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USA has 1726 Diplomats in colorectal surgery, 1456 are in practice of which 11.9% are women - Dr. Ian Calder Lavery.

KARACHI -- Recognition of any new sub-specialty by the medical profession all over the world has not been an easy task and the specialty of colorectal surgery was no exception. Speaking on the history of American Board of Colon and Rectal Surgery and its functioning at the CPSP during his recent visit to Pakistan, Dr. Ian Calder Lavery consultant colorectal surgeon at Digestive Disease Center Cleveland Clinic Ohio USA highlighted the different phases through which this specialty had to go since 1933 before the American Board of Colon and Rectal Surgery was eventually recognized as an independent institution. Figures available in 2009 showed that there are 1726 diplomats of colorectal surgery of which 1456, he said, are in active practice which includes 11.9% women consultants while 258 colorectal surgeons have retired. Requirements for training in colorectal surgery at present include five years in general surgery followed by one year in colorectal surgery.

It is generally felt that ano rectal surgery is inadequate in general surgery and complex colorectal problems are done more frequently during the one year training in colorectal surgery.

Tracing the history of American Board of Colon and Rectal Surgery Dr. Lavery recalled that it all stated in 1933 when a committee was formed and Proctologic Society was founded. It had three American Medical Association and three proctology society members. They agreed that there was a need to have a Board for this specialty separately to look after the developments in colorectal surgery. Hence American Board of Proctology Inc was established on 13th August 1935 to conduct examinations and issue certificates. In those days American Board of Surgery was being formed hence this American Board of Proctology also came under discussion. It was felt that proctology should be linked to general surgery but the American Board of Surgery was not at that time. In 1937 American Board of Surgery was formed. It was felt that American Board of Medical Specialties should issue the certificates in all specialties including special areas as well as general certificates.

American Board of Surgery excluded the ano rectal surgeons. On December 13, 1940 the American Board of Surgery approved proctology as a sub-specialty of the Board. The idea was that first one will be doing general surgery and then become specialist as proctologist but no certificate will be issued in general surgery to them but instead they will have certificates in proctology. Hence American Board of Surgery certificate in proctology was issued.

Later it was felt that colon rectum and anus diseases was a branch of medical practice. From 1942-49 it remained with different societies and Boards and during this period only eight candidates were certificated in proctology. Even then American Board of Surgery certificates were considered as more valuable than certificate in Proctology and American Rectal Surgeons could not be certified.

On November 14th 1945, American Board of Colon and Rectal Surgery were established as an independent board. The training requirements included three years in surgery and one year in proctology. On June 9th 1947 further confusion was created as American Proctology Society wanted to have a separate board as American Board of Proctology. In 1949 American Board of Proctology was recognized and in 1960 again there were many changes. It was suggested that first one should qualify as general surgeon before doing colon and rectal surgery. Today training requirement are five years in general surgery and then one years training in colorectal surgery. Now the number of diplomats of American Board of Colon and Rectal Surgery is increasing .There are too many applications every year and the number of accredited training programmes are also increasing. There are training programmes in different areas. Since we have more applications than accredited positions, those who cannot be accommodated apply next year.

But this also shows that we are training the best people, he remarked.

Ano Rectal Surgery, he stated, is not adequate in general surgery. Colorectal surgery is more frequently done during one years training in anorectal surgery. Some of these consultants then end up in gastroenterology. The American Board of Colon and Rectal Surgery requirement is that one must have done minimum of seventeen cases in six different categories. A survey conducted sometime ago among 1553 colorectal surgeons showed that only 50% responded and those who responded 40% were in practice of colorectal surgery for ten years. American Board of Colon and Rectal Surgery is responsible for the quality of the end product.

Responding to a question during the discussion Dr. Lavery said that first one has to become a member of American Board of General Surgery and then become member of American Board of Colon and Rectal Surgery. Answering yet another question he opined that in view of the medico legal problems, all fresh trainees are first taken for two years of which one year is for research. During this period the trainees are evaluated and they also evaluate the programme. Once both are satisfied, they are taken in the approved accredited training programmes. Those who work hard are successful in getting placements in the training programme. Replying to questions regarding recurrence in colorectal surgery Dr.Lavery opined that every one has his own recurrences and complications and those who say they had none, they are not reliable.

For overseas medical graduates who wish to get training in USA, first of all they have to do USMLE and then join for two years during which they are evaluated before they can be appointed to any clinical position. Once they join these accredited programmes, they can be trained just like others. Those who fail to qualify have three chances to repeat in a period of six years. There are Board eligible and Board certified colorectal surgeons. Board eligible can practice but they cannot train, he added.
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Publication:Pulse International
Geographic Code:1USA
Date:Nov 14, 2011
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