Cold Steel: Canadian Journal of Surgery Podcast

The only thing that can save us from our irascibly self-centered existence is to make sure that our existence is in the service of others

Mark Shrime, ENT surgeon, global surgery researcher and now career coach is our guest on this episode. The quote I read was from his wonderful book, “Solving for Why: A Surgeon’s Journey to Discover the Transformative Power of Purpose”. It’s important to understand just how much of a fascinating person Mark Shrime is to get a context for this conversation. Dr. Shrime was the International Chief Medical Officer at Mercy Ships, an international NGO that operates hospital ships. Mark is also one of the major figures in the global surgery space, and was part of the 2015 Lancet Commission on Global Surgery. If that were not enough, he is also an American Ninja Warrior! We explored why Mark felt the need to write a book on purpose as well as his insights on global surgery, amongst many other topics. This was such an important conversation not just for surgeons but for anyone trying discover meaning and purpose in their life. 

Links:

1. https://www.markshrime.com/ 
2. https://www.hachettebookgroup.com/titles/dr-mark-shrime/solving-for-why/9781538734162/?lens=twelve
3. https://www.thelancet.com/commissions/global-surgery
4. Shrime MG, Alkire BC, Grimes C, Chao TE, Poenaru D, Verguet S. Cost-Effectiveness in Global Surgery: Pearls, Pitfalls, and a Checklist. World J Surg. 2017 Jun;41(6):1401-1413. doi: 10.1007/s00268-017-3875-0. PMID: 28105528.
5. Smith ER, Kapoor P, Concepcion T, Ramirez T, Mohamed M, Dahir S, Cotache-Condor C, Adan Ismail E, Rice HE, Shrime MG. Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study. BMJ Open. 2023 May 2;13(5):e069572. doi: 10.1136/bmjopen-2022-069572. PMID: 37130683; PMCID: PMC10163539

Tsuyoshi Konishi

Dr. Tsuyoshi Konishi is an associate professor of Colon and Rectal Surgery at the University of Texas M.D. Anderson Cancer Center, in Houston, USA. We again got a chance to hear several of his talks at the COLOSOS conference in Toronto in Oct 2024. 

Dr. Konishi is really helping to bridge the gap between “Eastern” and “Western” approaches to colorectal cancer. In this episode, Dr. Konishi really broke down the sometimes nebulous concept of complete mesocolic excision in right sided colon cancers. We’d really encourage you to head over to our YouTube channel www.youtube.com/@coldsteelsurgery to check out the accompanying video and slides. One of the really enjoyable parts of this conversation was discussing some of the differences between Japanese and North American training – there’s lots we can learn! 

Maybe we should incorporate the Japanese system of having everyone upload their operative video prior to board certification?? What do you think? Send us an email at [email protected].

Check out YouTube version with Dr. Konishi's slides here: https://youtu.be/PGIBtYyBAxU 

Bio:

After completion of advanced training in the field of Surgical Oncology and Colorectal Minimally Invasive Surgery at top institutions including the University of Tokyo, Cancer Institute Hospital of the JFCR and Memorial Sloan-Kettering Cancer Center, Dr. Konishi served as an attending colorectal surgeons since 2010, and Head Attending since 2017, at Cancer Institute Hospital of the Japanese Foundation for Cancer Research in Tokyo, Japan. He took a leadership in advancing a minimally invasive surgery program for complex colorectal cancer.

Dr. Konishi’s research interest includes combining multidisciplinary approaches for complex colorectal cancer, including neoadjuvant therapy, extended surgical resection and a minimally invasive surgery. Particularly, he has been taking an international leadership in studying lateral pelvic lymph node dissection for rectal cancer.

Dr. Tsuyoshi Konishi is currently an associate professor of Colon and Rectal Surgery at the University of Texas M.D. Anderson Cancer Center, in Houston, USA. 

Links:

1. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis. 2009 May;11(4):354-64; discussion 364-5. doi: 10.1111/j.1463-1318.2008.01735.x. Epub 2009 Nov 5. PMID: 19016817.
2. Konishi T, You YN. Complete Mesocolic Excision and Extent of Lymphadenectomy for the Treatment of Colon Cancer. Surg Oncol Clin N Am. 2022 Apr;31(2):293-306. doi: 10.1016/j.soc.2021.11.009. Epub 2022 Mar 5. PMID: 35351279.
3. RELARC trial: Lu J, Xing J, Zang L, Zhang C, Xu L, Zhang G, He Z, Sun Y, Feng Y, Du X, Hu S, Chi P, Huang Y, Wang Z, Zhong M, Wu A, Zhu A, Li F, Xu J, Kang L, Suo J, Deng H, Ye Y, Ding K, Xu T, Zhang Y, Zhang Z, Zheng M, Su X, Xiao Y; RELARC study group. Extent of Lymphadenectomy for Surgical Management of Right-Sided Colon Cancer: The Randomized Phase III RELARC Trial. J Clin Oncol. 2024 Nov 20;42(33):3957-3966. doi: 10.1200/JCO.24.00393. Epub 2024 Aug 27. PMID: 39190853.
4. Motoyama S, Yamamoto H, Miyata H, Yano M, Yasuda T, Ohira M, Kajiyama Y, Toh Y, Watanabe M, Kakeji Y, Seto Y, Doki Y, Matsubara H. Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer: evaluation using data on 16,752 patients from the National Clinical Database in Japan. Esophagus. 2020 Jan;17(1):41-49. doi: 10.1007/s10388-019-00694-9. Epub 2019 Oct 3. PMID: 31583502; PMCID: PMC6976551.

This week we were joined by Dr. Jenny Seligmann. Dr. Seligmann is a Professor of Gastrointestinal and Translational Oncology and Honorary Consultant in Medical Oncology at the University of Leeds. Dr. Seligmann is one of the authors of the seminal FOxTROT trial, which investigated the use of neoadjuvant chemotherapy in advanced colon cancers. Dr. Seligmann is the lead investigator on the FOxTROT platform, the ARIEL trial, and continues to be on the leading edge of trials for colorectal cancer. In this episode, we explored neoadjuvant chemotherapy for colon cancer specifically. There's lots to take away from this conversation, but one of the things that stood out for us was some of the differences in the structure of the multidisciplinary tumor boards in Dr. Seligmann’s centre versus many centres in Canada. Perhaps in the future, all colorectal cancers will get discussed at tumor boards! What do you think? We’d love to hear your thoughts – email us at [email protected].

Bio:

Dr Jenny Seligmann is Professor of Gastrointestinal and Translational Oncology and Honorary Consultant in Medical Oncology at the University of Leeds, UK. She is the Chief Investigator of the FOxTROT Platform and the ARIEL trial, and has a programme of translational research. She is a member of the ESMO Lower Gastrointestinal Faculty and the UK NCRI Colorectal Cancer Executive Group.

x/twitter: @jenseligmann

Links:

1. Preoperative Chemotherapy for Operable Colon Cancer: Mature Results of an International Randomized Controlled Trial. https://ascopubs.org/doi/10.1200/JCO.22.00046
2. Professor Dion Morton: https://www.birmingham.ac.uk/staff/profiles/applied-health/morton-dion
3. Professor Phil Quirke: https://medicinehealth.leeds.ac.uk/medicine/staff/700/professor-philip-quirke
4. ARIEL trial: https://fundingawards.nihr.ac.uk/award/NIHR129268
5. FOCUS4 trial: http://www.focus4trial.org/
6. FOxTROT platform website: https://ctru.leeds.ac.uk/foxtrot/
7. COLOSOS trial: https://mycs-cdn.myconferencesuite.com/other/Project/3222/91/c0/PRELIM%20PROGRAM_COLOSOS%20CANADA_DL.pdf 

This episode is an edited version of a talk I gave to our first years during their Surgical Foundations course. It’s mainly a reminder to myself: this too shall pass.

Links:

1. Steven Covey 7 Habits of Highly Effective People: https://www.amazon.ca/Habits-Highly-Effective-People-Powerful/dp/0743269519
2. “Memento Mori”: https://dailystoic.com/memento-mori/
3. Hans Zimmer soundtracks: https://www.youtube.com/channel/UCJeBQabyLa_FvMxb6G67lkw
   
   

Selwyn O. Rogers Jr., MD, MPH, FACS, is a widely respected surgeon and public health expert. As founding director of the University of Chicago Medicine Trauma Center, Dr. Rogers is building an interdisciplinary team of specialists to treat patients who suffer injury from life-threatening events, such as car crashes, serious falls and gun violence. His team works with leaders in the city's trauma network to expand trauma care on the South Side.

Dr. Rogers has served in leadership capacities at health centers across the country, including most recently as vice president and chief medical officer for the University of Texas Medical Branch at Galveston. Dr. Rogers has also served as the chair of surgery at Temple University School of Medicine and as the division chief of trauma, burns and surgical critical care at Harvard Medical School. While at Brigham and Women's Hospital (BWH), he helped launch the Center for Surgery and Public Health to understand the nature, quality and utilization of surgical care nationally and internationally.
Additionally, as executive vice president for community health engagement, Dr. Rogers works with faculty across the University of Chicago as well as members of the community to develop a multidisciplinary approach to trauma care and health disparities. His work will help enhance the understanding of social factors that affect victims of violence and underserved populations, in addition to identifying approaches necessary to achieve better outcomes for trauma victims.

Dr. Rogers' clinical and research interests focus on understanding the healthcare needs of underserved populations. He has published numerous articles relating to health disparities and the impact of race and ethnicity on surgical outcomes.

Twitter: https://x.com/selwyn_rogers 

Links:

1. Ann Surg. 2024 Jul 1;280(1):29-31. doi: 10.1097/SLA.0000000000006258. Epub 2024 Mar 5.When Equality Is Not Equity: The Ethics of Access to Trauma Care: A Surgical Perspective. Bethany L Strong 1, Franklin Cosey-Gay 2, Kenneth L Wilson 2, Selwyn O Rogers Jr 2
2. Scarlet S, Rogers SO Jr. What Is the Institutional Duty of Trauma Systems to Respond to Gun Violence? AMA J Ethics. 2018 May 1;20(5):483-491. doi: 10.1001/journalofethics.2018.20.5.msoc2-1805. PMID: 29763395.
3. Chang DC, Oseni TO, Strong BL, Molina G, Ortega G, Chen H, Rogers SO Jr. The Other Global Pandemic: Scientific Racism and the Normality Bias. Ann Surg. 2021 Dec 1;274(6):e646-e648. doi: 10.1097/SLA.0000000000005168. PMID: 34387208.

This episode is a recording of the Queen’s Department of Surgery William Ersil Research Day. This year our invited speaker was Dr. Thomas Forbes, chief of surgery at University Health Network in Toronto and Editor-in-Chief of the Journal of Vascular Surgery.
In this “How I Built This” style episode in front of a live audience, we explored Dr. Forbes background, his training, the future of residency/fellowship training, his approach to leadership and how he goes “all in” for both work and his family life.
Thanks again to the Department of Surgery at Queen’s for allowing us to record this and to all those in attendance for being such a wonderful audience.

Bio: Dr. Forbes is Professor of Surgery and Chair of the Division of Vascular Surgery at the University of Toronto, a position he has held since 2014. He obtained his medical degree in 1990 from the University of Toronto and completed his general surgery and vascular surgery training at the University of Western Ontario. He is the co-Program Director of the Advanced Aortic Surgery Fellowship at the University of Toronto, a collaborative fellowship between vascular and cardiac surgery in open and endovascular therapies for thoracoabdominal aortic pathologies. Previously he was Chair/Chief of the Division of Vascular Surgery at the University of Western Ontario (2005-2014) and the inaugural Graduate Program Chair of the Masters of Science in Surgery program. He has published over 200 peer-reviewed papers, editorials and book chapters and given over 100 invited lectures or guest professorships. He is currently an Associate Editor of the Journal of Vascular Surgery and the Canadian Journal of Surgery and a member of several editorial boards. He is the Past-President of the Canadian Society for Vascular Surgery, Section Editor of Rutherford’s Textbook of Vascular Surgery and the Chair of the Vascular Care Working Group of the Cardiac Care Network in Ontario. He is also a former Program Director and vice-Chair of the Vascular Surgery Specialty Committee of the Royal College of Physicians and Surgeons of Canada.
Links:

1. https://surgery.queensu.ca/research/william-ersil-resident-research-day
2. Providing high-quality open aortic surgical care in the endovascular era. https://www-sciencedirect-com.proxy.queensu.ca/science/article/pii/S074152142200427X?via%3Dihub
3. Advanced Aortic fellowship: https://surgery.utoronto.ca/sites/default/files/inline-files/2025%20Fellowship%20in%20Advanced%20Aortic%20Surgery.pdf
4. https://www.audiblebleeding.com/forbes/

We are delighted to release our new collaborative mini-series on “Medico-legal Risks for
the Surgeon”. The Canadian Medical Protective Association and the Cold Steel podcast
have teamed up to release this mini-series exploring some common legal issues that
might arise for surgeons.

In this first episode, we explore some basic legal issues that surgeons might face. We
explore the peer-review system, documentation, inherent risk, the role of the system in
medico-legal errors, and the impact these issues have on surgeons.
Stay tuned for our other episodes!

Bio:
Dr. Richard Mimeault completed his medical degree at McGill University in 1982. He
went on to do an internship at the Wellesley Hospital in Toronto, followed by a general
surgery residency in Ottawa and then a two-year transplant fellowship at the University
Hospital in London, Ontario. In 1989, he returned to Ottawa where he started a practice
of general and hepatobiliary surgery at the Ottawa Hospital. He was in practice for 27
years during which time he was closely involved with the residency training program
and undergraduate education. He was also peer assessor for the College of Physicians
and Surgeons of Ontario (CPSO) and volunteered in third-world surgery and surgical
education. He joined the CMPA as a physician advisor in 2017.

Links:

1. Documentation workshop. https://www.cmpa-acpm.ca/en/education-events/teaching-resources/physician-patient/documentation--principles-of-medical-record-keeping
2. Test result workshop. https://www.cmpa-acpm.ca/en/education-events/workshops/workshop-test-results-follow-up
3. Haytham Kaafarani on Surgeons as a Second Victim: https://open.spotify.com/episode/6MiYBhgt2k7qDMCxUZt537
4. https://www.cmpa-acpm.ca/en/research-policy/know-your-risk/what-general-surgeons-need-to-know
5. Reducing Diagnostic Error with Janice Kwan: https://open.spotify.com/episode/6HJjgK3756tb7NO5fFQUDY

Thank you for joining us on Cold Steel!

Dr. Caprice Greenberg is a surgical oncologist at UNC School of Medicine in North Carolina. She is a preeminent health services researcher and also the founder of the Academy for Surgical Coaching. We caught up with her to do a deep dive on surgical coaching and the work that she’s done on a state-wide level to create a coaching program. Dr. Greenberg is an iconoclast and provides some really important insights on the importance on having a vision and pursuing it, no matter how off the beaten path it may be. 

Bio:

Dr. Greenberg is a world-renowned health services researcher and surgical oncologist, and she most recently served as chair of the Department of Surgery at the Medical College of Georgia at Augusta University.

She also is a leader in the study of care delivery in operating rooms and innovative approaches to collaborative learning and will bring research projects to the School of Medicine related to surgical coaching and methods to improve rural cancer care delivery.

Greenberg earned her MD from the University of Chicago Pritzker School of Medicine and her Masters of Public Health from the Harvard School of Public Health. Her general surgery residency was completed at Brigham and Women’s Hospital in Boston and she completed her surgical oncology fellowship at the Dana – Farber/Partners Cancer Center in Boston.

Links:

1. https://pubmed.ncbi.nlm.nih.gov/28650360/
2. https://pubmed.ncbi.nlm.nih.gov/28146224/
3. https://pubmed.ncbi.nlm.nih.gov/33605579/ 
4.  Academy for Surgical Coaching. https://surgicalcoaching.org/ 
5. Presidential address for AAS https://pubmed.ncbi.nlm.nih.gov/29078918/ 

Dr. Adom Bondzi-Simpson is a general surgery resident and PhD student at the University of Toronto. He’s been nationally recognized for his advocacy work and research work on social justice and social determinants of health. He is a winner of the Canadian Medical Association for Young Leaders, the 2023 winner of the Mikhael Award for Medical Education from the Resident Doctors of Canada, among other accolades. In this episode we do a very deep dive on Adom’s upbringing and background, and his thoughts on how we can make the house of surgery a more diverse and welcoming place.         

Links:

1.       https://temertymedicine.utoronto.ca/news/faces-temerty-medicine-adom-bondzi-simpson

2.       “Where is the Black doctor!?” CMAJ piece. https://www.cmaj.ca/content/194/34/E1175 

3.       https://pubmed-ncbi-nlm-nih-gov.proxy.queensu.ca/37640638/

4.       https://pubmed-ncbi-nlm-nih-gov.proxy.queensu.ca/37063147/ 

5.       CMA Award: https://www.cma.ca/get-involved/awards/awards-young-leaders/dr-adom-bondzi-simpson 

Thank you so much for joining us on Cold Steel!

The tremulous surgeon seems like such an oxymoron, an impossible paradox. The reality of course, is that many surgeons have a tremor. Our discussion on this episode with Lilli Cooper on tremors was a wonderful exploration of performance anxiety in surgery. Lilli Cooper is a plastic surgeon in the UK, and produced a segment for the BBC on tremors in surgeons. We caught up with her to talk about what she’s learned about tremors and the insights she has on performance in surgery. You can check out all the work she does on her website https://lillicooper.co.uk/. 

Links:

1.       https://lillicooper.co.uk/ 

2.       https://www.bbc.co.uk/programmes/m0021j9y

3.     A pilot study of performance enhancement coaching for newly appointed urology registrars. https://pubmed.ncbi.nlm.nih.gov/38767172/

4.     Enhancing surgical performance by adopting expert musicians' practice and performance strategies. https://www-sciencedirect-com.proxy.queensu.ca/science/article/pii/S0039606017306323

5.     Romy Nitsch and Jen Mccall on Imposterism in Surgery. https://open.spotify.com/episode/3UuP5JTGuhP8J2JvycoEFh