Basic Certification in Surgery by the American Board of Surgery
Basic Certification in Surgery by the American Board of Surgery
The purpose of this brief essay is first to outline and then to examine critically the basic philosophical and practical tenets which, in my personal view, represent the fundamental props supporting the conceptualization of the meaning and value of the ABS basic certificate in Surgery. The term basic certificate refers to the initial certificate offered to candidates by the Board, often called colloquially the General Surgery Certificate to distinguish it from the advanced specialty certificates also awarded by the Board. Three decades ago, the questions posed in the title would rarely have been asked. The basic certificate had cache and patina simply because it was enough for the public and the profession to know that a candidate had to meet a broad array of rigorous requirements to obtain it. These included successful completion of a General Surgery residency program and a stringent two-part examination process designed to assess essential cognitive knowledge in the discipline and to evaluate the ability to reason through a wide range of relevant clinical problems to a successful conclusion.
It is increasingly apparent to me, however, that these criteria in and of themselves may no longer be sufficiently robust. Given that assessment, my motive for undertaking this task is straightforward: I am convinced that the processes of certification in Surgery have meaning, value, and relevance largely in proportion to the degree that the basic certificate possesses these same qualities in a credible way. That certificate is currently under siege, I believe, because of the considerable anxieties being experienced in the academic surgical community concerning the future of the surgical workforce, with particular focus on the manner in which it should be educated to best serve the public good. Those anxieties are real; they reflect the many vexing problems facing that community, including altered candidate demography, decreasing candidate numbers, changing candidate expectations about lifestyle, perceived declines in candidate quality, and mandated reductions in actual training time, among many others. In such an uncertain and volatile environment, history teaches us that no concept is inviolate; no construct is indispensable; and reform, often precipitous, is the order of the day. These are all very appropriate responses, but I fear that, in the rush to change, those aspects of the current educational paradigm that have real value, including those elements of basic certification that I view as central to the integrity of ABS, are at risk for being discarded because their value is not adequately appreciated.
The frequency with which respected colleagues question that value is clear evidence of the trend. Among other things, it has been charged that the broadly trained and relatively versatile surgeon, which the certificate purports to identify, is a fiction; that, in any case, there is no role for such individuals in today's surgical world; that it takes too long to create these generalists to the detriment of specialists and specialist care; and that, as a consequence of all of this, the basic certificate has minimal currency today and that its most appropriate fate is to be cannibalized.
Let me try to respond to these assertions by reviewing briefly the evolution of the Board movement in North America, by outlining the stated purposes and organization of the ABS, by detailing the basic principles that I perceive underlie ABS decision-making concerning certification and its meaning, and by commenting on certain trends in surgical education and practice that are very likely to impact, some positively and some negatively, on the meaning of the basic certificate. The views being expressed are in no way official; rather, they are my own based on a more than 20-year association with the activities of the ABS, including 9 eventful years as its Executive Director. The essence of the message is that, in my opinion, basic certification by the ABS continues to have relevance to the modern surgical circumstance.
The purpose of this brief essay is first to outline and then to examine critically the basic philosophical and practical tenets which, in my personal view, represent the fundamental props supporting the conceptualization of the meaning and value of the ABS basic certificate in Surgery. The term basic certificate refers to the initial certificate offered to candidates by the Board, often called colloquially the General Surgery Certificate to distinguish it from the advanced specialty certificates also awarded by the Board. Three decades ago, the questions posed in the title would rarely have been asked. The basic certificate had cache and patina simply because it was enough for the public and the profession to know that a candidate had to meet a broad array of rigorous requirements to obtain it. These included successful completion of a General Surgery residency program and a stringent two-part examination process designed to assess essential cognitive knowledge in the discipline and to evaluate the ability to reason through a wide range of relevant clinical problems to a successful conclusion.
It is increasingly apparent to me, however, that these criteria in and of themselves may no longer be sufficiently robust. Given that assessment, my motive for undertaking this task is straightforward: I am convinced that the processes of certification in Surgery have meaning, value, and relevance largely in proportion to the degree that the basic certificate possesses these same qualities in a credible way. That certificate is currently under siege, I believe, because of the considerable anxieties being experienced in the academic surgical community concerning the future of the surgical workforce, with particular focus on the manner in which it should be educated to best serve the public good. Those anxieties are real; they reflect the many vexing problems facing that community, including altered candidate demography, decreasing candidate numbers, changing candidate expectations about lifestyle, perceived declines in candidate quality, and mandated reductions in actual training time, among many others. In such an uncertain and volatile environment, history teaches us that no concept is inviolate; no construct is indispensable; and reform, often precipitous, is the order of the day. These are all very appropriate responses, but I fear that, in the rush to change, those aspects of the current educational paradigm that have real value, including those elements of basic certification that I view as central to the integrity of ABS, are at risk for being discarded because their value is not adequately appreciated.
The frequency with which respected colleagues question that value is clear evidence of the trend. Among other things, it has been charged that the broadly trained and relatively versatile surgeon, which the certificate purports to identify, is a fiction; that, in any case, there is no role for such individuals in today's surgical world; that it takes too long to create these generalists to the detriment of specialists and specialist care; and that, as a consequence of all of this, the basic certificate has minimal currency today and that its most appropriate fate is to be cannibalized.
Let me try to respond to these assertions by reviewing briefly the evolution of the Board movement in North America, by outlining the stated purposes and organization of the ABS, by detailing the basic principles that I perceive underlie ABS decision-making concerning certification and its meaning, and by commenting on certain trends in surgical education and practice that are very likely to impact, some positively and some negatively, on the meaning of the basic certificate. The views being expressed are in no way official; rather, they are my own based on a more than 20-year association with the activities of the ABS, including 9 eventful years as its Executive Director. The essence of the message is that, in my opinion, basic certification by the ABS continues to have relevance to the modern surgical circumstance.
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