Part IV: Evaluation of Performance in Practice

Continuing certification requires ongoing participation in a local, regional or national outcomes registry or quality assessment program. You are expected to regularly review your outcomes and complication rates, address identified weaknesses, and reassess the results.

Hospital-Based and Individual Programs​

Hospital-Based and Individual Programs

This participation should be related to your current practice. We encourage you to find out what programs are available through your hospital. Many hospitals participate in national registry programs (see list below).

If there are no hospital-based or individual programs available to you, you may maintain a log of your own cases and morbidity outcomes utilizing the ACS Surgeon Specific Case Log System (with tracking of 30-day complications). We expect you to select a focused area of practice for practice assessment/quality improvement. You should identify an area of practice or types of procedures to study; define the measures to be assessed and goals of the activity; track patients’ outcomes; analyze the outcomes and compare them with the activity goals; and identify areas for improvement. Then you must reassess their performance after implementing changes to gauge improvement.

Program Guidelines

Essential Characteristics

  • The activity tracks meaningful and measurable patient outcomes. Processes of care or composite indicators associated with improved outcomes, reduced complications, or a better quality of life may be included.
  • The parameters assessed are important, scientifically acceptable, useable, relevant, and easy to collect.
  • Individual results are provided to the surgeon at least yearly, preferably a minimum of every six months.
  • A comparative analysis of individual and group results is provided.
  • The method for tracking procedures and outcomes minimizes selection bias.
  • The activity includes the ability for re-measurement after implementation of a quality improvement activity based on analysis of the results.

Essential Characteristics

  • The information is risk-adjusted when possible.
  • The time period between recording of data and reporting of results is minimized as much as possible.
  • Resources are provided to enable completion of quality improvement activities based on the results.
  • The activity provides comparisons over different time periods to track the effect of quality improvement activities.
  • Data entry is done by trained third-party personnel when possible.

Accepted Part IV Vehicles

This list continues to grow as our program evolves. The ABCRS has an open door policy regarding Part IV vehicles.
  • ACS Surgeon Specific Case Log System (with tracking of 30 day complications)
  • Cancer Quality Improvement Program (CQIP)
  • Florida Surgical Care Initiative
  • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
  • Mayo Clinic
  • Michigan Surgical Quality Collaborative (MSQC)
  • National Cancer Database (NCDB)
  • National Surgical Quality Improvement Program ACS (NSCIP)
  • Ongoing Professional Practice Evaluation (OPPE)
  • Piedmont Society Program
  • Press Ganey
  • Surgical Care and OutcomesAssessment Program (SCOAP) (Washington State)
  • Surgical Care Improvement Project (SCIP)
  • University Health System Consortium (UHC)
  • VHA Surgical Quality Improvement Program (VASQIP)


How to Document Evidence of Participation

No paperwork/copies are required at this time, however the information is subject to audit to assure its validity and reliability.

Ethics and Professionalism Policy

Unethical and unprofessional behavior is denoted by any dishonest behavior, including: cheating; lying; falsifying information; misrepresenting one’s educational background, certification status and/or professional experience; and failure to report misconduct. The American Board of Colon and Rectal Surgery has adopted a “zero tolerance” policy toward these behaviors, and individuals caught exhibiting such behaviors risk being permanently barred from certification, reported to state medical boards, and/or legally prosecuted for copyright or other violations.

Unethical behavior is specifically defined by the ABCRS to include the disclosure, publication, reproduction or transmission of ABCRS examinations, in whole or in part, in any form or by any means, verbal or written, electronic or mechanical, for any purposes. This also extends to sharing examination information or discussing an examination while still in progress. Unethical behavior also includes the possession, reproduction or disclosure of materials or information, including examination questions or answers or specific information regarding the content of the examination, before, during or after the examination. This definition specifically includes the recall and reconstruction of examination questions by any means and such efforts may violate federal copyright law. All ABCRS examinations are copyrighted and protected by law; the ABCRS will prosecute violations to the full extent provided by law and seek monetary damages for any loss of examination materials.

Continuing Certification

What does it mean when a physician is required?

Continuing Certification or Maintenance of Certification (MOC) is a process adopted by all 24 ABMS boards that assesses six core physician competencies approved by the ABMS and the ACGME throughout a physician’s career. The six competencies that have been identified as important to deliver quality care are communication skills, professionalism, medical knowledge, patient care, practice-based learning and improvement, which includes the ability to measure, and improve quality of care and system-based practice. All physicians certified after 1990 are required to participate in Continuing Certification.

What does it mean when a physician is required?

Prior to 1990, certification by the American Board of Colon and Rectal Surgery was granted for life. These certified colon and rectal surgeons are not required to recertify or to meet the requirements of Maintenance of Continuing Certification in this area but are strongly encouraged to do so.