Introduction: We aim to determine whether general surgery residents' feedback satisfaction relates to number of attendings providing consistent feedback. Methods: In January 2023, residents were surveyed about feedback perceptions post in-training exam. Respondents selected how many attendings gave consistent feedback, with those selecting 0-25 % or 76-100 % grouped as low-percentage (LP) or high-percentage (HP). Bivariate and multivariable analysis controlling for program effects was conducted. Perception of feedback quality, amount, and timeliness across rotation types and overall feedback satisfaction were collected. Results: Of 9854 examinees, 68 % (n = 6732) participated, with 18.0 % (n = 1213) LP and 18.7 % (n = 1257) HP. LP group was enriched with female, underrepresented in medicine, and junior trainees. Across all rotations queried, LP respondents were less satisfied in feedback quality, amount, and timeliness (p < 0.001). Overall satisfaction was lower for LP group (LP:4.88 vs HP:9.05, p < 0.001). Differences remained when controlling for program-level effects. Conclusion: Perception of more attendings providing consistent feedback is associated with higher feedback satisfaction.

OBJECTIVES:Identify the prevalence of practice-ready formative entrustable professional activity (EPA) assessments obtained by residents in their final year of general surgery training. BACKGROUND:EPA microassessments will be required for admissibility to American Board of Surgery general surgery certification beginning in 2028. EPA implementation began in July 2023 as the initial step in complying with these requirements. METHODS:EPA microassessments using the ABS entrustment scale (1=limited participation, 2=direct supervision, 3=indirect supervision, 4=practice ready) were completed in real time through a secure application. Deidentified data were downloaded at year end for programs, faculty assessors, and individual residents. Assessments of PGY5 residents by faculty were included. Descriptive statistics were utilized to summarize entrustment ratings and compared across the academic year (July 1, 2023-May 31, 2024) with χ 2 tests. RESULTS:A majority of PGY5 residents (n=1032, 67%) were assessed with 12,611 microassessments (mean 12.2/resident). All EPAs were assessed, with the most in gallbladder disease (n=2950). Median entrustment was practice-ready for all EPAs except renal replacement therapy and thyroid/parathyroid disease (median rating indirect supervision for both). Overall, 63% of microassessments (n=7946) during the chief year were practice-ready, with 59% (5571/9460) intraoperatively and 75% nonoperatively (2375/3151). In July 2023, 56% of PGY5 microassessments were rated indirect supervision or lower compared with 26% in May 2024. CONCLUSIONS:The majority of formative microassessments of PGY5 residents in general surgery training programs demonstrate practice readiness for 16 of 18 EPAs. Competence of chief residents grows from the beginning to the end of the PGY5 year for core general surgery activities.

Objective:The authors provide an overview of competency-based medical education, its association with the Accreditation Council for Graduate Medical Education Milestones as a competency framework, a description and outline of the emerging execution of Entrustable Professional Activities in surgical disciplines, and a research agenda focused on Entrustable Professional Activities for American Board of Surgery-certified surgical specialties in the United States.Background:Advances in surgical care inspire awe consistent with the impact of these developments on patients' lives. With this comes greater knowledge, new practices, and novel technologies for integration into residency training, making the skillset required of today's residents quite different from those in the past. Competency-based medical education and learner-centered approaches offer innovative and studied methodologies for teaching, learning, and assessment to meet the demands of today's educational environment.Methods:To develop an EPA research framework, we collaborated with an informationist, conducted a PubMed search, and analyzed publications in NVivo for key research themes.Results:The research agenda includes 5 domains of inquiry: entrustment and practice readiness; bias and environment; distinguishing features and certification; qualitative feedback; and patient outcomes. In addition, the authors provide questions and suggest data integration strategies that might foster a breadth of studies investigating the utility of Entrustable Professional Activities in surgical training.Conclusions:Collectively engaging in such a process of evaluation early in the process of competency-based reform will serve to optimize education, assessment, and, ultimately, patient care.

BACKGROUND:In September 2022, a summit was convened by the American Board of Surgery (ABS) to discuss competency-based reform in surgical education. A key output of that summit was the recommendation that the prior work of the Blue Ribbon I Committee convened 20 years earlier be revived. With leadership from the American College of Surgeons (ACS) and the American Surgical Association (ASA), the Blue Ribbon Committee (BRC) II was subsequently convened. This paper describes the output of the Residency Education Subcommittee of the BRC II Committee. METHODS:The Subcommittee organized its work around prioritized themes, including curriculum, assessment, and transition to practice. Top recommendations, time-based action steps, potential barriers, and required resources were detailed and vetted through group discussion, broader Committee review and critique, and subsequent refinement. RESULTS:Primary concluding emphases included transitioning to a competency-based training model, facilitating dynamically capable curricular reform emphasizing the digital transformation of surgical care, using predictive analytic assessment strategies to optimize training effectiveness and efficiency, and creating mentorship strategies to govern the transition from training to independent practice in an outcomes-accountable fashion. CONCLUSIONS:To implement the recommendations outlined, it was recognized that coordinated efforts across existing organizational structures will be required, informed by data set integration strategies that meaningfully measure educational and related patient outcomes.

In September 2022, a summit was convened by the American Board of Surgery (ABS) to discuss competency-based reform in surgical education. A key output of that summit was the recommendation that the prior work of the Blue Ribbon I Committee convened 20 years earlier be revived. With leadership from the American College of Surgeons (ACS) and the American Surgical Association (ASA) , the Blue Ribbon Committee (BRC) II was subsequently convened. This paper describes the output of the Residency Education Subcommittee of the BRC II Committee. The Subcommittee organized its work around prioritized themes including curriculum, assessment, and transition to practice. Top recommendations, time-based action steps, potential barriers, and required resources were detailed and vetted through group discussion, broader Committee review and critique, and subsequent refinement. Primary concluding emphases included transitioning to a competency-based training model, facilitating dynamically capable curricular reform emphasizing the digital transformation of surgical care, using predictive analytic assessment strategies to optimize training effectiveness and efficiency, and creating mentorship strategies to govern the transition from training to independent practice in an outcomes-accountable fashion. It was recognized that coordinated efforts across existing organizational structures will be required, informed by dataset integration strategies that meaningfully measure educational and related patient outcomes.

BACKGROUND: The American Board of Surgery has endorsed competency-based education as vital to the assessment of surgical training. From 2018 to 2020, a national pilot study was conducted at 28 general surgery programs to evaluate feasibility of implementing entrustable professional activities (EPAs) for 5 common general surgical conditions. ACGME core competency Milestones were also rated for each resident by program clinical competency committees. This study aimed to evaluate the validity of general surgery EPAs compared with Milestones. STUDY DESIGN: Prospectively collected, de-identified EPA Pilot Study data were analyzed. EPAs studied were EPA-1 (gallbladder), EPA-2 (inguinal hernia), EPA-3 (right lower quadrant pain), EPA-4 (trauma), and EPA-5 (consult). Variables abstracted included levels of EPA entrustment (1 to 5) and corresponding ACGME Milestone subcompetency ratings (1 to 5) for the same study cycle. Spearman’s correlations were used to evaluate the relationship between summative EPA scores and corresponding Milestone ratings. RESULTS: A total of 493 unique residents received a summative entrustment decision. EPA summative entrustment scores had moderate-to-strong positive correlation with mapped Milestone subcompetencies, with median rho value of 0.703. Among operation-focused EPAs, median rho values were similar between EPA-1 (0.688) and EPA-2 (0.661), but higher for EPA-3 (0.833). EPA-4 showed a strong positive correlation with diagnosis and communication competencies (0.724), whereas EPA-5, mapped to the most Milestone subcompetencies, had the lowest median rho value (0.455). CONCLUSIONS: Moderate-to-strong positive correlation was noted between EPAs and patient care, medical knowledge, and communication Milestones. These findings support the validity of EPAs in general surgery and suggest that EPA assessments can be used to inform Milestone ratings by clinical competency committees.

ImportanceEntrustable professional activities (EPAs) compose a competency-based education (CBE) assessment framework that has been increasingly adopted across medical specialties as a workplace-based assessment tool. EPAs focus on directly observed behaviors to determine the level of entrustment a trainee has for a given activity of that specialty. In this narrative review, we highlight the rationale for EPAs in general surgery, describe current evidence supporting their use, and outline some of the practical considerations for EPAs among residency programs, faculty, and trainees.ObservationsAn expanding evidence base for EPAs in general surgery has provided moderate validity evidence for their use as well as practical recommendations for implementation across residency programs. Challenges to EPA use include garnering buy-in from individual faculty and residents to complete EPA microassessments and engage in timely, specific feedback after a case or clinical encounter. When successfully integrated into a program’s workflow, EPAs can provide a more accurate picture of residents’ competence for a fundamental surgical task or activity compared with other assessment methods.Conclusions and RelevanceEPAs represent the next significant shift in the evaluation of general surgery residents as part of the overarching progression toward CBE among all US residency programs. While pragmatic challenges to the implementation of EPAs remain, the best practices from EPA and other CBE assessment literature summarized in this review may assist individuals and programs in implementing EPAs. As EPAs become more widely used in general surgery resident training, further analysis of barriers and facilitators to successful and sustainable EPA implementation will be needed to continue to optimize and advance this new assessment framework.

IntroductionThe growth of surgeon burnout is of significant concern. As we work to reimagine the practice of surgery, an accurate understanding of the extent of surgeon burnout is essential. Our goal was to define the current prevalence of burnout and quality of life (QOL) among SAGES surgeons.MethodologyAn electronic survey was administered to SAGES members to establish a current baseline for QOL, burnout, depression, and career satisfaction. To assess outcomes, we utilized the validated Maslach Burnout Inventory for Medical Personnel, the Medical Outcomes Study Short Form, and the Primary Care Evaluation of Mental Disorders. All scoring followed validated norm-based methods.ResultsOf 4194 active members, 604 responded (14.40%). 69% met burnout threshold, with high levels of emotional exhaustion and depersonalization, and low personal accomplishment. 81% reported "being at the end of their rope", 74% felt emotionally drained, and 65% felt used up daily. Nearly all maintained caring about what happened to their patients (96%), easily understanding how their patients feel (84.3%) and being capable of dealing effectively with their patient's problems (87.6%). However, respondents never, rarely, or occasionally felt energetic (77.5%) or experienced a sense of professional accomplishment (57.8%). The overall QOL score was 69/100, with lower Mental than Physical scores (62.69 (SD 10.20) vs.77.27 (SD 22.24)). More than half of respondents met depression criteria. While 77% supported they would become a physician again, less than half would choose surgery again or recommend surgery to their children. Furthermore, less than a third felt work allowed sufficient time for their personal lives.ConclusionsParticipating SAGES surgeons reported alarmingly high rates of burnout and depression. Despite experiencing emotional exhaustion and depersonalization, they maintained a strong commitment to patient care. These findings likely reflect the broader state of surgeons, underscoring the urgent need for action to address this critical issue.

OBJECTIVEThis study aimed to identify what best practices facilitate implementation of Entrustable Professional Activities (EPAs) into surgical training programs.DESIGNThis is a mixed methods study utilizing both survey data as well as semi-structured interviews of faculty and residents involved in the American Board of Surgery (ABS) EPA pilot study.SETTINGFrom 2018 to 2020, the ABS conducted a pilot that introduced five EPAs across 28 general surgery training programs.PARTICIPANTSAll faculty members and residents at the 28 pilot programs were invited to participate in the study.RESULTSAbout 117 faculty members and 79 residents responded to the survey. The majority of faculty (81%) and residents (66%) felt that EPAs were useful and were a valuable addition to training. While neither group felt that EPAs were overly time consuming to complete, residents did report difficulty incorporating them into their daily workflow (44%). Semi-structured interviews found that programs that focused on faculty and resident -development and utilized frequent reminders about the importance and necessity of EPAs tended to perform better.CONCLUSIONSEPA implementation is feasible in general surgery training programs but requires significant effort and engagement from all levels of program personnel. As EPAs are implemented by the ABS nationally a focus on resident and faculty development will be critical to success.

ABSTRACT:Although U.S. medical education has continued to place increased emphasis on defining competency standards and ensuring accountability to the public, health care inequities have persisted, several basic health outcomes have worsened, public trust in the health care system has eroded, and moral distress, burnout, and attrition among practicing physicians have escalated. These opposing trends beg the question of how the "good doctor" concept may be strengthened. In this perspective, the authors argue that revisiting the construct of physician character from an affirmational perspective could meaningfully improve medical education's impact on overall health by more holistically conceptualizing what-and who-a good doctor is. The authors introduce positive psychology's framework of character strengths, probe the distinction between character strengths and medical professionalism, and summarize the role of character strengths in promoting physician engagement and well-being in health care work. They contend that a systems-level approach to cultivating character strengths will foster physician moral agency and well-being and, by extension, transformational change in health care. Consistent with best practice in modern character education, the authors propose that institutions mindfully cultivate moral community among all stakeholders (students, faculty, staff, postgraduate trainees, and patients) and that moral community interaction centers on each member's personal aspirations with respect to living a good life, guided by the character strengths framework and informed by patient perspectives.

BackgroundDiversity, equity, and inclusion have been an intentional focus for SAGES well before the COVID-19 pandemic and the coincident societal recognition of social injustices and racism. Longstanding inequities within our society, healthcare, and the surgery profession have come to light in the aftermath of events that rose to attention around the time of Covid. In so doing, they have brought into focus disparities, injustices, and inequalities that have long been present in the field of surgery, selectively affecting the most vulnerable.MethodsThis White paper examines the current state of diversity within the field of surgery and SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) approach and effort to pave the way forward to meaningful change. We delineate the imperative for diversity, equity, and inclusion for all. By all, we mean to be inclusive of the diversity of gender and sexual orientation, race, ethnicity, geography, sex, and disability in the field of surgery.ResultsSAGES is an organization that lives at the intersection of education and innovation. It has a vital role in assisting the surgical profession in addressing these issues and needs and being a force alongside others for sustained and necessary change. SAGES can only realize these goals through a commitment across all aspects of the organization to embed diversity, equity, and inclusion into our very fabric.ConclusionTrue diversity, equity, and inclusion within a surgical organization is vital for its longevity, growth, relevance, and impact. Unfortunately, the absence of DEI limits opportunity, robs the organization of collective intelligence in an environment in which its presence is critical, contributes to health inequities, and impoverishes all within the society and its value to all with whom it interfaces. SAGES is an organization that lives at the intersection of education and innovation. It has a vital role in assisting the surgical profession in addressing these issues and needs and being a force alongside others for sustained and necessary change. SAGES can only realize these goals through a commitment across all aspects of the organization to embed diversity, equity, and inclusion into our very fabric. Strategies like those highlighted in this White Paper, may be within our grasp and we can learn yet more if we remain in a place of humility and teachability in the future.

ImportanceA competency-based assessment framework using entrustable professional activities (EPAs) was endorsed by the American Board of Surgery following a 2-year feasibility pilot study. Pilot study programs’ clinical competency committees (CCCs) rated residents on EPA entrustment semiannually using this newly developed assessment tool, but factors associated with their decision-making are not yet known.ObjectiveTo identify factors associated with variation in decision-making confidence of CCCs in EPA summative entrustment decisions.Design, Setting, and ParticipantsThis cohort study used deidentified data from the EPA Pilot Study, with participating sites at 28 general surgery residency programs, prospectively collected from July 1, 2018, to June 30, 2020. Data were analyzed from September 27, 2022, to February 15, 2023.ExposureMicroassessments of resident entrustment for pilot EPAs (gallbladder disease, inguinal hernia, right lower quadrant pain, trauma, and consultation) collected within the course of routine clinical care across four 6-month study cycles. Summative entrustment ratings were then determined by program CCCs for each study cycle.Main Outcomes and MeasuresThe primary outcome was CCC decision-making confidence rating (high, moderate, slight, or no confidence) for summative entrustment decisions, with a secondary outcome of number of EPA microassessments received per summative entrustment decision. Bivariate tests and mixed-effects regression modeling were used to evaluate factors associated with CCC confidence.ResultsAmong 565 residents receiving at least 1 EPA microassessment, 1765 summative entrustment decisions were reported. Overall, 72.5% (1279 of 1765) of summative entrustment decisions were made with moderate or high confidence. Confidence ratings increased with increasing mean number of EPA microassessments, with 1.7 (95% CI, 1.4-2.0) at no confidence, 1.9 (95% CI, 1.7-2.1) at slight confidence, 2.9 (95% CI, 2.6-3.2) at moderate confidence, and 4.1 (95% CI, 3.8-4.4) at high confidence. Increasing number of EPA microassessments was associated with increased likelihood of higher CCC confidence for all except 1 EPA phase after controlling for program effects (odds ratio range: 1.21 [95% CI, 1.07-1.37] for intraoperative EPA-4 to 2.93 [95% CI, 1.64-5.85] for postoperative EPA-2); for preoperative EPA-3, there was no association.Conclusions and RelevanceIn this cohort study, the CCC confidence in EPA summative entrustment decisions increased as the number of EPA microassessments increased, and CCCs endorsed moderate to high confidence in most entrustment decisions. These findings provide early validity evidence for this novel assessment framework and may inform program practices as EPAs are implemented nationally.

Objective: The ongoing complexity of general surgery training has led to an increased focus on ensuring the competence of graduating residents. Entrustable professional activities (EPAs) are units of professional practice that provide an assessment framework to drive competency-based education. The American Board of Surgery convened a group from the American College of Surgeons, Accreditation Council for Graduate Medical Education (ACGME) Surgery Review Committee, and Association of Program Directors in Surgery to develop and implement EPAs in a pilot group of residency programs across the country. The objective of this pilot study was to determine the feasibility and utility of EPAs in general surgery resident training. Methods: 5 EPAs were chosen based on the most common procedures reported in ACGME case logs and by practicing general surgeons (right lower quadrant pain, biliary disease, inguinal hernia), along with common activities covering additional ACGME milestones (performing a consult, care of a trauma patient). Levels of entrustment assigned (1 to 5) were observation only, direct supervision, indirect supervision, unsupervised, and teaching others. Participating in site recruitment and faculty development occurred from 2017 to 2018. EPA implementation at individual residency programs began on July 1, 2018, and was completed on June 30, 2020. Each site was assigned 2 EPAs to implement and collected EPA microassessments on residents for those EPAs. The site clinical competency committees (CCC) used these microassessments to make summative entrustment decisions. Data submitted to the independent deidentified data repository every 6 months included the number of microassessments collected per resident per EPA and CCC summative entrustment decisions. Results: Twenty-eight sites were selected to participate in the program and represented geographic and size variability, community, and university-based programs. Over the course of the 2-year pilot programs reported on 14 to 180 residents. Overall, 6,272 formative microassessments were collected (range, 0 to 1144 per site). Each resident had between 0 and 184 microassessments. The mean number of microassessments per resident was 5.6 (SD = 13.4) with a median of 1 [interquartile range (IQR) = 6]. There were 1,763 summative entrustment ratings assigned to 497 unique residents. The average number of observations for entrustment was 3.24 (SD 3.61) with a median of 2 (IQR 3). In general, PGY1 residents were entrusted at the level of direct supervision and PGY5 residents were entrusted at unsupervised practice or teaching others. For each EPA other than the consult EPA, the degree of entrustment reported by the CCC increased by resident level. Conclusions: These data provide evidence that widespread implementation of EPAs across general surgery programs is possible, but variable. They provide meaningful data that graduating chief residents are entrusted by their faculty to perform without supervision for several common general surgical procedures and highlight areas to target for the successful widespread implementation of EPAs.

This paper summarizes the proceedings of the joint European Surgical Association ESA/American Surgical Association symposium on Surgical Education that took place in Bordeaux, France, as part of the celebrations for 30 years of ESA scientific meetings. Three presentations on the use of quantitative metrics to understand technical decisions, coaching during training and beyond, and entrustable professional activities were presented by American Surgical Association members and discussed by ESA members in a symposium attended by members of both associations.

Supplementary Figures 1-5 from GPR109A Is a G-protein–Coupled Receptor for the Bacterial Fermentation Product Butyrate and Functions as a Tumor Suppressor in Colon

Background The influence of provider density and access on well-differentiated thyroid cancer (DTC) survival is uncertain. Methods We used the SEER18 database to study DTC patients undergoing surgery from 2000-2012. County-level endocrinologist and surgeon density were calculated. We evaluated the relationship between provider density and cause-specific survival controlling for demographic, socioeconomic, and treatment characteristics. Results Median endocrinologist density was 1.4/100 000 residents, with 15.5% of patients living in a county with no endocrinologist. Survival increased by 11% for each endocrinologist/100,000 people (P = .007). Median surgeon density was 14.8/100 000 residents, with only 1.7% of patients living in a county with no general surgeon or otolaryngologist. No significant association between surgeon density and survival was identified (P = .06). Rural residence was independently associated with lower survival (P = .009). Conclusions County-level endocrinologist density is associated with improved DTC survival. Results may reflect endocrinologist expertise, earlier diagnosis, or represent surrogacy for higher county-level access to specialized care.

BACKGROUND:Socioeconomic disparities have been associated with outcomes in many medical conditions. The association of socioeconomic status (SES) with readmissions after ventral and inguinal hernia repair has not been well studied on a national level. This study aims to evaluate the association of SES with readmission as a significant outcome in patients undergoing ventral and inguinal hernia repair.METHODS:A retrospective cohort study was performed evaluating patients undergoing ventral hernia and inguinal hernia repair with 1:1 propensity score matching using the Nationwide Readmissions Database (2016-2017). Both 30- and 90-day readmissions were examined. After matching, a multivariate logistic regression analysis was performed using confounding variables including hospital setting, comorbidities, urgency of repair, sociodemographic status, and payer. Likelihood of readmission was reported in odds ratio form.RESULTS:Readmission rates were 11.56% (24,323 out of 210,381) and 17.94% (30,893 out of 172,210) for 30- and 90-day readmissions, respectively. Patients with Medicaid and in the lower income quartile were more likely to present in an emergent fashion for hernia repair. After matching, a multivariate logistic regression analysis showed socioeconomic status (OR 1.250 and 1.229) was a statistically significant independent predictor of readmission at 30 and 90 days, respectively. Inversely, factors associated with the least likely chance of readmission were a laparoscopic approach (OR 0.646 and 0.641), elective admission (OR 0.824 and 0.779), and care in a teaching hospital (OR 0.784 and 0.798).CONCLUSION:SES is an independent predictor of readmission at 30 and 90 days following open and laparoscopic ventral and inguinal hernia repair. Patients with a lower socioeconomic status were more likely to undergo hernia repair in the emergent setting. Efforts toward mitigating SES disparities by potentially promoting MIS techniques, enhancing access to elective cases, and systematic approaches to perioperative care for this disadvantaged population can potentially enhance overall hernia outcomes.

OBJECTIVES: Reward and recognition of surgical educa-tion as an academic activity remains a highly variable process between institutions. The goal of this study is to provide expert consensus definition of an academic sur-gical educator, with focus on criteria for academic promotion. STUDY DESIGN AND SETTING: Following IRB approval, a Web-based modified Delphi process was used to gener-ate prioritized academic promotion criteria for surgical educators. PARTICIPANTS AND SETTING: Participants were recruited nationally from a pool of senior academic sur-geons who are members of the Society of University Sur-geons and the Society of Surgical Chairs. RESULTS: Following a three-round modified Delphi pro-cess, the top domains of educational activity for promo-tion to associate professor and professor were scholarship, teaching, and administration; mentorship was also a priority category for promotion to professor. The top three activities described for promotion to Asso-ciate Professor were active participation in conferences/ departmental educational activities for medical students and residents; educational portfolio demonstrating com-mitment to activities as an educator; and clinical teach-ing excellence at their home institution. The three activities most highly scored items for promotion to Pro-fessor were mentorship of junior surgical educators; active participation in conferences/ departmental educational activities for medical students and residents; and a record of teaching excellence at the medical stu-dent and resident levels. CONCLUSIONS: These findings demonstrate a progres-sion from teacher to scholar to leader across a surgical educator's career, with each level incorporating and building upon the prior activities. Identification of cate-gories and criteria may meaningfully inform best practi-ces to be incorporated into the career development and promotion processes for surgeons on an educator aca-demic pathway. ( J Surg Ed 79:173-178. (c) 2021 Associa-tion of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

T he mission statement of the American Board of Surgery (ABS) is as follows: ABS serves the public and the specialty of surgery by providing leadership in surgical education and practice, by promoting excellence through rigorous evaluation and examination, and promoting the highest standards for professionalism, lifelong learning, and the continuous certification of surgeons in practice. This year has seen the consequences of racism brought to national consciousness by the disproportionate impact of COVID19 on communities of color, overlaid by the recent killings of Ahmaud Arbery, Breonna Taylor, George Floyd, and other Black people. This combination of events has catalyzed societal movements that confront the consequences of structural racism and social injustice. It is clear that every institution in this country, including the ABS, needs to do more to be actively anti-racist. The ABS acknowledges that eliminating racism creates a more diverse, inclusive, and equitable profession, thereby improving ALL patients’ outcomes. The ABS has challenged itself by asking how we can address the role of racism in surgical leadership, training, and practice. Building on existing initiatives, the ABS committed to defining a more aggressive plan of action by holding a retreat on September 16, 2020, to address racism in surgery. This retreat’s goals were to (1) define racism, (2) identify the impact of racism on training, professionalism, and patient care, and (3) initiate a framework for the ABS to address racism in surgery substantively. The overall themes and next steps are summarized below.