Complex Thyroid/Parathyroid Surgery Certification Means Better Education for Surgeons

by Brendan C. Stack, Jr., MD, Michael Singer, MD, Brian Burkey, MD, MEd, Brian Nussenbaum, MD, MHCM, and Gregory Randolph, MD •

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.