On February 8, 2023, the American Head and Neck Society (AHNS) Endocrine Surgical Section (AHNS-ES) presented a town hall webinar on the initiation of a focused practice designation (FPD) for adult complex thyroid and parathyroid surgery by the American Board of Otolaryngology–Head and Neck Surgery (ABOHNS) and the American Board of Surgery (ABS). This event was well attended and represented an initiation of education about the FPD process to our colleagues. (A video of the event can be found at https://vimeo.com/799653048 or at www.AHNS.info.)
The event was organized by the AHNS-ES, hosted by AHNS president Brian Burkey, MD, MEd, the Institute Chair of Surgical Specialties for Cleveland Clinic in Florida, and featured ABOHNS executive director Brian Nussenbaum, MD, MHCM, among other panelists.
A Collaborative Background
Figure 1. The adult complex thyroid and parathyroid surgery FPD schema. Courtesy of Brian Nussenbaum, MD, MHCM, and Greg Ogrinc, MD, MS.
Thyroid and parathyroid surgery is within the scope of practice of ABOHNS and ABS diplomates who are certified in otolaryngology–head and neck surgery or general surgery, respectively. There are diplomates who focus their surgical practices on patients with thyroid/parathyroid diseases; some have completed fellowships while others have not, and continuing board certification activities aren’t currently focused on this content. These issues, among others, were part of the genesis of the FPD for adult complex thyroid and parathyroid surgery (Figure 1).
The ABS and American Association of Endocrine Surgeons (AAES) initiated an FPD for comprehensive endocrine surgery in 2019. The ABOHNS, AHNS, and American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) requested to proceed collaboratively with ABS and AAES, and this was agreed upon with a focus on adult complex thyroid and parathyroid surgery.
A work group was assembled from members of stakeholder certifying boards and surgical specialty societies:
- ABS: Peter Angelos, MD, PhD, Herb Chen, MD, and Jo Buyske, MD
- AAES: James Lee, MD, Kepal N. Patel, MD, and Tracy Wang, MD, MPH
- ABOHNS: Jeff Bumpous, MD, Dave Eisele, MD, Gaelyn Garrett, MD, MMHC, and Brian Nussenbaum, MD, MHCM
- AHNS: Lisa Orloff, MD, and Greg Randolph, MD
- AAO-HNS: Dave Steward, MD
The FPD initiation process started with an in-person meeting on August 22, 2019, followed by several video conferences afterward, resulting in American Board of Medical Specialties approval in 2022. Consensus was reached on co-administrative boards, the name of the FPD, that the assessment to obtain the new FPD will be a written exam, the initial FPD eligibility requirements, and the required practice components for eligibility.
The FPD Process and Governance
There are two pathways to earn the adult complex thyroid and parathyroid surgery FPD (Figure 2). The practice pathway, which doesn’t require a fellowship, will remain open after introduction. The practice component requirements can be decreased, but not eliminated, if one completes an AAES- or AHNS-accredited fellowship. Required cases are to include core and complex cases. Core cases include thyroidectomy, parathyroidectomy, and neck dissection for thyroid cancer. Complex cases include substernal goiter, re-operative thyroid or parathyroid surgery, tracheal resection for thyroid malignancy, and management of anaplastic or medullary thyroid cancers.
Figure 2. Adult complex thyroid and parathyroid surgery FPD requirements. Courtesy of Dr. Brian Nussenbaum, MD, MHCM.
Adult complex thyroid and parathyroid surgery FPD must be renewed every five years, and candidates must maintain good standing with their primary board certification. For ABOHNS diplomates, 60% of the annual minimum continuing medical education (CME) requirement needs to be thyroid/parathyroid content. (For example, of 25 American Medical Association PRS category I CME credits, a minimum of 15 credits need to be thyroid/parathyroid content.) The submission of new case logs will verify if the candidate is still meeting practice requirements. Candidates must also obtain a passing score on an article-based knowledge assessment.
There will be an opportunity to contribute patients to a quality control data registry. This will be strongly encouraged initially and likely required by the end of the first five-year cycle of the FPD. The boards will periodically revisit requirements beginning three years from the initiation of the new FPD.
The adult complex thyroid/parathyroid surgery FPD steering committee will consist of the following physicians:
- ABOHNS: Elizabeth Cottrill, MD, S. Mark Overholt, MD, Greg Randolph, MD (co-chair), David Steward, MD, and Richard Wong, MD
- ABS: Peter Angelos, MD, PhD, Ashley Cayo, MD, Herb Chen, MD (co-chair), Carmen Solórzano, MD, and Tracy Wang, MD, MPH
In The Future
Future tasks that still need to be completed for the adult complex thyroid and parathyroid surgery FPD include the creation of an exam committee, a definition of the scope of knowledge, an exam blueprint, content, and a road map to the first exam, which may possibly be given in 2025.
If you’d like to learn more about this FPD, there will be a panel on the topic at the Annual Meeting of the AAO-HNS, which will be held in Nashville from September 30 to October 4, 2023. You can also expect this information to be presented at other professional meetings and forums in 2024.
Drs. Stack, Jr., Singer, Burkey, Nussenbaum, and Randolph are members of the stakeholder associations that are preparing the adult complex thyroid and parathyroid surgery FPD.