Cold Steel: Canadian Journal of Surgery Podcast

Grace Rozycki is a professor of surgery. Primarily practicing at Johns Hopkins Bayview Medical Center, Dr. Rozycki specializes in trauma surgery and surgical critical care. Her research focuses on quality as it relates to emergent general surgery and injury.

She received her medical degree from Sidney Kimmel Medical College of Thomas Jefferson University.

In this episode we talk to her about her pioneering work in trauma ultrasound. We also get her thoughts about gender equity and mentorship in surgery.

1. Interview with Dr. David Livingstone for AAST: http://www.aast.org/Assets/99682126-7e34-438f-810b-d8c8534754ca/636987448036600000/rozycki-grace-pdf

2. WTA 2009 Presidential Address: http://westerntrauma.org/documents/PastPresidents/2009Rozycki.pdf

3. AAST 2016 Presidential Address: https://scholarworks.iupui.edu/bitstream/handle/1805/13289/Rozycki_2016_legacy.pdf?sequence=1&isAllowed=y

4. EAST 2014 Oriens Lecture: https://journals.lww.com/jtrauma/Fulltext/2014/07000/The_strength_that_it_takes__Ten_lessons_learned.2.aspx

Dr. Alex Poole is a general surgeon in Whitehorse, Yukon, although his practice is not a typical general surgery practice. In this episode we talk about what it's like to be a remote surgeon, his advice for those interested in a career in remote and rural surgery, and his work on frostbite injuries.

Links:

1. Treatment of severe frostbite with iloprost in northern Canada. CMAJ paper: https://www.cmaj.ca/content/188/17-18/1255/tab-article-info

2. Equestrian Injuries: Incidence, Injury Patterns, and Risk Factors for 10 Years of Major Traumatic Injuries. https://pubmed.ncbi.nlm.nih.gov/17434372/

3. GSA Provincial Surgeons of Australia: https://psa.generalsurgeons.com.au/

Dr. Sean Gregg is a general surgeon in Red Deer, Alberta. He has a special focus on hepatobiliary surgery but practices a full range of general surgical operations.  Dr. Gregg completed medical school, residency and HPB training at the University of Calgary.

In this episode we hear Dr. Gregg's fascinating life story, and how his experiences with a Thai street artist shaped his approach to surgical training. We also get his thoughts on how entrepreneurship and advocacy can unlock creativity in a surgical career.

Links:

1. Cold Steel episode with Dr. David Urbach on new models to improve surgical efficiency: https://soundcloud.com/cjs-podcast/e17-david-urbach-on-checklists-wait-times-in-the-time-of-covid-and-medical-devices

2. Globe & Mail op-ed on single-entry models: https://www.theglobeandmail.com/opinion/article-a-simple-scheduling-fix-could-help-clear-the-surgery-backlog/

3. Scott Gmora on out-of-the-box thinking: https://soundcloud.com/cjs-podcast/e05-scott-gmora-on-surgical-training

4. CBC news article on surgeons speaking out against AHS recommendations: 4. https://www.cbc.ca/news/canada/calgary/alberta-doctors-ahs-review-surgeries-1.5456152

This was a special episode of Cold Steel. In light of the murder of George Floyd and the subsequent protests, there has been a renewed international desire to confront the racial inequities that plague our society today. This applies to healthcare and in particular to surgery. To talk about this we have three phenomenal guests. 

Dr. Julius Ebinu is a neurosurgeon in Sacramento at UC Davis. 
Bio: https://health.ucdavis.edu/team/search/32267/julius-ebinu---neurological-surgery---minimally-invasive-surgery---spine-surgery---neuro-oncology-sacramento

Dr. Shahzeer Karmali is a previous guest on the show and is a minimally invasive and bariatric surgeon at the University of Alberta.
Bio: https://www.longdom.org/editor/shahzeer-karmali-13704

Dr. Morad Hameed is a recurrent guest on our show! He is a trauma and critical surgeon at Vancouver General Hospital and section head at UBC.  
Bio: https://surgery.med.ubc.ca/people/s-m-hameed/

Links:

1. .Moneeza Walji - Diversity in medical education: data drought and socioeconomic barriers. Editorial in CMAJ. https://www.cmaj.ca/content/187/1/11

2.#blackintheivory : https://www.nature.com/articles/d41586-020-01741-7

3. Langenfeld paper on social media and professionalism "An Assessment of Unprofessional Behavior Among Surgical Residents on Facebook: A Warning of the Dangers of Social Media": https://www.sciencedirect.com/science/article/pii/S1931720414001597

4.Daniel Coyle - The Culture Code: http://danielcoyle.com/the-culture-code/

5. Scott Page: https://www.amazon.ca/Difference-Diversity-Creates-Schools-Societies/dp/0691138540/ref=pd_lpo_14_t_0/144-1177497-3882233?_encoding=UTF8&pd_rd_i=0691138540&pd_rd_r=a51d0320-1d9c-414a-9693-8da0daa33eee&pd_rd_w=LxHKq&pd_rd_wg=Rp9r9&pf_rd_p=256a14b6-93bc-4bcd-9f68-aea60d2878b9&pf_rd_r=AP8HAG2NYQ2REKA89MSJ&psc=1&refRID=AP8HAG2NYQ2REKA89MSJ

6. CJS edtorial. Gender (and other) equity, diversity and inclusion
in surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006353/pdf/0620292.pdf

7. Annals of Surgery commitment to rapid peer review for articles on equity and social justice: https://twitter.com/AnnalsofSurgery/status/1271532880716427265

8. All-Blacks rugby team "Legacy": https://www.amazon.ca/Legacy-James-Kerr/dp/849450648X/ref=sr_1_2?dchild=1&gclid=CjwKCAjwltH3BRB6EiwAhj0IUN4vp5-TumaPXOrj6O3Jkq0vT6pIaQDwYGRyR6gi251DieBvmmIUdBoCLPMQAvD_BwE&hvadid=208296459563&hvdev=c&hvlocphy=9001332&hvnetw=g&hvqmt=e&hvrand=15113677967642998583&hvtargid=kwd-300495912229&hydadcr=22431_9261611&keywords=legacy+all+blacks&qid=1593068639&s=books&sr=1-2&tag=googcana-20

9. "A physician and father asks if things will be different for his boys" CBC article. https://www.cbc.ca/news/canada/ottawa/racism-black-doctor-growing-up-name-calling-medical-school-impact-career-1.5603251

10. United World Colleges Swaziland: https://www.uwc.org/news/?pid=159&nid=8&storyid=19

It’s not an understatement to say that Dr. David Feliciano is a true giant in trauma surgery. Dr. David V. Feliciano received his medical degree in 1970 from Georgetown University in Washington, D.C. He completed his general surgery training at Mayo Clinic, in trauma at Wayne State University, and vascular surgery at Baylor College of Medicine (where he trained under Dr. DeBakey). He was Professor of Surgery at Emory University and Surgeon-in-Chief at Grady Memorial Hospital in Atlanta, Georgia from 1991 to 2011. He is now a Clinical Professor of Surgery at the University of Maryland and an attending surgeon at Shock Trauma.

We discuss with him how he recruited such amazing faculty, developing one’s technical skills, research, and the future of trauma. 

1.Trauma textbook: https://www.amazon.ca/Trauma-Eighth-Ernest-Moore/dp/1259860671

2.“Everything You Ever Wanted to Know about Trauma” public lecture: https://www.youtube.com/watch?v=99yddsDe6oU

3.“Leftovers” by Dr. Feliciano has one of the best lines in a paper ever: At this point, the chief surgical resident on the trauma service met with the attending surgeon for violating his own well-known rule—“wounds that don’t heal contain dead tissue, infected tissue, cancer, or a foreign body.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263419/

4.Pitfalls in the management of peripheral vascular injuries. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877918/

Tim Pawlik (@https://twitter.com/timpawlik) is an academic surgeon focused on hepatobiliary diseases. He serves as the surgeon-in-chief of The Ohio State University Wexner Medical Center and Chair of the Department of Surgery in the College of Medicine. He has an MPH, PhD, and a Masters of Theology from Harvard Divinity School.

We talk to him about his unique training pathway, academic productivity and surgical“regret”. Finally, he gives us his thoughts on passion and leadership, specially duringCOVID19.

Links:
1. The Last Dance documentary: https://www.imdb.com/title/tt8420184/

2. When a Patient Regrets Having Undergone a Carefully and Jointly Considered Treatment Plan, How Should Her Physician Respond?: https://journalofethics.ama-
assn.org/article/when-patient-regrets-having-undergone-carefully-and-jointly-
considered-treatment-plan-how-should-her/2020-05

3. Regret in Surgical Decision Making: A Systematic Review of Patient and Physician
Perspectives. https://pubmed.ncbi.nlm.nih.gov/28243695/

4. A Singular Hope: How the Discussion Around Cancer Surgery Sometimes Fails.
https://pubmed.ncbi.nlm.nih.gov/27638674/?from_term=pawlik%2C+tim+AND+decis
ion&from_pos=5

5. Comparing Surgeon Approaches to Patient-Centered Cancer Care Using Vignette
Methodology. https://link.springer.com/article/10.1007/s11605-020-04661-z .

6. ASO Author Reflections: The Influence of Surgeon Characteristics on Patient-
Centered Approaches to Treatment Decision-Making.
https://link.springer.com/article/10.1245/s10434-020-08490-x .
7. https://www.ahpba.org/

8. Tim Pawlik’s peloton challenge
https://twitter.com/kelly_haisley/status/1248232421260173312

The transition from surgical residency to fellowship is a landmark step. Two fantastic surgery fellows offer us their advice on everything fellowship! Salila Hashmi and Greg Knapp are fellows in Hepato-Pancreato-Biliary and surgical oncology respectively.

We talk about applying to a fellowship, obtaining personal letters, the importance of resident electivesfor setting up fellowship opportunities, and how to get the most out of your time as a fellow. Good luck
to all fellows starting this July 1!!

Links:

1. Qualities and characteristics of successfully matched North American HPB surgery fellowship candidates:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857058/

2.A Survey of the Complex General Surgical Oncology Fellowship
Programs Regarding Applicant Selection and Rank: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684844/

3. MSK Global Oncology Program: https://www.mskcc.org/hcp-education-training/fellowships/international-surgical-oncology-global-cancer-disparities-fellowship

4. The surgeon and social media: Twitter as a tool for practicing surgeons: https://bulletin.facs.org/2016/06/the-surgeon-and-social-media-twitter-as-a-tool-for-practicing-surgeons/

5. NRMP (US Fellowship match): http://www.nrmp.org/match-calendars/

Dr. Reznick currently serves as dean in the Faculty of Health Sciences at Queen’s University and as chief executive officer of the Southeastern Ontario Academic Medical Organization (SEAMO). His passion for medical education contributed to the founding of the Wilson Centre, a renowned health profession education research institute based in Toronto.

In addition to ushering in competency-based medical education at Queen’s University, Dr. Reznick pioneered the objective structured clinical examination (OSCE) that is used each year to assess thousands of medical licensure applicants in Canada. Dr. Reznick’s seminal work as an educator and researcher has been recognized by organizations such as the Medical Council of Canada, Royal College of Surgeons of England and Karolinska Institutet.

In this episode we take a deep dive into competency-based medical education. 

Links:

1. Eight-year outcomes of a competency-based residency training program in orthopedic surgery: https://www.tandfonline.com/doi/full/10.1080/0142159X.2017.1421751

2.Setting Up a Surgical Skills Center:  https://link.springer.com/article/10.1007/s00268-007-9326-6

3. Assessing Competency in Surgery: Where to Begin?: https://linkinghub.elsevier.com/retrieve/pii/S0039606003001545

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Dr. Rebecca Auer (@auer_r on twitter: https://twitter.com/auer_r?lang=en) is a Surgical Oncologist and translational researcher studying the impact of surgery on the immune system and subsequent cancer recurrence. In her laboratory the focus is to develop innovative cancer therapeutics that can be administered during the perioperative period and to translate these therapies to the clinic.  With three active clinical studies of perioperative cancer therapies, Dr. Auer aims to improve cancer outcomes for all patients who undergo invasive cancer surgeries.

Dr. Auer talks about her training pathway, being a surgeon-scientist, developing a COVID19 vaccine, her work on vaccines and cancer, and her tips for "work-life harmony".

Links:

1.  Rebecca Auer bio: http://www.ohri.ca/profile/rauer

2. Dr. Auer lab page: https://www.auerlab.com/

3. Are morbidity and mortality conferences becoming a lost art?: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440886/

4. Morbidity and mortality conferences in general surgery: a narrative systematic review: http://canjsurg.ca/63-3-e211/

5. Perioperative Influenza Vaccination Reduces Postoperative Metastatic Disease by Reversing Surgery-Induced Dysfunction in Natural Killer Cells: https://clincancerres.aacrjournals.org/content/19/18/5104.long

6. Killers 2.0: NK cell therapies at the forefront of cancer control: https://www.jci.org/articles/view/129338

Dr. David Notrica (@surgery4kids on Twitter: https://twitter.com/surgery4kids) is a native of Atlanta, Georgia. He graduated Cum Laude from Duke University in 1988 and Emory University School of Medicine in 1992 where he was class president and a member of the Alpha Omega Alpha National Medical Honor Society. He completed his General Surgery residency training at Emory University in 1997 and his Pediatric Surgery Fellowship training at Texas Children's Hospital in Houston in 1999. He is an Associate Professor of Surgery at Mayo Clinic Medical School, Associate Professor at the University of Arizona College of Medicine Phoenix, and Associate Program Director for the Pediatric Surgery Fellowship at Phoenix Children's Hospital. He was one of the founding members of the ATOMAC pediatric research network. He Co-founded and co-chairs the Western Pediatric Trauma Conference, the Southwest Trauma and Acute Care Symposium, and Trauma Conference International. Dr. Notrica developed and continues to direct the Level 1 Trauma Center for Phoenix Children's Hospital. 

We discuss all things pediatric surgery with Dr. Notrica, both on a clinical level but also on a systems-level. 

Links:

1. ATOMAC guidelines: https://surgery4children.com/diagnoses-and-treatment/trauma/atomac-guideline/

2. Non-op management of blunt abdominal trauma in children: https://pubmed.ncbi.nlm.nih.gov/26402546/?from_term=notrica%2C+david&from_pos=2

3. Shock Index: https://journals.lww.com/jtrauma/Citation/2012/09000/Shock_Index___A_simple_clinical_parameter_for.45.aspx

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