Cold Steel: Canadian Journal of Surgery Podcast

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 [email protected]. 

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 [email protected] 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/

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/

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

 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

 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

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