Cold Steel: Canadian Journal of Surgery Podcast

Dr. Andrew Ibrahim (https://twitter.com/AndrewMIbrahim) is a general surgeon at the University of Michigan and an architect at the firm HOK. In this episode, we talk about his path and how he combined his passion for surgery and architecture.  We get his thoughts on visual abstracts,  the concept of design, his vision for hospitals of the future and what architects might learn from surgeons.

Links:

Links:
1. WIRED story about Dr. Ibrahim: https://www.wired.com/story/lets-save-some-lives-doctors-journey-into-pandemic/
2. Dr. Ibrahim’s website, which also has great resources on visual abstracts: https://www.surgeryredesign.com/
3. Design-thinking and IDEO: https://www.ideo.com/
4. Ernest Codman: https://qualitysafety.bmj.com/content/11/1/104
5. Health in All Design: https://www.hok.com/news/2019-12/health-in-all-design-dr-andrew-ibrahim-on-the-intersection-of-architecture-and-healthcare/#:~:text=%E2%80%9CAt%20HOK%20we%20have%20launched,public%20space%20for%20health%20intervention.
6. Annals of Surgery paper on “Building a Better Operating Room”: https://pubmed.ncbi.nlm.nih.gov/27163950/
7. Health and Design Fellowship: https://medicine.umich.edu/dept/surgery/education/health-design-fellowship

Bio:

Andrew M. Ibrahim MD, MSc is an Assistant Professor of Surgery, Architecture & Urban Planning at the University of Michigan and Chief Medical Officer at HOK, a global design and architecture firm. He completed his undergraduate and medical degrees education both with Honors at Case Western Reserve University with a year of coursework at University College London and The Bartlett School of Architecture. In addition to his health services research degree from the University of Michigan as a Robert Wood Johnson Clinical Scholar, he completed additional policy training as a Crile Fellow at Princeton University and as a Doris Duke Fellow at John Hopkins Hospital.

Dr. Ibrahim’s research at the interface of healthcare, policy evaluation and architecture has resulted in numerous publications, book chapters, international presentations and appointment to the editorial boards at the Annals of Surgery and the JAMA Network. He is one the youngest Senior Principal’s at HOK and currently serves as the Innovation Principal on a >$2 billion academic health center master plan.

Our guest for this episode doesn’t believe in comfort zones. Dr. Vivian McAlister is a transplant surgeon, a professor of surgery in London, Ontario, and a former Editor-in-Chief of the Canadian Journal of Surgery. At the age of 52, Dr. McAlister decided to enlist with the Canadian Forces Health Services as a combat surgeon. For all his contributions to Canada as a surgeon and researcher, he was recently named an Office of the Order of Canada. In this episode, we talk about why chose to become a military surgeon, some of the challenges of current training paradigms, and his experience being an Editor-in-Chief of CJS. 

Please note that in this episode, we do discuss the very real but terrible things Dr. McAlister witnessed while on tour with the Canadian military. Please see below: 

12:30 – 16:45: description of injuries of children after being hit with improvised explosive devices (IEDs) 

Links:
1. Dr. McAlister naming to the Order of Canada: https://www.schulich.uwo.ca/surgery/about_us/news/2021/dr_vivian_mcalister_named_officer_of_the_order_of_canada.html#:~:text=Order%20of%20Canada-,Dr.,to%20the%20Order%20of%20Canada.
2. Dr. McAlister’s John McCrae Memorial Medal: https://www.cma.ca/john-mccrae-memorial-medal-2019-recipient 
3. Injury profile suffered by targets of antipersonnel improvised explosive devices: prospective cohort study: https://bmjopen.bmj.com/content/bmjopen/7/7/e014697.reviewer-comments.pdf
4. Dr. McAlister’s paper on the history of CJS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512859/
5. The current state of resident trauma training: Are we losing a generation? http://canjsurg.ca/61-3-153/

Bio:

Vivian McAlister is a surgeon at University Hospital London. He is a professor in the Department of Surgery. He is a member of the Canadian Forces Medical service and has deployed to Afghanistan and Haiti. He is a general surgeon with special interest in hepatobiliary, endobiliary, transplant and combat surgery. His research interests include fundamental and clinical research in these areas as well as the history of medicine.

https://www.schulich.uwo.ca/generalsurgery/people/bio/vivian_mcalister.html

We are absolutely delighted to have Karen Norris (@freckleface23 on twitter) join us on the podcast today. Karen Norris is the conference manager at the Canadian Association of General Surgeons and manages the Canadian Surgery Forum, the largest annual meeting for Canadian general surgeons. In this episode we talk about what the future holds for conferences in a COVID world, including how organizations can optimize their virtual conferences and what hybrid conferences might look like. 

Links:
1. The Art of Gathering: How We Meet and Why it Matters - https://www.penguinrandomhouse.com/books/319055/the-art-of-gathering-by-priya-parker/
2. Meetings Mean Business Canada Advocacy Video: https://vimeo.com/367271986
3. Meetings Mean Business webpage: https://www.meetingsmeanbusiness.ca/
4. TraumaCon: https://traumacon.org/
5. Mike Morrison (Twitter): https://twitter.com/mikemorrison?lang=en
6. Article I referenced about one conference using unique networking opportunities: https://www.bizbash.com/production-strategy/virtual-events/article/21202973/how-american-film-markets-virtual-conference-created-spontaneous-networking-opportunities 
7. The Canadian Association of General Surgeons: https://cags-accg.ca/
8. The Canadian Surgery Forum: https://www.canadiansurgeryforum.com/

Bio:

Karen Norris has a degree in Political Science and Sociology from Queens University, a diploma in Event Management from Algonquin College and in 2015 she achieved her Certified Meeting Professional (CMP) designation from the Events Industry Council.

She is the Conference Manager at the Canadian Association of General Surgeons (CAGS) and manages the Canadian Surgery Forum which is the largest surgical meeting in Canada attracting 1000+ delegates annually. Before her position with CAGS, she had coordinated conferences for the Association of Faculties of Medicine of Canada and the Coaching Association of Canada.

She has sat on numerous boards and committees with Meeting Professionals International (Ottawa Chapter) and The Professional Convention Management Association (Canada-East Chapter). She has also sat on various tourism advisory boards for major Canadian cities who host business events and she currently sits on the Algonquin College Event Management Program Advisory Board.

She was awarded Planner of the Year in 2018 by the Ottawa Chapter of Meetings Professional International and was a member of the team who won the 2019 “RISE” Award for most Innovative Educational Programming by Meeting Professionals International for an inaugural conference entitled “The Event”.

Whenever she can, she works with Meetings Mean Business Canada, the advocacy arm of the business events industry for Canada to garner support from government officials and the public about the economic impact of conferences and events.

It’s our pleasure to start off the new year with an episode on social media and surgery! In this episode, we were joined by Dr. Sean Langenfeld (https://twitter.com/seanlangenfeld). Dr. Langenfeld is a colorectal surgeon at the University of Nebraska and has spent a long time doing research and thinking about social media and surgery. We talk about the concept of “professionalism” on social media, the infamous “medbikini” incident, and online reputation management. 

Links:

1. An assessment of unprofessional behavior among surgical residents on Facebook: a warning of the dangers of social media. https://pubmed.ncbi.nlm.nih.gov/24981657/
2. The Glass Houses of Attending Surgeons: An Assessment of Unprofessional Behavior on Facebook Among Practicing Surgeons. https://pubmed.ncbi.nlm.nih.gov/26276300/
3. CNN article on #MedBikini: https://www.cnn.com/2020/07/25/cnn10/medbikini-backlash-and-apologies-trnd/index.html
4. RETRACTED: Prevalence of unprofessional social media content among young vascular surgeons. https://www.jvascsurg.org/article/S0741-5214(19)32587-X/fulltext
5. Social Dilemma documentary. https://www.netflix.com/ca/title/81254224
6. ASCRS Facebook group. https://www.facebook.com/fascrs/groups/

Bio (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755771/):

Dr. Sean Langenfeld is a staff colon and rectal surgeon at the University of Nebraska Medical Center in Omaha, NE. Sean received his undergraduate and medical school training at St. Louis University in St. Louis, MO, and performed his General Surgery Residency training at the University of Kansas School of Medicine, Wichita, KS. Following this, Sean completed his Colon and Rectal Surgery residency at the University of Texas, in Houston, TX. Since that time he has been at the University of Nebraska where he is an Associate Professor of Surgery, Chief of Colon and Rectal Surgery and Associate Program Director for the General Surgery Residency. He is also the Director, Endoscopic Simulation at the University of Nebraska Medical Center.

Sean remains a busy active clinician and academic surgeon, teaching residents on a daily basis. He is an active researcher and has several ongoing projects on the use of social media in surgery and simulation training in the era of the modern residency. He is an active participant in multiple surgical societies and serves on several national committees of the American Society of Colon and Rectal Surgeons.

Sean and his wife, Elizabeth, have three children, and live in Omaha, NE. When not working, Sean enjoys playing in a men's soccer league, watching all Creighton Bluejays' sports teams, and is a huge Nebraska Cornhusker football fan.

In this episode, we were lucky enough to have Dr. Nicholas Zyromski (https://twitter.com/nzyromski) give us a masterclass on pancreatitis. We go over classification and then go through a host of controversial topics: endoscopic management, percutaneous drainage, antibiotics, nutrition, and surgical management.

Don't forget to check out Dr. Zyromski's music, including "P-Blues"!

Links:

1. Nicholas Zyromski on Spotify:  https://open.spotify.com/artist/3H9y3W3B8a2K7SGAXgzNB6
2. Atlanta Criteria: https://pubs.rsna.org/doi/full/10.1148/rg.2016150097
3. John Howard: https://bulletin.facs.org/2019/05/john-m-howard-a-pioneer-in-vascular-trauma-and-pancreatic-surgery/#:~:text=Howard%20was%20known%20for%20his,of%20pancreatitis%20and%20pancreatic%20cancer.
4. Thomas Howard “As Good As it Gets” editorial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1877065/
5.  Transgastric Pancreatic debridement video: https://link.springer.com/article/10.1007/s11605-019-04375-x
6.  Prospective Analysis of the Mechanisms Underlying Ineffective Deep Vein Thrombosis Prophylaxis in Necrotizing Pancreatitis. https://pubmed.ncbi.nlm.nih.gov/33039510/
7.  Endoscopic management of pancreatic ascites due to duct disruption following acute necrotizing pancreatitis. https://onlinelibrary.wiley.com/doi/full/10.1002/jgh3.12113

Dr. Zyromski's Bio: 

As a gastrointestinal surgeon with a specialty in pancreas and hepatobiliary surgery, a substantial portion of my clinical practice involves caring for patients with GI and HPB malignancy. My major interest within this sub discipline is pancreatic disease. In this context, my research goals are two: 

1. Clinical research: To continue to expand and build upon an already active clinical research program within the pancreatic service. Current efforts include collaboration within the Department of Surgery pancreatic surgery group evaluating methods to improve technical considerations in surgery for pancreatic cancer as well as retrospective clinical studies utilizing lndiana Universlty's large volume of pancreatic cancer patients. Future directions include prospective randomized trials, evaluating optimal management for patients with pancreatic cancer including anticoagulation in the setting of superior mesenteric vein/portal venous resection. 

2. Basic science research: The fundamental platform of my basic science laboratory program is to evaluate pancreatic disease in the context of obesity. Obesity is epidemic in America in 2007 and has been shown to be an independent risk factor both for developing severe acute pancreatitis as well as for developing pancreatic cancer. Over the past year, in efforts to get my laboratory program up and running, I have focused on the pancreatitis arm. The big picture, however, also includes the study of pancreatic cancer. This fall we have experiments planned to investigate the mechanisms by which obesity may potentiate the development of pancreatic cancer in our well-established murine model of congenital obesity. As both arms of this laboratory program mature , the ultimate goal is to provide translational application.

In this episode, we discuss the Danish mask study. We discuss the paper itself and the results.  More importantly, we discuss the challenges of science communication and science literacy for physicians and the general public. 

We were joined once again by Drs. Kelly Vogt (https://twitter.com/kellynvogt) and Morad Hameed (https://twitter.com/moradhameed).

Email us at [email protected] with your thoughts and comments!

Links:

1. Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers. Annals of Internal Medicine. https://www.acpjournals.org/doi/10.7326/M20-6817

2. The curious case of the Danish mask study. https://doi-org.ezproxy.library.ubc.ca/10.1136/bmj.m4586

3. https://www.tmz.com/2020/11/22/facebook-masks-oxford-masks-false-information-covid-coronavirus/

In this episode, we were joined by surgical oncologist Dr. Carolyn Nessim (www.twitter.com/carolynnessim). Dr. Nessim works at the Ottawa General Hospital and gave us a masterclass on melanoma. We talk about an initial approach to melanoma, staging, immunotherapy, and a walk-through of how Dr. Nessim does her groin dissections.

Links

1. http://carolynnessim.com/
2. The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652033/
3. Cordeiro et al. Sentinel Lymph Node Biopsy in Thin Cutaneous Melanoma: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/26932710/
4. Socioeconomic Status and Melanoma in Canada: A Systematic Review. https://pubmed.ncbi.nlm.nih.gov/32955341/

Brief Bio:

Dr. Carolyn Nessim is a Surgical Oncologist at the Ottawa Hospital and Assistant Professor of Surgery at the University of Ottawa. She completed her MD, MSc (Biomedical Sciences) and General Surgery Residency at the University of Montreal. Her fellowship training was in Surgical Oncology at the University of Toronto and then at the Peter MacCallum Cancer Center in Melbourne Australia.

She is currently also a Clinician Investigator in the Cancer Therapeutics Program at The Ottawa Hospital Research Institute (OHRI) as well as the Program Director for the Complex Surgical Oncology Subspecialty Fellowship training program. Her clinical practice focuses on the treatment of patients with Soft Tissue Sarcoma/GIST, Melanoma/Skin Cancers, Gastric cancer and Neuroendocrine Tumours. She is the Regional Co-Lead for Melanoma and Skin Cancers and Gastric Cancer in the Champlain LHIN. She has been invited as a speaker and moderator at several national and international conferences on the topics of Sarcoma and Melanoma. She is a member of Cancer Care Ontario's Skin Cancer Advisory Board as well as the American Society of Clinical Oncology's Technical Expert Group for Melanoma.

Dr.  Ryan Martin is an orthopedic surgeon at the Foothills Medical Centre in Calgary, Alberta. We talked to him about what it was like to be a sports doctor for the Calgary stampeders, and the preparation he does for going into the operating room.

Dr. Martin received his medical degree from the University of Ottawa. He later went on to complete his Orthopedic surgical residency at the Cumming School of Medicine, University of Calgary (Calgary, AB). After completing his surgical residency, he began his sub-specialization. He completed his Orthopedic Trauma Fellowship at the Hospital for Special Surgery - Cornell University (New York, NY) and his Sport Medicine and Arthroscopy Fellowship at the University of Toronto (Toronto, ON).

Since returning to Calgary, Dr. Martin has taken up practice centered out of the Foothills Medical Centre. While running a busy Level 1 trauma practice he has focused on the arthroscopic treatment of traumatic knee conditions involving fractures as well as cartilage and ligament injuries.

Dr. Martin travels nationally and internationally to lecture and present his research. He serves on several committees including the Trauma representative for the University of Calgary Orthopedic Surgery Residency Training Committee, Co-Chair of the Canadian Orthopedic Residency Forum and Co-lead of the bulk Allograft Cartilage Transplantation Program. He also serves as an Orthopedic Surgeon for the Calgary Stampeders Football Club.

When his is not working Dr. Martin spends most of his time with his wife and son. He enjoys skiing, mountain biking, playing hockey and painting.

Links:

1. EBRS-CAGS Journal Club: Antibiotics versus Appendectomy for Appendicitis: https://us02web.zoom.us/webinar/register/WN_wm0nIlJLR-2zcRcqDUs8uQ

2. Ammolite Biomodels: https://www.ammolitebiomodels.com/

In this episode, Dr. Kelly Vogt (https://twitter.com/kellynvogt) and Dr. Rebecca Auer(https://twitter.com/auer_r) join us to talk about the documentary film "RBG". What can we as surgeons learn about from the work of Ruth Bader Ginsburg? 

Links: 

-RBG documentary: https://www.netflix.com/ca/title/80240086

This is a special episode of Cold Steel done in collaboration with the Canadian Association of General Surgeons (CAGS: www.twitter.com/CAGS_ACCG). In lieu of the annual Canadian Surgical Forum (CSF), CAGS put on a series of fantastic webinars over the week of Nov 26 - 30. These were highly impactful and relevant webinars. Topics included: 

-The COVID-19 Elective Surgery Crisis and New Models of Surgical Referral and Care

- Alone in the Night: Difficult Scenarios in ACS

- Revitalizing the Morbidity and Mortality Conference (MMC)

- Diversity in Health Research Outcomes 

In this session, we discussed the challenges facing Morbidity and Mortality Conferences (MMC's) and how we can continue to revitalize this time-honoured tradition. The session was moderated and organized by Ameer Farooq, with Dr. Morad Hameed, Dr. Chelsea Harris, and Dr. Christian Finley as the invited panelists. 

To check out all the CAGS webinars, please go to the CAGS website (https://cags-accg.ca/). Please consider becoming a member to access all the great content available to CAGS members.

Links for M&M's

1. Dr. Hameed narrative review paper on MMC's: http://canjsurg.ca/63-3-e211/

2. Failure to rescue paper by Dr. Amir Ghaferi: https://www.nejm.org/doi/full/10.1056/nejmsa0903048

3. The last dance: https://www.netflix.com/ca/title/80203144

4. Association between technical skill and long-term survival for colon cancer: https://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2020.5462

5. Ethics M&Ms: https://meridian.allenpress.com/jgme/article/8/3/462/189862/Ethics-M-amp-Ms-Toward-a-Recognition-of-Ethics-in

6. cultural complications - https://www.culturalcomplications.com/

7. ottawa M&M "OM3" model: https://emottawablog.com/2018/03/improving-morbidity-mortality-rounds-om3/

8. Positive deviance for continuous quality improvement: https://pubmed.ncbi.nlm.nih.gov/26188970/

9. Pan-Canadian standards for Cancer Surgery (Finley): https://pubmed.ncbi.nlm.nih.gov/31364830/