of which institution provides
medical liability insurance
also must be determined.
All of the previous details of
the program must be included in
the program letter of agreement
and master contract between
institutions before the program
begins. The parent program
must apply to the ACGME RRC
for surgery in advance of any
new program or rotation of
six months or more in length.
Shorter elective or required
rotations do not necessitate
advanced approval, although
the rotation must still comply
with all ACGME regulations.
The ACS intervenes
The American College of
Surgeons (ACS) offers several
resources to help establish rural
surgical programs, training, and
sites. One type of experience that
may have relevance for the future
of rural general surgery is the
ACS Transition to Practice (TTP)
Program, which is designed
to help better prepare new
graduates of surgical residency
for independent practice. These
programs may be customized
for a graduate who has a specific
type of future practice location in
mind and are ideal for preparing
a new graduate to enter a rural
practice. TTP fellows are best
placed in independent hospitals
without a general surgery
residency program, to avoid
any erosion of surgical resident
case volume or operative
experience. 5 Details about the
TTP Program are available
In addition, the members
of the Education Committee
of the ACS Advisory Council
for Rural Surgery are available
to consult with any institution
interested in developing a rural
site or track. Interested parties
should contact Karen Deveney,
MD, FACS, at deveneyk@ohsu.
edu for further information.
Rural surgeons also are
encouraged to contact the
program director of the general
surgery training program in their
state to express their interest in
serving as mentors to surgical
trainees and helping to ensure the
future of rural general surgery.
Finally, medical students
with an interest in rural
general surgery as a career can
locate a list of general surgery
residency programs that provide
rural surgery experiences in
residency at www.facs.org/
Center in Williston,
ND, a rotation site
for University of
North Dakota’s rural
1. Etzioni DA, Finlayson SR, Ricketts
TC, Lynge DC, Dimick JB.
Getting the science right on the
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2. Ritchie WP, Rhodes RS, Biester
TW. General surgery workloads
and practice patterns in the United
States, 2007–2009. Ann Surg.
3. Harris JD, Hosford CC, Sticca RP. A
comprehensive analysis of surgical
procedures in rural surgery practices.
Am J Surg. 2010;200( 6):820-825.
4. Sticca RP, Mullin BC, Harris JD,
Hosford CC. Surgical specialty
procedures in rural surgery
practices: Implications for rural
surgery training. Am J Surg.
5. Richardson JD. ACS Transition to
Practice Program offers residents
additional opportunities to hone skills.
Bull Am Coll Surg. 2013;98( 9): 23-27.