W elcome, new and old members, to the Candidate and Associates Society of the American College of Surgeons (CAS-ACS). Our agenda for this year will be bold and innovative, but we need energetic young surgeons like you if it is to be successful. Our theme for the year will be "Developing Leaders Today for Leadership Tomorrow." As Chair of the CAS, I intend to promote this theme throughout the College and to work with all areas to develop programs that support this goal.

During the next few months, we will be planning a dynamic CAS program for the Clinical Congress that will bring young surgeons together with leaders in organized surgery. But our most important mission is attracting and developing young surgeon leaders for future leadership roles at the local, regional, and national levels. It is no longer acceptable for surgeons to sit on the sideline and let others dictate the local, regional, or national health care agenda. We must learn how to strategize and implement changes that not only protect our patients but that also lead to outstanding health care outcomes in the current dynamic environment. The time is now for all of you to step up and be a part of the solution.

I look forward to meeting you soon. In the meantime, please send your comments and questions to cas-news@facs.org . Your feedback is important to us!

Jeffrey S. Upperman, MD
Chair, CAS-ACS
Childrens Hospital of Pittsburgh
Department of Pediatric Surgery
Pittsburgh, PA

The CAS annual meeting took place October 18 and 19 during the annual Clinical Congress in Chicago. The Executive Committee met on Saturday afternoon and heard reports from the subcommittee and Advisory Council representatives. Several noteworthy accomplishments that occurred during the past year were reported, including a continuing increase in CAS membership, the development of this e-newsletter, and a new focus on residents and young surgeons for the College's annual Spring Meeting. Plans were made to collaborate with the Committee on Young Surgeons (CYS) on issues of mutual interest, including opportunities to learn about practice management and the need to address the issue of restrictive covenants. It was also noted that some of the CAS bylaws may need to be amended, and a task force was appointed to look into this issue. The meeting concluded with the election of Michael Sutherland, MD, to the position of Secretary for 2004 and with an expression of thanks to Judith Gorelick, MD, for her service as Chair during 2003.

The Council of Representatives (COR) met on Sunday, October 19. Subcommittee reports similar to those presented to the Executive Committee were shared with the COR, and Jeffrey Lukish, MD, reported on the results of the CAS survey regarding factors influencing a physician's choice to pursue a surgical career and perceptions regarding work hour limitations. The survey results have been developed into a manuscript that is being submitted for publication.

The COR then broke into specialty groups, and members were elected to serve on the Executive Committee, Advisory Councils, and subcommittees. The subcommittees met, elected new chairs, and developed agendas for the upcoming year. The Membership Committee (Chair: Adam Ball, MD) will continue efforts at recruitment and innovative strategies. The Communications Committee (Chair: Juan Paramo, MD) will continue our e-newsletter CAS-ACS News, write pieces for the Bulletin and possibly for ACS NewsScope, and try to encourage more involvement from the specialty societies. The Issues Committee (Chair: Gregory Cherr, MD) will collaborate with the CYS on a statement regarding restrictive covenants and will explore the issue of whether residents and fellows are students or employees. The Education Committee (Chair: Barry Jenkins, MD) plans to organize a paper presentation session for the Spring Meeting, to develop a CAS clinical paper award, and to construct a statement regarding the importance of including practice management education in residency curricula. Ideas for next year's symposium were discussed. The meeting was adjourned and followed by lunch and the annual symposium.

Danielle Katz, MD
Vice-Chair
CAS-ACS
Syracuse, NY

The CAS-ACS would like to invite and encourage you to attend next year's Spring Meeting. For a second year in a row, the Spring Meeting will include two general sessions specifically designed to enhance the presence and participation of the members of the CAS-ACS. Both sessions will be held on Tuesday, April 27, 2004.

The first session, "Spectacular Cases," will allow members of the CAS-ACS to present extraordinary cases to a panel of experts. The second session, "Surgical Jeopardy," will feature teams of residents from programs around the country competing in a test of surgical trivia based on the famed TV game show. Both sessions were extremely successful and well attended during this past year's Spring Meeting.

CAS-ACS is actively involved in planning, promoting, and endorsing a more "resident friendly" Spring Meeting. We want to develop new programs that are dedicated and relevant to CAS-ACS members. Your feedback and ideas are very important to us and are always well received.

Juan C. Paramo, MD
Chair
Communications Committee
CAS-ACS
Section of Surgical Oncology
Mount Sinai Medical Center
Miami Beach, FL

The CAS-ACS has taken a leadership role in the resident work hour debate. Our group initially developed a comprehensive work hour statement in 2001. During the College's 2001 Clinical Congress, the CAS had a lively panel discussion on the proposed federal regulation of resident work hours. This panel discussion included such distinguished members as Drs. David Leach, CEO of the ACGME; Patrick O'Leary, former Present of the Association of Program Directors in Surgery; and Brian Burkey, Committee on Young Surgeons.

The CAS also has participated in national discussions about resident work hours with other organizations, such as the Resident/Fellow Section of the AMA, and the Committee of Interns and Residents. To further contribute to this issue, several members of the CAS executive committee have published research and thought pieces in this area (Drs. Gregory Cherr, Danielle Katz, and Willie Underwood, to name just a few). Finally, during the CAS general session at the 2003 Clinical Congress, Dr. Jeffrey Lukish reported the findings of a surgical resident survey, which was conducted with the support of the CAS. This extremely well done study demonstrates the opinions of surgical residents with regard to issues in surgical training.

We look forward to the completion of Dr. Lukish's manuscript and the continued contributions of the CAS to the evolving environment of surgical resident training.

During the 2003 ACS Clinical Congress, the CAS continued its agenda of educating the surgical community about issues that are important to candidates and associates. This year we returned to the work hour theme with a very educational and lively discussion about work hour reform. Drs. James Hasset, University of Buffalo; Gary Dunnington, Southern Illinois University, Springfield, IL; Richard Bell, Northwestern University, Chicago; Frank Cannizzo, oncology fellow, Roswell Park Cancer Institute; and Gregory Cherr, moderator, University of Buffalo, informed the participants about changes implemented at their institutions that were designed to optimize surgical education in the environment of work hour limitations. The panelists discussed the system changes that were implemented at their institutions to enhance the quality of and efficiency in the training of their residents, which included, but were not limited to:

1. No Saturday conferences
2. Elimination of pre-rounding
3. Call q 4 or less (cross-coverage)
4. Home at noon post in-house call
5. Home call for all non-trauma general surgery rotations
6. Year research blocks replacing short rotations
7. Restructured or eliminated specialty rotations
8. End of 100 percent of attending surgeries being covered by residents.

Dr. Dunnington described a model for training surgical resident that may be revolutionary. His department developed surgical skills labs, which use simulator technology to train and evaluate residents' ability to perform several procedures. This innovation has reduced the number of operative cases and procedures necessary to reach proficiency in performing laparoscopic cholecystectomy, GI hand-sewn anastomosis, chest tube placement, and vascular anastomosis, just to name a few.

The CAS plans to continue it leadership role in the area of resident work hours and will also continue to bring exciting educational programs to the ACS Clinical Congress that are specific to the interest of ACS Candidate and Associate members. We look forward to seeing you next year.

Richard Santucci, MD
Associate Member -CAS-ACS
Assistant Professor of Urology
Wayne-State University
Detroit, MI

Willie Underwood, III, MS, MD
Associate Member - CAS-ACS
Lecturer of Urology
University of Michigan
Ann Arbor, MI

The Candidate and Associate Society of the American College of Surgeons (CAS-ACS) is an organization within the American College of Surgeons that was formed to benefit young and future surgeons through involvement in the College's activities. Membership in the CAS-ACS is automatic when you become a member of the Candidate Group or an Associate Fellow of the American College of Surgeons. Candidate Group membership is open to all surgical residents enrolled in an accredited graduate educational program, surgical research, or fellowship program. Associate Fellow membership is open to young surgeons who are currently engaged in a second surgical residency, a research or a fellowship program, a surgical specialty practice, and are within five years of graduation from formal surgical residency training. Currently, over 2,700 Associate Fellows and 4,400 Candidate Group members are part of the CAS-ACS.

Benefits of becoming a CAS-ACS member:

• free Journal of the American College of Surgeons subscription
• free Bulletin of the American College of Surgeons subscription
• free Clinical Congress and Spring Meeting registration and access to CME credit
• reduced pricing for selected postgraduate courses at the Clinical Congress
• information on clinical and research fellowship opportunities
• free access to the College's job and resume databank
• electronic newsletter and Web site
• educational materials to meet requirements for board certification
• opportunities to serve on various College committees
• opportunities for local chapter affiliation
• access to ACS-sponsored insurance programs (life, health, disability)
• a voice in advocacy and policy-making issues concerning residents and young surgeons

Join today!

Adam J. Ball, MD
Chair
Membership Committee
CAS-ACS
Miami, FL

We are interested in making sure that the content of CAS-ACS News meets the interests and responds to the needs of surgical residents and newly practicing surgeons across the country. Your feedback and ideas are important to us. Please send your comments about this newsletter and your ideas for articles to the Editor at cas-news@facs.org .

Juan C. Paramo, MD, Chair, Miami Beach, FL
Naveed Alam, MD, Winnipeg, Canada
Christy Dunst, MD, Minneapolis, MN
Richard Santucci, MD, Detroit, MI

Jeffrey Upperman, MD, Chair, Pittsburgh, PA
Danielle Katz, MD, Vice-Chair, Syracuse, NY
Michael Sutherland, MD, Secretary, Ocean Springs, MS
Naveed Alam, MD, Winnipeg, Canada
Cecelia Haines Boardman, MD, Richmond, VA
Gregory S. Cherr, MD, Buffalo, NY
Judith Gorelick, MD, New Haven, CT
Scott Hansen, MD, San Francisco, CA
Mark Hatton, MD, Burlington, MA
John Karamichalis, MD, Omaha, NE
Jeffrey Lukish, MD, Washington, DC
Juan C. Paramo, MD, Miami Beach, FL
Robert W. Reagan, Jr., MD, Chapel Hill, NC
Steven V. Richards, MD, Oklahoma City, OK
Joshua Rosenow, MD, Chicago, IL