1. Acute Care Surgery Committee Progress Report AAST Membership September 27, 2006 New Orleans

2. Members Gregory J. Jurkovich, M.D., Chair (2006) Michael F. Rotondo, M.D., Vice Chair L.D. Britt, M.D., M.P.H. Christopher T. Born, M.D. William G. Cioffi, M.D. Thomas J. Esposito, M.D., M.P.H. David B. Hoyt, M.D. Robert C. Mackersie, M.D. Mark A. Malangoni, M.D. Ronald V. Maier, M.D. J. Wayne Meredith, M.D. E. Eugene Moore, M.D. Lena M. Napolitano, M.D. Grace S. Rozycki, M.D. David A. Spain, M.D. Alex B. Valadka, M.D. Sharon Gautschy (AAST executive directory) Kim Anderson Schenarts PhD (consultant)

3. Task leaders Curriculum work group: Rotondo & Jurkovich Site selection work group: Hoyt & Jurkovich Competency work group: Rozycki & Malangoni

4. Time Line Sept 2006Present curriculum outline and time line to AAST Membership Fall 2006Publish curriculum outline and operative requirements Fall 2006Complete curriculum details Fall 2006Write program requirements and pre-site visit check list of essentials program requirements

5. Time Line (cont.) Jan 2007ABS retreat; AAST retreat Spring 2007Site visits; Competency verification tools (tests, case logs, web-based education, etc) Fall 2007Interviews for fellowships All of 2007Develop competency testing tools, case registry, matching program, criteria for certification of current practitioners July 2008Begin first year formal AAST - ACS fellowships

6. Curriculum

7. Required Clinical Rotations Surgical Critical Care Trauma/Surgical 6 months Elective critical care3 months Emergency & Elective Surg.15 months Total24 months

8. Suggested Clinical Rotations Acute Care Surgery4-6 m Thoracic1-3 m Vascular/I-R1-3 m Tx/Pancreatic/Hepatobiliary1-3 m Orthopedic surgery1 m Neurosurgery1 m Electives or maximize above1-3 m (suggest Burn, Peds, Endoscopy) TOTAL15 months

9. Key footnotes Trainees must participate in acute care surgery call no less than 12 months Flexibility in the timing of these rotations, and the structure of the 24-m training, should be utilized to optimize the fellow’s training The rational for “out-of-system” rotations for key portions of the training must be based on educational value of the rotation Acute Care Surgery fellowship sites must have an RRC-approved SCC residency Participation in elective surgery is an essential component of the fellowship training An academic environment is mandatory and fellows should be trained to teach others and conduct research in acute care surgery

10. Curriculum: rotations & cases Completed educational rotation plan 9 months critical care 15 months advanced surgical experience - elective and emergency 4-6 months acute care surgery 12 months trauma/acute care surgery call Emphasis vascular, thoracic, upper GI Minimize ortho and neurosurgery Finalize operative experience case list Plan to publish in J. Trauma

11. Site Selection

12. Interested Sites UT Houston U. Florida U. Michigan UC-San Diego Emory U. Pennsylvania U. Washington Vanderbilt Ohio State Miami Valley/Wright St. Maryland Shock-T Cook County/Rush UT Southwestern Michigan State U. Nevada Harvard/ MGH U. Connecticut Loyola USC UC-Irvine

13. Site Selection Issues (Feb 15, 2006 phone conf; August 2006 emails ) Institutional commitment Faculty qualifications Fellowship director qualifications Curriculum implementation Core competency evaluation Educational elements Evaluation system Impact on general surgery training

14. Site Selection group (Feb 2006 phone conf) Process should be inclusive, helpful, supportive, flexible and creative Will be some minimum, essential criteria Eg: RRC SCC program; EGS cases Must do Emergency General Surgery Site visit inspections to identify creative training models Costs for site visits covered by application fee to AAST Not RRC-accredited at this time (financial, efficiency, flexibility) Model similar to Transplant, Oncology, Ortho trauma

15. Acute Care Surgery Trauma, Critical Care, and Emergency Surgery Access, Expert, Available For the best care of our patients.