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  • Acute Care Surgery

  • Introduction

    Acute Care Surgery (ACS) is an evolving specialty with three essential components- trauma, critical care and emergency surgery.  Following a survey of the surgical critical care program directors and of the major trauma organizations it was clear that trauma and critical care surgeons were increasingly responsible for emergency surgical care. This increasing responsibility was a result of increasing need for trauma and emergency surgical coverage in both academic and community hospitals. There was an educational gap identified and Acute Care Surgery as a specialty emerged. Leaders in Trauma and Acute Care Surgery have developed educational goals and encouraged a more formalized curriculum for training programs to meet this educational gap. The AAST has taken the lead in reviewing programs who have decided to pursue this more formalized curriculum. These approved programs undergo a rigorous review to ensure that each trainee meets the goals of the Acute Care Surgery program.

    Historical Timeline

    2003 Joint meeting of ACS, AAST, WEST and EAST addressing problems of access to emergency surgical care and the future of trauma surgery. AAST forms Ad hoc committee to develop the reorganized specialty of Trauma, Surgical Critical Care and Emergency Surgery.
    2005 ACEP survey nearly 75% emergency departments identify inadequate on-call specialty coverage
    2005 AAST renames previous ad hoc committee - Acute Care Surgery Committee
    2006 IOM report- Future of Emergency Care, confirms shortage of on call specialists
    2007 AAST retreat ; Development of curriculum, competency tools, case registry, certification criteria, site visits
    July 2008 First formal AAST Acute Care Surgery Fellowship program begins
    2014 Refinement of operative case requirements
    2018 Shift from a rotation based curriculum to a longitudinal/experiential model with case minimum requirements

    Currently there are 32 fully accredited ACS programs to date with several other programs in various stages of the accreditation process.  

    Legend:  ACS- American College of Surgeons,  AAST- American Association for the Surgery of Trauma, WEST- Western Trauma Association, EAST- Eastern Association for the Surgery of Trauma

    Additional References

    • Green, SM:  Trauma Surgery:  Discipline in Crisis. Ann of Emerg Med  53: 198-2017, 2009.
    • Sheldon, SF:  Access to Care and the Surgeon Shortage.  Ann Surgery 252 (4): 582-590, 2010.
    • Napolitano, LM, Fulda, GJ, Davis, KA, Ashley, DW, et al.  Challenging Issues in Surgical Critical Care, Trauma,  and Acute Care Surgery:  A Report from the Critical Care Committee of the American Association for the Surgery of Trauma. J Trauma 69(6): 1619-1633, 2010.
    • Jurkovich GJ, Davis KA, Burlew CC, Dente CJ, Galante JM, Goodwin JS 2nd, Joseph B, de Moya M, Becher RD, Pandit, V: Acute Care Surgery: An Evolving Paradigm. Curr Probl Surg. 2017 Jul;54(7):364-395
    • Burlew CC, Davis KA, Fildes JJ, Esposito TJ, Dente CJ, Jurkovich GJ: Acute care surgery fellowship graduates' practice patterns: The additional training is an asset. J Trauma Acute Care Surg. 2017 Jan;82(1):208-210
    • Davis KA, Dente CJ, Burlew CC, Jurkovich GJ, Reilly PM, Toschlog EA, Cioffi WG. Refining the operative curriculum of the acute care surgery fellowship. J Trauma Acute Care Surg. 2015 Jan: 78(1):192-6

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