The internet was initially conceived by the Defense Advanced Research Projects Agency in the late 1950s. The purpose was to develop a communications system that would be difficult to disrupt in the event of a nuclear war.
By the early 1970s, university students could use an early version of the internet (known as the Advanced Research Projects Agency Network), but it was not user friendly and was text-based only. It was not until 1993 when what we would recognize as the internet became publicly available.
Like other advances that affect civilization in a major way, this platform grew far beyond those first steps and is now used in every spectrum of human endeavor. Medicine is no different. Because of the internet and digital technology, printed textbooks and “snail mail” are reaching obsolescence. Google and artificial intelligence can now answer almost any question in moments and with reasonable accuracy. To lose one’s smartphone is to be cut off from the rest of the world.
George F. Sheldon, MD, FACS, was among the first in medicine to recognize the incredible power and implications of the internet on surgeons, and therefore, the ACS. Through his drive and vision, the ACS web portal was born. The portal provided ACS members with a single sign-on, personalized gateway to the internet.
Launched in 2006, the portal contained “communities” for specialties, subspecialties, chapters, and demographic groups, as well as for various interests. Communities featured core content, Really Simple Syndication known as RSS feeds, reports/reviews/editorials, surgical videos, links to related websites and podcasts, important meeting dates, algorithms, and more. Each user had a My Page with tabs for My Profile, My CME, My Chapter, My Cases, and My Bookmarks.
By the time smartphones were introduced in 2007, portals became even more accessible, but members still needed to log in to view content. Around this time, Philip R. Caropreso, MD, FACS, began using listserv technology for the Iowa Chapter of the ACS, and this subsequently evolved into a national listserv for rural surgeons.
Rural surgeons used both the portal and listserv to communicate about surgery, which was useful in relieving their professional isolation. As “internet 2.0” took hold, David B. Hoyt, MD, FACS, ACS Executive Director at the time, saw the potential for joining surgeons together to take advantage of their colleagues’ knowledge and experience and initiated the search for a vendor that could connect members with each other in a true two-way fashion. His vision included hearing the thoughts and needs of members directly to help steer educational initiatives, quality programs, and leadership.
After identifying the College’s core platform needs, Dr. Hoyt and his team chose from a handful of vendors. Tyler G. Hughes, MD, FACS, former community administrator for the ACS web portal’s Rural Surgery Community, was selected to serve as Editor-in-Chief. Not only would the ACS Communities platform be mobile-friendly and available via an app, but it also would be delivered in real-time or daily digest emails according to user preference.
On August 6, 2014, acscommunities.facs.org successfully launched. The number of communities quickly expanded; today, there are more than 100 communities, each with its own discussions, library, events, and announcements. Communities are both open (any member may join or leave) and closed (viewable only to members of that community), and many have a community administrator(s) to keep things active.
Since its launch, the platform received nearly 6.3 million pageviews, and more than 50,000 members of the College have agreed to the site’s terms of use. In all, 6,825 unique contributors have posted approximately 156,000 discussion group posts, created nearly 27,000 threads, and viewed library items more than 437,000 times.
The ACS Communities platform continues to be a valued and popular benefit of membership. In 2020, Bernardi et al. published an analysis* on the quality and safety of information exchanged in the communities. The top 10 most active communities were General Surgery, Colon and Rectal Surgery, Breast Surgery, Rural Surgery, Women Surgeons, History of Surgery, Endocrine Surgery, Bariatric Surgery, Practice Issues and Economics, and Trauma Surgery.
Over the years, a number of administrators have served the communities. As examples, Michael R. Starks, MD, FACS, headed the Endocrine Community until this year when Leon Kushnir, MD, FACS, assumed that role. Scott R. Steele, MD, MBA, FACS, was the initial editor for Colon and Rectal Surgery, helping set the tone for that very successful community. Other stalwart administrators of note are Britt H. Tonnessen, MD, FACS (Vascular), Michael D. Sarap, MD, FACS (Ohio Chapter), and Girma Tefera, MD, FACS (Surgical Volunteerism). Community administrators have done an outstanding job working through the vicissitudes of managing mass communications.
A few communities have grown largely as the result of their administrators’ engagement. Unlike the initial specialty communities for which members were populated using the College’s association management database, communities of special interest require members to join as they wish.
The History of Surgery community began with several dozen members and has grown to nearly 1,000 members. Don K. Nakayama, MD, MBA, FACS, has led that community for many years, contributing dozens of interesting essays on surgical history. Similarly, Surgeon Writers has grown to approximately 400 surgeons who share writing tips, publication tips, and books or articles they’ve written. That community is led by Carol E. H. Scott-Conner, MD, PhD, MBA, FACS.
The newest community is Sustainability, formed in response to members’ requests for a community of surgeons to discuss environmental impacts of OR practices and equipment. The Sustainability admins are Colleen M. Fitzpatrick, MD, FACS, and Benjamin Miller, MD, FACS.
Considering the pace of computer technology, for a platform like the ACS Communities to remain vibrant and active for more than 10 years is remarkable. The Oxford Dictionary defines community as “a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals.” Indeed, over the course of this past decade, thousands of conversation threads (nearly 27,000) have helped to establish a great sense of fellowship and community—all with the goal to serve all with skill and trust.
