Cold Steel: Canadian Journal of Surgery Podcast

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 [email protected] or @canjsurg on twitter.

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/

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.

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. 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.

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.

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 [email protected] 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.

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.

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 [email protected]. 

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.

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.