Cold Steel: Canadian Journal of Surgery Podcast (Canadian Journal of Surgery)

Dr. Bellal Joseph is a trauma surgeon and the chief of the division of trauma, surgical critical care, burns, and acute care surgery at the University of Arizona in Tucson. While it was impossible to delve into the breadth and depth of his research interests, we did explore some of our favorites with Dr. Joseph, including his ongoing investigation into new technologies like REBOA, traumatic brain injuries, and frailty in surgery. What shines through in this conversation is Dr. Joseph’s incredible authenticity, energy and passion for injured and disadvantaged patients, as well as his vision for how physicians can embrace their own brand. 

X/Twitter: https://x.com/TopKniFe_B

1. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma: https://pubmed.ncbi.nlm.nih.gov/30892574/

2. Conflicts of interest and REBOA: https://pubmed.ncbi.nlm.nih.gov/37316993/

3. Brain Injury Guidelines? https://pubmed.ncbi.nlm.nih.gov/35343931/

4. Trauma Specific Frailty Index (TSFI)? https://journals.lww.com/jtrauma/abstract/2023/01000/prospective_validation_and_application_of_the.6.aspx

5. Evaluation of Frailty Assessment Compliance in Acute Care Surgery: Changing Trends, Lessons Learned. https://pubmed.ncbi.nlm.nih.gov/34710704/

1. Some of our favourite tweets:
2. https://x.com/TopKniFe_B/status/1759365974141321232
3. https://x.com/TopKniFe_B/status/1752607469552157060
4. https://x.com/TopKniFe_B/status/1752014880578949430

Dr. Erin King-Mullins is a colorectal surgeon in Fayetteville, Georgia. She created the Colorectal Wellness Center. On this episode, we talk to her about why and how she created the Colorectal Wellness Center. Along the way we get her insights on entrepreneurship, creativity, and paving your own way. 

Links:

1. Dr. King-Mullin’s children’s book “Mommy! I made a Boo-Boo”: https://www.amazon.ca/Mommy-Made-Boo-Boo-Erin-King-Mullins/dp/B0CF4LKWRC
2. Corona-Mamas: https://www.godaddy.com/resources/mindset/godaddy-qa-corona-mamas-erin-king-mullins
3. https://colowellness.com/

We are delighted to release our new collaborative mini-series on “Medico-legal Risks for
the Surgeon”. The Canadian Medical Protective Association and the Cold Steel podcast
have teamed up to release this mini-series exploring some common legal issues that
might arise for surgeons.

In this first episode, we explore some basic legal issues that surgeons might face. We
explore the peer-review system, documentation, inherent risk, the role of the system in
medico-legal errors, and the impact these issues have on surgeons.
Stay tuned for our other episodes!

Bio:
Dr. Richard Mimeault completed his medical degree at McGill University in 1982. He
went on to do an internship at the Wellesley Hospital in Toronto, followed by a general
surgery residency in Ottawa and then a two-year transplant fellowship at the University
Hospital in London, Ontario. In 1989, he returned to Ottawa where he started a practice
of general and hepatobiliary surgery at the Ottawa Hospital. He was in practice for 27
years during which time he was closely involved with the residency training program
and undergraduate education. He was also peer assessor for the College of Physicians
and Surgeons of Ontario (CPSO) and volunteered in third-world surgery and surgical
education. He joined the CMPA as a physician advisor in 2017.

Links:

1. Documentation workshop. https://www.cmpa-acpm.ca/en/education-events/teaching-resources/physician-patient/documentation--principles-of-medical-record-keeping
2. Test result workshop. https://www.cmpa-acpm.ca/en/education-events/workshops/workshop-test-results-follow-up
3. Haytham Kaafarani on Surgeons as a Second Victim: https://open.spotify.com/episode/6MiYBhgt2k7qDMCxUZt537
4. https://www.cmpa-acpm.ca/en/research-policy/know-your-risk/what-general-surgeons-need-to-know
5. Reducing Diagnostic Error with Janice Kwan: https://open.spotify.com/episode/6HJjgK3756tb7NO5fFQUDY

Thank you for joining us on Cold Steel!

Dr. Caprice Greenberg is a surgical oncologist at UNC School of Medicine in North Carolina. She is a preeminent health services researcher and also the founder of the Academy for Surgical Coaching. We caught up with her to do a deep dive on surgical coaching and the work that she’s done on a state-wide level to create a coaching program. Dr. Greenberg is an iconoclast and provides some really important insights on the importance on having a vision and pursuing it, no matter how off the beaten path it may be. 

Bio:

Dr. Greenberg is a world-renowned health services researcher and surgical oncologist, and she most recently served as chair of the Department of Surgery at the Medical College of Georgia at Augusta University.

She also is a leader in the study of care delivery in operating rooms and innovative approaches to collaborative learning and will bring research projects to the School of Medicine related to surgical coaching and methods to improve rural cancer care delivery.

Greenberg earned her MD from the University of Chicago Pritzker School of Medicine and her Masters of Public Health from the Harvard School of Public Health. Her general surgery residency was completed at Brigham and Women’s Hospital in Boston and she completed her surgical oncology fellowship at the Dana – Farber/Partners Cancer Center in Boston.

Links:

1. https://pubmed.ncbi.nlm.nih.gov/28650360/
2. https://pubmed.ncbi.nlm.nih.gov/28146224/
3. https://pubmed.ncbi.nlm.nih.gov/33605579/ 
4.  Academy for Surgical Coaching. https://surgicalcoaching.org/ 
5. Presidential address for AAS https://pubmed.ncbi.nlm.nih.gov/29078918/ 

We’re really excited to bring you talks that we recorded as part of the CANUCS Surgical Fellows course. CANUCS is a national organization that stands for Canadian collaborative on urgent care surgery. Dr. Chad Ball and Kelly Vogt were instrumental in bringing together some really fantastic speakers  to talk about the critical knowledge and skills that surround obtaining a staff job, as well as being successful both personally and professionally in a demanding career. 

Dr. Rob Leeper is an acute care and trauma surgeon at Western University in London, Ontario. Dr. Leeper gives a talk that I wish I had heard when starting out in practice, and gives some profound advice on how to think about a surgical career as well as some really practical advice such as, “Give me Cordis or give me death!” 

As always, we’d love to hear your thoughts and feedback, so please email us at podcast.cjs@gmail.com.

Bio:

Dr. Rob Leeper is an Assistant Professor in the Department of Surgery at Western University. He is an acute care and trauma surgeon with an interest in resuscitation, both inside and outside the operating room. He did residency in Western and went on to do a prestigious trauma fellowship at Johns Hopkins University. He is the father of 3 and a former college football player.

Links: 

1. https://soundcloud.com/cjs-podcast/e127-rob-leeper-on-data-driven-competitive-trauma-simulation-and-starting-out-in-practice

We’re really excited to bring you talks that we recorded as part of the CANUCS Surgical Fellows course. CANUCS is a national organization that stands for Canadian collaborative on urgent care surgery. Dr. Chad Ball and Kelly Vogt were instrumental in bringing together some really fantastic speakers to talk about the critical knowledge and skills that surround obtaining a staff job, as well as being successful both personally and professionally in a demanding career. 

Dr. Kelly Vogt is an acute care and trauma surgeon at Western University in London, Ontario and is an outstanding surgeon-scientist. Dr. Vogt lays out her advice for starting a career in research as a surgeon, and how to navigate everything from involving trainees to writing your first grant. She’s a longstanding friend of the podcast, and you can check out all the other episodes we’ve done with Dr. Vogt in the shownotes. 

As always, we’d love to hear your thoughts and feedback, so please email us at podcast.cjs@gmail.com.

Bio:

Dr. Kelly Vogt joined the Division of General Surgery, Department of Surgery, Western University in September of 2014, and is appointed at London Health Sciences Centre’s Victoria Hospital. Dr. Vogt is a recipient of the Schulich Clinician-Scientist Award. As a Schulich Clinician Scientist, she will have protected time to further her research in clinical epidemiology, specializing in clinical trials, and registry-related research in the field of Acute Care Surgery and Trauma.

After graduating from the University of Waterloo with a BSc in Health Studies, Dr. Vogt received her medical degree and general surgery residency training at Schulich School of Medicine & Dentistry, Western University. Dr. Vogt also received a MSc in Health Research Methodology from McMaster University, a degree she completed during her residency. Upon finishing her residency, Dr. Vogt joined the Division of Acute Care Surgery LA County, University of Southern California Medical Center in Los Angeles where she completed a fellowship program in trauma and surgical critical care, followed by an appointment to the Division as a Clinical Instructor.

Links: 

1. https://soundcloud.com/cjs-podcast/e04-csf-edition-kelly-vogt-on-the-evolution-of-acs-tips-for-a-career-in-academic-surgery
2. https://soundcloud.com/cjs-podcast/e105-death-and-dying-in-surgery-with-kelly-vogt-and-morad-hameed
3. https://soundcloud.com/cjs-podcast/surgical-companion-2-rbg
4. https://soundcloud.com/cjs-podcast/surgical-companion-1-the-aging-surgeon
   
   

This episode is an edited version of a talk I gave to our first years during their Surgical Foundations course. It’s mainly a reminder to myself: this too shall pass.

Links:

1. Steven Covey 7 Habits of Highly Effective People: https://www.amazon.ca/Habits-Highly-Effective-People-Powerful/dp/0743269519
2. “Memento Mori”: https://dailystoic.com/memento-mori/
3. Hans Zimmer soundtracks: https://www.youtube.com/channel/UCJeBQabyLa_FvMxb6G67lkw
   
   

Dr. Adom Bondzi-Simpson is a general surgery resident and PhD student at the University of Toronto. He’s been nationally recognized for his advocacy work and research work on social justice and social determinants of health. He is a winner of the Canadian Medical Association for Young Leaders, the 2023 winner of the Mikhael Award for Medical Education from the Resident Doctors of Canada, among other accolades. In this episode we do a very deep dive on Adom’s upbringing and background, and his thoughts on how we can make the house of surgery a more diverse and welcoming place.         

Links:

1.       https://temertymedicine.utoronto.ca/news/faces-temerty-medicine-adom-bondzi-simpson

2.       “Where is the Black doctor!?” CMAJ piece. https://www.cmaj.ca/content/194/34/E1175 

3.       https://pubmed-ncbi-nlm-nih-gov.proxy.queensu.ca/37640638/

4.       https://pubmed-ncbi-nlm-nih-gov.proxy.queensu.ca/37063147/ 

5.       CMA Award: https://www.cma.ca/get-involved/awards/awards-young-leaders/dr-adom-bondzi-simpson 

We’re really excited to bring you talks that we recorded as part of the CANUCS Surgical Fellows course. CANUCS is a national organization that stands for Canadian collaborative on urgent care surgery. Dr. Chad Ball and Kelly Vogt were instrumental in bringing together some really fantastic speakers  to talk about the critical knowledge and skills that surround obtaining a staff job, as well as being successful both personally and professionally in a demanding career. 

Dr. Ashlie Nadler is an Assistant Professor at the University of Toronto and practices at Sunnybrook Hospital. She has unique training in both acute care surgery as well as surgical oncology. In this talk, she examines the adage of being “Available, Affable, and Able” as a mantra for success in a surgical career.

As always, we’d love to hear your thoughts and feedback, so please email us at podcast.cjs@gmail.com.

Bio:

Dr. Ashlie Nadler has been appointed in the Department of Surgery, Division of General Surgery, University of Toronto as an Assistant Professor and Surgeon-Teacher at Sunnybrook Health Sciences Centre. Ashlie completed the medical program and General Surgery Residency Program at the University of Toronto. She then did a surgical oncology fellowship in Philadelphia at the Fox Chase Cancer Center and at the same time did a Master of Public Health, Drexel University, in Philadelphia. Ashlie is Sub-section Lead, Acute Care Surgery, Department of Surgery and Integrated Community Program, Sunnybrook Health Sciences Centre. Her clinical interests are in acute care surgery and emergency surgical oncology.  Her research interests are in quality improvement, education, and acute care surgery.

Thank you so much for joining us on Cold Steel!

The tremulous surgeon seems like such an oxymoron, an impossible paradox. The reality of course, is that many surgeons have a tremor. Our discussion on this episode with Lilli Cooper on tremors was a wonderful exploration of performance anxiety in surgery. Lilli Cooper is a plastic surgeon in the UK, and produced a segment for the BBC on tremors in surgeons. We caught up with her to talk about what she’s learned about tremors and the insights she has on performance in surgery. You can check out all the work she does on her website https://lillicooper.co.uk/. 

Links:

1.       https://lillicooper.co.uk/ 

2.       https://www.bbc.co.uk/programmes/m0021j9y

3.     A pilot study of performance enhancement coaching for newly appointed urology registrars. https://pubmed.ncbi.nlm.nih.gov/38767172/

4.     Enhancing surgical performance by adopting expert musicians' practice and performance strategies. https://www-sciencedirect-com.proxy.queensu.ca/science/article/pii/S0039606017306323

5.     Romy Nitsch and Jen Mccall on Imposterism in Surgery. https://open.spotify.com/episode/3UuP5JTGuhP8J2JvycoEFh 

Thank you so much for joining us on the podcast!

In many philosophical and religious traditions, there is an emphasis on how intentionality is one of the fundamental tenets of being able to live a fulfilling life. Marcus Aurelius wrote, “You have power over your mind – not outside events. Realize this and you will find strength.” One surgeon who is trying to restore that intentionality back to the culture of surgery is Dr. Sharon Stein. Dr. Stein is a colorectal surgeon who has been at the pinnacle of academic surgery and has been among many other things the past president of the Association of Women Surgeons, Chair of American College of Surgeons Women in Surgery Committee, and an executive council of the American Society of Colon and Rectal Surgeons. Recently, Dr. Stein started the Intentional Surgeon podcast, dedicated to helping surgeons rediscover their purpose. We had a powerful discusson on a whole myriad of topics, with the throughline of how we can try to restore intentionality and purpose to everything that we do. You can find Dr. Stein on her website www.intentionalsurgeon.com and you can also email her at slsteincoaching@gmail.com as well as on X at @slssteinmd1. 

Links:

1. Intentional Surgeon podcast: https://www.intentionalsurgeon.com/
2. Gender Inequity in the Clinical Setting. Clin Colon Rectal Surg. 2023 Sep; 36(5): 309–314.
3. Association of Women Surgeons 2020 Presidential Address: Sculpting our Future. https://pubmed-ncbi-nlm-nih-gov.proxy.queensu.ca/33046220/

In this episode, we spoke with Drs. Jen McCall and Romy Nitsch about imposterism. Dr. McCall is a minimally invasive gynecology fellow at the University of Ottawa and Dr. Nitsch is a minimally invasive gynecologist at Queen’s University. The two researchers, along with Jessica Pudwell and Jamie Pyper, recently published a study in the Journal of American College of Surgeons on imposter phenomenon in women surgeons. Their study highlights the near universal phenomenon of imposter phenomenon among women surgeons, some of the risk factors associated with imposterism, and perhaps some strategies for how we might mitigate it. 

Jennifer McCall X/Twitter: https://x.com/jenn__mccall 

Romy Nitsch X/Twitter: https://x.com/romynitsch

Links:

1. Dr. McCall and Nitsch’s article in JACS: Impostor Phenomenon and Impact on Women Surgeons: A Canadian Cross-Sectional Survey. https://pubmed-ncbi-nlm-nih-gov.proxy.queensu.ca/38712839/
2. Mann A, Shah AN, Thibodeau PS, et al. Online well-being group coaching program for women physician trainees: a randomized clinical trial. JAMA Netw Open 2023;6:e2335541 –e2335541.

On this episode, Dr. Elizabeth Squirrell joined us to talk about Crohns disease. Dr. Squirrell is a staff gastroenterologist at Queen’s University and has a special expertise in inflammatory bowel disease. In this two part series, we first talk about the diagnosis of crohns disease and the different patterns of its presentation. In part 2, we talk about the changing landscape of medical therapy for Crohns disease and how Dr. Squirrell approaches the treatment of Crohns. Make sure to check out the links below for all the papers that are discussed in both part 1 and part 2 of this series. 

Links:

1.  Is there an optimal sequence of biologic therapies for inflammatory bowel disease? – Brian Bressler: https://journals.sagepub.com/doi/10.1177/17562848231159452
2. Vedolizumab as Induction and Maintenance Therapy for Crohn's Disease – Sandborn et al. - https://www.nejm.org/doi/full/10.1056/NEJMoa1215739
   • They measured Clinical remission at week 6 and did have a significant result in one of their groups (p=0.02) but had a remission rate of 14.5% in the double-blind group and 17.7% in the open label group. Contrasted to the ustekinumab study (below) where they measured at 8 weeks and record 40.2% remission in biologic naïve patients and 20.9% remission in prior TNF exposed patients (the vedo study was a mix of bio exposed and bio naïve so would expect somewhere between). 
3.  Ustekinumab as Induction and Maintenance Therapy for Crohn’s Disease – Feagan et al. - https://nejm.org/doi/full/10.1056/NEJMoa1602773#APPNEJMoa1602773SUP
4. ECCO-ESCP Consensus on Surgery for Crohn’s Disease – Bemelman et al. - https://academic.oup.com/ecco-jcc/article/12/1/1/3813784
5. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis – Ytterberg et al. - https://www.nejm.org/doi/full/10.1056/NEJMoa2109927
6. ACG Clinical Guideline: Management of Crohn's Disease in Adults – Lichtenstein et al. - https://journals-lww-com.proxy.queensu.ca/ajg/Fulltext/2018/04000/ACG_Clinical_Guideline__Management_of_Crohn_s.10.aspx
7. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Luminal Crohn’s Disease – Panaccione et al. - https://www.cag-acg.org/images/publications/CAG-CPG-Luminal-Crohns-Disease-JCAG-July2019.pdf   

On this episode, Dr. Elizabeth Squirrell joined us to talk about Crohns disease. Dr. Squirrell is a staff gastroenterologist at Queen’s University and has a special expertise in inflammatory bowel disease. In this two part series, we first talk about the diagnosis of crohns disease and the different patterns of its presentation. In part 2, we talk about the changing landscape of medical therapy for Crohns disease and how Dr. Squirrell approaches the treatment of Crohns. Make sure to check out the links below for all the papers that are discussed in both part 1 and part 2 of this series. 

Links:

1.  EXPERIENCES WITH PREFRONTAL LOBOTOMY FOR INTRACTABLE ULCERATIVE COLITIS. https://jamanetwork.com/journals/jama/article-abstract/304807
2.  ACG Clinical Guideline: Management of Crohn's Disease in Adults. https://journals-lww-com.proxy.queensu.ca/ajg/Fulltext/2018/04000/ACG_Clinical_Guideline__Management_of_Crohn_s.10.aspx
3.  The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856208/

Shiva Jayaraman is a minimally invasive and hepatobiliary surgeon at St. Joseph’s Hospital. He’s been traveling around the world talking about his innovative peer-to-peer coaching program for bile duct injuries. Not only is this such an important clinical topic that virtually every general surgeon in the world has to deal with, but his group’s approach to coaching is something that we should be trying to replicate on a national and international level.

Make sure to check out part 2 of our interview with him, a masterclass on subtotal cholecystectomy: https://youtu.be/9ptTuPCJ8WA 

Twitter: @cutitoutPODCAS1

Shiva's YouTube: https://www.youtube.com/channel/UCKUnmUDH1z3c9VMR1iv6tpg 

Links:

1. Helping the Surgeon Recover: Peer-to-Peer Coaching after Bile Duct Injury. https://pubmed.ncbi.nlm.nih.gov/34111530/
2. Shiva’s Approach to Tough Gallbags: https://www.youtube.com/watch?v=oX35O61qga0 
3. The inferior boundary of dissection as a novel landmark for safe laparoscopic cholecystectomy. https://pubmed.ncbi.nlm.nih.gov/33648820/
4. The Academy of Surgical Coaching. https://surgicalcoaching.org/
5. Personal Best by Atul Gawande. https://www.newyorker.com/magazine/2011/10/03/personal-best
6. Thinking your way through a difficult subtotal cholecystectomy. https://journals-lww-com.proxy.queensu.ca/journalacs/fulltext/2022/12000/thinking_your_way_through_a_difficult_laparoscopic.23.aspx
7. TVASurg: www.tvasurg.ca/lapchole

Dr. Elena Parvez is a surgical oncologist and Assistant Professor in the Department of Surgery. Her clinical expertise and research interests are in breast cancer. She is exploring breast cancer outcomes in refugees to Canada who have breast cancer. She has received funding from Canadian Institutes of Health Research (CIHR) to conduct a trial which identifies a strategy to avoid post-neoadjuvant radiation therapy in patients with locally advanced breast cancer who have a complete response to neoadjuvant chemotherapy.

She presented this work at the “Best of CSF Research 2023” session last year.

Join us at the upcoming CSF in Winnipeg!

https://www.canadiansurgeryforum.com/

Links:

1. Adjuvant radiation therapy among immigrant and Canadian-born/long-term resident women with breast cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10718225/
2. https://experts.mcmaster.ca/display/parveze
3. https://www.canadiansurgeryforum.com/ 

Well the summer has come and gone and we’re back into the swing of things! We’re really excited that in a couple of weeks, many surgeons from across Canada will be meeting for our largest national conference, the Canadian Surgical Forum. This year it is in the lovely city of Winnipeg. It’s a time to catch up with friends and colleagues across the country, and to hear the amazing work that’s been going on. This is a teaser for the type and calibre of work that goes on at CSF. Dr. Elena Parvez presented this work last year at the best research of CSF 2023 session. Dr. Parvez is an assistant professor of surgery at McMaster University in Hamilton. Her clinical practice is in surgical oncology. In this episode, she presented her work on adjuvant radiation therapy among immigrant and Canadian-born women with breast cancer. 

We look forward to meeting many of our listeners at CSF this year and we’ll be recording some interviews live at CSF. We’d love to hear your feedback and suggestion for content for the upcoming year. As always, you can also send your thoughts to podcast.cjs@gmail.com. 

 Janice Kwan is an internist at Mount Sinai Hospital in Toronto. Her research interests focus on health care quality and diagnostic error. She collaborated with folks from the Canadian Medical Protective Association (CMPA) to investigate diagnostic errors in surgery. Her paper, published in the Canadian Journal of Surgery, highlight the significant consequences of diagnostic errors in surgery. We also talked about de-biasing techniques and other strategies for reducing diagnostic error in surgery.

Janice Kwan Twitter:  https://twitter.com/kwanjanice

 Links:

1.  Characteristics and contributing factors of diagnostic error in surgery: analysis of closed medico-legal cases and complaints in Canada.  https://www.canjsurg.ca/content/67/1/E58
2.  Diagnostic Process:  https://www.improvediagnosis.org/processes/the-diagnostic-process/
3.  Improving Diagnosis in Healthcare:  https://nap.nationalacademies.org/resource/21794/interactive/
4.  I-PASS tool:  https://www.ahrq.gov/teamstepps-program/curriculum/communication/tools/ipass.html
5.  Society to Improve Diagnosis in Medicine (SIDM) Fellowship in Diagnostic Excellence.  https://www.improvediagnosis.org/sidmfellowship/#:~:text=The%20Society%20to%20Improve%20Diagnosis,error%20community%2C%20and%20help%20you

The only thing that can save us from our irascibly self-centered existence is to make sure that our existence is in the service of others

Mark Shrime, ENT surgeon, global surgery researcher and now career coach is our guest on this episode. The quote I read was from his wonderful book, “Solving for Why: A Surgeon’s Journey to Discover the Transformative Power of Purpose”. It’s important to understand just how much of a fascinating person Mark Shrime is to get a context for this conversation. Dr. Shrime was the International Chief Medical Officer at Mercy Ships, an international NGO that operates hospital ships. Mark is also one of the major figures in the global surgery space, and was part of the 2015 Lancet Commission on Global Surgery. If that were not enough, he is also an American Ninja Warrior! We explored why Mark felt the need to write a book on purpose as well as his insights on global surgery, amongst many other topics. This was such an important conversation not just for surgeons but for anyone trying discover meaning and purpose in their life. 

Links:

1. https://www.markshrime.com/ 
2. https://www.hachettebookgroup.com/titles/dr-mark-shrime/solving-for-why/9781538734162/?lens=twelve
3. https://www.thelancet.com/commissions/global-surgery
4. Shrime MG, Alkire BC, Grimes C, Chao TE, Poenaru D, Verguet S. Cost-Effectiveness in Global Surgery: Pearls, Pitfalls, and a Checklist. World J Surg. 2017 Jun;41(6):1401-1413. doi: 10.1007/s00268-017-3875-0. PMID: 28105528.
5. Smith ER, Kapoor P, Concepcion T, Ramirez T, Mohamed M, Dahir S, Cotache-Condor C, Adan Ismail E, Rice HE, Shrime MG. Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study. BMJ Open. 2023 May 2;13(5):e069572. doi: 10.1136/bmjopen-2022-069572. PMID: 37130683; PMCID: PMC10163539

This week we were joined by Dr. Jenny Seligmann. Dr. Seligmann is a Professor of Gastrointestinal and Translational Oncology and Honorary Consultant in Medical Oncology at the University of Leeds. Dr. Seligmann is one of the authors of the seminal FOxTROT trial, which investigated the use of neoadjuvant chemotherapy in advanced colon cancers. Dr. Seligmann is the lead investigator on the FOxTROT platform, the ARIEL trial, and continues to be on the leading edge of trials for colorectal cancer. In this episode, we explored neoadjuvant chemotherapy for colon cancer specifically. There's lots to take away from this conversation, but one of the things that stood out for us was some of the differences in the structure of the multidisciplinary tumor boards in Dr. Seligmann’s centre versus many centres in Canada. Perhaps in the future, all colorectal cancers will get discussed at tumor boards! What do you think? We’d love to hear your thoughts – email us at podcast.cjs@gmail.com.

Bio:

Dr Jenny Seligmann is Professor of Gastrointestinal and Translational Oncology and Honorary Consultant in Medical Oncology at the University of Leeds, UK. She is the Chief Investigator of the FOxTROT Platform and the ARIEL trial, and has a programme of translational research. She is a member of the ESMO Lower Gastrointestinal Faculty and the UK NCRI Colorectal Cancer Executive Group.

x/twitter: @jenseligmann

Links:

1. Preoperative Chemotherapy for Operable Colon Cancer: Mature Results of an International Randomized Controlled Trial. https://ascopubs.org/doi/10.1200/JCO.22.00046
2. Professor Dion Morton: https://www.birmingham.ac.uk/staff/profiles/applied-health/morton-dion
3. Professor Phil Quirke: https://medicinehealth.leeds.ac.uk/medicine/staff/700/professor-philip-quirke
4. ARIEL trial: https://fundingawards.nihr.ac.uk/award/NIHR129268
5. FOCUS4 trial: http://www.focus4trial.org/
6. FOxTROT platform website: https://ctru.leeds.ac.uk/foxtrot/
7. COLOSOS trial: https://mycs-cdn.myconferencesuite.com/other/Project/3222/91/c0/PRELIM%20PROGRAM_COLOSOS%20CANADA_DL.pdf 

Dr. Sharmila Dissanaike is a trauma and acute care surgeon and is the chair of surgery at Texas Tech University. She holds multiple national leadership roles, including as President-Elect of the American Burn Association, Vice-President of the Southwest Surgical Congress, and Governor of the American College of Surgeons. We really delved into her thoughts on her philosophy on leadership. How do you create a supportive culture? How do you make the hard decisions and have the hard conversations? Most importantly, how do we stay true to ourselves and our own values?

X/Twitter: https://x.com/DissanaikeMD

Links:

• Burnout, shiftwork and suicide: 2022 Scott B. Frame Memorial Lecture. https://journals-lww-com.proxy.queensu.ca/jtrauma/fulltext/2022/07000/burnout,_shiftwork_and_suicide__2022_scott_b_.21.aspx
• New Yorker piece about Brittany Bankhead-Kendall, a trauma surgeon recruited & supported by Dr. Dissanaike: https://www.newyorker.com/science/medical-dispatch/a-doctors-dark-year
• How to prevent burnout (maybe): https://pubmed.ncbi.nlm.nih.gov/27810134/

 Most of us come out of training and have no idea on how to balance a busy clinical practice, academic interests, and most importantly, our home and personal lives. Mr. Adi Kumar is trying to change that. Mr. Kumar is a consultant neurosurgeon in the UK and has written a book called Work Less, Live More: The Doctor’s Guide for Time Freedom. We caught up with him to talk about his unconventional academic interests and his thoughts on how we as physicians can lead more fulfilling lives.

 Links:

1. Work Less, Live More e-book: https://adi-kumar.ghost.io/worklesslivemore/
2. https://adi-kumar.ghost.io/
3. Doctors and Writers: https://doctorsandwriters.com/
4. X/Twitter: https://twitter.com/adi_kumar1
5. #038 Why being a surgeon is a Loser's Game. https://adi-kumar.ghost.io/038-why-being-a-surgeon-is-a-losers-game/ 
6. The Neurosurgeons YouTube channel. https://www.youtube.com/c/TheNeurosurgeons

Clip of Senate hearing with Robert F. Kennedy Jr.

That was a clip from a Senate hearing with  Robert F Kennedy Jr, who, as many listeners will know, is the current US Secretary of Health and Human Services. In 2025, many folks around the world have become interested in the way that science currently works, particularly around the process of peer review. Peer review is a process where scientific journals ask experts in the field to evaluate the validity and accuracy of articles that are submitted to the journal. There are many challenges around peer review in the modern era, and one particularly thorny one is finding reviewers who have the time and expertise to provide high-quality reviews.

David Maslove is a Clinician Scientist in the Departments of Medicine and Critical Care Medicine at Queen’s University. He, along with economist Chris Cotton and a team of other researchers, recently published an article in the Journal of Critical Care Medicine entitled “Effect of Monetary Incentives on Peer Review Acceptance and Completion: A Quasi-Randomized Interventional Trial”. Dr. Maslove performed what is, in some ways, a very simple study conceptually – does paying reviewers increase the rate at which reviewers complete their reviews? We delve into this study in depth and hear Dr. Maslove’s thoughts on this really important topic.

What do you think? Do you think peer reviewers should be paid? Send us your thoughts via email at podcast.cjs@gmail.com or on X @coldsteelpod.

Links:

1. Cotton CS, Alam A, Tosta S, Buchman TG, Maslove DM. Effect of Monetary Incentives on Peer Review Acceptance and Completion: A Quasi-Randomized Interventional Trial. Crit Care Med. 2025 Mar 6. doi: 10.1097/CCM.0000000000006637. Epub ahead of print. PMID: 40047491.
2. Maslove DM, Tang B, Shankar-Hari M, Lawler PR, Angus DC, Baillie JK, Baron RM, Bauer M, Buchman TG, Calfee CS, Dos Santos CC, Giamarellos-Bourboulis EJ, Gordon AC, Kellum JA, Knight JC, Leligdowicz A, McAuley DF, McLean AS, Menon DK, Meyer NJ, Moldawer LL, Reddy K, Reilly JP, Russell JA, Sevransky JE, Seymour CW, Shapiro NI, Singer M, Summers C, Sweeney TE, Thompson BT, van der Poll T, Venkatesh B, Walley KR, Walsh TS, Ware LB, Wong HR, Zador ZE, Marshall JC. Redefining critical illness. Nat Med. 2022 Jun;28(6):1141-1148. doi: 10.1038/s41591-022-01843-x. Epub 2022 Jun 17. PMID: 35715504.
3. Maslove DM, Badawi O. The Many Faces of Prediction Modeling in Critical Care. Crit Care Med. 2022 Apr 1;50(4):687-689. doi: 10.1097/CCM.0000000000005409. PMID: 35311775.
4. https://med.stanford.edu/master-clinical-informatics-management/stanford-clinical-informatics/ms-phd-in-biomedical-informatics.html
   
   

We’re really excited to bring you talks that we recorded as part of the CANUCS Surgical Fellows course. CANUCS is a national organization that stands for Canadian collaborative on urgent care surgery. Dr. Chad Ball and Kelly Vogt were instrumental in bringing together some really fantastic speakers  to talk about the critical knowledge and skills that surround obtaining a staff job, as well as being successful both personally and professionally in a demanding career. 

I was really honoured to be asked to talk about culture in surgery. It was great to reflect on many of the discussions we’ve had through the years on the podcast and think about what we can continue to improve the culture of surgery. 

As always, we’d love to hear your thoughts and feedback, so please email us at podcast.cjs@gmail.com. 

Links: 

1. Treatment of Ongoing Hemorrhage: The Art and Craft of Stopping Severe Bleeding. https://www.amazon.ca/Treatment-Ongoing-Hemorrhage-Stopping-Bleeding/dp/3319634941
2. https://canucs.ca/
3. Rhea Liang and Simon Fleming on Culture Change in Surgery: https://www.canjsurg.ca/cold-steel-episode-81-rhea-liang-and-simon-fleming
4. Effects of Hierarchy in the OR: https://academic.oup.com/bja/article-abstract/110/3/463/249144
5. Elaine Bromiley: https://www.youtube.com/watch?v=6qKYRDxwQf8
6. Haytham Kaafarani : https://open.spotify.com/episode/6MiYBhgt2k7qDMCxUZt537 

We’re really excited to bring you talks that we recorded as part of the CANUCS Surgical Fellows course. CANUCS is a national organization that stands for Canadian collaborative on urgent care surgery. Dr. Chad Ball and Kelly Vogt were instrumental in bringing together some really fantastic speakers  to talk about the critical knowledge and skills that surround obtaining a staff job, as well as being successful both personally and professionally in a demanding career. 

Dr. Morgan Schellenberg is a trauma and acute care surgeon who recently joined us back in Canada as a staff surgeon at St. Michael’s Hospital in Toronto. She lays out some very practical advice about one of the most important decisions we have to make at the end of the very long road of training: how to choose your first job! Dr. Schellenberg also has some really keen insights into working in the US versus Canada. 

As always, we’d love to hear your thoughts and feedback, so please email us at podcast.cjs@gmail.com.

Bio:

Dr. Morgan Schellenberg is a trauma and acute care surgeon at St. Michael’s Hospital in Toronto. Previously she did her residency at Queen’s University and fellowship at Keck School of Medicine of USC and subsequently went on to practice in Los Angeles.

Tsuyoshi Konishi

Dr. Tsuyoshi Konishi is an associate professor of Colon and Rectal Surgery at the University of Texas M.D. Anderson Cancer Center, in Houston, USA. We again got a chance to hear several of his talks at the COLOSOS conference in Toronto in Oct 2024. 

Dr. Konishi is really helping to bridge the gap between “Eastern” and “Western” approaches to colorectal cancer. In this episode, Dr. Konishi really broke down the sometimes nebulous concept of complete mesocolic excision in right sided colon cancers. We’d really encourage you to head over to our YouTube channel www.youtube.com/@coldsteelsurgery to check out the accompanying video and slides. One of the really enjoyable parts of this conversation was discussing some of the differences between Japanese and North American training – there’s lots we can learn! 

Maybe we should incorporate the Japanese system of having everyone upload their operative video prior to board certification?? What do you think? Send us an email at podcast.cjs@gmail.com.

Check out YouTube version with Dr. Konishi's slides here: https://youtu.be/PGIBtYyBAxU 

Bio:

After completion of advanced training in the field of Surgical Oncology and Colorectal Minimally Invasive Surgery at top institutions including the University of Tokyo, Cancer Institute Hospital of the JFCR and Memorial Sloan-Kettering Cancer Center, Dr. Konishi served as an attending colorectal surgeons since 2010, and Head Attending since 2017, at Cancer Institute Hospital of the Japanese Foundation for Cancer Research in Tokyo, Japan. He took a leadership in advancing a minimally invasive surgery program for complex colorectal cancer.

Dr. Konishi’s research interest includes combining multidisciplinary approaches for complex colorectal cancer, including neoadjuvant therapy, extended surgical resection and a minimally invasive surgery. Particularly, he has been taking an international leadership in studying lateral pelvic lymph node dissection for rectal cancer.

Dr. Tsuyoshi Konishi is currently an associate professor of Colon and Rectal Surgery at the University of Texas M.D. Anderson Cancer Center, in Houston, USA. 

Links:

1. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis. 2009 May;11(4):354-64; discussion 364-5. doi: 10.1111/j.1463-1318.2008.01735.x. Epub 2009 Nov 5. PMID: 19016817.
2. Konishi T, You YN. Complete Mesocolic Excision and Extent of Lymphadenectomy for the Treatment of Colon Cancer. Surg Oncol Clin N Am. 2022 Apr;31(2):293-306. doi: 10.1016/j.soc.2021.11.009. Epub 2022 Mar 5. PMID: 35351279.
3. RELARC trial: Lu J, Xing J, Zang L, Zhang C, Xu L, Zhang G, He Z, Sun Y, Feng Y, Du X, Hu S, Chi P, Huang Y, Wang Z, Zhong M, Wu A, Zhu A, Li F, Xu J, Kang L, Suo J, Deng H, Ye Y, Ding K, Xu T, Zhang Y, Zhang Z, Zheng M, Su X, Xiao Y; RELARC study group. Extent of Lymphadenectomy for Surgical Management of Right-Sided Colon Cancer: The Randomized Phase III RELARC Trial. J Clin Oncol. 2024 Nov 20;42(33):3957-3966. doi: 10.1200/JCO.24.00393. Epub 2024 Aug 27. PMID: 39190853.
4. Motoyama S, Yamamoto H, Miyata H, Yano M, Yasuda T, Ohira M, Kajiyama Y, Toh Y, Watanabe M, Kakeji Y, Seto Y, Doki Y, Matsubara H. Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer: evaluation using data on 16,752 patients from the National Clinical Database in Japan. Esophagus. 2020 Jan;17(1):41-49. doi: 10.1007/s10388-019-00694-9. Epub 2019 Oct 3. PMID: 31583502; PMCID: PMC6976551.

On this episode, we had the opportunity to speak with Beverly Blaney. Bev is a psychotherapist who has extensive experience doing therapy with physicians in particular, as well as conducting workshops on mindfulness for Queen’s School of Medicine. We asked her about her perspective on the psychological challenges surgeons experience during their training, and her thoughts on what we could do to make ourselves more resilient. 

Links

1.      Atomic habits by James Clear

2.      Essentialism: The Disciplined Pursuit of Less – Greg McKeown

We’re really excited to bring you talks that we recorded as part of the CANUCS Surgical Fellows course. CANUCS is a national organization that stands for Canadian collaborative on urgent care surgery. Dr. Chad Ball and Kelly Vogt were instrumental in bringing together some really fantastic speakers  to talk about the critical knowledge and skills that surround obtaining a staff job, as well as being successful both personally and professionally in a demanding career. 

Dr. Morad Hameed is an innovator, leader, and trauma surgeon. He currently is the chief of acute care surgery at Stanford University and held many leadership roles within Canada. We don’t really think we can do justice to this talk. Nominally this talk was about transitions in practice during a surgical career, but really this talk was an ode to joy in surgery and how we can find fulfillment as both surgeons and human beings.  

As always, we’d love to hear your thoughts and feedback, so please email us at podcast.cjs@gmail.com.

Bio:

Morad Hameed is a trauma surgeon, intensivist, and public health researcher. He completed medical school and surgical residency at the University of Alberta, graduate studies in public health at Harvard University, and fellowships in Trauma Surgery and Surgical Critical Care at the University of Miami. He spent 3 years on the surgical faculty at the University of Calgary, before moving to the University of British Columbia (UBC), where he spent 19 years at the Vancouver General Hospital (VGH), which is the home of province-wide centers of excellence in trauma surgery and critical care.
 
 His clinical interests span innovations in trauma surgery and emergency general surgery (including chest wall trauma, abdominal wall reconstruction, and applications of extracorporeal life support in trauma), process and quality improvement, surgical rescue, value-based healthcare, and surgical systems. He has been a committed surgical educator who served as the director of one of Canada’s most dynamic surgical residency programs, and one of its most accomplished trauma and acute care surgery fellowship programs. He has won divisional, departmental, hospital-wide, and province-wide awards for his teaching. His main research interest is in public health aspects of trauma and emergency surgery, including social determinants of health and disparities in access to high quality emergency surgical care, and his research programs have received support from the Michael Smith Foundation and the Canadian Institutes of Health Research.
 
 Dr. Hameed’s leadership roles have included terms as the Head of the VGH and UBC Divisions of General Surgery and President of the Canadian Association of General Surgeons. His work with these organizations has prioritized creativity, innovation, inclusive networks, and cross-disciplinary partnerships to rethink and redesign systems of surgical care.
 
 He is excited to arrive at Stanford, where he is blessed to begin to work with another exceptionally talented group of trauma and acute care surgeons and intensivists. At Stanford, Dr. Hameed is inspired to help build surgical services that explore the intersections of surgery with data science, organizational theory, public health, global health, and sustainability, and that contribute to the pursuit of universal access to high quality surgical care and the highest standards of human health in California and around the world.

Links:

1. E141 Journal Club with Morad Hameed on Cardiac Injuries
2. E105 Death, Dying, and MAID in Surgery with Kelly Vogt and Morad Hameed
3. E94 Mental Health and Surgery with Rebecca Afford, JJ Sidhu and Morad Hameed
4. E28 Equity in Surgery with Julius Ebinu, Shahzeer Karmali, and Morad Hameed
5. E14 COVID19 with Neil Parry And Morad Hameed
6. E02 Morad Hameed on Process-Mapping in ACS

Selwyn O. Rogers Jr., MD, MPH, FACS, is a widely respected surgeon and public health expert. As founding director of the University of Chicago Medicine Trauma Center, Dr. Rogers is building an interdisciplinary team of specialists to treat patients who suffer injury from life-threatening events, such as car crashes, serious falls and gun violence. His team works with leaders in the city's trauma network to expand trauma care on the South Side.

Dr. Rogers has served in leadership capacities at health centers across the country, including most recently as vice president and chief medical officer for the University of Texas Medical Branch at Galveston. Dr. Rogers has also served as the chair of surgery at Temple University School of Medicine and as the division chief of trauma, burns and surgical critical care at Harvard Medical School. While at Brigham and Women's Hospital (BWH), he helped launch the Center for Surgery and Public Health to understand the nature, quality and utilization of surgical care nationally and internationally.
Additionally, as executive vice president for community health engagement, Dr. Rogers works with faculty across the University of Chicago as well as members of the community to develop a multidisciplinary approach to trauma care and health disparities. His work will help enhance the understanding of social factors that affect victims of violence and underserved populations, in addition to identifying approaches necessary to achieve better outcomes for trauma victims.

Dr. Rogers' clinical and research interests focus on understanding the healthcare needs of underserved populations. He has published numerous articles relating to health disparities and the impact of race and ethnicity on surgical outcomes.

Twitter: https://x.com/selwyn_rogers 

Links:

1. Ann Surg. 2024 Jul 1;280(1):29-31. doi: 10.1097/SLA.0000000000006258. Epub 2024 Mar 5.When Equality Is Not Equity: The Ethics of Access to Trauma Care: A Surgical Perspective. Bethany L Strong 1, Franklin Cosey-Gay 2, Kenneth L Wilson 2, Selwyn O Rogers Jr 2
2. Scarlet S, Rogers SO Jr. What Is the Institutional Duty of Trauma Systems to Respond to Gun Violence? AMA J Ethics. 2018 May 1;20(5):483-491. doi: 10.1001/journalofethics.2018.20.5.msoc2-1805. PMID: 29763395.
3. Chang DC, Oseni TO, Strong BL, Molina G, Ortega G, Chen H, Rogers SO Jr. The Other Global Pandemic: Scientific Racism and the Normality Bias. Ann Surg. 2021 Dec 1;274(6):e646-e648. doi: 10.1097/SLA.0000000000005168. PMID: 34387208.

This episode is a recording of the Queen’s Department of Surgery William Ersil Research Day. This year our invited speaker was Dr. Thomas Forbes, chief of surgery at University Health Network in Toronto and Editor-in-Chief of the Journal of Vascular Surgery.
In this “How I Built This” style episode in front of a live audience, we explored Dr. Forbes background, his training, the future of residency/fellowship training, his approach to leadership and how he goes “all in” for both work and his family life.
Thanks again to the Department of Surgery at Queen’s for allowing us to record this and to all those in attendance for being such a wonderful audience.

Bio: Dr. Forbes is Professor of Surgery and Chair of the Division of Vascular Surgery at the University of Toronto, a position he has held since 2014. He obtained his medical degree in 1990 from the University of Toronto and completed his general surgery and vascular surgery training at the University of Western Ontario. He is the co-Program Director of the Advanced Aortic Surgery Fellowship at the University of Toronto, a collaborative fellowship between vascular and cardiac surgery in open and endovascular therapies for thoracoabdominal aortic pathologies. Previously he was Chair/Chief of the Division of Vascular Surgery at the University of Western Ontario (2005-2014) and the inaugural Graduate Program Chair of the Masters of Science in Surgery program. He has published over 200 peer-reviewed papers, editorials and book chapters and given over 100 invited lectures or guest professorships. He is currently an Associate Editor of the Journal of Vascular Surgery and the Canadian Journal of Surgery and a member of several editorial boards. He is the Past-President of the Canadian Society for Vascular Surgery, Section Editor of Rutherford’s Textbook of Vascular Surgery and the Chair of the Vascular Care Working Group of the Cardiac Care Network in Ontario. He is also a former Program Director and vice-Chair of the Vascular Surgery Specialty Committee of the Royal College of Physicians and Surgeons of Canada.
Links:

1. https://surgery.queensu.ca/research/william-ersil-resident-research-day
2. Providing high-quality open aortic surgical care in the endovascular era. https://www-sciencedirect-com.proxy.queensu.ca/science/article/pii/S074152142200427X?via%3Dihub
3. Advanced Aortic fellowship: https://surgery.utoronto.ca/sites/default/files/inline-files/2025%20Fellowship%20in%20Advanced%20Aortic%20Surgery.pdf
4. https://www.audiblebleeding.com/forbes/

Dr. Vahagn Nikolian (https://twitter.com/VNikolian?s=20) has been thinking about the way we can adopt virtual care far before the COVID19 pandemic. Dr. Nikolian is a surgeon at Oregon Health & Science University and specializes in abdominal wall reconstruction. In this episode, we talk to him about how he got interested in telehealth, how we can streamline telehealth consults, and where he sees telemedicine going in the future. 

1. Pilot study on eClinics: https://journals.lww.com/annalsofsurgery/Fulltext/2018/10000/Pilot_Study_to_Evaluate_the_Safety,_Feasibility,.18.aspx

2. Role of telemedicine in postoperative care: https://mhealth.amegroups.com/article/view/19310/19390

3. Touch. CMAJ. https://www.cmaj.ca/content/183/18/2141

4. Surgical plans generated from telemedicine visits are rarely changed after in-person evaluation in spine patients. https://pubmed.ncbi.nlm.nih.gov/33227550/

Bio:
Twitter: @VNikolian
Link to OHSU profile: https://www.ohsu.edu/people/vahagn-c-nikolian-md

Dr. Vahagn Nikolian is a board-certified General Surgeon with advanced training and expertise in abdominal wall reconstruction. He is a member of a talented team of surgeons at OHSU where he uses his experience and research to help advance the treatment of patients with hernias and abdominal wall defects.

Dr. Nikolian was raised in Southern California, where he attended medical school and graduated with honors from the University of Southern California. He completed his surgical residency at the University of Michigan. He completed his complex abdominal wall reconstruction fellowship at Columbia University Medical Center in New York City. His research and commentaries have been published in several prominent journals such as the Journal of the American Medical Association and Annals of Surgery. His research at OHSU involves utilizing technology to improve patient care. Specifically, he directs his efforts towards improving access to digital health and improving outcomes in hernia surgery using minimally invasive and robotic surgical technology. To date, he has over 60 peer-reviewed publications and book chapters focused on general surgery, resident education, and digital health. He has received numerous national awards as well as funding from the National Institutes of Health and other surgical societies.

Dr. Nikolian aims to work with patients, their families, and primary care doctors to develop patient-centered treatment plans. He looks forward to collaborating with other specialists to give patients the most options and the best possible outcomes.

It’s not uncommon for surgeons to think about taking a break at various points in their career, but for many of us, it might seem daunting to think about how to make that happen. Dr. Paul Duffy is an orthopedic surgeon, Clinical Assistant Professor and Division Chief of Orthopedia Trauma at the Foothills Medical Centre in Calgary, Alberta. He recently gave a fantastic grand rounds for the Department of Surgery in Calgary about his experience taking a 6 month sabbatical. In this episode, we asked him to share with us his thoughts on his career and “taking a break” in the form of a sabbatical.

Dr. Melissa “Red” Hoffman is one of only 80 dual-boarded trauma surgeons and palliative care physicians in the US. She joined us on this episode to talk about surgical palliative care and how surgeons can potentially do this better. We also ask her about her life journey informs the work that she does today, including her outstanding writing. 

Links:

1. Dr. Melissa Red Hoffman: https://redhoffmanmd.com/
2. The Sound of Silence – When there are no Words. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2737686
3. Surgical Palliative Care podcast: https://redhoffmanmd.com/podcast/ 
4. Being Mortal by Atul Gawande: http://atulgawande.com/book/being-mortal/
5. The impact of country and culture on end-of-life care for injured patients: results from an international survey. https://pubmed.ncbi.nlm.nih.gov/21045742/

Bio (From Dr. Hoffman’s website):

When she was 19 years old, Dr. Red’s father was tragically killed in Cairo, Egypt. Her father’s violent death, and the experiences which followed, inspired her to pursue a career in both trauma surgery and hospice and palliative medicine. She now utilizes both her integrative medicine training as well as her training in palliative medicine to provide whole-person care to her surgical patients and their families.

As one of just 80 surgeons in the United States who is board-certified in hospice and palliative medicine, Dr. Red is a leader in the field of surgical palliative care.

She writes and speaks extensively on how to integrate palliative medicine into the care of all surgical and trauma patients. She has an active online presence, has a bi-monthly column in General Surgery News entitled The Surgical Pause and is the creator and host of The Surgical Palliative Care Podcast.

In her free time, Dr. Red enjoys writing, reading, taking long walks, eating gorgeous food and drinking yummy drinks, and spending time with her orange cat Sammy and her boyfriend Brandon.

Dr. Marcus Burnstein is a colorectal surgeon at St. Michael's Hospital in Toronto, Ontario. In this episode, we ask him to break down his approach to patients presenting with anal pain, perianal abscess, and perianal fistula. We also hear about the famous "circle of love"!

Check out the CAGS seminar on perianal disease on April 1 at 7 pm ET! Register here: https://cags-accg.member365.ca/public/event/details/1c1d9fd96fc1866649258c9aee3cff283c4c2fe4/1

Also, check out the CAGS video library for all previously recorded CAGS webinars: https://cags-accg.member365.ca/sharingnetwork/education/videolibrary

Bio (from U of T website):

Dr. Burnstein is a graduate of the Faculty of Medicine, Dalhousie University. He trained in General Surgery at the University of Toronto and in Colon and Rectal Surgery at the University of Toronto and the Lahey Clinic Medical Centre in Burlington, Massachusetts.

Dr. Burnstein began his career at Dalhousie University in 1986. He was the Program Director of the General Surgery Residency Program at Dalhousie University from 1989 – 1992. In 1992, Dr. Burnstein joined the Department of Surgery at the University of Toronto, where he has been the Program Director of the General Surgery Residency Program (1994 – 2001) and Head, Division of General Surgery, St. Michael's Hospital (1996 –2003). He was the Program Director of the University of Toronto Residency Program in Colon and Rectal Surgery from 1996 - 2011.

Dr. Burnstein is a Member of the Board of Directors of the American Board of Colon and Rectal Surgery and is an Examiner for the American Board. He has served as an Associate Editor of Diseases of the Colon and Rectum and an Associate Editor of the Canadian Journal of Surgery. He has served as the President of the Canadian Society of Colon and Rectal Surgeons and as the Chair of the Royal College of Canada Specialty Committee for Colon and Rectal Surgery.

Dr. Burnstein is an Associate Professor of Surgery at the University of Toronto, and practices at St. Michael's Hospital.

This episode we had a special guest, Dan Van Hooren. Dan is the head coach for the University of Calgary Dinos basketball team and is a legend in Canadian university basketball history (see bio below). We asked Dan to tell us about what goes into creating great teams - the parallels to surgery were striking!

Links:
1. Georges Laraque book: https://www.amazon.ca/Georges-Laraque-Story-Unlikeliest-Tough/dp/0143181017
2. Wooden: A Lifetime of Observations On and Off the Court: https://www.amazon.ca/Wooden-Lifetime-Observations-Reflections-Court/dp/0809230410
3. Eleven Rings: The Soul of Success by Phil Jackson: https://www.amazon.ca/Eleven-Rings-Success-Phil-Jackson/dp/0143125346
4. The 7 Habits of Highly Effective People: https://www.franklincovey.com/the-7-habits/
5. Legacy (All Blacks) by James Kerr - https://www.chapters.indigo.ca/en-ca/books/legacy/9781472103536-item.html
6. The Inner Game of Tennis: https://www.amazon.ca/Inner-Game-Tennis-Classic-Performance/dp/0679778314
7. The Gold Standard: Building a World-Class Team by Coach K: https://www.goodreads.com/book/show/6033770-the-gold-standard

Bio (from Dinos website):

Dan Vanhooren joined the Dinos in May 2000 and is the seventh men’s basketball head coach at the University of Calgary.

Since he took over the program, Vanhooren’s Dinos have made a steady climb into elite status in U SPORTS basketball. In just four years, he took a program that had not enjoyed a winning season in nearly a decade all the way to the conference title and within two points of the national final in 2004. It was Calgary’s first Canada West championship since 1993, and their first-round victory at the Final 8 in Halifax was the Dinos’ first national quarterfinal win in 38 years. The two-point semifinal loss came at the hands of the Carleton Ravens, who went on to win the CIS title.

In 2008, he coached the Dinos to their best conference record since 1976 (18-4) and played host to the Canada West Final Four in front of a sold-out Jack Simpson Gym. Eight years later in 2016, the Dinos won their sixth Canada West Championship and went on to compete in the national finals for the first time since 1966 against the Carleton Ravens. The Dinos finished with a silver medal. It was the first of five consecutive trips to the national tournament for the Dinos, who captured three conference titles in four years (2016, 2018, 2019) and reached the program's pinnacle with the 2018 national championship - a 79-77 win over Ryerson in Halifax.

The following season, the Dinos posted the first undefeated season in program history at 20-0, winning an eighth Canada West title before falling in the national final. Vanhooren earned his second Canada West coach of the year honour in 2018-19 and became the first Dinos coach to win the Stewart W. Aberdeen Trophy as U SPORTS coach of the year the same season.

Currently, he is head coach of the Canadian national junior team.

Vanhooren moved to Calgary following a four-year stint as head coach of Medicine Hat College. In 2000 he coached the Rattlers to a bronze medal finish and was named the ACAC south coach of the year.

He played varsity basketball at the University of Alberta under the legendary Don Horwood. After three seasons with the Golden Bears, Vanhooren graduated with a Bachelor of Physical Education in 1993 and moved to graduate studies at the University of British Columbia. While attending UBC he worked for the NBA’s Vancouver Grizzlies in their inaugural season, and he received his Master’s of Human Kinetics in 1996.

Vanhooren is a certified NCCP Level III coach.

Dan and his wife Kara reside in northwest Calgary with their three children: Peyton, Wyatt, and Nash.

Dr. Mark Soliman (https://twitter.com/MarkSoliman?s=20) is a colorectal surgeon at Advent Health in Orlando, Florida. We got to talk to Dr. Soliman about his passion for robotic colorectal surgery and where he sees robotics going in the future. We then did a deep dive on the use of video in surgery, from how to edit surgical videos to how Dr. Soliman incorporates video into resident education!

Links:

1. Dr. Soliman's YouTube channel: https://www.youtube.com/channel/UChQEa8aXKsDLFA85in8YIUA

2. How to start a robotic program: https://www.sages.org/video/robotic-startup-tips-tricks-to-a-successful-start/

Bio (from AdventHealth website):

Mark Soliman, MD, FACS, FASCRS is a board-certified colon and rectal surgeon. He is the Medical Director of Colorectal Surgery for the AdventHealth Digestive Health and Surgery Institute and also the Department Chairman for Colorectal Surgery. A Florida native and a proud graduate of the University of Florida, he was part of an elite junior medical program through which he earned both his undergraduate and medical degrees with honors by age 23. After serving as Chief Resident at Baptist Health System in Birmingham, AL, he obtained his advanced subspecialty training in Colorectal Surgery at the Colon and Rectal Clinic of Orlando. Dr. Soliman is one of the most recognized colorectal surgeons nationwide in robotic colorectal surgical operations and has written nearly 50 book chapters, scientific abstracts, and manuscripts on this and its related fields. He is proficient in the Arabic language.

Dr. Clay Cothren Burlew is a trauma surgeon in Denver, Colorado. She is world-renowned for her work on pelvic packing as well blunt cerebrovascular injuries, among many other things. We caught up with her to find out how she manages stay so productive, and specifically to talk to us about pelvic packing and blunt cerebrovascular injury. 

Twitter: https://twitter.com/ClayBurlew?s=20

Links:

1. Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents.
Cothren CC, Biffl WL, Moore EE, Kashuk JL, Johnson JL.
Arch Surg. 2009 Jul;144(7):685-90.

2. Preperitoneal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift.
Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR.
J Trauma. 2007 Apr;62(4):834-9; 

3. Occam's razor is a double-edged sword: concomitant pulmonary embolus and fat embolism syndrome.
Cothren CC, Moore EE, Vanderheiden T, Haenel JB, Smith WR.
J Trauma. 2008 Dec;65(6):1558-60. 

Bio (from https://www.eventscribe.com/2020/AAST2020/fsPopup.asp?Mode=presenterInfo&PresenterID=931211):

Dr. Clay Cothren Burlew is a Professor of Surgery at Denver Health Medical Center/University of Colorado. Dr. Burlew grew up in San Antonio, Texas. She is a graduate of Amherst College, earning her degree in Biology magna cum laude. She attended medical school at UT Southwestern Medical School, where she was ranked 1st in her class and was elected to the Alpha Omega Alpha medical honor society. She completed her general surgery residency and Surgical Critical Care fellowship at the University of Colorado. At DHMC she is the Associate Chief of the Department of Surgery and the Director of the Surgical Intensive Care Unit. She is also the Program Director of the Surgical Critical Care Fellowship and the AAST-approved Trauma & Acute Care Surgery Fellowship.

Dr. Burlew is an active surgical investigator, educator, and clinician; she has received multiple awards in each of these areas including the J. Cuthbert Owens Award, the DHMC Award for Academic Excellence, the Bartle Faculty Teaching Award, the Eiseman Medical Student Teaching Award, the Academy of Medical Educator's award for Excellence in Mentoring, and the 2017 American College of Surgeons Travelling Fellowship to Australia/New Zealand. She serves on the Committee on Trauma for the American College of Surgeons, the Board of Managers for the American Association for the Surgery of Trauma, and is a Past-President of the Southwestern Surgical Congress. She is on the Editorial Board of The Journal of Trauma and Acute Care Surgery, The World Journal of Emergency Surgery, and Trauma Surgery and Acute Care Open, and reviews for an additional 15 journals in an ad hoc capacity. She has authored over 200 peer-reviewed articles and 70 book chapters. She has given over 100 national lectures and scientific presentations.

In this episode we interview Dr. Lawrence Gillman, a trauma surgeon at the University of Manitoba. We start off talking about the course that he and Dr. Sandy Widder developed, the Simulated Trauma and Resuscitation Team Training (STARTT course). We also get his thoughts on mentoring in point-of-care and trauma ultrasound. Finally, and most powerfully, Dr. Gillman shares his experience having to cope with the love of his beloved wife Kerry, and the impact that has had on his family and his career.

Links:

1. S.T.A.R.T.T.: development of a national, multidisciplinary trauma crisis resource management curriculum-results from the pilot course. https://pubmed.ncbi.nlm.nih.gov/24158191/

2. Andy Kirkpatrick on Telementored Ultrasound: https://soundcloud.com/cjs-podcast/e06-andy-kirkpatrick

3. Strategies to improve communication in telementoring in acute care coordination: a scoping review. https://pubmed.ncbi.nlm.nih.gov/33253511/

4. Trauma Team Dynamics textbook: https://www.amazon.ca/Trauma-Team-Dynamics-Resource-Management/dp/3319165852

5. Cozi app: https://www.cozi.com/

Bio (from https://umanitoba.ca/faculties/health_sciences/medicine/units/surgery/8759.html):

Dr. Gillman completed medical school and surgical residency at the University of Manitoba. He subsequently completed a Masters in Medical Education at the University of Dundee followed by fellowship training in Critical Care Medicine and Trauma Surgery at the University of Calgary. He joined the Department of Surgery at the University of Manitoba in 2010 as an assistant professor and currently practices as an Acute Care/Trauma Surgeon and Intensivist.
Research Focus
Dr. Gillman’s research interests include point of care ultrasound, surgical education and crisis simulation. Specifically he is focusing on improving training in point of care ultrasound including redeveloping the credentialing process for the FAST (Focused Assessment with Sonography for Trauma) examination. Other work in this area focuses on validating the use of ultrasound to measure the optic nerve sheath diameter as a non-invasive way to predict intracranial pressure. On the surgical education side, he is working on developing a novel video game platform utilizing an endoscope as a controller to teach early endoscopy skills. Finally, Dr. Gillman is co-founder of the S.T.A.R.T.T. (Standardized Trauma and Resuscitation Team Training) Course, a national trauma crisis simulation course, and is working on developing and improving the course curriculum.

Jessica Grossman is a digital marketer, actress and model. She also is a powerful advocate for patients with Crohns disease. She specifically has done so much to destigmatize what it’s like to live with a stoma, which is a surgically created opening that allows stool to exit the body into a bag. Her work with her website uncoverostomy.org has garnered widespread attention and is an incredible resource for patients with inflammatory bowel disease. In this episode, we explored what it’s like to live with a stoma, and what physicians and surgeons can do better when counseling patients who might have or need a stoma. 
Jessica's social media:

Instagram: https://www.instagram.com/jessgrossman/?hl=en
Twitter: https://twitter.com/JessGrossman?s=20

Uncoverostomy on Social Media:
Twitter: https://twitter.com/uncoverostomy?s=20
Instagram:  https://www.instagram.com/uncoverostomy/

Links:

1. https://uncoverostomy.org/
2. https://uncoverostomy.org/2021/04/22/the-covid-19-vaccine-whats-the-worst-that-can-happen/
3. https://uncoverostomy.org/2019/10/03/time-stop-showing-off-ostomy-10-years-uncover-ostomy/

Dr. Peter Angelos (https://twitter.com/pangelos1?s=20) is an endocrine surgeon at the University of Chicago and is really one of the founders of the field of surgical ethics. We ask him to define for us the term “surgical ethics” and chat about a number of important ethical issues such as informed consent, paternalism, and the limits of disclosure. 

Links:

1. SOUTHWESTERN SURGICAL CONGRESS EDGAR J. POTH MEMORIAL LECTURE. Surgical ethics and the challenge of surgical innovation. https://www.americanjournalofsurgery.com/article/S0002-9610(14)00457-7/fulltext

2. Dr. Angelos’s column on MD Edge: https://www.mdedge.com/authors/peter-angelos-md-phd-facs

3.The personal dimension of informed consent: https://www.mdedge.com/surgery/article/79179/personal-dimension-informed-consent

4. David Urbach on the word “leaks”: https://soundcloud.com/cjs-podcast/e17-david-urbach-on-checklists-wait-times-in-the-time-of-covid-and-medical-devices

5. Tim Pawlik: https://soundcloud.com/cjs-podcast/e26-tim-pawlik-on-surgical-regret-leadership-and-academic-success

6. The Right Choice? Paternalism, Autonomy, and the Incidental Finding. https://www.mdedge.com/surgery/article/88487/right-choice-paternalism-autonomy-and-incidental-finding 

7. How was your night, Doc? The limits of disclosure in preop. https://www.mdedge.com/obgyn/article/77752/how-was-your-night-doc-limits-disclosure-preop

8. How to Solve Ethical Conflicts in Everyday Surgical Practice: A Toolbox. https://link.springer.com/chapter/10.1007%2F978-3-030-05964-4_29

Bio (from https://www.uchicagomedicine.org/find-a-physician/physician/peter-angelos)

Peter Angelos, MD, PhD, is a highly regarded surgeon who has extensive experience in surgery of the thyroid, parathyroid and adrenal glands. He is also an expert in treating endocrine cancers, including thyroid, parathyroid and adrenocortical cancers, as well as islet cell tumors of the pancreas.

Dr. Angelos has a special interest in minimally invasive endocrine surgery, a type of surgery that is performed through small incisions. Minimally invasive surgery has many benefits for patients -- from less scarring and pain, to a shorter hospital stay and a quicker recovery.

An accomplished author, Dr. Angelos has published many journal articles and book chapters on his research into improving outcomes of thyroid and parathyroid surgery, minimally invasive endocrine surgery and best practices for thyroid cancer treatment.

Dr. Angelos is a recognized expert in medical ethics, and serves as associate director of the University of Chicago MacLean Center for Clinical Medical Ethics. He has written widely on ethical issues in surgical practice and how to best teach medical ethics to surgical residents.

He is past president of the American Association of Endocrine Surgeons.

This week we have a treat for our listeners – two episodes with Dr. Colin Schieman. Dr. Schieman is a thoracic surgeon at the University of Calgary and the current program director for the thoracic surgery program. We discuss a key issue in modern surgical training – are direct entry programs good or bad for training and trainees? Dr. Schieman also gives his approach for intra operative teaching. 

Don’t forget to check out our bonus episode this week, where Dr. Schieman gives us his approach to lung nodules and lung cancer screening!

Links:

1. Scott Gmora: https://soundcloud.com/cjs-podcast/e05-scott-gmora-on-surgical-training

2. Thoracic surgery training in Canada: https://www.jtcvs.org/article/S0022-5223(16)31423-4/pdf

3. General thoracic surgical training in North America: Contrasting general thoracic surgery residencies in Canada and the United States. https://www.sciencedirect.com/science/article/pii/S0022522318318579?via%3Dihub

Bio:
Dr. Colin Schieman is a Clinical Associate Professor at the University of Calgary in the section of thoracic surgery. He did medical school, residency, and thoracic surgery fellowship at the University of Calgary. He then went on to do additional thoracic surgery training at Mayo Clinic, and subsequently practiced at St. Joseph's Hospital in Hamilton, Ontario. He came back to the University of Calgary as Assistant Professor in 2016, and is now the Program Director for the Thoracic Surgery Fellowship program.

E77 Masterclass With Colin Schieman On Lung Nodules And Lung Cancer Screening by Canadian Journal of Surgery

Dr. Brian Cameron is a pediatric surgeon at McMaster University in Hamilton, Ontario. He has dedicated himself both to pediatric surgery and to global surgery, and has worked around the world in resource-limited settings. This was a particularly memorable episode for us because Dr. Cameron retires this year! This episode was a chance for us to ask him about his career, his life story, and of course, global surgery. Congratulations again to Dr. Cameron on his well-earned retirement!

Links:

1. Establishing disability weights for congenital pediatric surgical conditions: a multi-modal approach. Poenaru D, Pemberton J, Frankfurter C, Cameron BH, Stolk E. Popul Health Metr. 2017 Mar 4;15(1):8. doi: 10.1186/s12963-017-0125-5. PMID: 28259148 Free PMC article.

2. Procedural skills training for Canadian medical students participating in international electives. Margolick J, Kanters D, Cameron BH. Can Med Educ J. 2015 Apr 20;6(1):e23-33. eCollection 2015. PMID: 26451227 Free PMC article.

3. Surgical training in Guyana: the next generation.
Cameron BH, Martin C, Rambaran M.
Can J Surg. 2015 Feb;58(1):7-9. doi: 10.1503/cjs.010414.
PMID: 25621909 Free PMC article.

4. Evaluating the long-term impact of the Trauma Team Training course in Guyana: an explanatory mixed-methods approach.
Pemberton J, Rambaran M, Cameron BH.
Am J Surg. 2013 Feb;205(2):119-24. doi: 
10.1016/j.amjsurg.2012.08.004. Epub 2012 Dec 13.
PMID: 23246285

5. International surgery: the development of postgraduate surgical training in Guyana.
Cameron BH, Rambaran M, Sharma DP, Taylor RH.
Can J Surg. 2010 Feb;53(1):11-6.
PMID: 20100407 Free PMC article.

6. Teaching in Fiji: practising medicine, coping with coups.
Cameron BH.
CMAJ. 1989 Apr 1;140(7):833-5.
PMID: 2924235 Free PMC article. No abstract available.

7. Lancet commission on global surgery: https://www.thelancet.com/commissions/global-surgery

8. Bethune Roundtable: https://www.cnis.ca/what-we-do/public-engagement-in-canada/bethune-round-table/

9. Morad Hameed Trauma system app: https://www.em-consulte.com/article/859211/the-electronic-trauma-health-record-design-and-usa

10. Masters of Global Surgical Care at UBC: https://www.grad.ubc.ca/prospective-students/graduate-degree-programs/master-global-surgical-care

Bio ( from https://www.ccghr.ca/q-brian-cameron/):

Dr. Brian Cameron is a Professor of Pediatric Surgery at McMaster University and a pediatric surgeon at McMaster Children Hospital. He is the director of both the McMaster International Surgery Desk and MacGlObAS. His research interests include global surgical research and education.

Leena Yousefi is a multiple award winning family lawyer and founder of YLaw in Vancouver, BC. We asked her to come on the show to talk a difficult subject: divorce. Leena has some really insightful comments on some of the factors that specifically seem to play a role in physician divorce, as well as some of the advice she gives her clients who unfortunately end up going through a divorce.

YLaw website: https://www.ylaw.ca/
YLaw twitter: https://twitter.com/ylawfamilylaw?s=20
Leena Yousefi featured on BBC: https://www.bbc.com/news/business-52481276

Bio (from YLaw website): 

Leena (Ronak) Yousefi is a multi award winning family lawyer, accredited mediator and the founder of YLaw, the fastest growing female-led law firm in Western Canada.

She has been chosen as one of the Top 25 Most Influential Lawyers in Canada, one of  Business in Vancouver’s Top 40 under 40, and voted as the #1 top-rated Vancouver Divorce Lawyer in BC*. She has won over 90% of her family law cases from 2013 to present*.

In 2020, she was named by Lexpert as the only family lawyer in Canada to become the Rising Star of the legal profession.

This week we were joined by an icon of surgery, Dr. Ken Mattox. Dr. Mattox talked to us about the evolution of trauma surgery, the development of the Trauma textbook, the Las Vegas Trauma, Critical Care, and Acute Care Surgery Conference, and why he thinks we need to challenge the status quo.

Links:

1. Trauma textbook: https://www.amazon.ca/Trauma-Seventh-Kenneth-L-Mattox/dp/0071663517

2. Top Knife: https://www.amazon.ca/Top-Knife-Craft-Trauma-Surgery/dp/1903378222

3. Comment on trauma care systems in Saudi Arabia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931788/

4. Trauma, Critical Care, and Acute Care Surgery (TCCACS) Las Vegas course: https://www.trauma-criticalcare.com/tccacs/home/

5. Quiet Zone Facebook group: https://www.facebook.com/groups/538557893206223/

6. Randomized trial of pneumatic antishock garments in the prehospital management of penetrating abdominal injuries. https://pubmed.ncbi.nlm.nih.gov/3578970/

7. Extreme Ownership: How U.S. Navy SEALs Lead and Win. https://www.amazon.ca/Extreme-Ownership-U-S-Navy-SEALs/dp/1250067057

View full episode transcript: http://canjsurg.ca/cold-steel-episode-80-kenneth-mattox/ 

Bio (from https://www.bcm.edu/departments/surgery/meet-our-team/history-of-leadership/kenneth-l-mattox-m-d):

Dr. Kenneth L. Mattox is a distinguished service professor at Baylor College of Medicine and formerly chief of staff and surgeon-in-chief at Ben Taub Hospital, where he has worked since 1973.  One of his most remarkable contributions was his work in establishing and developing the internationally renowned Ben Taub Hospital Emergency Center and Trauma Center. Dr. Mattox is past President of the American Association for the Surgery of Trauma and Secretary-Treasurer of the Michael E. DeBakey International Surgical Society. He previously chaired the Mayor's Red Ribbon Committee to address the Houston Fire Department Emergency Medical Service. He sat on the Hospital Subcommittee of the Mayor's Special Task Force on the Medical Aspects of Disaster. Currently, Dr. Mattox serves as a consultant to the Center for Biologic Evaluation and Research of the FDA.

Dr. Mattox has served on the Board of Directors of the Rotary Club of Houston, Doctors’ Club of Houston, Wayland Baptist University, the American Association for the Surgery of Trauma, the Southeast Texas Trauma Regional Advisory Council, the American College of Surgeons Board of Governors, and serves as Chairman of the Board of the John P. McGovern Museum for Health and Medical Science.

We were joined this week by Drs. Rhea Liang (https://twitter.com/LiangRhea?s=20) and Simon Fleming (https://twitter.com/OrthopodReg?s=20) to talk about bullying, psychological safety, and culture change in surgery. We hope that the episode can be an opportunity for discussion and reflection for listeners.

Links:

1. RCS England Theatre podcast: https://anchor.fm/rcseng/episodes/Culture-Change-Why-do-we-need-culture-change-ekeo1v/a-a3djbs4

2. Simon Fleming: I launched an anti-bullying campaign to change culture in healthcare -https://blogs.bmj.com/bmj/2019/04/10/simon-fleming-i-launched-an-anti-bullying-campaign-to-change-culture-in-healthcare/

3. Operate with Respect: https://www.surgeons.org/en/about-racs/about-respect

4. Why do women leave surgical training? A qualitative and feminist study. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32612-6/fulltext

5. All of us have a survivorship bias in regard to how we were trained in medicine. https://blogs.bmj.com/bmj/2020/11/30/all-of-us-have-a-survivorship-bias-in-regard-to-how-we-were-trained-in-medicine/

Bios: 

Associate Professor Rhea Liang (twitter: @LiangRhea) is a general and breast surgeon on the Gold Coast. She is a surgical educationalist, Surgical Discipline Lead at Bond University and the immediate past Chair of the Operating With Respect Education Committee, RACS. She also researches, advocates and consults widely in diversity and equity issues.

Simon Fleming (twitter: @OrthopodReg) is a London-based Trauma and Orthopaedic registrar. While passionate about Orthopaedics, surgical training & mentoring, he has special interests in hand surgery, competency decisions & combating bullying, undermining, harassment and the lack of diversity and equity in healthcare. He undoes all the good work he does in the gym with a love of great food and tries to change the world in his spare time.

Read full transcript here: http://canjsurg.ca/e82-chuck-vollmer-masterclass-on-pancreatic-fistulas/

Dr. Charles "Chuck" Vollmer joined us again for this episode for a masterclass on pancreatic fistulas. Please listen to our previous episode with Dr. Vollmer for more about him, his career, and his fascination with all things pancreas.

Previous episode with Dr. Vollmer: https://soundcloud.com/cjs-podcast/e33-chuck-vollmer-on-peer-review-and-productivity

Bibliography for this episode:

1. The Surgery of the Pancreas. https://www.amazon.com/Surgery-Pancreas-richard-cattell/dp/B0000CIKY7

2. Pancreaticoduodenectomy for Islet Carcinoma : A Five-Year Follow-Up
A O Whipple. https://pubmed.ncbi.nlm.nih.gov/17858621/

3. Of Fistula and Football. https://pubmed.ncbi.nlm.nih.gov/32976277/

4. Decision points in pancreatoduodenectomy: Insights from the contemporary experts on prevention, mitigation, and management of postoperative pancreatic fistula. https://pubmed.ncbi.nlm.nih.gov/33892952/

5. The Fistula Risk Score Catalog: Toward Precision Medicine for Pancreatic Fistula After Pancreatoduodenectomy. https://pubmed.ncbi.nlm.nih.gov/32541227/

6. Taking Theory to Practice: Quality Improvement for Pancreaticoduodenectomy and Development and Integration of the Fistula Risk Score. https://pubmed.ncbi.nlm.nih.gov/29981917/

7. Risk Prediction for Development of Pancreatic Fistula Utilizing the ISGPF Classification Scheme. https://pubmed.ncbi.nlm.nih.gov/18175170/

8. Postoperative pancreatic fistula: an international study group (ISGPF) definition. https://pubmed.ncbi.nlm.nih.gov/16003309/

9.  Defining the practice of pancreatoduodenectomy around the world. https://www.sciencedirect.com/science/article/pii/S1365182X15320165

10. The Influence of Intraoperative Blood Loss on Fistula Development Following Pancreatoduodenectomy. https://pubmed.ncbi.nlm.nih.gov/33201132/

11. Extended Experience with a Dynamic, Data-Driven Selective Drain Management Protocol in Pancreaticoduodenectomy: Progressive Risk Stratification for Better Practice. https://pubmed.ncbi.nlm.nih.gov/32081751/

12. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. https://pubmed.ncbi.nlm.nih.gov/20622661/

Dr. Jillian Horton (https://twitter.com/JillianHortonMD?s=20) is an an internist at Max Rady College of Medicine in Winnipeg and the author of "We Are All Perfectly Fine". In the book, Dr. Horton beautifully explores burnout and her own personal journey in medicine. We talked to her about the process of writing and the vulnerability involved with such an honest depiction of her own struggles, as well as where we can go with the culture of medicine to make training better. 

Links:

1. We Are All Perfectly Fine: https://www.harpercollins.ca/9781443461634/we-are-all-perfectly-fine/

2. Med Life with Dr. Horton: https://www.cmaj.ca/medlife

3. The ‘good’ doctor: It’s time to stop treating character like an afterthought in medicine – and everywhere else. https://www.theglobeandmail.com/opinion/article-the-good-doctor-its-time-to-stop-treating-character-like-an/

Bio (from https://www.gold-foundation.org/newsroom/news/dr-jillian-horton-2020-afmc-gold-humanism-award/):

Dr. Horton is a general internist who serves in multiple leadership positions at University of Manitoba’s Max Rady College of Medicine in Winnipeg, including: inaugural Director of the college’s and Faculty of Health Sciences programs in Physician and Learner Wellness; Director of the Alan Klass Health Humanities Program; and Associate Chair of the Department of Internal Medicine. Dr. Horton previously served as the Associate Dean of Undergraduate Student Affairs at the medical college. She has won numerous awards for mentorship, professionalism, and teaching.

Dr. Carl Brown (https://twitter.com/drcarl_vancouvr?s=20) is a colorectal surgeon at St. Paul’s Hospital in Vancouver, British Columbia. He gave us a masterclass on rectal cancer, starting really with the history of rectal cancer surgery to the evidence around neodjuvant therapy and then giving us a peek at the future of rectal cancer treatment. We then discuss how we should best adopt new technology such a TEM or taTME. A reminder to listeners that we know have the transcripts for all our episodes available on the CJS website – this is a handy written resource to go over, especially for detailed masterclasses like this one. As always, we welcome your feedback on twitter @canjsurg or via email at podcast.cjs@gmail.com.

Dr. Brown on Twitter: @drcarl_vancouvr

Links:

1. Techniques and technology evolution of rectal cancer surgery: a history of more than a hundred years. https://www.tandfonline.com/doi/full/10.1080/13645706.2016.1198381

2. Swedish Rectal Cancer trial in NEJM on preop radiotherapy- https://www.nejm.org/doi/full/10.1056/nejm199704033361402.

3. German Rectal cancer trail on preop vs post op radiotherapy - https://www.nejm.org/doi/full/10.1056/nejmoa040694

4. Dutch rectal cancer trail on preoperative radiotherapy plus TME (published in NEJM) - https://www.nejm.org/doi/full/10.1056/nejmoa010580

5. The "Holy" Plane of Rectal Cancer surgery by Healds - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291757/

6. Rates of Circumferential Resection Margin Involvement Vary Between Surgeons and Predict Outcomes in Rectal Cancer Surgery (Phil Quirke) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422458/

7. CCTG CO.28 primary endpoint analysis: Neoadjuvant chemotherapy, excision and observation for early rectal cancer, the NEO trial. https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.3508

8. Transanal endoscopic microsurgery: a review (by Dr. Brown in CJS) - http://canjsurg.ca/vol57-issue2/57-2-127/

9. Hey, I just did a new operation!: Introducing innovative procedures and devices within an academic health center. https://pubmed.ncbi.nlm.nih.gov/24866545/

10. IDEAL Collaboration: https://www.ideal-collaboration.net/

In this episode, repeat guest and co-editor in chief of CJS Dr. Ed Harvey joins us to discuss “innovation”. Innovation is one of those buzzwords that everyone loves to throw around and use, but rarely do we actually think about what it means to do innovative work and how we might be more innovative. Dr. Harvey is an orthopedic surgeon at McGill University in Montreal, and is involved in several startups developing new devices. We’d love to hear your thoughts – what makes someone “innovative”? What can we do to create environments that encourage innovation? Send us an email at podcast.cjs@gmail.com or tweet at us @canjsurg. 

Check out our previous interview with Dr. Harvey here: https://soundcloud.com/cjs-podcast/e49-ed-harvey-on-the-canadian-journal-of-surgery-and-ebm-in-surgery

Links:

1. Parodi and development of vascular graft: https://vascularnews.com/endovascular-revolution-in-the-aorta-25-years-of-a-landmark-case/

2. Crossing the Chasm: https://www.harpercollins.com/products/crossing-the-chasm-3rd-edition-geoffrey-a-moore?variant=32130444066850

3. The Pitch podcast: https://gimletmedia.com/shows/the-pitch

4. The Hard Thing About Hard Things: https://www.chapters.indigo.ca/en-ca/books/the-hard-thing-about-hard/9780062273208-item.html

Bio (adapted from https://rimuhc.ca/-/edward-harvey-md): 

Dr. Harvey is a Professor of Surgery and Senior Scientist at Centre for Translational Biology at McGill University. His research focuses on the repair and recovery of the orthopaedic trauma patient. Encompassing fundamental and clinical aspects of healing, his interests include implant and fracture optimization, stem cells and neovascularization, biosensors and evaluation of novel hardware and surgical approaches to expedite fracture repair, and innovation and business models in surgical discovery. He actively collaborates with basic scientists, clinicians and others to drive mutual research goals.

The Solving Healthcare podcast hosted by Kwadwo Kyeremanteng has launched medical podcasting in Canada into a whole new level. Dr. K is an intensivist based out of Ottawa, and his podcast, solving healthcare, has been a tremendous source of excellent information on COVID, medicine, exercise, nutrition, and so much more. As if he wasn’t busy enough, Dr. K has now also created the Solving Wellness platform, an online website and community that is targeted at wellness for healthcare workers. It was an absolute pleasure to throw down with Dr. K. We talk about our shared Edmontonian heritage, his work with the Solving Healthcare podcast, and the Solving Wellness platform. 

We are excited to announce that Cold Steel listeners can receive a free membership on the Solving Wellness platform if you go to the solving wellness website: www.drkwadwo.ca/solvingwellness and enter promo code: coldsteel. There are only 10 free memberships, so hurry to join! Remaining listeners can still get a 15% discount on their membership fees at Solving Wellness if you use promo code coldsteel15. 

Twitter:
Dr. K: https://twitter.com/kwadwo777?s=20
Solving Healthcare podcast: https://twitter.com/KwadCast?s=20

1. Solving Healthcare podcast: https://drkwadwo.ca/

2. Solving Wellness: www.drkwadwo.ca/solvingwellness

3. Resource Optimization Network: https://www.resourceoptimizationnetwork.com/

4. Pareto Principle: https://en.wikipedia.org/wiki/Pareto_principle

5. Suicide and self-harm in adult survivors of critical illness: population based cohort study: https://pubmed.ncbi.nlm.nih.gov/33952509/

Dr. Christopher "Chip" Doig is an intensivist at the Foothills Medical Centre in Calgary, Alberta, Canada. We focused on a number of ethical issues in the ICU, from donation after cardiac death to the idea of “futility”, and how to discuss that with patients and their families. Finally, we try to understand how Dr. Doig remains so fresh after all these years as an intensivist. 

Links:

1. Resumption of Cardiac Activity after Withdrawal of Life-Sustaining Measures. https://www.nejm.org/doi/full/10.1056/NEJMoa2022713

2. Ethics roundtable debate: Patients and surrogates want 'everything done' – what does 'everything' mean? https://ccforum.biomedcentral.com/articles/10.1186/cc5016

3. The name of the dog. https://www.nejm.org/doi/full/10.1056/nejmp1806388

Biography (from U of C website)
Dr Christopher Doig (better known as Chip) graduated from the University of Saskatchewan (MD with distinction), trained in Vancouver and Calgary with specialization in Internal Medicine and Critical Care Medicine. He has additional training in clinical epidemiology and health care ethics. Dr. Doig is a tenured Professor in the Departments of Critical Care Medicine, Medicine and Community Health Sciences in the Cumming School of Medicine, University of Calgary. He is a past Department Head for Community Health Sciences, and immediate past head for the Department of Critical Care Medicine, He has held other leadership roles including as a President and on the Board of the Alberta Medical Association (AMA), the board of the Canadian Medical Association (CMA), and STARS (Shock, Trauma and Rescue Society).

Dr. Doig has been recognized with a number of local, provincial, national, and international awards. These include: the McLeod Distinguished Achievement Award for Faculty from the University of Calgary, AHS President’s Excellence Award in Quality Improvement for the provincial ICU delirium initiative (co-lead), AMA Medal for Distinguished Service (contributions to developing critical care in Alberta), CMA Dr. William Marsden Award in Medical Ethics, the E. Garner King Award from the Canadian Critical Care Society, The Royal Life Saving Society Bronze Benefactor Medal (for work with STARS), and the Global Sepsis Award (Alberta Sepsis Network) from the Global Sepsis Alliance.

Dr. Doig’s publications include in leading medical journals including Nature Medicine, New England Journal of Medicine, JAMA, Canadian Medical Association Journal, Academic Medicine and leading critical care journals including the American Journal of Critical Care Medicine, Critical Care Medicine, Intensive Care Medicine, and the Journal of Critical Care. Dr. Doig’s publications cover a breadth of translational medicine, clinical trials, outcomes-based research involving large cohorts and complex datasets, medical ethics, and medical education.

Dr. Doig’s experience provides a unique perspective on acute care delivery involving critically ill patients, quality improvement and patient safety, public engagement, and engagement with government on health policy issues. Dr. Doig is currently developing methods to evaluate physician performance Dr. Doig’s ongoing education includes enrolment in a Master’s in Health Economics (London School of Economics) and a Master’s of Public Policy (Harris School of Public Policy, University of Chicago).

Chip is most proud to be a father to 4 fantastic kids, and 30 years married to Suzanne. He enjoys time off in the mountains (biking, hiking and skiing), swimming, and playing soccer (currently ranked second in his family in goal scoring but hoping to improve). He is the Vogel Team Captain of Canadian National Medical Soccer playing at the World Medical Football Championships.

This week we were joined by THE Dr. Walt Biffl, of the Biffl score for blunt cerebrovascular injury. We picked Dr. Biffl’s brain  on what goes into generating good clinical guidelines. We then delve into his work on blunt cerebrovascular disease, and finally, on pancreatic trauma. As always, sends your questions, thoughts, and comments to podcast.cjs@gmail.com. 

Links:

1. A tribute to Ernest E. “Gene” Moore. https://wjes.biomedcentral.com/articles/10.1186/s13017-018-0206-1

2. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. https://wjes.biomedcentral.com/articles/10.1186/s13017-019-0278-6

3. WTA guidelines. https://www.westerntrauma.org/western-trauma-association-algorithms/

4. Evidence-based medicine in trauma/acute care surgery- what does that look like? https://pubmed.ncbi.nlm.nih.gov/30274801/

5. Biffl scale on Radiopaedia. https://radiopaedia.org/articles/biffl-scale-for-blunt-cerebrovascular-injury

We were lucky enough in June to interview a true Canadian icon, Dr. Liane Feldman (https://twitter.com/lianefeldman?s=20)! Dr. Feldman is the Chief of the Division of General Surgery at McGill University and the newest president of the Society of American Gastrointestinal and Endoscopic Surgeons or SAGES. We really wanted to try to understand – what does it mean to be a minimally invasive surgeon? Where does Dr. Feldman see SAGES going in the future? And finally, we discuss the work Dr. Feldman did to help create the Fundamental Use of Surgical Energy or FUSE program. The FUSE program is now a core part of North American surgery programs and helps residents to understand the actual mechanics of surgical energy devices – in other words, what exactly is the difference between blue and yellow on the bovie??? For all this and more, stay with us.

Links:

1. SAGES: https://www.sages.org/

2. SAGES twitter (bot!): https://twitter.com/SAGES_Updates?s=20

3. James IV Traveling Fellowship report: https://jamesivassociationsurgeons.com/report_liane_feldman_md.php

4. FUSE program: https://www.fuseprogram.org/

This week we had the pleasure of speaking with Dr. Mark Hamilton on the podcast. Dr. Hamilton is a neurosurgeon at the Foothills Medical Centre in Calgary. Dr. Hamilton helped us walk through a number of neurosurgical issues that are pertinent to general surgeons, such as hydrocephalus, the role of craniectomy in traumatic brain injuries, and DVT prophylaxis in patients with traumatic brain injuries. 

As always, send your comments and feedback to podcast.cjs@gmail.com.

Links:

1. Treatment of hydrocephalus. https://pubmed.ncbi.nlm.nih.gov/19410156/

2. RESCUE - ICP trial in NEJM. https://www.nejm.org/doi/full/10.1056/nejmoa1605215

3. ICP monitoring in TBI. https://www.nejm.org/doi/full/10.1056/nejmoa1207363

4.  Reducing the risks of proximal and distal shunt failure in adult hydrocephalus (the shout-Qi initiative). https://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-019-0156-3

Bio (https://hbi.ucalgary.ca/profiles/dr-mark-hamilton):

Dr. Hamilton graduated from McGill University Medical School in 1983. He did his Neurosurgery Residency at the University of Calgary and received his FRCSC in 1991. He did Fellowship training in cerebrovascular, skull base and Pediatric Neurosurgery at the Barrow Neurological Institute in Phoenix, Arizona and joined the University of Calgary Department of Clinical Neurosciences in 1994 where he is currently a Professor of Neurosurgery with additional appointments in the Department of Surgery and the Department of Pediatrics. He was the Chief of the Division of Pediatric Neurosurgery from 2002-2011 and is the current Director of the Adult Hydrocephalus Program. 

Dr. Hamilton established the University of Calgary Adult Hydrocephalus Program and started the University of Calgary Adult Hydrocephalus Clinic in 2008. Dr. Hamilton is the chair of the international Adult Hydrocephalus Clinical Research Network (AHCRN) which has eight clinical sites in three countries, President of the Hydrocephalus Society (International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF)) and a member of the Board of Directors of the Hydrocephalus Association (HA) and the Medical Advisory Board (MAB) of HA and a member of the Board of Directors of Hydrocephalus Canada.. He was recently the Congress President for “Hydrocephalus 2015” the 7th annual meeting of the ISHCSF. Dr. Hamilton is a member of the Editorial Boards of The Journal of Neurosurgery, The Canadian Journal of Neurological Sciences, Fluids and Barriers of the CNS, and PLOS One. His main clinical and research interests are the diagnosis and management of hydrocephalus in adults.

On this episode we were joined by Dr. Richard Buckley. Dr. Buckley is an orthopedic surgeon at the Foothills Medical Centre in Calgary. Dr. Buckley has had an amazingly productive career, with more than 30 years of clinical practice and hundreds of publications. Most importantly, however, Dr. Buckley has really pushed surgeons in Calgary and across Canada to think beyond received wisdoms and critically examine how we treat patients and how we organize our systems. We get a taste of his unique insights on topics from resident call, to his orthopedic textbook and finally, his thoughts on how to age and retire gracefully from a life in surgery. 

Links:

1. Surgical Exposures in Orthopedics. https://www.amazon.ca/Surgical-Exposures-Orthopaedics-Anatomic-Approach/dp/0781776236

2. Canadian Orthopedic Trauma Society. http://cots.medicine.dal.ca/

3. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. https://pubmed.ncbi.nlm.nih.gov/17200303/

4. Surgical Companion: The Aging Surgeon episode:  http://canjsurg.ca/e47-surgical-companion-1-the-aging-surgeon/

5. Relation between surgeon age and postoperative outcomes: a population-based cohort study. https://www.cmaj.ca/content/192/15/E385

Bio (taken from:  https://whenithurtstomove.org/wp-content/uploads/Rick-Buckley-EN.pdf)

Dr. Richard Buckley has been on the active medical staff in Calgary since 1990. He is a Professor in the Department of Surgery, in the Division of Orthopaedic Trauma. His active clinical practice is that of orthopaedic trauma and he is extremely active in teaching undergraduate, and post graduate medicine. He has been involved in the Orthopaedic Trauma Fellowship in Calgary, with nearly 50 International Fellows under his tutelage. He is also active in the research front.

Dr. Buckley is an extremely active member of the Association for Study of Internal Fixation (ASIF)(AO). There he has held numerous course Chairman and Board responsibilities, including the International Education Board, International Research Board and has been a member of the Board of Trustees for International AO. He has been a member of the Orthopaedic Trauma Association since 1990 and has held positions on the Membership Committee and Nominating Committee for this

 International leading Association.

Dr. Buckley has also been extremely active in the Canadian Orthopaedic Association (COA) and has been a member of the Membership Committee and Chair of the Membership Committee, COA Advisor to the Canadian Society of Orthopaedic Technologists and Chairman and Founder of the Canadian Orthopaedic Resident Forum (a resident review course).

Dr. Buckley’s present research focus is almost exclusively related to trauma and he is an active member within the Canadian Orthopaedic Trauma Society. He has published over 80 papers and is an Editor of 4 major International, Internationally translated orthopaedic textbooks.

Is intercessory prayer more or less effective than lasix? These seemingly random questions are the “rabbit holes” that keep Dr. Wayne Rosen up at night. Dr. Rosen is a colorectal surgeon at the Peter Lougheed Centre in Calgary, Alberta. Dr. Rosen has long delighted the calgary surgical community with his entertaining and thoughtful critiques of a whole host of philosophical and bioethical concepts, ranging from evidence based medicine to how we might ration surgical resources in a pandemic like COVID. We recorded this conversation back in May 2021. We would love to hear your thoughts on any of the topics we discussed on this week’s episode on twitter @canjsurg or by email at podcast.cjs@gmail.com. 

Links:

1. Dr. Rosen's website: http://www.limitsofebm.org/

2. Cochrane review on intercessory prayer: https://www.cochrane.org/CD000368/SCHIZ_intercessory-prayer-for-the-alleviation-of-ill-health#:~:text=Intercessory%20prayer%20is%20one%20of,in%20some%20kind%20of%20need.

3. Doing Right by Hebert and Rosen: https://www.amazon.ca/Doing-Right-Practical-Trainees-Physicians/dp/0199031339

Bio (from colondoc.ca):

Dr. Wayne Rosen did his undergraduate degree in the arts at Queens' University in Kingston, Ontario. After this he studied in Europe for two years and returned to Canada to study medicine. Dr. Rosen graduated in 1991 from Queens University Medical School in Kingston, Ontario, and completed his General Surgery training at the University of Calgary in 1997. He subsequently worked in overseas for three months and practiced briefly in Calgary, and then at the North York General Hospital in Toronto for almost two years. Starting in 2000,  Dr. Rosen completed a fellowship in Colorectal Surgery at the University of Texas in Houston, under the mentorship of Dr. H. Randolph Bailey. Following this, he joined the faculty of the Department of Surgery at the University of Calgary at the Peter Lougheed Hospital in 2001. For 10 years he shared a clinical practice with Dr. Doug Johnson until moving out on his own in the summer of 2011.   His clinical practice is now situated at the Peter Lougheed Centre and is primarily in the area of colon and rectal surgery.

Dr. Rosen is a Fellow of the Royal College of physicians and Surgeons of Canada (FRCS). He is also board certified in both general and colorectal surgery in the United States. He is also a Fellow of the American Society of Colon and Rectal Surgery.

In addition to his clinical practice, Dr. Rosen is active as a teacher and instructor with both residents and medical students at the University of Calgary.  He is the Chair of the Medical Skills Course at the University of Calgary Medical School and he co-chairs the undergraduate medical students bioethics course with Dr. Ian Mitchell. He regularly lectures and gives seminars on topics related to colon and rectal surgery, as well as bioethics. He has an active interest in biomedical ethics, with a particular interest in areas related to informed consent, resource allocation, medicine and law, and ethical issues in research. Most recently he is interested in the challenges and limits of Evidence-Based Medicine. He has a Masters in Medical Science (MSc Bioethics). Dr. Rosen is a clinical assistant professor in the department of surgery at the University of Calgary.

If you were to wander into one of the operating rooms at the Ottawa Civic Hospital and hear a discussion about colorectal surgery, Plato, and Drake simultaneously, you could be pretty sure that you were in the OR of Dr. Husein Moloo (https://twitter.com/HMoloo?s=20). Dr. Moloo is a dually trained minimally invasive and colorectal surgeon in Ottawa. We had the pleasure of speaking with the Renaissance man Dr. Moloo about the impressive quality improvement initiatives he has led in Ottawa, as well as his thoughts on the unique shared practice model in the Ottawa colorectal group. True to the advice he shares at the end of the podcast, Dr. Moloo was recently named the maiden director of Planetary Health at the University of Ottawa. To paraphrase the Canadian philosopher Drake, “If you ain’t been a part of it at least you got to witness.”

Links:

1. "Range" by David Epstein: https://davidepstein.com/the-range/

2. Enabling front line–driven perioperative quality improvement through organizational infrastructure built around the Comprehensive Unit Based Safety Program. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125925/

3. Creating a Culture of Quality. HBR. https://hbr.org/2014/04/creating-a-culture-of-quality

4. IHI Open School: http://www.ihi.org/education/IHIOpenSchool/Pages/default.aspx

5. Kotter's 8 step process for change: https://www.kotterinc.com/8-steps-process-for-leading-change/

6. Implementation of a systematic tobacco treatment protocol in a surgical outpatient setting: a feasibility study.http://canjsurg.ca/64-1-e51/

7. Group practice impacts on patients, physicians and healthcare systems: a scoping review.https://bmjopen.bmj.com/content/11/1/e041579.abstract

8. Retired Surgeons’ Reflections on Their Careers. https://jamanetwork.com/journals/jamasurgery/fullarticle/2758649

9. Plato's Allegory of the Cave: https://faculty.washington.edu/smcohen/320/cave.htm#:~:text=In%20the%20allegory%2C%20Plato%20likens,along%20which%20puppeteers%20can%20walk.

With all the attention to inequities in the surgical community and beyond, sometimes the invisible disparities goes unnoticed. Mental health and its impact on surgical outcomes has been relatively poorly studied, and so on today’s episode we invited the authors of a new narrative review on the topic to talk about what they found. The title of the paper is “Improving Surgical Quality for patients with Mental Health Illness: A Narrative review” and was published this August. Dr. Rebecca Afford, Dr. JJ Sidhu, and Dr. Morad Hameed joined us to talk about mental health and its impact on surgical outcomes. We would love to hear your thoughts – what does your institution to manage surgical patients with mental health conditions? Email us at podcast.cjs@gmail.com or on twitter @CanJSurg.

Links:

1. Improving Surgical Quality for Patients with Mental Health Illnesses: A Narrative Review. https://journals.lww.com/annalsofsurgery/Abstract/9000/Improving_Surgical_Quality_for_Patients_with.93312.aspx

Bios:

Rebecca Afford is a second year general surgery resident at the University of British Columbia.

Jesse Sidhu is a psychiatrist at the Vancouver General Hospital and is the Deputy Medical Director for Vancouver Mental Health and Substance Use, Acute, Tertiary, & Urgent Services.

Morad Hameed is the and intensivist at the Vancouver General Hospital (VGH) and an Assistant Professor of Surgery at the University of British Columbia (UBC). He is the Head of the UBC and VGH Division of General Surgery and is a Service Chief for Acute Care Surgery at VGH.

A big welcome to all the surgical "roofers" joining us on the show! We had the inimitable Dr. Michael Rosen (https://twitter.com/MikeRosenMD?s=20) on this episode. Dr. Rosen is a world renowned expert in abdominal wall reconstruction at the Cleveland Clinic, and on this episode he gave us a masterclass on all things hernia.

Links:

1. Atlas of Abdominal Wall Reconstruction: https://www.elsevier.ca/ca/product.jsp?isbn=9780323374590

2. Clinical trial on role of robotics in hernia repair: https://clinicaltrials.gov/ct2/show/NCT02816658

3. American Hernia Society Quality Collaborative: https://www.prweb.com/releases/2016/08/prweb13620209.htm

4. David Krpata's Groin pain clinic: https://www.generalsurgerynews.com/In-the-News/Article/08-19/Experts-Describe-Unique-Approaches-to-Groin-Pain-After-Hernia-Repair/55620?sub=836D4EB2B96F992350511873881EC4EFFD0886FFAF298E476CEDDB4816C90B2

Bio:

Dr. Michael J. Rosen is an abdominal wall reconstructive and general surgeon in Cleveland, Ohio and is affiliated with multiple hospitals in the area, including Louis Stokes Cleveland Veterans Affairs Medical Center and Cleveland Clinic. He received his medical degree from University of Southern California and has been in practice for more than 20 years. He is an expert in abdominal wall reconstruction and Director of the Hernia Center at the Digestive Diseases Institute at Cleveland Clinic.

Dr. John C Alverdy (https://twitter.com/JCAlverdy?s=20) is a minimally invasive surgeon at the University of Chicago. He is an iconoclastic scientist whose research focuses on gut microbiome and its impact on surgical site infections. His lab is continuously NIH funded, with publications in Nature and many other high impact journals. More importantly, however, Dr. Alverdy is willing to challenge commonly accepted ideas, like the very basic tenet that we really know why anastomoses leak. He gave a fantastic talk this year at the American Society of Colon and Rectal Surgeons, and we’d highly encourage you all to listen to that well. 

Links:

1. ASCRS distinguished lectureships. https://fascrs.org/my-ascrs/meetings-events/2021-annual-scientific-meeting/distinguished-lectureships

2. The gut microbiota and gastrointestinal surgery. https://pubmed.ncbi.nlm.nih.gov/27729657/

3. Re-examining causes of surgical site infections following elective surgery in the era of asepsis. https://pubmed.ncbi.nlm.nih.gov/32006469/

4. Serial Endoscopic Surveillance & Direct Topical Antibiotics to Define the Role of Microbes in Anastomotic Healing (SES-DTA). https://clinicaltrials.gov/ct2/show/NCT02682485

5. Alverdy lab website: https://wiki.uchicago.edu/display/surgery/Alverdy+Lab+Wiki

Bio (from University of Chicago surgery website): 

John C. Alverdy, MD, performs a wide variety of complex minimally invasive and open gastrointestinal surgical procedures with decades of experience in the field. Dr. Alverdy is nationally recognized for introducing several new operations into the field, including minimally invasive pancreatic surgery, bariatric surgery, and surgery for disorders of the foregut including the esophagus and stomach.

Dr. Alverdy has also run a continuously funded NIH-funded laboratory that studies the molecular interactions of bacteria and the intestinal mucosa in order to understand how life-threatening infections arise after trauma and major surgery and during critical illness. He has developed several anti-infective polymer-based compounds that can attenuate the virulence of several multi-drug resistant pathogens that cause life threatening infections in surgical patients and works with the IME to synthesize, refine, and scale the compounds for pre-clinical testing.

On this episode we had a masterclass on gastrointestinal neuroendorine tumors by endocrine and trauma surgeon Dr. Daryl Gray. Dr. Gray is an associate professor Western in London, Ontario, and is possibly one of the most interesting people in the world. We explore his life, his experience being the father of a teen TV star, and of course his passion, neuroendocrine tumors. 

Links:

1. The surgeons: https://www.amazon.com/The-Surgeons/dp/B01J2P4QEE

2. Max & shred: https://www.imdb.com/title/tt3946016/

3. ROSCOE magazine: https://cags-accg.ca/about/cags-magazine-roscoe/read-the-digital-issue-of-roscoe/

4. Roscoe R. Graham: An enduring legacy in the 21st century. https://pubmed.ncbi.nlm.nih.gov/27806000/

Dr. Martin Schreiber is a trauma and critical care surgeon at Oregon Health & Science University in Portland. He has had a major impact on our understanding of resuscitation in trauma, among many other topics. We talked to Dr. Schreiber about his experience with the military, his advocacy around trauma research, and trauma resuscitation.

Links:

1. Trauma Center Association of America calls for NIH Trauma Institute. https://www.traumacenters.org/news/557958/TCAA-Chair-Calls-for-Creation-of-Trauma-Institute-in-the-NIH-.htm

2. Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. https://pubmed.ncbi.nlm.nih.gov/32897344

3. Tranexamic acid in trauma. How should we use it? https://journals.lww.com/jtrauma/Citation/2013/06000/Tranexamic_acid_in_trauma__How_should_we_use_it_.30.aspx

Bio (from https://www.ohsu.edu/people/martin-a-schreiber-md-facs-fccm)

Dr. Schreiber’s special areas of interest are trauma surgery and surgical critical care. He received his medical degree in 1988 from Case Western Reserve University in Cleveland, OH. Dr. Schreiber completed his internship at Madigan Army Medical Center in Fort Lewis, WA., and his residency training at the University of Washington in Seattle. His trauma and critical care fellowship was completed at the University of Washington.

We were lucky to have Dr. Neel Datta on the podcast this week! Dr. Datta is a colorectal surgeon in Calgary. He did a Masters of Health Economics at the London School of Economics, and has used that expertise to model some of the issues around surgical workforce planning in Canada. We really dug into some of the issues around unemployment and underemployment of surgeons in Canada, and perhaps some solutions to that very real problem.

Links:

1. The current state of resident trauma training: Are we losing a generation? https://www.canjsurg.ca/content/61/3/153.long

2.  Ahmer Karimuddin On The "Struggling" Trainee, CaRMS, & Resident Selection. https://soundcloud.com/cjs-podcast/e64-ahmer-karimuddin-on-the-struggling-trainee-carms-resident-selection

3. Shane DiNapoli On Physician Finances, Professional Corporations, And Financial Planning. https://soundcloud.com/cjs-podcast/e63-shane-dinapoli-on-physician-finances-professional-corporations-and-financial-planning

4. Hepato-pancreato-biliary surgery workforce in Canada. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447518/

5. A novel approach for the accurate prediction of thoracic surgery workforce requirements in Canada. https://pubmed.ncbi.nlm.nih.gov/24787697/

6. Calcutta Cricket Club! https://www.calcuttacricketclub.com/

This is a special episode for us! We celebrate our 100th episode by presenting a mix of some of our favourite "advices" from our guests. We have to thank all of our many guests who have shared their time, expertise, and passion with us. 

We look forward to bringing you many more episodes!

As always, would love to hear your thoughts and feedback at podcast.cjs@gmail.com or @canjsurg on twitter.

This week we were lucky enough to have a masterclass with Dr. Helen Macrae, a colorectal surgeon at Mount Sinai in Toronto. We talked about her career in surgical education. We then leveraged Dr. Macrae's considerable expertise and got her approach to the acute colitic, laparoscopic total colectomy, and pelvic pouch reconstruction.

Links:

1. Teaching Surgical Skills — Changes in the Wind. https://www.nejm.org/doi/pdf/10.1056/nejmra054785

2. E24 Richard Reznick On Competency - Based Medical Education.  https://soundcloud.com/cjs-podcast/e24-richard-reznick-on-competency-based-medical-education/s-eAqN5PDEoyG

3. Treatment of hospitalized adult patients with severe ulcerative colitis: Toronto consensus statements. https://pubmed.ncbi.nlm.nih.gov/22108451/

Bio (https://surgery.utoronto.ca/content/helen-macrae)

Dr. MacRae received a B.Sc. and M.D. from the University of Alberta. She did her General Surgery training in Alberta, as well. Following this, she spent two years in the Colorectal Surgery Program at the University of Toronto, before joining the faculty in January 1997. Most recently, she completed a mini-sabbatical in laproscopic surgery at the Wellesley Hospital. 

Dr. MacRae's clinical interests are in the areas of inflammatory bowel disease, and laproscopic colon surgery. Her research interests are in the field of surgical education.  She is Director for the Colorectal Surgery Residency Program.

This week we were joined by Dr. Sunil Patel (https://twitter.com/epipatelmd?s=20). Dr. Patel is a colorectal surgeon in Kingston, Ontario. The group in Kinston is one of the few general surgery groups in Canada that has really utilized robotics in their practice, and we wanted to understand both why and how they introduced robotics into their group. Dr. Patel has also done fascinating research into the topic of spin in surgical research, and he walks us through the concept of spin and how the astute reader can avoid being fooled by it. 

Links:

1. The use of "spin" in laparoscopic lower GI surgical trials with nonsignificant results: an assessment of reporting and interpretation of the primary outcomes. https://pubmed.ncbi.nlm.nih.gov/24201393/

2. Spin Is Common in Studies Assessing Robotic Colorectal Surgery: An Assessment of Reporting and Interpretation of Study Results. https://pubmed.ncbi.nlm.nih.gov/26252850/

3. An Assessment of the Industry-Faculty Surgeon Relationship Within Colon and Rectum Surgical Training Programs. https://pubmed.ncbi.nlm.nih.gov/26966083/

4. Spin in articles about minimally invasive transanal total mesorectal excision: an assessment of the current literature. https://pubmed.ncbi.nlm.nih.gov/30341922/

5. Reviewing the Reviewers: Potential Financial Conflicts of Interest in Editorial Boards of Surgery Journals. https://pubmed.ncbi.nlm.nih.gov/34091509/

Bio (https://surgery.queensu.ca/administration/attending-staff/sunil-patel):

Dr. Sunil Patel is a fellowship trained colorectal surgeon at Kingston Health Sciences Centre.  He has specialized training in minimally invasive surgery, including robotic surgery, laparoscopic surgery and transanal total mesorectal excision (Ta-TME). Dr. Patel and his partners are the only group offering high volume Robotic Colorectal Surgery in the Province.

Dr. Patel specializes in treating Rectal Cancer, Colon Cancer, Inflammatory Bowel Disease and Diverticular Disease.  Dr. Patel and his partners are the only high volume rectal cancer surgeons in Southeast Ontario. 

Dr. Patel completed his general surgery in London, Ontario.  He completed his colorectal surgery fellowship in New York City at Memorial Sloan Kettering Cancer Center and New York Presbyterian Hospital.  Memorial Sloan Kettering Cancer Center is considered one of the top Cancer hospitals in the world.  He has also completed a Masters of Epidemiology at the London School of Hygiene and Tropical Medicine in London, UK.

Dr. Patel’s research interests include barriers to treatment in colorectal cancer and inflammatory bowel disease patients, the use of smart phone technology in delivering clinical care and evidence based health care.

Dr. Patel is also a member of the Cancer Care and Epidemiology at the Cancer Research Institute and the Regional Colorectal Cancer Screening and GI Endoscopy Lead (LHIN).

Dr. Teodor Grantcharov (https://twitter.com/TGrantcharovMD?s=20) is a bariatric surgeon at St. Michael’s Hospital in Toronto. Dr. Grantcharov is world renowned for his work on the OR blackbox, a platform that allows for immense data capture (video, audio, physiologic) as well as advanced analytics. We asked Dr. Grantcharov about what it took to develop the OR blackbox, not just technologically, but culturally and institutionally. You can find out more about the OR blackbox at surgicalsafety.com.

Links:

1. Quantifying recall bias in surgical safety: a need for a modern approach to morbidity and mortality reviews. https://pubmed.ncbi.nlm.nih.gov/30693745/

2. Twitter discussion on best methods for recording open cases: https://twitter.com/ameerfarooq/status/1335675502313447426

3. OR Black Box: https://www.surgicalsafety.com/

4. Gordon, L, Reed, C, Sorensen, JL, Schulthess, P, Strandbygaard, J, Mcloone, M et al.. Perceptions of safety culture and recording in the operating room: understanding barriers to video data capture. Surg Endosc. 2021; :. doi: 10.1007/s00464-021-08695-5. PubMed PMID:34608519 .

5. Nensi, A, Palter, V, Reed, C, Schulthess, P, Mcloone, M, Grantcharov, T et al.. Utilizing the Operating Room Black Box to Characterize Intraoperative Delays, Distractions, and Threats in the Gynecology Operating Room: A Pilot Study. Cureus. 2021;13 (7):e16218. doi: 10.7759/cureus.16218. PubMed PMID:34367818 PubMed Central PMC8341265.

6. Levin, M, McKechnie, T, Kruse, CC, Aldrich, K, Grantcharov, TP, Langerman, A et al.. Surgical data recording in the operating room: a systematic review of modalities and metrics. Br J Surg. 2021;108 (6):613-621. doi: 10.1093/bjs/znab016. PubMed PMID:34157080 .

7. Gallant, JN, Brelsford, K, Sharma, S, Grantcharov, T, Langerman, A. Patient Perceptions of Audio and Video Recording in the Operating Room. Ann Surg. 2021; :. doi: 10.1097/SLA.0000000000004759. PubMed PMID:33630449 .

Bio (http://stmichaelshospitalresearch.ca/researchers/teodor-grantcharov/):

Dr. Teodor Grantcharov completed his surgical training at the University of Copenhagen, and a doctoral degree in Medical Sciences at the University of Aarhus in Denmark.

Dr. Grantcharov is a Professor of Surgery at the University of Toronto. He holds the Keenan Chair in Surgery at St. Michael’s Hospital in Toronto.

Dr. Grantcharov is the inaugural Director of the International Centre for Surgical Safety – a multidisciplinary group of visionary scientists with expertise in design, human factors, computer- and data science, and healthcare research. He previously held Canada Research Chair in Simulation and Surgical Safety and was awarded the Queen Elizabeth II diamond jubilee medal for his contributions to clinical research and patient safety in Canada. Dr. Grantcharov was awarded the honorary fellowship of the Imperial College in London, the honorary medal of the Bulgarian and Danish surgical societies and multiple national and international awards for his contributions to surgical education and surgical safety.

Dr. Grantcharov’s clinical interest is the area of minimally invasive surgery, while his academic focus is in the field of surgical innovation and patient safety.  He has become internationally recognized as a leader in this area with his work on curriculum design, assessment of competence and impact of surgical performance on clinical outcomes. Dr. Grantcharov developed the Surgical Black Box, which aims to transform the safety culture in medicine and introduce modern safety management systems in the high-risk operating room environment.

Dr. Grantcharov has more than 200 peer-reviewed publications and more than 200 invited presentations in Europe, South- and North America. He sits on numerous committees with Surgical Professional Societies in North America and Europe.

He sits on the Editorial Boards of the British Journal of Surgery and Surgical Endoscopy.

This week on the podcast we spoke with Dr. John Neary, an internist at McMaster University. Dr. Neary was instrumental in submitting a motion in 2020 that asked that Royal College Exam waive the requirements to write the royal college exam for trainees graduating in 2020, given the challenges that COVID19 were presenting for the administration of the exam. We also talked about the decision of the Medical Council of Canada to eliminate the MCQE Part II. Beyond these two very controversial topics, we had a much deeper conversation with Dr. Neary about the nature of examinations in medical education, and what the ideal exam would look like. We’d love to hear your thoughts – did studying for your royal college exam make you a better physician? Email at podcast.cjs@gmail.com or tweet at us @CanJSurg. 

Links:

1. Petition: https://docs.google.com/forms/d/e/1FAIpQLSfC63jV31Ptd5iMuktc98Av9G_a5vmtHDTEuvWEEGO8C8s71g/viewform

2. Cancellation of MCQEII by MCC: https://www.thestar.com/news/canada/2021/01/04/amid-an-uproar-over-cancelled-tests-some-say-the-body-that-oversees-medical-exams-for-resident-doctors-seeking-licences-is-obsolete.html

Bio: 

John Neary is a general internist at St. Joseph’s Healthcare Hamilton and an Assistant Professor of Medicine at McMaster University.  He did his undergraduate degree in mathematics! He has worked as a consultant in internal medicine at SHN since finishing his residency at McMaster in 2010.

Welcome back to another episode of our “Companion” series on the important topic of death and dying in surgery.  Dr. Kelly Vogt lead our discussion, and we were lucky enough to also be joined again by Dr. Morad Hameed. We focused on the topic of Medical Assistance in Dying (MAID), but branched out to explore how we can better prepare surgeons and patients for discussions around end of life care. We’d love to hear your thoughts – how does MAID get operationalized in your hospital, and how does that interact with the surgical service? Email us at podcast.cjs@gmail.com or tweet at us @CanJSurg.

Links:

1. The impact of country and culture on end-of-life care for injured patients: results from an international survey. https://pubmed.ncbi.nlm.nih.gov/21045742/

2. BC Cancer website on MAID. http://www.bccancer.bc.ca/health-info/coping-with-cancer/medical-assistance-in-dying

This week on the podcast we talked about a topic that we have heard about all too frequently on the news lately: gun violence. We were joined by Dr. John Kortbeek, a trauma and critical care surgeon at the University of Calgary. We asked Dr. Kortbeek about the topic of gun control in general and specifically on gun control policies in Canada. 

1. Canadian Doctors for Protection from Guns. https://www.doctorsforprotectionfromguns.ca/

2. Najma Ahmed - Award from CMA for gun control work. https://www.cma.ca/cma-sir-charles-tupper-award-political-advocacy-2020-recipient

3. Planet Money episode on "smart guns""https://www.npr.org/sections/money/2016/04/08/473581490/episode-694-the-gun-that-wouldnt-shoot

This week we had a masterclass on common bile duct injuries by Dr. Francis Sutherland. Dr. Sutherland is a hepatobiliary surgeon at the University of Calgary. Dr. Sutherland talks about not just how CBD injuries happen, but why they happen, and the cognitive biases that lead up to them. Please check out the show notes for videos and papers that supplement our discussion. 

Links:

1. The importance of cognitive map placement in bile duct injuries. https://pubmed.ncbi.nlm.nih.gov/29173261/

2. Is an optical illusion the cause of classical bile duct injuries? https://pubmed.ncbi.nlm.nih.gov/33411998/

3. Video from Dr. Shiva Jayaraman of a CBD injury which illustrates the cognitive mapping errors: https://www.youtube.com/watch?v=I0AtJqCj2dI

4. Claude Couinaud: a passion for the liver. https://pubmed.ncbi.nlm.nih.gov/12413326/

5. Rouvière's sulcus: a useful landmark in laparoscopic cholecystectomy. by Thomas Hugh. https://pubmed.ncbi.nlm.nih.gov/9313706/

6. Thinking, Fast and Slow by Daniel Kahnemann. https://www.goodreads.com/book/show/11468377-thinking-fast-and-slow

7. Memories of colonoscopy: a randomized trial. https://pubmed.ncbi.nlm.nih.gov/12855328/

8. Causes and Prevention of Laparoscopic Bile Duct Injuries
Analysis of 252 Cases From a Human Factors and Cognitive Psychology Perspective. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1514483/

9. Subtotal Cholecystectomy-"Fenestrating" vs "Reconstituting" Subtypes and the Prevention of Bile Duct Injury: Definition of the Optimal Procedure in Difficult Operative Conditions. https://pubmed.ncbi.nlm.nih.gov/26521077/

10. Trauma ICU Rounds podcast on "Managing the Difficult Cholecystectomy" with a good discussion on subtotal cholecystectomy. https://www.traumaicurounds.ca/episodes/episode-42-management-of-the-difficult-gallbladder-gen2n

Bio (from https://charbonneau.ucalgary.ca/our-members/associate-members/francis-sutherland):

Dr. Sutherland graduated from the University of Calgary Medical School and did his General Surgery Residency in Calgary. Upon completion he then went to the University of Western Ontario and completed a Fellowship in Transplantation under the mentoring of Dr. Bill Wall. Upon returning to Calgary he initially was involved in the Organ Transplant Program. He then focused his surgical career on Hepatobiliary Surgery by taking a one year sabbatical to work under Professor Bernard Launois at the University of Rennes in France. Dr. Sutherland has been a Faculty Member since 1990 and is currently at the Foothills Hospital. His clinical practice evolves around General Surgery with a strong focus and interest in hepatobiliary and pancreatic surgery. He is an integral member of the Hepatobiliary Multidisciplinary Clinic at the Tom Baker Cancer Centre. His research interests have evolved around studying the hepatobiliary anatomy and has made innovative observations in this area. He has also studied the ways to minimize blood loss during major hepatic resections and has an interesting in pancreatic cysts.

Happy new year to all our listeners! We hope you all have a fulfilling and healthy 2022!

We are very excited this week to bring you this episode on Black Surgeons in North America. This initiative lead by Dr. Don Nakayama  is an amazing collection of the contributions of black surgeons across North America. We were lucky to sit down with Dr. Vivian McAllister, a longtime friend of the podcast and one of the authors of the chapter on black surgeons in Canada, to tell us about the contributions of black Canadian surgeons. We were also lucky enough to be joined by Dr. Nakayama, as well as Dr. Cathy Slaney, a sociologist who’s work has focused on her great-grandfather Dr. Anderson Abbott, one of the surgeons profiled in the book. Last but not least, we were joined  by Shannon Prince, the curator of the Buxton National Historic Site and Museum. This episode was a fascinating foray into the untold stories of the contributions of black surgeons in our country. 

We were also really inspired by our guests thoughts about how we can perhaps learn from this history to help us heal the ongoing racial wounds that exist within our culture and society. As always, we would love to hear your thoughts by email at podcast.cjs@gmail.com or on twitter @CanJSurg.

Links:

1. Black Surgeons and Surgery in America - available from the ACS website. https://www.facs.org/publications/black-surgeons-and-surgery-in-america

2. Family Secrets by Cathy Slaney. https://www.dundurn.com/books_/t22117/a9781896219820-family-secrets

3. Buxton National Historic Site and Museum: http://www.buxtonmuseum.com/

Bios:

Shannon Prince: http://www.buxtonmuseum.com/about/ShannonPrince_bio.pdf

Catherine Slaney: https://www.thestar.com/news/gta/2011/02/23/woman_finds_out_famous_relative_was_black.html?rf

Vivian McAlister: https://www.cma.ca/dr-vivian-mcalister

Don Nakayama: https://www.med.unc.edu/surgery/dr-don-nakayama-joins-pediatric-surgery/

We are delighted to bring you our CaRMS 2022 general surgery residency highlights! We invited all the English-speaking general surgery programs across the country on to the podcast to talk about what makes their program unique. We were able to get most of the programs across country. Our hope is that this episode will be helpful for prospective applicants to learn a bit about the programs as we head into the interview cycle. 

We have no affiliation with CaRMS. 

Links:

1. Canadian Resident Matching Service (CaRMS) residency program descriptions: https://www.carms.ca/match/r-1-main-residency-match/program-descriptions/

2. Memorial University of Newfoundland (St. John's) website: https://www.med.mun.ca/getdoc/d2d3e138-196f-4741-95f6-bac3516d85a2/GSResidencyProgram.aspx

Interview with Dr. Mathieson starts at 6:30

3. Dalhousie University (Dalhousie): https://medicine.dal.ca/departments/department-sites/surgery/divisions/general-surgery/education/residency.html

Interview with Dr. Helyer starts at 16:30

4. University of Toronto: https://surgery.utoronto.ca/residency-division-general-surgery

5. University of Ottawa: https://www.uottawagensurg.com/

6. Western (London): https://www.schulich.uwo.ca/generalsurgery/education/postgraduate/index.html

Interview with Dr. Ott starts 40:30

7. McMaster University (Hamilton): https://surgery.mcmaster.ca/divisions/general-surgery/education/postgraduate-training-programs

Interview with Dr. Marcaccio starts at 1 hr 1 min

8. Queen's University (Kingston): https://surgery.queensu.ca/postgraduate/general-surgery

9. Northern Ontario School of Medicine (NOSM): https://www.nosm.ca/generalsurgery/program-overview-highlights/

10. McGill: https://www.mcgill.ca/generalsurgery/education/residency

Interview with Dr. Liberman starts at 25 min mark

11. Max Rady College of Medicine (Winnipeg): https://umanitoba.ca/medicine/department-surgery/general-surgery-residency

Interview with Dr. McKay starts at 1 hr 12 min

12. University of Saskatchewan: https://medicine.usask.ca/department/clinical/surgery-divisions/general-surgery-pages/residency-program.php

13. University of Calgary: https://cumming.ucalgary.ca/departments/surgery/sections/general-surgery/education

Interview with Dr. Rochon starts at 1 hr 22 min

14. University of Alberta: https://www.ualberta.ca/surgery/divisions/general-surgery/index.html

Interview with Dr. Mapiour starts at 1 hr 31 min

15. University of British Columbia: https://www.ualberta.ca/surgery/divisions/general-surgery/index.html

Interview with Dr. Scott starts at 1 hr 42 min

16. Great thread with tips for virtual interviews: https://twitter.com/BobbyYanagawa/status/1468017910165782531

We’ve all experienced the frustration of working in clinical environments that just don’t seem to be set up intuitively. But what if there were ways to improve the design of the places and processes where clinicians practice? In this episode, we spoke with Dr. Andrew Petrosoniak and Dr. Chris Hicks, both ER docs at St. Mike’s Hospital in downtown Toronto. They have done extensive work on human-centred design, particularly in the emergency department, and have done amazing work redesigning the St. Mike’s trauma bay and many other areas in the ED. Check out links in the shownotes to see pictures of their newly redesigned trauma bay, and also check out their website advancedperformance.ca. 

Links:

1. Breaking the Shackles of Poor Design: https://emcrit.org/emcrit/breaking-the-shackles-of-bad-clinical-design/

2. Trauma Resuscitation Using in situ Simulation Team Training (TRUST) study: latent safety threat evaluation using framework analysis and video review. https://pubmed.ncbi.nlm.nih.gov/33097610/

3. Design Thinking-Informed Simulation: An Innovative Framework to Test, Evaluate, and Modify New Clinical Infrastructure. https://pubmed.ncbi.nlm.nih.gov/32039946/

4. The Human Factor: Optimizing Trauma Team Performance in Dynamic Clinical Environments. https://pubmed.ncbi.nlm.nih.gov/29132571/

In this episode we had a great conversation with Dr. Sam Minor. Dr. Minor is a general surgeon in Halifax, Nova Scotia at Dalhousie. Dr. Minor has helped develop in situ trauma simulations that help not just residents but also staff surgeons prepare for major traumatic injuries. Dr. Minor also tells us about what it’s like to practice in Halifax and about some of his other research interests. 

1. Prospective study of single-stage repair of contaminated hernias with the novel use of calcium sulphate antibiotic beads in conjunction with biologic porcine submucosa tissue graft. https://pubmed.ncbi.nlm.nih.gov/33180691/

2. Minor S, Schroder C, Heland D. Utilizing the Intensive Care Unit to Teach End-of-Life Skills to Rotating Junior Residents. American Journal of Surgery Am J Surg 2008 Sep 11

Bio (https://medicine.dal.ca/departments/department-sites/critical-care/our-people/faculty/samuel-minor.html):

Dr. Minor has developed various programs at the Dalhousie Surgical Skills Center including percutaneous tracheostomy insertion, critical care skills (difficult airway management, percutaneous chest tube insertion, US guided interventions), open abdomen management and abdominal wall reconstruction. He also teaches crisis resource management at the Atlantic Canada Simulation Center which focuses on ACLS and ATLS utilizing the SimMan 3G.

Research activities are in the areas of medical education, open abdomen management and post tracheostomy care.

This week we were joined again by Dr. Colin Schieman for a masterclass on paraesophageal hernias! Dr. Schieman is a previous guest on the podcast and is a thoracic surgeon in Calgary. In this episode we discuss types of paraesophageal hernia, the management of gastric volvulus, as well as operative approaches to repair.

Links: 

1. Colin Schieman on Direct Entry Training: https://soundcloud.com/cjs-podcast/e76-colin-schieman-on-direct-entry-training-and-intra-operative-teaching

2. Colin Schieman on Lung Nodules: https://soundcloud.com/cjs-podcast/e77-masterclass-with-colin-schieman-on-lung-nodules-and-lung-cancer-screening

3. Paraesophageal hernia: clinical presentation, evaluation, and management controversies. https://pubmed.ncbi.nlm.nih.gov/20112630/

Bio:

Dr. Colin Schieman is a Clinical Associate Professor at the University of Calgary in the section of thoracic surgery. He did medical school, residency, and thoracic surgery fellowship at the University of Calgary. He then went on to do additional thoracic surgery training at Mayo Clinic, and subsequently practiced at St. Joseph's Hospital in Hamilton, Ontario. He came back to the University of Calgary as Assistant Professor in 2016, and is now the Program Director for the Thoracic Surgery Fellowship program.

Dr. Su-Yin MacDonell (https://twitter.com/MacdonellSu?s=20&t=x_rOcGb83XcxYyWjb0ow2g) is an anesthetist specializing in periop medicine at St. Paul’s Hospital in Vancouver. She is particularly interested in the concept of noise in the OR, and how that can affect decision-making and focus in the OR. We were privileged to hear about her research around noise in the OR, and her thoughts around how we can improve the OR environment and communication across the drapes. 

Links:

1. Noise in the operating room during induction of anesthesia: impact of a quality improvement initiative. https://pubmed.ncbi.nlm.nih.gov/35014000/

2. Effect of noise on auditory processing in the operating room. https://pubmed.ncbi.nlm.nih.gov/24246628/

Bio (from http://periopcongress.org/wp content/uploads/2019/10/MacDonell.pdf)

Su-Yin started her career as a professional ballet dancer before completing her BSN at UVIC (2005). After two years as a medical-surgical Registered Nurse, she obtained her MD at UBC(2011). Her Residency in Anesthesiology at UBC (2017) was lengthened slightly by having two daughters. Following residency, Su-Yin had additional training in Perioperative Vascular Medicine in Hamilton, Ontario and Point of Care Ultrasound (POCUS) certification through CHEST. Su-Yin completed her masters in Perioperative Medicine, through the
University College of London.

As a staff Anesthesiologist at St. Paul’s Hospital (Vancouver), she is part of the ERAS working group, Perioperative Anesthesia group and is the Perioperative Medicine Fellowship Director (Anesthesia). 

Outside of medicine, Su-Yin continues to dance, reluctantly cleans up after husband and two young children, and tries to read before falling asleep with the light on.

We were delighted this week to have Dr. Tarek Razek (https://twitter.com/Trazek) on the podcast with us. Dr. Razek is a trauma surgeon at McGill University and really a major figure in global surgery in Canada, and he pondered with us the questions with us of how we can best make an impact in global surgery without repeating the colonialism of the past. His approach is beautifully summarized in his piece published in the Lancet in 2015, where he wrote, “However, now that increasing attention is being paid to surgery in public health, we must also capitalise on this opportunity to move beyond descriptive studies.” Please enjoy our conversation with Dr. Razek. 

Links:

1. Tarek Razek on ICRC deployment: http://www.cnis.ca/img/Press_Clipping_-_2009_Jan_-_Outpost_-_Dr._Tarek_Razek.pdf

2. Global access to surgical care: moving forward. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00004-2/references

3. Association Between Real-time Electronic Injury Surveillance Applications and Clinical Documentation and Data Acquisition in a South African Trauma Center. https://jamanetwork.com/journals/jamasurgery/fullarticle/2674877

Bio(from: https://www.mcgill.ca/generalsurgery/tarek-razek#:~:text=Biography%3A,University%20of%20Pennsylvania%20in%20Philadelphia)
Dr. Tarek Razek is trauma/general surgeon and intensivist who is the current Director of the Adult Trauma Program at the McGill University Health Centre (MUHC). He completed his surgical training at McGill University and his trauma surgery/ICU fellowship at the University of Pennsylvania in Philadelphia.

He is a co-director of the Centre for Global Surgery at the MUHC. He actively participates in surgical and trauma development programs in Tanzania, Rwanda, Mozambique, Ethiopia, Malawi, Ukraine, Haiti, Chile, Uruguay, Nepal and Mexico.

In this episode, we chatted with Drs. Wesley Francis, Don Major, and Greg Padmore. These fantastic surgeons came from the Carribean to train in North America, and we were curious to explore what their experience was like and how they used their training to improve surgical care when they returned home. 

Links:

1. https://www.ahpba.org/

2. Cancer Surgery Centre Bahamas - https://cancersurgerybahamas.com/

3. https://www.barbadosadvocate.com/news/qeh-surgeon-breakthrough-cancer-operation

Bios:

Dr. Wesley Francis is a graduate of the University of the West Indies (Mona). He did his surgical residency at Wayne State University (Detroit, MI) and completed a Surgical Oncology Fellowship at Tom Baker Cancer Center in Calgary Alberta. He is currently a Consultant Surgical Oncologist at the Princess Margaret Hospital in Nassau Bahamas where he also serves as the Director of Operating Room. He also serves as the Director of the Bahamas National Cancer Registry.

Dr. Don Major is a graduate of University of the West Indies (St Augustine). He did his surgical residency at UWI Bahamas where he became the first Bahamian to complete the UWI Bahamas surgical residency program. He completed his surgical oncology and hepatobiliary (HPB) fellowship at the Tom Baker Cancer Center in Calgary Alberta. He is currently a Consultant Surgical Oncologist and Hepatobiliary surgeon at the Princess Margaret Hospital.

Dr. Greg Padmore, a 2011 MBBS graduate who completed his pre-clinical years at The UWI Mona Campus and his clinical years at the Cave Hill Campus in Barbados. He is finishing up a two-year Fellowship at the University of Calgary, Canada, where he is undergoing subspecialty training in Hepato-pancreato-biliary Surgery to be followed by Surgical Oncology. 
He was the 2012 Intern of the Year in Barbados.

This week we were joined by Dr. Bill Kent, a cardiac surgeon at the University of Calgary, to talk about minimally invasive techniques in cardiac surgery. We were curious to learn from him where MIS techniques fit in an era of rapid evolution in cardiac surgery and particularly with the advent of new catheter based techniques. Dr. Kent had a number of important insights into the introduction of new technologies in surgery and the challenges associated with trying something new.

Links:

1. Minimally invasive cardiac surgery and the importance of qualitative patient-centered metrics to guide innovations. https://www.sciencedirect.com/science/article/pii/S0022522319304507?via%3Dihub

Bio:

Dr. William Kent is a cardiac surgeon whose practice focuses on valve surgery and mechanical circulatory support. A Fellow of the Royal College of Surgeons of Canada and a member of the International Society for Minimally Invasive Cardiothoracic Surgery, the Society of Thoracic Surgeons, the Canadian Society of Cardiac Surgeons and the American College of Surgeons, Dr. Kent is particularly interested in minimally invasive mitral valve repair and aortic valve surgery, including aortic valve and root repair as well as the Ross procedure.

Dr. Kent completed his undergraduate BA and MSc degrees in Neuroscience at Western University before obtaining his MD and FRCSC in General Surgery at Queen’s University. He began his Cardiac Surgery training at the University of Alberta and then continued his residency training at the University of Calgary. Dr. Kent then completed a Fellowship in complex valve surgery, transplant and mechanical circulatory support at Northwestern University in Chicago, before joining the Libin Cardiovascular Institute in 2013.

 His current position is Clinical Assistant Professor in the Section of Cardiac Surgery. He leads the Minimally Invasive Valve Surgery Program and is Surgical Director of the Mechanical Circulatory Support Program.

Dr. Elizabeth Clement (https://twitter.com/LizClementMD?s=20&t=l43U6ZXhsJgw39faiXIpQQ), colorectal surgery fellow at St. Paul's Hospital in Vancouver, put together a fantastic set of mock oral exams. These were delivered at the Alberta Association of General Surgeons (AAGS) annual meeting in Banff in November 2021.  We were grateful to be able to use some of the recordings to share with you some more mock orals.

Thanks again to the brave residents who allowed us to use their recordings!

Links:

1. AAGS website: https://www.aags.ca/

2. Tony Maclean's tips on examsmanship: https://soundcloud.com/cjs-podcast/e10-tony-maclean-on-examsmanship

Dr. Eric Pauli is a surgical endoscopist at Penn State. He has a very varied and novel practice, including abdominal wall reconstruction, endoscopy and general surgery. We had a great talk with him about surgical endoscopy and his work on endoscopic management of anastomotic leaks.

This is also our very first video version of the podcast! Check it out on the CJS YouTube page: https://www.youtube.com/watch?v=SoA36iqiB-4

Links:

1. Endoscopic Management of Postoperative Complications. https://www.sciencedirect.com/science/article/pii/S0039610920301031?via%3Dihub

2. Endoscopic management of colovesical and colovaginal fistulas with over-the-scope clips: A single-institution case series.https://pubmed.ncbi.nlm.nih.gov/34762356/

3. A Handy Tool to Teach Segmental Liver Anatomy to Surgical Trainees. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061562/

Bio:

Dr. Pat Sylla (https://twitter.com/patsyllamd?s=20&t=_w5QG96wjQE-0ttVJJaUmw) is a minimally invasive and colorectal surgeon at Mount Sinai Hospital in New York. She is a world famous innovator and was the first surgeon in the world to perform a transanal total mesorectal excision for rectal cancer. We caught up with her in-person (!) at the recent Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) annual meeting. Shout out to SAGES for putting on a great conference! 

Links:

1. Pat Sylla talk on Truths, Half-Truths, Fake News about taTME https://www.youtube.com/watch?v=ahWOaKa5WeQ

2. Sylla P, Rattner DW, Delgado S et al.  NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 2010;24:1205–10. https://pubmed.ncbi.nlm.nih.gov/20186432/

3. Urethral Injury and Other Urologic Injuries During Transanal Total Mesorectal Excision: An International Collaborative Study. https://pubmed.ncbi.nlm.nih.gov/31567502/

4. Consensus on structured training curriculum for transanal total mesorectal excision (TaTME). https://pubmed.ncbi.nlm.nih.gov/28462478/

5. SAGES 2022 Presidential Address with Dr. Liane Feldman: https://vimeo.com/showcase/9362041/video/689727749

6. SAGES 2022 Gerald Mark Lecture by KMarie King: https://vimeo.com/showcase/9362041/video/689071108

7. SAGES 2022 General Session on Worldwide Variation in TME. Dr. Sylla is one of the panelists: https://vimeo.com/showcase/9362041/video/689468095

Bio (from https://www.mountsinai.org/profiles/patricia-sylla)

Dr. Sylla has been a leader in developing minimally invasive approaches to the surgical treatment of colon and rectal cancer. She joins Mount Sinai from Massachusetts General Hospital, where she practiced for seven years within the Division of General and Gastrointestinal Surgery and was an Assistant Professor of Surgery at Harvard Medical School. While there, Dr. Sylla developed a research and clinical program using Natural Orifice Translumenal Endoscopic Surgery (NOTES). NOTES represents an innovative approach to transanal surgery, which may allow for faster recovery and fewer operative complications. In 2009, Dr. Sylla performed the first-ever rectal cancer surgery on a human using this approach. She has since extended this in a pilot study and is helping train surgeons in this technique. Dr. Sylla’s clinical interests include laparoscopic and robotic surgery for colon and rectal cancer, diverticulitis, rectal prolapse, ulcerative colitis and Crohn’s disease, transanal endoscopic microsurgery (TEM), and treatment of benign anorectal disorders.
Dr. Sylla received a Bachelor of Science degree Cum Laude in Biology from Georgetown University. She earned a Doctor of Medicine from Weill Cornell Medical College. Dr. Sylla completed residency training in Surgery at Columbia University Medical Center. Subsequently, she completed two fellowship training programs; Colon & Rectal Surgery at The Mount Sinai Hospital and Minimally Invasive Surgery at Massachusetts General Hospital.

Furthermore, Dr. Sylla has is highly trained and experienced in treating rectal prolapse and performing transanal endoscopic surgery.

Dr. Jonathan Meakins is former Chair of the Department of Surgery at McGill and is an Officer of the Order of Canada for his outstanding work in immunobiology, laparoscopic surgery, and transplantation. Among his many interests is his love of art, and at the age of 73 Dr. Meakins has gone back to school to obtain his Masters in Fine Arts.

Check out the links to see some of the fascinating work Dr. Meakins has done to demonstrate how the critical viewing of art can perhaps make us better clinicians. 

Links:

1. Wide-ranging textbook of surgical research. https://www.thelancet.com/journals/lancet/article/PIIS0140673610614717/fulltext?rss=yes

2. Surgical Infection in Art. https://jamanetwork.com/journals/jamasurgery/article-abstract/596694

3. Reflective of the physician’s eye. https://www.cmaj.ca/content/cmaj/183/10/1176.full.pdf

4. Renowned surgeon Jonathan Meakins goes for master’s in art history. http://www.theseniortimes.com/renowned-surgeon-jonathan-meakins-goes-for-masters-in-art-history/

5. Art at the McGill University Health Centre. https://www.cmaj.ca/content/190/49/E1457

Bio (from https://muhc.ca/news-and-patient-stories/news/dr-jonathan-l-meakins-inducted-canadian-medical-hall-fame#:~:text=For%20his%20contributions%2C%20he%20was,of%20the%20McGill%20University%2C%20Dr.):

Dr. Jonathan L. Meakins is an expert in immunobiology and surgical infections. Former Chair of the Department of Surgery at McGill University (1989-1993, 1998-2002) and former Surgeon-in-Chief of the Royal Victoria Hospital (1988-1998), he has safely and effectively advanced surgical technologies and demonstrated a relationship between compromised immune responses and poor surgical outcomes, leading to significant improvements in clinical assessments and nutritional supports for surgical patients.

Over the course of his career, he has published over 225 articles and edited or co-edited 6 books. He was co-editor of the Canadian Journal of Surgery for 10 years. For his contributions, he was named an Officer of the Order of Canada, as a leader in the development of laparoscopic surgery and transplantation surgery in 2000.

Third generation of his family to work in the field of medicine for the Faculty of Medicine of the McGill University, Dr. Meakins now oversees the Jonathan Campbell Meakins and Family Memorial Scholarship program, originally established by his father, Dr. Jonathan Fayette Meakins. This is a scholarship that recognizes excellence in medical education.

An art-loving doctor, Dr. Meakins has worked for many years to develop the arts within the MUHC. He plays an active role in the MUHC's Arts and Heritage Centre as Director, helping to bring the arts into clinical settings. He believes that art within the institution helps to humanize the sometimes sterile hospital environment and can have an impact on patients and their families.

Welcome to all our Cold Steel listeners! We are excited to be collaborating with the Society of American Gastrointestinal and Endoscopic Surgeons or SAGES. SAGES produces an excellent podcast called the SAGES stories podcast, where they highlight some of the amazing work SAGES members have been doing. 

In this episode, SAGES stories hosts Shirin Towfigh and Kevin El Hayek interview one of our favourite former guests Dr. Liane Feldman, the outgoing presidents of SAGES.

Links:

1. SAGES Stories: https://www.sages.org/category/sages-stories/

2. Cold Steel interview  https://soundcloud.com/cjs-podcast/e89-liane-feldman-on-sages-presidency-future-of-mis-and-fuse-program?in_system_playlist=artist-stations%3A636175068

This week we had the pleasure of interviewing Dr. Peter Brennan (https://twitter.com/BrennanSurgeon?s=20&t=VZQWDi0op02x9_8qdn3Avg). Dr. Brennan is an oral maxillofacial surgeon in Portsmouth, England. A tremendously accomplished academic, Dr. Brennan has a keen interest in human factors in surgery. In addition, he is the co-editor of the Gray’s Surgical Anatomy. 

Links:

1. Dr. Brennan’s PhD on human factors: https://researchportal.port.ac.uk/portal/files/18357979/Peter_A_Brennan_PhD_thesis.pdf
2. We need to reduce hierarchy and empower junior doctors to speak up (BMJ): https://blogs.bmj.com/bmj/2019/05/03/improving-patient-safety-we-need-to-reduce-hierarchy-and-empower-junior-doctors-to-speak-up/
3. MDT meetings: https://onlinelibrary.wiley.com/doi/full/10.1111/jop.12853
4. Gray’s Surgical Anatomy: https://www.elsevier.com/books/grays-surgical-anatomy/brennan/978-0-7020-7386-1

Bio (from https://solentmaxillofacialclinic.com/professor-peter-brennan/)

Peter has been a consultant Oral and Maxillofacial Surgeon at Portsmouth Hospitals NHS Trust since 2002. He is also honorary Professor of Surgery and Head of the Academic Department of Surgery, at the University of Portsmouth. He qualified with honours in both medicine (1994) and dentistry (1987) gaining distinctions and winning many prizes in subjects including anatomy, pharmacology, anaesthetics, surgery, obstetrics and gynaecology and ophthalmology.

Last year, the Royal College of Physicians and Surgeons of Glasgow elected Peter as an Honorary Fellow, the first Maxillofacial Surgeon to receive this accolade.

Peter’s main clinical interests are head and neck malignancy, reconstructive free flap surgery and neck lumps. He is a research supervisor, an examiner for higher research degrees and has published over 500 papers to date covering many aspects of oral and maxillofacial surgery including cancer. Peter’s research has been awarded both National and International research prizes, and he has lectured extensively in the UK and abroad.

Peter has edited a number of books including the definitive 2 volume reference textbook of the speciality, Maxillofacial Surgery, which is used worldwide. He is the lead editor of the forthcoming Gray’s Surgical Anatomy, sister publication to the famous Gray’s Anatomy.

Dr. Bill Wall is one of the pioneers of liver transplantation, especially in Canada. We spoke to him on this episode about his training, the early days of transplantation and about his new children's book!

Links:

1. Member of the Order of Canada: https://www.gg.ca/en/honours/recipients/146-9121

Bio (from https://www.gg.ca/en/honours/recipients/146-9121)

William Wall is a dedicated and compassionate physician whose surgical and clinical proficiency have benefited many Canadians with end-stage organ disease. Professor of surgery at the University of Western Ontario, he established Canada's first liver transplant program at the London Health Sciences Centre, where he is director of the Multi-Organ Transplant Program. In this role, he has promoted excellence in research and patient care, as well as public awareness and support for organ donation. Widely respected by his peers, he served as president of the International Liver Transplantation Society.

This week we were joined by Dr. Pasieka once again to talk about strategies to find stress and burnout as surgeons, especially in the context of COVID19. Check out her paper below!

Links:

1. Shinrin-yoku, yoga and other strategies in the fight against COVID-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405594/

Bio:

Dr. Janice L Pasieka graduated from the University of Western Medical School and did her General Surgery Training at the University of Calgary. She then did two and a half years of Endocrine Surgical Training. The first year was spent in Dr David Hanley’s lab at the University of Calgary, then a year at the University of Michigan, under the mentorship of Dr. Norman Thompson followed by time at the Karolinska Institute in Stockholm, Sweden. She then returned to Calgary and has devoted her clinical practice solely to endocrine surgical diseases.

At the Tom Baker Clinic Center, Dr Pasieka was the driving force behind the development of a multidisciplinary clinic for Neuroendocrine Tumors as well as the Multidisciplinary Hereditary Endocrine Clinic. She is responsible for the development of the only Canadian AAES accredited fellowship program in Endocrine Surgery.
Dr Pasieka has been Secretary-Treasurer of the American Association of Endocrine Surgeons (AAES) and in 2010 she became the first Canadian and second woman to become President. She has served on the Council of the International Association of Endocrine Surgeons (IAES), and in 2016 became the Secretary-Treasurer - a position she holds at the present time. Dr Pasieka was the Canadian James IV Traveling Surgical Fellow 2006 and recently was appointed to the James VI Board of Directors. In 2007, the Women’s Executive Network named her as one of Canada’s 100 Most Powerful Women.
Dr Pasieka recently completed her six year term as a Governor of the American College of Surgeons. Her areas of interests (besides running, mountain biking, cycling and hiking & snowshoeing with her dog Kocher) evolve around neuroendocrine tumors, adrenal disease, thyroid cancer and the study of surgical outcomes in patients with hyperparathyroidism. To date she has over 140 peer-review publications, has edited 3 Endocrine Surgical textbooks and written over 24 book chapters.

This week on the podcast we spoke with Dr. Paul Engels, a trauma surgeon from McMaster University in Hamilton, Ontario. We got into some pretty detailed discussions around trauma training specifically, but more broadly about how we define what a resident should be able to perform at the end of training. 

Links:

1. The current state of resident trauma training: Are we losing a generation? https://pubmed.ncbi.nlm.nih.gov/29806811/

2. Canadian Collaborative on Urgent Care Surgery (CANUCS): https://canucs.ca/

3. Cause for concern: Resident experience in operative trauma during general surgery residency at a Canadian centre. https://journalhosting.ucalgary.ca/index.php/cmej/article/view/69323/54233

4. Toward an all-inclusive trauma system in Central South Ontario: development of the Trauma-System Performance Improvement and Knowledge Exchange (T-SPIKE) project. https://pubmed.ncbi.nlm.nih.gov/33720676/

5. ASSET course: https://www.facs.org/quality-programs/trauma/education/asset/

6. Treatment of Ongoing Hemorrhage: The Art and Craft of Stopping Severe Bleeding. https://www.amazon.ca/Treatment-Ongoing-Hemorrhage-Stopping-Bleeding/dp/3319634941. 

7. Simulated Trauma and Resuscitation Team Training (S.T.A.R.T.T) course: https://caep.ca/cpd-courses/simulated-trauma-and-resuscitation-team-training-s-t-a-r-t-t/

8. Definitive Surgical Trauma Care (DSTC™) Courses.  https://iatsic.org/DSTC/

9. Advanced Trauma Operative Management (ATOM) course. https://atomcourse.com/#:~:text=The%20Advanced%20Trauma%20Operative%20Management,post%2Dcourse%20exams%20and%20evaluations.

10.  BEST - Basic Endovascular Skills for Trauma. https://medschool.ucsd.edu/som/surgery/divisions/trauma-burn/training/courses/Pages/REBOA-Course.aspx.

Bio:

Paul Engels is a Trauma/General Surgeon and Intensivist at McMaster University in Hamilton, Ontario. He completed his residency in General Surgery and fellowship in Critical Care at the University of Alberta. He completed a fellowship in Trauma & Acute Care Surgery at Sunnybrook Health Sciences Centre in Toronto. He is a Fellow of the Royal College of Surgeons of Canada and the American College of Surgeons, as well as a member of the Eastern Association for the Surgery of Trauma and the American Association for the Surgery of Trauma.

We had the unique opportunity on this episode to speak with the Honourable Minister John Haggie. Dr. Haggie is a general surgeon who spent his career in Newfoundland and Labrador, and went on to become a Member of the House of Assembly in 2015. He was appointed to be the Minister of Health at that time and has continued to serve in that porfolio ever since. We spoke to him about his fascinating life story, his thoughts on leadership and the role of physicians in politics, and about his favourite book Shogun!

Bio (fromhttps://www.gov.nl.ca/hcs/department/minister/):

The Honourable John Haggie
Minister of Health and Community Services

Born in England, the Honourable John Haggie completed his medical studies at Victoria University in Manchester. He held several positions as physician, surgeon, tutor and registrar in the North West region of England and after a two-year fellowship, he received a doctorate in cancer research.

Since moving to Canada in the early nineties, Minister Haggie has had a long and distinguished career in medicine in Newfoundland and Labrador. He practiced initially as a general surgeon in St. Anthony with the Grenfell Region Health Services. In 1997, he was appointed attending surgeon of general and vascular surgery at James Paton Memorial Hospital in Gander. In 2008, he was appointed Chief of Staff at James Paton Memorial Hospital.

Dr. Haggie served as President of the Newfoundland and Labrador Medical Association and the Canadian Medical Association.

In Newfoundland and Labrador’s 2015 general election, he was elected MHA for the District of Gander and appointed to Cabinet to serve as the Minister of Health and Community Services, and continues to serve in that portfolio.

Dr. Haggie resides in Gander with his wife Jeanette and two Westies, Chloe and Gracie.

Lauren Kirwan is the nurse clinician for general surgery at the Foothills Medical Centre. She is currently finishing up her nurse practitioner degree. 

We wanted to ask Lauren her thoughts about what it means to be an OR nurse and what she wishes surgeons would do to make the OR environment better. We also hear about the impact of COVID19 on our nursing colleagues. We’d love to hear from our nurse listeners – what are some things that make your day or make you mad in the operating room? Email us at podcast.cjs@gmail.com with your thoughts and comments. 

Links:

1. Melinda Davis on the Anesthetist - Surgeon relationship: https://soundcloud.com/cjs-podcast/e40-melinda-davis-on-career-counseling-and-the-anesthetist-surgeon-relationship

2.  Atul Gawande paper on Safe Surgery Checklist implementation in South Carolina. Perception of Safety of Surgical Practice Among Operating Room Personnel From Survey Data Is Associated With All-cause 30-day Postoperative Death Rate in South Carolina. https://journals.lww.com/annalsofsurgery/Abstract/2017/10000/Perception_of_Safety_of_Surgical_Practice_Among.14.aspx

Podcast transcript: https://www.canjsurg.ca/content/e127-rob-leeper-competitive-motivation-trauma-simulation-and-starting-out-practice

Dr. Rob Leeper is a trauma surgeon at Western University in London, Ontario. We spoke with Dr. Leeper about his work on trauma simulation and particularly on his work on data drive competitive motivation strategies. Finally, Dr. Leeper shared with us the tips that he wished he had when started out in practice. 

Links:

1. Data Driven Competitive Motivation Strategies in a Longitudinal Simulation Curriculum for Trauma Team Training. https://pubmed.ncbi.nlm.nih.gov/30833203/

2. Multidisciplinary Difficult Airway Course: An Essential Educational Component of a Hospital-Wide Difficult Airway Response Program. https://pubmed.ncbi.nlm.nih.gov/29628333/

3. The role of trauma team leaders in missed injuries: does specialty matter? https://pubmed.ncbi.nlm.nih.gov/24089109/

Bio: 

Dr. Rob Leeper is an Assistant Professor in the Department of Surgery at Western University. He is an acute care and trauma surgeon with an interest in resuscitation, both inside and outside the operating room. He did residency in Western and went on to do a prestigious trauma fellowship at Johns Hopkins University. He is the father of 3 and a former college football player.

Podcast transcript: https://www.canjsurg.ca/content/e128-helen-pham-australian-surgical-training-programs-and-advice-starting-residency

A big welcome to all the new resident starting this week on their journeys to become physicians and surgeons. To help you on the journey, we caught up with Dr. Helen Pham. Dr. Pham is a clinical associate lecturer at the University of Sydney and is the current HPB fellow at the University of Calgary. Dr. Pham shared with us some of the differences in training paradigms for surgical programs between Canada and Australia, and also gave us her invaluable advice for new trainees. We would love to hear your tips – what do you wish you knew when you were starting out as a PGY1? Email us at podcast.cjs@gmail.com or tweet at us @CanJSurg.

Links:

1. Dr. Pham's notes, textbook recommendations: https://drive.google.com/drive/folders/1x-QJxNi6T-p5EgNy4ChwImmn2KtzlSAN?usp=sharing

2. QxMD: https://read.qxmd.com/ 

3. 100 years of surgical education: the past, present, and future.  https://bulletin.facs.org/2013/07/100-years-of-surgical-education/ 

4. Five things they don’t teach you in medical school. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5042714/

Bio:

Dr. Helen Pham is an HPB fellow at the University of Calgary. She was previously the Clinical Superintendent of Surgery at Westmead Hospital. She has a number of publications in liver and pancreatic surgery.

Podcast transcript: https://www.canjsurg.ca/content/e129-paul-mcbeth-engineering-and-surgery

This week we heard from Dr. Paul McBeth, intensivist and trauma surgeon at the University of Calgary. Dr. McBeth combines his unique engineering background with surgery, and shared his insights on how we all might use an engineering mindset to discover new ways of looking at old problems.

Links:

1. Robotics in neurosurgery. https://pubmed.ncbi.nlm.nih.gov/15476655/

2. Cost-effective remote iPhone-teathered telementored trauma telesonography. https://pubmed.ncbi.nlm.nih.gov/21150536/

Bio:

Dr. Paul McBeth is a Clinical Associate Professor in the Departments of Surgery and Critical Care Medicine at the University of Calgary. He began his career as an engineer with post graduate training in surgical robotics and human performance evaluation. He participated in the design and development of Project neuroArm: an image-guided neurosurgical robot system. During his medical training he continued to develop his research interests in robotics and remote ultrasound. Dr. McBeth completed post graduate training in General Surgery at the University of Calgary with sub-specialty training in Critical Care Medicine at the University of British Columbia and Trauma Surgery at the Elvis Presley Memorial Trauma Centre in Memphis, Tennessee. Dr. McBeth also holds an Adjunct position at the Schulich School of Engineering, University of Calgary where he is involved the a number of technology development projects. He has over 75 peer-reviewed publications and is currently leading a research program supporting intelligent systems monitoring for pre-hospital transport of critically ill patients.

Podcast transcript: https://www.canjsurg.ca/content/e130-homer-tien-ornge-emergency-transport-covid19-vaccine-distribution-leadership

Dr. Homer Tien is a trauma surgeon at Sunnybrook Hospital in Toronto. We were so excited to have him on the show because of the incredible work that he has done in multiple leadership roles, more recently as the president and CEO of ornge, Ontario’s air ambulance and transport service. Largely because of the amazing work he had done with ornge, Dr. Tien was also made in charge of the COVID19 vaccine distribution task force back in April 2021. This was a conversation about trauma care, paramedic services, and air ambulances, but even more importantly, we got to hear Dr. Tien’s insights on leadership. 

Links:

1. Preventable Deaths From Hemorrhage at a Level I Canadian
Trauma Center. https://www.researchgate.net/profile/Fernando-Spencer-Netto/publication/6585292_Preventable_Death_From_Hemorrhage_at_a_Level_I_Canadian_Trauma_Center/links/5a1d4cd50f7e9b2a5317123c/Preventable-Death-From-Hemorrhage-at-a-Level-I-Canadian-Trauma-Center.pdf

2. Ornge. https://www.ornge.ca/home

3. Amid third wave, U of T’s Homer Tien takes over province’s COVID-19 vaccine task force: CBC. https://www.utoronto.ca/news/amid-third-wave-u-t-s-homer-tien-takes-over-province-s-covid-19-vaccine-task-force-cbc

4. Clinical handover from emergency medical services to the trauma team: A gap analysis. https://pubmed.ncbi.nlm.nih.gov/33084560/

5. Operation Remote Immunity 3.0 wraps up after coordinating nearly 200 vaccine clinics in 29 remote and isolated communities. https://www.canada.ca/en/indigenous-services-canada/news/2022/02/operation-remote-immunity-30-wraps-up-after-coordinating-nearly-200-vaccine-clinics-in-29-remote-and-isolated-communities.html

Bio:

Tien earned a bachelor's degree in biochemistry from Queen's University in 1989.In 1992, he graduated with a Doctor of Medicine from McMaster University. He then pursued residency training in family medicine before obtaining his Independent Practice Certificate in 1993. His training was sponsored by the Canadian Forces. After training, he was then posted with the Field Ambulance at CFB Petawawa, and served as the unit medical officer for the 1st Battalion of the Royal Canadian Regiment. While at RCR, he deployed to Croatia on Operation Harmony. He then deployed to Bosnia with IFOR on Operation Alliance. He then served with Canadian special forces at Dwyer Hill Training Centre as their first unit medical officer. He has also deployed to the Golan Heights, and has worked with Veterans Affairs in the recovery of RCAF airmen missing from World War II, in the Burma recovery mission.

He later underwent four years of further residency training in general surgery via the Canadian Forces and the University of Toronto from 1998 to 2002.

As a Canadian Forces surgeon, he also deployed to the NATO-led multinational stabilization force in Bosnia in 2003, to Kabul with ISAF in 2004, and multiple times to the Role 3 Multinational Medical Unit in Kandahar.

In 2007, he earned a Master of Science in clinical epidemiology from the University of Toronto.

He is currently the president and CEO of Ornge, an air ambulance non-profit based on Ontario. He also holds the rank of colonel in the Canadian Forces Health Services, associate professorship at the University of Toronto,and was the former director of Trauma Services at Sunnybrook's Tory Regional Trauma Centre. He is the first to hold the Canadian Forces Major Sir Frederick Banting Term Chair in Military Trauma Research.

In April 2021, Tien was appointed to head Ontario's COVID-19 Vaccine Distribution Task Force for Phase 2 of the rollout

Podcast transcript: https://www.canjsurg.ca/content/e131-jeff-way-spirituality-surgery-managing-busy-practice-and-advocacy

We touched some “taboo” subjects today on the podcast – money and religion! Dr. Jeff Way is a trauma and general surgeon in Calgary. Today we asked Dr. Way about his interest in spirituality and how that has affected his career, inside and outside the operating room. We got his thoughts on managing a busy practice as well as his work on a provincial and national level with the government on healthcare and billing. 

Links:

1. Establishment and cost analysis of an office surgical suite. https://www.nlc-bnc.ca/eppp-archive/100/201/300/cdn_medical_association/cjs/vol-39/issue-5/0379.htm

Podcast transcript: https://www.canjsurg.ca/content/e132-donna-kimmaliardjuk-breaking-down-barriers-and-caring-indigenous-patients

On this episode, we had the privilege of speaking with Dr. Donna Kimmaliardjuk (@DKimmaliardjuk on Twitter). Dr. Kimmaliardjuk is the first Inuk cardiac surgeon in Canada and has won numerous awards for her trailblazing work. We were lucky enough to catch up with her to ask her about her career and get her thoughts on how we can both make surgery a more inclusive profession and how we can better serve our Indigenous patients.

Links:
Twitter: https://twitter.com/DKimmaliardjuk?s=20&t=DnmhGW0RRouo2ojP9oPEDQ

1. I had to open his chest to save his life. That’s the day I felt, this is badass. https://www.thestar.com/news/canada/2020/03/08/i-had-to-open-his-chest-to-save-his-life-thats-the-day-i-felt-this-is-badass.html

2. Postoperative outcomes for Nunavut Inuit at a Canadian quaternary care centre: a retrospective cohort study. https://www.cmajopen.ca/content/10/2/E304

3. Canada's first Inuk heart surgeon returns from U.S. to take job in St. John's. https://www.cbc.ca/news/canada/newfoundland-labrador/donna-may-kimmaliardjuk-cardiac-surgeon-1.6166828

4. Canada’s first Inuk cardiac surgeon gets to the heart of the matter. https://www.theglobeandmail.com/business/adv/article-canadas-first-inuk-cardiac-surgeon-gets-to-the-heart-of-the-matter/

5. If Joyce Echaquan were white, she would still be alive, Quebec coroner says. https://www.cbc.ca/news/canada/montreal/echaquan-coroner-report-health-care-system-racism-1.6199964

Bio:

Dr. Donna May Kimmaliardjuk is Canada's first Inuk cardiac surgeon. She attended medical school at the University of Calgary and then was matched to the University of Ottawa for her cardiac surgery residency. She went on to train at the prestigious Cleveland Clinic for her fellowship. She has won numerous awards, including the 2018 Indspire award. She is currently a staff cardiac surgeon at Eastern Health in St. John's, Newfoundland.

Podcast transcript: https://www.canjsurg.ca/content/e133-masterclass-charles-vollmer-types-and-workup-cystic-neoplasms-pancreas

Dr. Charles Vollmer is the Chief of GI Surgery and Director of Pancreatic Surgery at the University of Pennsylvania. He is a repeat guest of the show. We were lucky enough to have him do another masterclass for Cold Steel, this time on cystic neoplasms of the pancreas. In part 1 of this masterclass, Dr. Vollmer gives us an overview of cystic lesions of the pancreas, as well as their diagnosis and management. Make sure to check out part 2 as well, where Dr. Vollmer specifically focuses on IPMNs. 

Links:

1. https://soundcloud.com/cjs-podcast/e33-chuck-vollmer-on-peer-review-and-productivity

2. https://soundcloud.com/cjs-podcast/e82-charles-vollmer-on-pancreatic-fistulas

Bio:

Dr. Charles Vollmer is the Chief of GI Surgery and Director of Pancreatic Surgery at the University of Pennsylvania where he holds the rank of Professor of Surgery. Dr. Vollmer began his career at the Beth Israel Deaconess Medical Center in Boston where he served as an Assistant Professor of Surgery at Harvard Medical School before moving to Penn in 2011. He specializes in Pancreaticobiliary and other complex gastrointestinal surgery with a clinical research focus in outcomes assessment of high-acuity surgery. He has authored over 100 manuscripts and numerous book chapters. He is active in multiple national and international surgical societies where he has served in various leadership positions, including being a past President of the AHPBA. He is the current Scientific Program Chair for the IHPBA, and sits on their Executive Committee and Council. He is currently a reviewer for over 20 medical specialty journals and is on the Editorial Boards of Annals of Surgery, Surgery, HPB, JOGS, and the Journal of Surgical Oncology.

Podcast transcript: https://www.canjsurg.ca/content/e134-masterclass-charles-vollmer-cystic-neoplasms-pancreas-part-2

Dr. Charles Vollmer is the Chief of GI surgery at the University of Pennsylvania and is a passionate pancreatic surgeon. This is the second part of our masterclass series with Dr. Vollmer on cystic lesions of the pancreas. In part II, Dr. Vollmer dives deep specifically on IPMNs, giving us an in-depth discussion of types of IPMNs, the various guidelines for IPMN management, as well as an overview of operative principles for resecting IPMNs.

Podcast transcript: https://www.canjsurg.ca/content/e135-how-publish-papers-wendy-carroll

This week we got to peek behind the curtains of academic publishing with Wendy Carroll. Wendy is the Managing Editor of the Canadian Medical Association Journal Group. Wendy had some amazing insights into what goes on during the submission process, as well as the overall landscape for journals in 2022. Perhaps our favourite part of our conversation with Wendy was her tips about what makes for good writing!

Links:

1. Eight Step editing: https://www.editors.ca/eight-step-editing-jim-taylor-0

2. Predatory publishing solicitation: a review of a single surgeon's inbox and implications for information technology resources at an organizational level.  https://pubmed.ncbi.nlm.nih.gov/34105930/