• Introduction

    Acute Care Surgery (ACS) is an evolving specialty with three essential components- trauma, critical care and emergency surgery.  Representing a new training paradigm, many concerns were voiced.  In response, Grace Rozycki, MD, MBA and Ernest E. Moore, MD sent out a survey to SCC program directors to assess the interest and possible barriers to starting an ACS fellowship program.  Seventy four program directors were surveyed with 47(63%) responding.  Forty one percent indicated that they were interested in starting an ACS fellowship with plan to submit an application.   Reasons given by the remaining 53% against starting a fellowship included adverse impact on general surgery residency, adequate financial resources and the lack of interest.   The results of the survey confirmed increasing interest in starting an ACS fellowship program while also identifying barriers that need to be addressed to achieve the goal of growing the newly formed specialty that is Acute Care Surgery. 

    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

    Currently there are seven 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.