Cold Steel: Canadian Journal of Surgery Podcast

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/

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

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 [email protected] 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/

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.

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

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 [email protected] 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 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 [email protected] 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.

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 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).

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.