American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

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Colon, Rectum, and Anus Part II

Colon, Rectum & Anus, Part I – V45N2 coverVol. 45, No. 3, 2019

  • The Epidemiology and Biology of Colon Cancer

  • Colorectal Cancer Risk Factors

  • Colorectal Cancer: Determinants of Clinical Outcomes

  • Colon Cancer Prevention

  • Colon Cancer Screening

  • Colorectal Cancer Screening and Surveillance

  • Surveillance after Treatment of Colorectal Neoplasia

  • Familial or Genetically Determined Colorectal Neoplasia

  • Diagnosing and Staging Colon Cancer

  • Enhanced Recovery after Surgery

  • Operative Management of Colon Cancer

  • Complicated Colon Cancer

  • Chemotherapy for Colon Cancer

  • Rectal Cancer

  • Anal Cancer

Take the CME test

Featured Commentary

The online formats of SRGS include access to What You Should Know (WYSK): commentaries on articles published recently in top medical journals. These commentaries, written by practicing surgeons and other medical experts, focus on the strengths and weaknesses of the research, as well as on the articles' contributions in advancing the field of surgery.

Below is a sample of one of the commentaries published in the current edition of WYSK.

Weinberger SE. Can Maintenance of Certification Pass the Test? JAMA. 2019;321(7):641-642.

Commentary by: Taylor Riall, MD, PhD, FACS

In his JAMA Viewpoint, Steven E. Weinberger, MD, FRCP, describes the greatest controversies surrounding the maintenance of certification (MOC) process defined by the American Board of Medical Specialties (ABMS) and its 24 constituent specialty boards: the formal recertification examination and the requirement for ongoing practice evaluation to drive continuous quality improvement. Physicians lament the lost time/productivity preparing for the exam and feel that it is neither relevant to their practice nor reflective of their clinical judgment. The assessment of practice and quality improvement is even more complex. Quality registries such as American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP®) fulfill the MOC requirement; however, they are expensive and not readily available to all physicians. Surgeons without access to qualifying registries can enter and track their own data through the ACS Surgeon Specific Registry (ACS SSR™),1 designed to allow individual surgeons to track cases, measure their outcomes, and systematically improve their practices. However, it remains unclear if the self-entered data achieve this lofty goal.

The ABMS vision for continuous certification defines a formative process focused on identifying and closing gaps in knowledge and skills relevant to a physicians practice.2 Most specialty boards have gone to longitudinal certification models designed to promote ongoing learning and assessment in a clinician’s relevant field. The American Board of Surgery (ABS) has revised MOC and rebranded it as continuous certification;3 a work in evolution, the process has been responsive to surgical societies and surgeons. The high-stakes, 10-year exam has been replaced by an online, open-book knowledge assessment given every two years. It can be done over two weeks without the inconvenience of going to highly secured testing centers. It consists of 20 questions on core principles and 20 chosen by the Diplomate on a practice-related area. A score of 80 percent is required to pass, and the exam can be retaken once. Aligned with the concept of ongoing learning and closing knowledge gaps, surgeons have a one-year grace period to remediate and take the exam again if it is failed on the second attempt. In the new model, the need for Continuing Medical Education (CME) category 1 credits decreases from 150 to 125 and, there is no longer a need for self-assessment credit. The other requirements are largely unchanged and listed on the ABS website and continuing certification document.3

As Weinberger suggests, if specialty boards are willing to listen to their constituents and adopt new models that provide value to physicians and their patients, then the continuous certification process of the future will be successful. As physicians, and surgeons especially, we are privileged: we are trusted with life and death decisions for our patients when they are most vulnerable—under anesthesia, paralyzed, and unable to make decisions for themselves. With that trust comes a great responsibility for continuous learning and self-governance. If we do not govern ourselves, others will rightfully step in and do it for us. This is why it is critical that we—physicians, specialty societies, and specialty boards—sit at the table together to resolve the embroiled battle over MOC.4


  1. American College of Surgeons. American College of Surgeons Surgeon Specific Registry. Accessed August 17, 2019.
  2. American Board of Medical Specialties. Continuous Certification: Vision for the Future Commission. Published 2019. Updated February 13, 2019. Accessed August 17, 2019.
  3. American Board of Surgery. The American Board of Surgery Continuous Certification Process. Accessed August 17, 2019.
  4. Wachter R. The ABIM Controversy: A Brief History of Board Certification and MOC. Accessed August 17, 2019.


Recommended Reading

The editor has carefully selected a group of current, classic, and seminal articles for further study in certain formats of SRGS. The citations below are linked to their abstract on PubMed; free full-text is available where indicated.

SRGS has obtained permission from journal publishers to reprint these articles. Copying and distributing these reprints is a violation of our licensing agreement with these publishers and is strictly prohibited.

Abdalla M, Herfarth H. Rethinking Colorectal Cancer Screening in IBD, Is It Time to Revisit the Guidelines? J Crohns Colitis. 2018;12(7):757-759. doi: 10.1093/ecco-jcc/jjy073.

Battersby NJ, et al. Prospective Validation of a Low Rectal Cancer Magnetic Resonance Imaging Staging System and Development of a Local Recurrence Risk Stratification Model. Ann Surg. 2016;263(4):751-60.

Buettner S, et al. Inclusion of Sarcopenia Outperforms the Modified Frailty Index in Predicting 1-Year Mortality among 1,326 Patients Undergoing Gastrointestinal Surgery for a Malignant Indication. J Am Coll Surg. 2016;222(4):397-407.e2. doi: 10.1016/j.jamcollsurg.2015.12.020. Epub 2015 Dec 23.

Frasson M, et al. Risk Factors for Anastomotic Leak After Colon Resection for Cancer: Multivariate Analysis and Nomogram From a Multicentric, Prospective, National Study with 3192 Patients. Ann Surg. 2015;262(2):321–330.

Zimmermann MS, et al. Influence of Anastomotic Leak After Elective Colorectal Cancer Resection on Survival and Local Recurrence: A Propensity Score Analysis. Dis Colon Rectum. 2019;62(3):286-293.