AAST's Saturday Cutting Newsletter
President's Note:
Written By: Dr. Patrick Reilly
Wrapping up a wonderful week in Las Vegas. It’s as if I can hear fire alarms ringing repeatedly in my head (oh wait…that actually happened…lol). The 83rd Annual Meeting of AAST and Clinical Congress of Acute Care Surgery and 7th World Trauma Congress was a huge success with record attendance, great science, and plenty of time for socializing and networking. Congratulations to all of the speakers and poster presenters who made the sessions exceptional and the science top-notch. A special shout out to Mike Rotondo and Amy Goldberg for serving as our named lecturers. Their talks were exactly what I had hoped and highlighted their amazing accomplishments that should truly motivate us all. And finally, thanks again to the extended AAST staff who assured that everything ran seamlessly.
Personally, I am honored to have had the opportunity to serve as your President, and confident that the society will be in great hands as the leadership transitions over to Ronny Stewart. Safe travels back home, and make your plans early for our next meeting in Boston in 2025!
Program Chair's Note:
Written By: Dr. Karen Brasel
Record-breaking attendance and outstanding science across an incredible diversity of topics and the involvement of so many people across practice settings, ages, and countries. Am very grateful to all who have volunteered for committee work and for contributing their immense talent to the meeting. I think the highlight of the meeting for me has been seeing all of the interactions that I have seen outside the meeting rooms-the energy and vibrancy are contagious and make me excited to see and continue the work of the AAST!!!
Looking forward to seeing everyone next year in Boston.
Associate Member Chair's Note:
Written By: Dr. Brittany Bankhead
The AAST meeting this year has been fulfilling to all those in attendance. Vegas has afforded us the opportunity for cutting-edge science, professional mentorship & networking, and cultivating friendships with those who we call our closest friends- they hold the same values, take care of the sickest patients in the hospital, and are driven to the same goals. Thank you, AAST, for affording us the opportunity to fill our cup with science for our patients and full hearts with our friends once again; can’t wait to do it again in Boston.
Editor's Note
Written By: Dr. Shannon M. Foster
WHAT A MEETING!
You may wonder why I have always opened my comments in such a salutation – and this week explains it: the ‘colleagues’ references the work – research, publications, education, professional advancements – and the ‘friends’ – the social connection, inclusion, a sense of belonging. It is the combination of both that will keep active members, ensure recruitment, and inspire repeat attendance. Embracing this balance assures AAST remains the professional and academic home of the Acute Care Surgeon.
We must shout our thanks to Dr. Brasel and the Program Committee, and all AAST administrators and staff – Sharon and the red beret, Jermica, Rachel, Brea, Kaitlyn, Bridget and visionary Erin (with such savior faire!) who have put color, ambiance, and the best swag ever into our Paris Las Vegas world.
Thank you to all for attending, participating from afar, spreading the news – and for reading.
With respect and appreciation,
Shannon
shannonfostermd@gmail.com
Be all that you can be—and do all that we can do?
Written By: Dr. Elinore Kaufman
Surgeon A: “How are things at your place?”
Surgeon B: “Good, busy, especially because we are now taking over [fill in the blank new service line or hospital].”
Surgeon A: “Do you have enough staff to do all that?”
Surgeon B: “Well, we are hoping to hire, but…” <shrug>.
This is one of the first conversations I had after walking into AAST this week, and it struck me that I could probably have the same conversation with any colleague attending this meeting, or with any colleague back at their institution covering the trauma service, the SICU, emergency general surgery, or [fill in the blank].
One the main reasons I chose a career in trauma surgery was that I believed this path would allow me to use all the skills I had developed throughout residency to help patients in the broadest way possible. And in a way, that is our mission—to do all that we can do, on short notice, with little planning, and variable resources, for people who really need it. As Dr. Reilly mentioned in his presidential address on Wednesday, our value to patient care and health system functioning has combined with changes in the priorities of our other surgical colleagues to result in a continuously expanding mission.
Although this growing footprint allows us to continue to grow our skills, do cases, and help patients, as Surgeon B mentioned, keeping up with the pace can be a challenge. Perhaps the second most common conversation is,
Surgeon C: What does your institution define as 1.0 FTE?
Surgeon D: Well two of my partners are leaving and one is out on leave so…
As Patrick Murphy and others have documented, the definition of 1.0 FTE is elusive. In a 2022 survey of departmental leaders, Murphy et al determined that “a reasonable workload for a 1.0 FTE acute care surgeon at a Level I center is 24 to 28 service weeks per year and four to five in-house calls per month.” Early-career acute care surgeons reported a similar goal: 24 weeks of service and 48 calls per year, but also reported working substantially more than that goal. In a way, 1.0 FTE is to some extent always determined by the formula (work to be done)/(number of people available to do it).
Balancing these tensions requires health systems to recognize the value we bring and requires us to prove that worth. At the same time, service is not service is not service, and call is not call is not call. It’s difficult to communicate clearly and honestly about how busy we are, or to figure out how busy we should be. But the right kind of support, systems, and teams at the right times can change a grueling week into something much more manageable.
If trauma surgeons are truly to run the department, the hospital, and, perhaps, the country, as Dr. Reilly argued we should; if we are to do so while being present in our families and communities and while remaining whole humans; if we are to be all that we can be—we must get creative when it comes to doing all that we can do.
President's Address: Interview of Dr. Patrick Reilly
Written By: Dr. Julia Coleman
SESSION IV: PRESIDENTIAL ADDRESS
"BE ALL YOU CAN BE"
WEDNESDAY, SEPTEMBER 11, 2024 at 12:15 PM - 1:15 PM
A much anticipated part of the annual meeting program is the Presidential Address, and a preview of the title of the talk alone is promising that this year will not disappoint. This year, the AAST President Dr. Patrick Reilly will deliver his address entitled “Be All You Can Be” on Wednesday, September 11th at 12:15. In anticipation of the annual meeting and this address, Dr. Reilly spent some time with the AAST Communications Committee previewing his talk and discussing his thoughts about the evolution of acute care surgery.
Dr. Reilly went to medical school at Jefferson Medical College, followed by residency at Medical Center of Delaware and then fellowship at the Hospital of University of Pennsylvania, the last of which has been his home for the majority of his 30-year career. Dr. Reilly is currently the C. William Schwab Professor in the Division of Traumatology, Surgical Critical Care, and Emergency Surgery, having served as the Division Chief and fellowship Program Director in the preceding years. Dr. Reilly has been a leader not just within his institution but also nationally in the Committee on Trauma and AAST. Residents, fellows, and early-career surgeons might wonder when they see Dr. Reilly on the podium, how did such a leader get to where he is? When you ask Dr. Reilly this question, his answer is simple – “In the most simple form - I raised my hand.” Dr. Reilly’s path is testament to the impact of showing up and contributing, which he emphasizes as the keys to success. His leadership path, sparked by the encouragement of his mentors, started by working in committees, organizing workshops, and applying principles in his local leadership development and passion towards surgical education as a program director. These paths, fueled by his passion and paired to his engagement, ultimately led to an ascension of leadership positions culminating in his Presidential position. This story line has been true for him, and many others in the AAST with diverse interests. According to Dr. Reilly, “There’s lots of ways to find your passion, share it with others in the organization, and build on that to be lucky enough to end up in the role of President in the AAST.”
This is the core spirit of his upcoming address, where he will also talk about the importance of the acute care surgeon and defining our field in a dynamic time in health care. From serving in a variety of leadership positions institutionally and nationally, Dr. Reilly has had a front seat to observing and leading the changes in acute care surgery, as the field has expanded beyond trauma to emergency general surgery and intensive care. This expansion seems appropriate when one considers all the acute care surgeon does in the hospital. According to Dr. Reilly, “It has dawned on me over time in administration roles that sometimes the people in charge have gaps of knowing what’s going on in the hospital, especially on nights, weekends, and holidays…“Trauma surgeons have a unique place clinically in the hospital that helps them to know everything from the prehospital providers and care to the rehab of our patients after hospitalization”. This insight leaves acute care surgeons well poised to be in positions of leadership in hospitals and to advocate for our patients “from the front door to the back door” with our unique perspective with “boots on the ground” in the hospital. The experience and knowledge that is required to excel as an acute care surgeon certainly lends to strong leadership skills, which are direly needed in leadership in surgical education, research, and advocacy. Dr. Reilly does not that hospital systems are slowly starting to recognize this as well. “Everyone in the hospital values the role that the acute care surgery team brings. Now all of a sudden, hospitals within health systems that aren’t even trauma centers wants emergency general surgery and critical care.” The greatest opportunity and also challenge in the future of acute care surgery will be founded on our specialty’s ability to adapt and change to rise to the challenge of all that is expected from acute care surgeons. This is certainly true when considering the vitality of the work force when there is increasing hesitancy in surgeons as whole to do emergency surgery and take overnight call. “There’s a big void. We will have to struggle with the question is do we want to be the emergency general surgeon for all patients, while also doing critical care, at non-trauma centers.”
Due to his extensive experience in surgical education and leadership, Dr. Reilly has a valuable perspective for early career surgeons and trainees. He believes in the value and importance of pursuing opportunities locally and nationally. “Finding your way in your own institution is really important. Our national societies values us, but we also need to knock down the old ivy towers at our own institutions.” And what does this look like? Part of it is getting involved in AAST, an opportunity that wasn’t afforded to all surgeons and trainees years ago. Dr. Reilly reflected, “When I started, you couldn’t get into AAST. It was a senior trauma academic society…now we’ve evolved with the Associate Member group including trainees and junior faculty to get them involved.” He described how the “new enthusiasm and ideas” has added great value to the organization. Beyond getting involved in AAST, Dr. Reilly’s advice to early-career surgeons and trainees is to stay consistent and follow through: “From an academic standpoint, presentations are great, but publications are the currency of academia and promotion.”
In closing, when you ask Dr. Reilly what he is most proud of, the answer is swift: “The fellows I trained…to be involved in the training of so many excellent surgeons and emergency medicine doctors doing surgical critical care.” Dr. Reilly clearly has the philosophy that his success if other people’s success – this has permeated into his work in the AAST as President and in the other organizations where he has been influential. His Presidential Address “Be All You Can Be” will likely include an audience of his trainees and those who have been impacted by him – but even for those who have not heard him speak yet, it will be one to remember.
7th World Trauma Congress Keynote Address: Interview of Dr. Yasuhiro Otomo
Written By: Martha Godfrey, MD, MS
SESSION II: 7TH WORLD TRAUMA CONGRESS KEYNOTE ADDRESS
WEDNESDAY, SEPTEMBER 11, 2024
9:45 AM - 10:15 AM
The World Trauma Congress and the American Association for the Surgery of Trauma (AAST) are honored to have Dr. Otomo share his wisdom about disaster preparedness and deployment of physicians in Japan after natural catastrophes. As the Director of the Disaster Center Hospital in Japan he has played a vital role in the response to multiple natural disasters and has been instrumental in improving the response of an entire country to traumatic injury.
I had the opportunity to interview him and learn more about his fascinating career helping others. Dr. Otomo’s guiding principle “has always been whether my actions benefit society. I have never acted for my own benefit.” This is very clear in his life story as he has worked tirelessly in his career to not simply help individual patients, but rather to help an entire population after tragedy strikes.
Like many of us he began his career in medicine simply to help others. For him however he saw a new type of war in Japan that played a pivotal role in his life and his career. Dr. Otomo described a ‘war state’ however it was caused by automobile accidents with unprecedented fatalities and termed a “traffic war”. He explained, “in 1970, Japan saw 16,765 fatalities from traffic accidents in a single year, a number nearly equivalent to the 17,282 deaths over two years in the First Sino-Japanese War”. At the time there was no system in place to treat trauma victims which undoubtedly played a significant role in the death toll. In response to the massive number of trauma victims the country invested in new programs like the first Advanced Emergency Medical Center at the Nippon Medical School where Dr. Otomo graduated in 1984.
This launched his career in Acute Medicine.
It was another tragedy however that truly solidified his dedication to disaster medicine. On January 17, 1995 at 5:46am the Great Hanshin-Awaji Earthquake, commonly known as the Kobe Earthquake hit. The earthquake resulted in the loss of more than 6,400 lives and caused an estimated $100 billion in damages. That same year Dr. Otomo began working at the newly established National Disaster Medical Center. The earthquake’s impact on Japan was profound and for Dr. Otomo “marked the beginning of [his] full-fledged commitment to disaster medicine." After the earthquake it became clear “to prevent avoidable disaster-related deaths, it was crucial to quickly enter disaster-stricken areas, provide life-saving emergency care, and transport severely injured patients to facilities outside the disaster zone.” It is because of this that the Japan Disaster Medical Assistance Team (DMAT), a specialized medical team designed specifically for this purpose, was formed. Dr. Otomo was instrumental in creating the Japan DMAT and considers it one of his greatest achievements.
The Japan DMAT has “become an indispensable entity in the Japanese government's health crisis management.” The Japan DMAT has responded to numerous earthquakes and floods with phenomenal results, however one of its most recent successes was its response to the COVID-19 pandemic. During the pandemic the “Japan DMAT played a crucial role in supporting hundreds of medical institutions and elderly care facilities…significantly contributing to the containment of the virus and saving countless lives.” Having recognized the substantial success of the Japan DMAT, the Japanese government has expanded its responsibilities to include not just natural disasters, but also to now encompass all health crisis management. Dr. Otomo is very proud of the work performed by the Japan DMAT and more importantly of the numerous lives saved.
Another of his remarkable achievements was when he joined Tokyo Medical and Dental University in 2006 and revitalized the underperforming emergency department, transforming it into a highly active Advanced Emergency Medical Center. He guided many medical students and residents toward a career in acute medicine and surgery. The Department of Acute Critical Care and Disaster Medicine, which started with seven members, grew to 102, becoming one of the most active departments of acute care surgery in Japan by the time he retired from the university in 2023.
Dr. Otomo continues to be focused on the future of Acute Care Surgery in Japan. One of the biggest challenges for him during most of his career was the lack of an “academic organization specifically for trauma surgeons in Japan.” Other organizations like the Japanese Association for Acute Medicine established in 1973 and the Japanese Society for the Surgery of Trauma established in 1987 are multidisciplinary in nature and as such are not designed to meet the specific needs of trauma surgeons. It was not until 2009 that the Japanese Society for Acute Care Surgery (JSACS), equivalent to the AAST in the United States, was established. This organization is critical to the future of Acute Care Surgery in Japan. It is actively working toward the creation of an Acute Care Surgeon subspecialty recognized by the Japan Surgical Society. Dr. Otomo believes that “producing a large number of competent Acute Care Surgeons in Japan will not only improve the level of trauma and emergency surgery care in the country but also contribute to the overall improvement of surgeons’ working conditions. Ultimately, this will contribute to protecting the lives of the entire population."
Fitts Lecture: Interview of Dr. Michael Rotondo
Written By: Kaitlin Ritter, MD
SESSION IX: FITTS LECTURE
"THE ACADEMIC MEDICAL CENTER AND THE US HEALTHCARE ECONOMY
THURSDAY, SEPTEMBER 12, 2024
11:35 AM - 12:35 PM
Surrounded by the lights, glitz, and glam of Las Vegas, the 83rd Annual Meeting of the AAST promises to be a spectacular event and this year’s Fitts Oration given on Thursday September 12th by Dr. Michael Rotondo will no doubt be a crown jewel of the conference. Entitled “Academic Medicine and the U.S. Healthcare Economy-Altruism, Capitalism, and Egoism” Dr. Rotondo will offer our community his insights into the economic headwinds that challenge all of us in academic medical centers - indeed, within the entire American healthcare system.
As a trauma surgeon and the CEO of University of Rochester, Dr. Rotondo is uniquely positioned to understand these pressures. In preparing for his address, he notes that “American healthcare faces a number of issues on delivering on their mission across clinical care, research, and education.” Items such as operating margins and balance sheets drive our healthcare systems and “the forces of business influence our delivery of care as much as the forces of altruism.”
So how DO we run a sustainable business while still serving our altruistic mission?
Dr. Rotondo believes that surgeons are the key. “We need to be on the solutions side of things instead of having the system subjected on to us.” Exploring options such as financial flexibility, reimaging care delivery processes, and using digital transformation are all key aspects for future economic and healthcare sustainability. While outside entities such as private equity are playing an increasing role in the business of medicine, as surgeons “we know our business better than anybody else. We need to figure out how to work with them to execute more effectively [so we can] put that growth back into our academic mission.”
But it is not just economics that drive the future of acute care surgery. Mentorship is essential. “If you really do care about acute care surgery, if you care about having this specialty continue to thrive in the service to the patient, you have to be committed to others that are willing to take on this challenging work.” Dr. Rotondo credits organizations such as the AAST for helping him find his ‘family.’ He recalls mentors such as Dr. Schwab taking him around the conference and making introductions. It is this guidance and support that he feels is an imperative for all ACS surgeons. “If you can’t impart whatever value you may have to the people that are coming up and working their way through that arc of development, then you’re not really committed to the patients.”
Regardless of the venue, be it the board room, the operating room, or the conference center, Dr. Rotondo’s commitment to the future of Trauma and Acute Care Surgery makes him the natural choice to give this year’s Fitts Oration. His long legacy of accomplishments paired with a deep sense of responsibility to the field of Acute Care Surgery and the collective wisdom brought through his dealings with students, trainees, and physicians who serve its mission will no doubt permeate his lecture. Dr. Rotondo’s address will certainly be an event not to be missed. I look forward
Expert Surgeon Lecture: Interview of Dr. Amy Goldberg
Written By: Simin Golestani, MD
SESSION XII: EXPERT SURGEON LECTURE
"A LOOK BACK…..ON THE EVER-CHANGING PRACTICE OF TRAUMA SURGERY"
FRIDAY, SEPTEMBER 13, 2024
10:30 AM - 11:00 AM
At the AAST expert lecture this year, participants will have the opportunity to hear Dr. Goldberg present a talk entitled: “A Look Back…..on the Ever-Changing Practice of Trauma Surgery.” Having given numerous talks during her career, she chose this specific topic to be able to take a moment to pause, and to examine the number of practices that have changed over time. She explains that it has been a privilege to have a front row seat to the improvements and growth that has occurred in the field of trauma surgery in the past thirty years.
A look back on Dr. Goldbergs life and career proves that there is no one more qualified to be giving this lecture. For most academic surgeons, the decision is often made early in one’s career to selectively focus energy on a few areas, such as research, teaching, advocacy, leadership or excellent clinical skills. Yet somehow, Dr. Goldberg manages to not only be involved in every single of this areas, but to excel in them as well. When asked how she manages to expertly wear so many hats, she states: “To do anything well, you must have a passion for it, and I do things I have a passion for. I genuinely love everything I do.” For Dr. Goldberg, all her areas of focus work synergistically, and she can shift her priorities as needed.
The daughter of a schoolteacher, Dr. Goldberg is an educator at heart and teaching is something that is woven into all aspects of her career. When she takes trauma call, she is taking time to teach residents and medical students, and when she is in in meetings with her leadership teams, she also sees those as opportunities to teach. A previous varsity athlete, she had always wanted to become a sports coach, and in a way, she is able to fulfill that dream now as a mentor and teacher to so many. During Dr. Goldbergs training as a young surgeon, there was a serious deficit of female surgeons in leadership positions. Now as the first female Dean that Temple has appointed in 120 years, she is using her position to train and celebrate women surgeons and encourage the advancement of women in leadership positions locally and nationally.
For Dr. Goldberg, her career in advocacy began as a response to a need she witnessed taking care of victims of gun violence in the trauma bay. She channeled her outrage at the violence in Philadelphia into creating the The Cradle to Grave” project, which educates vulnerable youth on the seriousness of gun violence. Now, eighteen years since its creation, research done on the project shows a change in attitude towards gun violence amongst the participants. Despite the challenges and disappointments of the constant gun violence in the country, Dr. Goldberg is hopeful. She recalls that as a fellow thirty years ago, gun violence was not a topic that received national attention and now after decades of advocacy it is established by the surgeon general as public health crisis. “Unfortunately, we, as trauma surgeons are needed. But it gives me hope that we have been listed to and heard. As slow as it may be, that is what keeps me motivated.”
Despite her impressive achievements as a Chair of the Department of Surgery, a Dean of a prestigious medical school and most recently The Chair of the American Board of Surgery, Dr. Goldberg says that failures are just as important to learn from than successes. “Stumbling makes us better. No doubt about that. The important part is picking yourself back up.” She has talked openly about her desire to leave medical school before finishing and the importance of resilience in the face of challenges as a surgeon. She encourages her trainees and colleagues to share moments of difficulty, because recognizing that all surgeons will at some point stumble is the key to mental wellness and the ability to have a long satisfying career.
It is hard to imagine any situation, in a trauma surgery or a boardroom, that would shake Dr. Goldberg’s confident nature, however, there has been one thing that caused her tremendous stress. “Throwing the first pitch at the Phillies game was one of the most challenging things I’ve done!” A huge sport fan, Dr. Goldberg enjoys watching sports, especially Philadelphia’s teams, going on runs, and participating in half marathons.
Dr. Golberg’s passion, talent and resilience shines through every talk that she gives, and this year’s AAST expert lecture will be no different. Participants will hear not only about the institutional and national shifts that have occurred in the practice of trauma, but also the most important changes that happen, as Dr. Goldberg states, “One patient at a time.”