Embed Size (px)
Citation preview
CANAD IAN CANAD IAN CANAD IAN CANAD IAN CANAD IAN AS SOC IAAS SOC IAAS SOC IAAS SOC IAAS SOC IAT IONT IONT IONT IONT IONOF GENERAL SURGEONSOF GENERAL SURGEONSOF GENERAL SURGEONSOF GENERAL SURGEONSOF GENERAL SURGEONS
General Surgery Matters
421 Gilmour Street
Ste. 300
Ottawa, ON K2P 0R5
Tél.: 613-882-6510
www.cags-accg.ca
INSIDE:
WINTER 2016
A banner year for CAGS
Continued on page 2
President’s Message
Dr. Chris de Gara
President’s Messagecontinued ........................ 2
CAGS ResidentMentorship Program ..... 2
Board Members &Committee Chairs ......... 3
CSF 2015 ..................... 4-8
2015 Stevens NorvellAward Winners .............. 8
2015 Excellence inTeaching AwardWinners ........................... 9
2015 Science Award ..... 9
2015 CSRF AwardWinners ........................ 10
2015 CJS Editor’s ChoiceAward ............................ 11
Scrub Caps Off ..... 11-12
Operating GrantCompetition ................. 13
Save the Date .............. 14
Dear Colleagues,
Welcome to the Holidayedition of the CAGSnewsletter. This has indeedbeen a banner year for CAGS.Past president, DebrahWirztfeld, spearheaded majorinitiatives including theEndoscopy Task Force, theStrategic Planning sessionsand our membership survey.Her year as presidencyculminated in her inspirationalpresidential address on thetopic of Leadership. Theseinitiatives have done much toinform the activities for mypresidency. It was clear fromthe membership survey thatadvocacy was felt to be a veryimportant activity that CAGShad not been doing aparticularly good job of. Toaddress this I have made it mymission to visit each and everyprovince (and hopefullyterritories too) on thePresident’s Advocacy andListening Tour. It is my hopeto present at each provincialGeneral Surgery associationmeeting and during the visithave the opportunity to meet,
and accompanied byprovincial general surgicalleaders, with the ProvincialHealth Ministers to raise issuesof not only of provincial butalso national concern.
The themes that have formedthe foundation of CAGS’sfuture initiatives are:
1. Human Resources Planning— It has become increasinglyclear that General Surgerylacks any form of coherentplan. We are completelyunable to inform trainees ofthe labour market. To this endDr Matt Strickland, SurgeryResident, University ofToronto, and members of theResident committee carriedout a survey regardingGeneral Surgery jobsavailability. He presentedthese data at the recentNational Workforce Summit inOttawa to considerableacclaim. Additionally, work isnearly completed on asearchable database of allhospitals in Canada and theGeneral Surgeons who workin them. It is hoped that bywidely disseminating theinformation from theseprojects that CanadianGeneral Surgery trainees aretruly better informed.
2. Your CAGS Endoscopy TaskForce has been working hardto bring some order to the
Canadian General SurgeonEndoscopy scene. I wouldencourage you to read theproceedings paper thatfollowed the Endoscopy TaskForce meeting held in Toronto,February 2014 (http://www.researchgate.net/publication/275048291_Endoscopy_in_Canada_Proceedings_of_the_National_Roundtable).The issues of access to endosuites, effective residenttraining, maintenance ofpracticing General Surgeonendoscopy skills andcredentialing through coursesand Train-the-Trainer programsare all actively being pursued.
3. By its very nature Canadawith it huge distances has aremote and rural access toGeneral Surgery services issue.Once again much activity ison-going to explore how bestto deliver these services on aprovince by province basis.
To date I have already hadmeetings with President ClaireMarx and Vice President SteveCannon of the Royal Collegeof Surgeons of England – areasof commonalities anddissimilarities were discussed.Opportunities for transatlanticfellowships were alsodiscussed. A meeting at theClinical Congress in Chicagoin September with American
PAGE 2
GENERAL SURGERY MATTERS
Continued from page 1
A banner year for CAGS cont’dCollege President Warshaw andExecutive Director Dr David Hoytand colleagues was attended witha strong Canadian contingent ofpast CAGS Presidents Warnock,Christopher Schlachta, GeraldFried, President Elect MoradHameed and BJ Hancock, SectionHead of Pediatric General Surgery,Manitoba. After initially queryingthe purpose of the meeting CAGShas been invited to the AmericanCollege for a day to a half meetingto discuss areas of mutual interest.The Ontario Association of
General Surgeons meeting inToronto, November 7, wasextremely well attended withplenty of support for CAGS’initiatives. Similarly at the NorthPacific Surgical Association inPortland, November 14, withGeneral Surgeons from Alberta,British Columbia, Washington andOregon attendees, our messagewas well received.
Ultimately it is my hope to relaythe Value Proposition that isGeneral Surgery both to ourpolitical leaders and the public.
With an ever aging andincreasingly complex diseaseprofile, failure to support thecritical and vital role that GeneralSurgery plays in the health care ofCanadians would have farreaching consequences.
With the ensuing newsletters Ihope to be able to update you onthese and other CAGS initiatives.
Best wishes and season’s greetingsto you all.
Dr. Chris de GaraCAGS President
Dear Canadian Medical Studentand General Surgery Residents,
Beginning in the 2015/16academic year, your CAGSResident Committee is proud tointroduce the CAGS ResidentMentorship Program. This nationalresident-led initiative will facilitatethe pairing of interested medicalstudents from across Canada withresident mentors in generalsurgery programs.
This is a new initiative by theCAGS Resident Committee withthe goal of giving medical studentsan inside view into life in generalsurgery, and to hopefully foster astronger understanding of fit forthe specialty heading towardsCaRMS.
We welcome interested medicalstudents and general surgeryresidents to register for the CAGSResident Mentorship Program. Theprogram will operate in twoformats:
1) Impromptu mentorship:medical students and residentsinterested in more casualparticipation would be enteredinto a database. Residents wouldbe available to answer questionsvia email or go for coffee withlocal or visiting elective students.The vision for this group would bea list of people available as aresource to interested students,but would not focus on arelationship with a specificstudent.
2) Longitudinalmentorship:medical students and residentsinterested in a more long-termmentorship relationship would bepaired through the program. Thevision for this would follow thetraditional mentor/menteerelationship, and the hope is thatthe resident and student wouldmeet on a semi-regular timeframe.Mentors would be able to provideinsight into surgery, residency, andeventually provide advice aboutelectives and CaRMS.
If you are interested inparticipating in this new program,please contact us [email protected],and indicatea) if you are a medical student ora residentb) your year of study,c) your program, andd) which type of mentorship youare interested in.
Looking forward to hearing fromyou,
Daniel Sisson(PGY-2 Queen’s University)
Stephanie Lim(PGY-2 University of Manitoba)
Mentorship DirectorsCAGS Resident [email protected]
CAGS Resident Mentorship Program
PAGE 3WINTER 2016
Your 2015-2016 Board Members and Committee ChairsExecutive BoardPresidentDr. Christopher de [email protected]
President ElectDr. Morad [email protected]
President Elect SecundusDr. David [email protected]
Past PresidentDr. Debrah [email protected]
Secretary-TreasurerDr. Sean [email protected]
Representatives of theProvinces
British Columbia/YukonDr. Stephen [email protected]
Alberta/NWTDr. Paul [email protected]
SaskatchewanDr. Michael [email protected]
ManitobaDr. Brent [email protected]
OntarioDr. Christopher [email protected]
QuébecDr. Julie [email protected]
New BrunswickDr. Patrick [email protected]
Nova ScotiaDr. Les [email protected]
Newfoundland & LabradorDr. Peggy [email protected]
Prince Edward IslandDr. Phil [email protected]
Committee ChairsClinical Practice CommitteeDr. Shahzeer [email protected] Continuing ProfessionalDevelopment CommitteeDr. Olivier [email protected] Nominating CommitteeDr. Debrah [email protected]
Membership CommitteeDr. Neil [email protected]
Postgraduate EducationCommitteeDr. Mark [email protected]
Program CommitteeChairDr. Shiva [email protected]
Program CommitteeCo-chairDr. Chad [email protected] Research CommitteeDr. Alice [email protected] Residents’ CommitteeCo-chairDr. Gurp [email protected]
Residents’ CommitteeCo-chairDr. Gaby [email protected]
Test CommitteeDr. Roger [email protected]
Professionalism CommitteeDr. Samuel [email protected]
Oncology CommitteeDr. Frances [email protected]
Laparoscopic and EndoscopicSurgery CommitteeDr. James [email protected]
Acute Care SurgeryCommitteeDr. Sandy [email protected]
International SurgeryCommitteeDr. Gwen [email protected]
Hepatobiliary andTransplantation CommitteeDr. Shiva [email protected]
Endocrine, Head, and NeckCommitteeDr. Todd [email protected]
PAGE 4
GENERAL SURGERY MATTERS
Canadian Surgery FORUM 2015
Continued on page 5
Dr. Debrah Wirtzfeld delivering the Presidential Address
Dr. O. James Garden delivering the Langer Lecture
Dr. Alexander Patterson delivering the Royal College GallieLecture
Incoming President Dr. Chris de Gara at the CAGS AnnualGeneral Meeting
PAGE 5WINTER 2016 Continued from page 4
Honorary Members
Continued on page 6
Dr. Allan Okrainec with Langer Lecturer Dr. O. James Garden Dr. James Rutka with Gallie Lecturer Dr. Alexander Patterson
Honorary member Dr. William Wall presented by Dr. Vivian McAlisterand Dr. Debrah Wirtzfeld
Honorary member Dr. Hugh Scarth presented by Dr. Mark Walshand Dr. Debrah Wirtzfeld
PAGE 6
GENERAL SURGERY MATTERS
Industry Partners
Continued on page 7
Dr. Debrah Wirtzfeld with PlatinumPartner from Ethicon Dr. Debrah Wirtzfeld with Platinum Partners from Medtronic of
Canada Ltd.
Dr. Debrah Wirtzfeld with PlatinumPartners from Olympus Canada Inc.
Dr. Debrah Wirtzfeld with GoldPartner from Takeda Canada
Dr. Debrah Wirtzfeld with SilverPartner from Edwards Lifesciences(Canada) Inc.
Continued from page 5
PAGE 7WINTER 2016
National Laparoscopic Suturing Competition
Competitors of the 2015 National Laparoscopic Suturing Competition
Suturing competition semi-finalists and judges. From leftto right: Dr. ShahzeerKarmali, Dr. Chris de Gara,Dr. Shannon Stogryn, Dr.Caolan Walsh, Dr. AndrasFecso, Dr. Jeffrey Gu, and Dr.Jaap Bonjer
Dr. Andras Fecso from University of Toronto facing off against Dr. CaolanWalsh from Dalhousie University in the final round
Suturing Champion Dr. Caolan Walsh with Mr. Jerry Podrebarac
Continued on page 8
Continued from page 6
PAGE 8
GENERAL SURGERY MATTERS
Congratulations to the 2015 Stevens Norvell Award Winners!
SurgicalJeopardy
2015 Surgical Jeopardy Champions from University of Manitoba
2015 Stevens Norvell Award Winners
Dr. Stevens Norvellinitiated and developed thisexamination 26 years ago inorder to test and measureresidents’ general surgery-specific knowledge. Nowknown as the CAGS In-Training Exam, all generalsurgery residents in Canadatake the test through theirprogram office, at theirrespective universities. Namedafter the exam’s creator, thisnational award is given to theresidents in each post-graduate training year whoachieve either the highest orsecond highest score on theexam.
Resident Year 1:First - Dr. Yaseen Al LawatiMcGill UniversitySecond - Dr. Ashley DrohanDalhousie University
Resident Year 2:First - Dr. Adina FeinbergUniversity of TorontoSecond - Dr. Jessica CoffeyUniversity of Western Ontario
Resident Year 3:First (two tied)Dr. Mehdi QiabiSherbrooke UniversityDr. Matt StricklandUniversity of TorontoSecond - Dr. Elliot WakeamUniversity of Toronto
Resident Year 4:First - Dr. David GomezJaramilloUniversity of TorontoSecond - Dr. David NathanGintherUniversity of Saskatchewan
Resident Year 5/6:First (three tied)Dr. Paul LyseckiMcMaster UniversityDr. Solomon AzouzUniversity of TorontoDr. Marvin HsiaoUniversity of TorontoSecond - Dr. Boris ZevinUniversity of Toronto
PAGE 9WINTER 2016
Congratulations to the 2015 Excellence in Teaching Award Winners!
2015 Excellence in Resident Teaching Award Winners
This award is granted annually by each General SurgeryResidency Program. The Program Directors ofeach faculty of medicine in Canada will select one ortwo recipients based on demonstrated teachingexcellence. Each program may develop its own criteria
by which to make the selection. Programs may considerfaculty evaluations of resident teaching, studentevaluations of resident teaching, and selection by otherresidents in the program.
Dalhousie University Dr. Scott PennerLaval University Dr. Cindy Boulanger-GobeilMcGill University Dr. Jad Abou Khalil & Dr. Lawrence LeeMcMaster University Dr. Shiraz Elkheir & Dr. Christine KengMemorial University Dr. Jenelle TaylorNorthern Ontario School of Medicine Dr. Justin PolingQueen’s University Dr. Ephraim TangSherbrooke University Dr. Alexandre BougieUniversity of Alberta Dr. Suzana KüpperUniversity of British Columbia Dr. Candace HaddockUniversity of Calgary Dr. Kenton RommensUniversity of Manitoba Dr. Markus ZiesmannUniversity of Ottawa Dr. Jean Michael AubinUniversity of Saskatchewan Dr. David Nathan GintherUniversity of Toronto Dr. Dylan Pannell & Dr. Amandeep PooniUniversity of Western Ontario Dr. Jeff Hawel
2015 CAGS Science AwardDr. Debrah Wirtzfeld (center) with 2015 CAGS ScienceAward Recipients, Dr. Caitlin Chrystoja (left) andDr. Malak Alzahrani (right)
PAGE 10
GENERAL SURGERY MATTERS
2015 CSRF Award Winners
Dr. Debrah Wirtzfeld with 2015CSRF Grant Recipient Dr.Richard Garfinkle
Dr. Guillaume MartelUniversity of Ottawa andOttawa Hospital ResearchInstitute
Major liver resection can beassociated with significantintraoperative blood loss. Suchblood loss is a key determinant ofperioperative morbidity andmortality, as well as possibly long-term oncologic outcome. Ourresearch group is interested inidentifying simple perioperativeinterventions to decrease bloodloss and transfusion in liversurgery. Several techniquescurrently exist to do so, including
the use of low central venouspressure (CVP) anesthesia. Wholeblood phlebotomy prior to livertransection (distinct from acutenormovolemic hemodilution) is anovel intervention, whose aim isto decrease CVP, producing astate of controlled hypovolemia. Asmall body of existing literature,as well as our own preliminaryobservations, appears to supportits use in liver resection andtransplantation. In the PRICE trial,we hypothesize that the use ofphlebotomy during liver resectionwill lead to a decrease inoperative blood loss andperioperative blood transfusion,
over and above the standard ofcare of low-CVP anesthesia. Wewill conduct a proof of principlerandomized controlled trialwhere patients will be allocatedto phlebotomy plus standard ofcare or to standard of carealone. Participants will be thosepatients undergoing electivemajor liver resection at theOttawa Hospital for anyindication. A total of 62 patientswill be randomized over 18months. Liver surgeons will beblinded to the intervention. Welook forward to sharing ourresults at the Canadian SurgeryForum in 2018.
Dr. Richard GarfinkleMcGill University
Low-anterior resections arecommonly performed operationsin the treatment of rectal cancerand benign colonic disease.Anastomotic leak continues to bethe most dreaded postoperativecomplication, and to date, thediverting loop ileostomy has beenthe most effective means ofreducing its clinical consequences.However, a second operation toclose the loop ileostomy comeswith its own potential morbidity.Of all complications, postoperativeileus is the most commonlyobserved following ileostomyclosure, with rates typicallyreported between 15-32%.
Studies have previouslydemonstrated that thedefunctionalized bowel undergoesa series of functional andstructural changes, such as
atrophy of the intestinal villi andmuscular layers. It has beenhypothesized that these changesmay contribute to thedevelopment of postoperativeileus, and that stimulating thedefunctionalized bowel prior toclosure may functionally preparethe excluded bowel for intestinaltransit. A recently publishedrandomized controlled trialincluding 70 patients out of Spainwith stimulation via the distallimb of the ileostomy using athickened water-based solutionreported significantly reducedrates of postoperative ileus in thestimulated group when comparedto the control group (2.85% vs.20.0%, p=0.024).
The purpose of our study is todetermine the impact ofstimulating the distal limb of aloop ileostomy on postoperativeileus. This is a multicenterrandomized controlled trial
involving five Canadianuniversity-affiliated teachinghospitals with large colorectalpractices. This study will be thefirst multicenter study to evaluatepreoperative bowel stimulation,and the first of its kind in NorthAmerica.
“The PRICE Trial: Phlebotomy resulting in controlled hypovolemia to prevent blood loss inmajor hepatic resections”
“Does Bowel Stimulation Before Loop Ileostomy Closure Reduce Postoperative Ileus?A Multicenter Randomized Controlled Trial”
Continued on page 12
PAGE 11WINTER 2016
2015 Canadian Journal of Surgery Editor’s Choice Award Recipients
Dr. Vivian McAlister (right)with 2015 Canadian Journalof Surgery Editor’s ChoiceAward Recipients, from left toright, Dr. Daniel Kagedan,Dr. Andrew Haller, andDr. Caitlin Chrystoja
Scrub Caps Off...Scrub Caps Off aims to highlight thestrong work that Canadian ChiefGeneral Surgery Residents are doingacross the country. After nearly fiveyears of working as clinical resident,after untold numbers of call shifts, andhaving seen the highs and lows of theprofession, we believe these leadersdeserve to have their accomplishmentsshared.
Ryan RochonUniversity of Calgary
Q1) It’s your Chief year! Did youever believe this year wouldcome? How would you reflecton the journey overall thus-far?
Overall, it has been a greatexperience. The time has gone byextremely fast. There have been alot of great times and a few toughtimes. I think a General Surgeryresidency is something that willexpose who you really are as yourtrue character will show itself whenyou are pushed to your limit andmaybe a little farther…
Q2) So what is next? Where areyou off to in July? Have youalready lined up a job or afellowship or are you stillkeeping your options open?
I have been accepted to thecolorectal fellowship at theUniversity of Calgary. I would like tostay in an academic center inCanada.
Q3) What are you going to missthe most about residency?
The comradery. A good residencyprogram functions like a sports team.The close friendships you create duringresidency are special. Our annual tripsto Banff for Basic Science retreats standout. The American College of Surgerymeeting in Chicago with all the chiefresidents was fantastic.
Q4) Where did you go to medicalschool and how did you comeabout the decision to specialize inGeneral Surgery? Was itsomething you gradually got into
PAGE 12
GENERAL SURGERY MATTERS
or is there an “aha” momentfrom your background ortraining?
I went to medical school at UBC.I originally consideredOrthopedics but it didn’t fit aswell as I thought it would. I wasfortunate to have a greatexperience with the GeneralSurgery group in Prince George,BC. They were very supportive ofmy application to GeneralSurgery. I did an elective inPrince George last year and itreally reminded me of what agood thing they have going onthere. An elective with Dr. MoradHameed at VGH in the beginningof my 4th year of medical schoolsolidified my decision.
applied to medical school.Applying to medicine was one ofthe best decisions I have made. Ihave been a runner for a longtime but quite inconsistent duringresidency.
Q6) If you had to go backand do something else,anything other thanmedicine, and morespecifically surgery, whatwould it be?
Unfortunately, I can’t sing ordance so show business is out. Iwouldn’t give up myundergraduate years for anything.
Q7) What was the absolutefunniest moment duringyour residency?
There have been a lot of funnymoments over the last four years.Recently, I was rounding early onthe colorectal service and wokeup a patient who we wereplanning to discharge that day.He woke up a little confused andreferred to me as “cougar face.”The other resident on the servicehad to leave the room as hestarted to laugh. I still have noidea how to take that remark butI am sure it was meant as acompliment...
Q8) How about the scariest?
The scariest moment occurredlast month on September 10when my wife gave birth to ourtwins. It is an exciting time butalso terrifying for many reasons.Needless to say, I started studyingearly for the Royal College exam.
Q9) What is your go to foodon call?
A good night of call includesyour favorite staff orderingVietnamese.
Q10) If you could give somewords of wisdom to newResidents starting GeneralSurgery in the light ofeverything we’re facing thesedays across Canada (limitedjobs, duty hour restrictions,more and morespecialization), what would itbe?
The main advice I give to thejunior residents is that there is nosubstitute for hard work. Peopleform an opinion of you veryquickly. If you are perceived aslazy it is almost impossible toovercome. I also believe in beingkind to everyone. Sometimes itcan be really hard because youare exhausted, irritated and fedup but you will never regret it.
I also try to impress the fact thatwe all make mistakes. It’s how wehandle those mistakes that matter.Do not make excuses…
In regards to jobs, good peopleare always in demand. If youwork hard and get along witheveryone it’s hard for them to sayno.
Continued from page 11
Scrub Caps Off... cont’d
Q5) Where did you grow upand what did you do in yourlife before medicine? Not justprofessionally, but did youhave any hobbies or passionsthat you still pursue?
I grew up in Abbotsford, BC. Iwas a chiropractor before I
PAGE 13WINTER 2016
CANADIAN ASSOCIATIONOF GENERAL SURGEONS
RESEARCH FUNDCANADIAN ASSOCIATION OF GENERAL SURGEONS
OPERATING GRANT COMPETITION 2016
The Canadian Surgery Research Fund was founded in the early 1980s to promote researchperformed by general surgeons and general surgery residents in both clinical and basicscience. The CSRF currently funds two research projects per year as well as sponsoring aResident Research Retreat.
Applications are requested for Operating Grants from the Canadian Surgical ResearchFund. These can be submitted by E-mail to: [email protected]
1. The deadline for receipt is June 30th, 2016.2. There are two operating grants of $10,000 each.3. Applicants must be CAGS members.4. Residents are encouraged to apply with a CAGS member as supervisor.
Applications in all areas will be considered. We encourage proposals in these priorityareas:
1. Supply of General Surgeons2. Competence in Endoscopy and/or Endoscopic Services in Canada3. Access to Surgical Care by Canadians4. Community Surgery
The application should include:• A title page with information regarding all co-applicants and contact information for the
principal applicant, including an email address• A summary of the application (max. 1 page)• A detailed description of the proposed research (maximum 5 pages), a list of references
cited, and a detailed budget explaining how the $10,000 of funding will be allocated• A curriculum vitae of the principal applicant (max. 3 pages), and if the principal appli-
cant is a resident, of the faculty supervisor (max. 3 pages)• A letter of support from the Head of the Division of General Surgery or Chair of the
Department of Surgery of the institution where the work will be performedApplications not received by the stated deadline or not conforming to these requirements willnot be considered for funding.
For further information please contact:Dr. Alice WeiResearch Committee Chair10EN - 215, 200 Elizabeth StUniversity Health NetworkToronto, ON M5G 2C4Tel: (416) 340-4232Fax : (416) 340-3808email : [email protected]
HHHHHappy appy appy appy appy HHHHHolidaysolidaysolidaysolidaysolidays!!!!!
PAGE 14
GENERAL SURGERY MATTERS
Save thedate!
SAVE THE DATE!2016 CANADIAN SURGERY
FORUM
Sept 8-11, 2016Fairmont Royal York
Toronto
