochsnerdesigned the third Board tie in 2001

  17. ABTSInclusion of CV Surgery • Operations for pulmonary tuberculosis were decreasing while number of CV cases was increasing • Question of a separate certifying Board for CV surgery • Questionnaire showed most thoracic programs included CV surgery • No other group wished to assume responsibility • BTS decided to examine candidates in CV surgery • Decision not to issue separate certificate • Board felt that a candidate should be examined in the entire field of thoracic surgery, whatever their experience (1956)

  18. ABTSEvaluation of Training Programs • Board initially thought that it should not be involved in approving hospitals/programs • Commissioned a committee in 1949 • Sent a list of provisionally approved residencies to the Council on Medical Education and Hospitals of AMA in 1950 • Together they inspected these hospitals/programs until 1967, when the RRC was officially formed

  19. ABTSResidency Review Committee • Evolved from Board and AMA Council of Medical Education in collaboration with American College of Surgeons • Met for several years during the 1950’s and the 1960’s • Tripartite Committee approved in 1967 • Clarification of program requirements • Discussion of matching program for residents through ABMS began by Dr. Beattie from 1964 – 1969 • Became a reality in 1992 under the aegis of the TSDA and leadership of Mark Orringer

  20. ABTSFrom Affiliate to Independent • Originally suggested in 1969 by ABMS, as it was the only affiliate Board and by protocol had no vote at the medical specialties forum. • ABMS approved ABTS as a member Board in 1970 • ABTS became an independent primary member of ABMS in 1971 • “American” added to the name of the Board of Thoracic Surgery • Certificate also changed

  21. ABTSFinal Discussions of a “Cardiovascular Board” • Board (by early 1970’s) had established its interest in CV surgery, and this had been accepted by the other bodies interested in cardiac and vascular problems. • Inclusion of “Cardiovascular” in the Board’s name • Much difference of opinion • Compromise reached: the text of the certificate was revised to state that the holder was qualified in Thoracic and Cardiac Surgery

  22. ABTS3/3 Pilot Trial Program • 5 centers approved • A few residents completed the program • “Died due to lack of interest” • Did not received promised training in G.S. • Technical skill development was the responsibility of the CT faculty • Rivalry between special residents and those involved in the standard program • Residents changed their specialty and withdrew from the program

  23. ABTSRequirements for Recertification (1981) • Valid ABTS certificate at time of application • Valid license to practice medicine • Evidence of accumulation of 100 hours of CME • Submit a practice review in the form of an operative experience covering the most recent 100 consecutive major operations performed • Cognitive exam (SESATS) • Diplomates who received certificates prior to 1975 were “grandfathered” and were not required to recertify

  24. ABTSEvolution of 125 Cases Per Year • Originally adequate operative experience was defined as:“Candidates had to have an operative case load that reached at least the 30th percentile marker of experience of all candidates applying for the examination.” • Reached a point where it was no longer important • Evolved to 125 cases per year averaged and no fewer than 100 cases in any given year

  25. ABTSThe Examinations • Written exam was first developed with the help of The National Board of Medical Examiners (NBME) • Written questions were submitted by ABTS diplomates and exam was collated in Philadelphia (Question pool book was limited) • Mini-conference after every four candidates suggested by Dr. Roe in 1982 • 93% of all candidates who applied eventually passed • Only 79% of residents, who completed thoracic training were finally certified, due to inability to pass ABS exams

  26. ABTSManpower Studies • Mid-1970’s – Manpower study from University of Michigan School of Public Health suggested that if 135 thoracic surgeons were certified each year, that would be adequate to take care of the population in 2013 • 1976 – Graduate Medical Education National Advisory Committee (GMENAC) was established • 1981: Final report recommended a 10% decrease in the number of thoracic surgeons trained

  27. ABTSLong Range Planning (1985) • Size of Board • More orderly rotation of directors • Represent option from regional thoracic societies • Adding a member of the public • Did not occur until 2013 • Expanded use of computers in the Board office • New location for the Board office

  28. ABTSNew Location for Board Office • Philadelphia with ABS • Evanston with ABMS • Considerable disagreement • Evanston was chosen for physical location of the Board • Dr. Najafi was instrumental in moving the Board office to Evanston • Exam preparation was to remain in Philadelphia

  29. ABTSFiduciary Responsibilities • Increase in work load for the Board and fixed income from exam fees of 130 candidates per year • Written exam in Dallas • Oral exam in Chicago • Recertification exam • Education of Board members in psychometric science • Participation in ABS exams, RRC, ABMS and Council of Board Executives

  30. ABTSFiduciary Responsibilities • Annual donation of $25,000 from the AATS and STS • Committee of Drs. Roe, Hatcher and Urschel • Diplomates asked for $300 donation to the ABTS Endowment Fund • Voluntary dues of $50 per year • Solvency resulted from the generosity of the majority of the diplomates

  31. ABTSAdministrative Directors • Louise Sper (1948-1986) • Recruited by Dr. William Tuttle • Glennis Lundberg (1986-2002) • Recruited by Drs. Anjali and Maloney • Patricia Watson (2002-present) • Recruited by Drs. Gay and Cleveland

  32. ABTSCurrent Administrative Staff Gloria Nance Stacy Wilhite Sarah Dunlap

  33. ABTSExamination Chairs • L. Penfield Faber – 1st chair (1991-1994) • Gordon Murray (1994-1998) • Richard Anderson (1998-2001) • Gordon Olinger (2001-2004) • Larry Cohn (2004-2007) • John Calhoon (2007-2009) • Mark Allen (2009-present)

  34. ABTSCarolyn Reed • First woman director (1997-2003) • First woman vice-chair (2003-2005) • First woman chair (2005-2007)

  35. ABTSExamination Formats • Originally, a norm-referenced written exam • 1994 – first criterion-referenced written exam • Drs. Ben Wilcox, John Ochsner, Pen Faber, and Mary Lunz, PhD oversaw its development • 1995 – Dr. Gordon Murray initiated efforts to restructure the oral exam to a criterion-referenced exam

  36. ABTS – 1988Examination Restructure • Examination pool of questions determined to be inadequate and statistical analysis revealed better questions needed • Cardiac and general thoracic Board members rewrite entire written and oral examination questions during extra time at each and every Board function. • Board consultants recruited to write questions. Full day of editing under direction of Pen Faber

  37. ABTSRestructuring of the Board • 1992 – position of Secretary/Treasurer would be elected by the Board for an initial period of five years with the possibility of reelection for an additional five years • Freed up one position for another Board nomination, rather than have the secretary/treasurer be a representative from one of the parent organizations

  38. ABTSRestructuring of the Board • AATS (4) • STS (4) • ASA (2) • ACS (2) • TSDA (2) • AMA (1) • ABS (1) • Secretary/Treasurer

  39. ABTS - 1998 • 50th year anniversary celebration • Discussion to change written exam (Westin, O’Hare) to computer-based electronic exam • Representative to RRC for Surgery (General Vascular Surgery) reported that ABTS would no longer be represented

  40. ABTS - 1998 • Written exam pass rate: 85% • 142 candidates scheduled for oral exam, 1999 • Finance committee recommended a “maintenance fee” - $100 per Diplomate per year

  41. ABTS - 1999 • Approval of ABTS to send an “observer” representative to CTSNet • Development of the new examination database • Discussion of moving the In Training Exam to an electronic format • Approval by ABMS of the 6 competencies

  42. ABTS - 1999 • Dr. David Campbell elected President of CCCETS • Resolution stating:“The American Board of Thoracic Surgery acknowledges that recertification/competency is a continuous process”

  43. ABTS - 1999 • Electronic transfer of Op Log from CTSNet to ABTS • Resolution to change wording of “recertification to maintenance of certification” • Resolution passed stating that the ABTS assumes responsibility for the assessment of competency for thoracic surgeons

  44. ABTS - 1999 • Motion passed:“The ad hoc Long Range Planning Committee recommends that the ABTS change its current policy regarding ABS certification so that at a point in the future, yet to be determined, ABS certification will become optional. The ABTS will meet with other organizations involved in thoracic surgery education (RRC, TSDA, AATS, STS, ACS) to discuss the significant implications of this decision.” • Motion passed:“to change the term of office for the secretary/treasurer to 7 years, not subject to renewal”

  45. ABTS - 2000 • ABTS officially joins CTSNet with link on its website • Search committee formed for successor to Dr. Richard Cleveland • Fred Crawford – Chair • Peter Pairolero – Vice-Chair • Richard Cleveland – Secretary-Treasurer • Marvin Pomerantz – Past Chair

  46. ABTS - 2000 • Report of ABMS Maintenance of Certification (MOC) Committee “The Member Boards of the ABMS are committed to evolve their current or planned programs of recertification into programs of MOC as currently defined by the ABMS. It is understood that for some boards, this transition will require time, flexibility and assistance from the ABMS and other member boards.”

  47. ABTS - 2000 • Two motions pass regarding written exam • Number of items reduced from 300 to 250 • Distractors reduced from 5 to 4 • First administration of electronic in-training exam(CTSNet) • CME added to re-certification process

  48. ABTS – 2000 • Joint Council proposed a 6 year “ideal” residency program consisting of: • 3year core (prerequisite) • 3 year (requisite) • ABTS starts MOC planning • CME established for SESATS • Dr. William A. Gay nominated and elected to succeed Dr. Cleveland

  49. ABTS – 2001 • First discussion of use of ACGME CPT codes for the operative log • Joint Council endorsed the ABTS recommendation to make ABS certification optional and that it should be done as quickly as possible • Further discussion of an integrative 6 year program

  50. ABTS – 2001 • Exam candidates signed an attestation to the security of the exam • 9-point rating scale for the oral exam was reduced to a 4-point scale • Dr. David Nahrwold spoke to the Board regarding MOC

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