T

T
lGH Department of Su,ge~ is alive and well and very active. Most ,ecently
our departmental GFT offices and clinics have been redone, renovated and enlarged on
the fifth floor of the 'A' Pavilion. New clinics and a full-time teaching office will certainly
improve our teaching program. The very convenient physical space is ample and will satisfy our expansion needs for the next five years. Serious efforts
to acquire endownment funding has been initiated to provide
necessary funding for more academic pursuits.
What's New
at The JGH
Our Division of (VT continues to be headed by Nate Sheiner. He
continues a very active surgical practice and enjoys visiting his two granddaughters in the
USA. Normand Miller is Program Director of Vascular Surgery at McGill and is very actively
involved in the executive committee of the hospital. Bob Goodman, one of our cardiac
surgeons, recently took a leave
of absence. However, Yves Langlois continues a very ambitious
surgical program as we recruit a
new surgeon.
Tassos Dionisopoulos has been
GFT since 1993 adding strength
and depth to our Plastic Surgery
Division which is guided by Maynard Shapiro.
~
(please seeThe JGH pg.4)
Sir Mortimer B. Davis Jewish General Hospital
................................................................................
::::I
-'"
ca.
II)
What's New at the Jewish General Hospital
1
H.RockeRobertson Visiting Professorship
12
Letters to the Editor
2
M.D.Anderson Experience
............................................................................................................................
14
....................................................................................................................................
Editorial
3
Surgical Epidemiology
15
Jewish General Hosptial Surgical Staff
5
CAGS
15
Kudos
6
Were YouThereThen?
..................................................................................................................
. . . ...
••...........•..•.•.............
••.•••.............•...............•..•.•
.........•
16
Canadian Network for International Surgery
7
McGill Anesthesia
17
Surgical Education in Developing Countries
8
International Visiting ResearchFellows
18
Sal Mount to Stay
8
RVHDivision of General Surgery Staff
18
Rotations at Barrie Memorial Hospital
8
A Decline in General Surgery Applicants
19
History of Plastic Surgery (cont'd)
9
Obituary
20
...........................................................
Departure
9
McGill University Hospital Centre
21
Welcome Aboard
9
OHIBData
21
................................................................................................................................
......................
,
The Surgical Education Corner
10
Upcoming Events
..
22
DEPARTMENT OF SURGERY
NEWSLETTER
McGILL UNIVERSITY
VOL. 6, NO.1, WINTER 1996
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3
C
ORE CURRICUlUM
PRESENT WERE
SURGERY IN GENERAl
Recently some concern has been expressed and some
questions are being asked about gradual changes which
have taken place in Core Curriculum for Surgery programs
across Canada.
Editorial
When the Core Curriculum was originally designed, the Royal College Committee on Specialties (COS) received input in order to prepare the Objectives and Training
Requirements from all the Surgical Specialties. For example,
Dr. Paul F.Odell of Ottawa, Chairman of Otolaryngology submitted those for E.N.T.; Dr. W. Rennie of Manitoba submitted
those for Orthopedic Surgery; Dr. M. T. Richard submitted
those for Neurosurgery. The idea was that we structure a
common core of training of a generic type so that our "undifferentiated" Surgical Residents would develop the knowledge, skills and attitudes in Surgery in General so as to pass
the Principles of Surgery Exam in two years.
A council resolution in April 1990 (#90-074) stipulated that
Core Training Program Committees include the Program Directors of each Residency Program which is dependent on
core training. This seemed to be a good idea at the time.
Gradually, however, it has evolved so that these very same
Program Directors are requiring Core Surgical Residents to attend rotations in their Specialties, so that all across Canada
right now, the Core Curricular Programs have become different in many ways, since they have become "rotation based':
That therefore is the problem.
These matters have been discussed at the Royal College both
by the Accreditation Committee (Head - Ms. Jo Cassie) and
by the Credentials Committee (Head - Ms. Sheila Waugh).
The Accreditation Committee stipulated that henceforth, it
would accredit two types of Core Surgery - the "Common
Core" model and the "Core Surgery directly under the control
of the Surgical Specialty" model.
In order to resolve some of these issues, a meeting of the
Chairs of the Royal College Specialty Committees in surgical
disciplines was held on January 12 at the Royal College. This
meeting was organized by Dr. J. P. DesGroseilliers and was
chaired by Dr. Gilles Beauchamp, Chair of the Test Committee
for Principles Of Surgery.
Dr. Brian Evans, representing Dr. L. Hurst, Chair, Plastic Surgery
Dr. John P. Girvin, Chair, Neurosurgery
Dr. E. D. Monaghan, Chair, General Surgery
Dr. Paul F. Odell, Chair, Otolaryngology
Dr. Ernest W Ramsey, Chair, Urology
Dr. T. R. Todd, Chair, Thoracic Surgery
Dr. James P. Waddell, Chair, Orthopedic Surgery
Dr. Ken Harris, Coordinator, Core Surgery, UWO
Mrs. J. Cassie, Head, Accreditation
Mme. L. Papineau, Head, Exams
Mrs. S. Waugh, Head, Credentials Section
Dr. R. D. Weisel of Cardiac Surgery was unable to attend.
A number of matters were clarified. It was emphasized
that Program Directors are still in charge of the rotations of
their trainees and it is the job of the Coordinator of Core Curriculum working with the Specialty Programs to arrange the
appropriate rotations.
In discussion, there was a general sense that two years "Common" core training are not required to attain the objectives
of Core Surgery, and that many of the objectives can be attained in the course of training in the surgical specialty concerned. If training in the specialty concerned could start
sooner, it would add flexibility to the rotations 'possible in
the later years of residency. These Specialties wish to add
rotations in their own discipline during the two years of Core
and that these be" double counted" to extend the length of
training in their own discipline.
The Committee agreed to the following definition of "Core
Surgery": two years of training in an accredited surgery residency to meet the Core Surgery objectives, with at least
twelve months of clinical activity outside the specialty concerned. However, this was not approved by the Royal College Credentials Committee in late January.
It was agreed that all the Surgical Specialty Committees will
be invited to propose amendments to their residency requirements to reflect this current thinking.
The objectives for Core Surgery are to be reviewed by a small
"ad-hoc" committee chaired by Dr. James Waddell. The current objectives date from April 11, 1992. It will be necessary
to "harmonize" these objectives with the contents of the
Principles of Surgery Exam.
Core Surgery is still a relatively recent concept and has been
working quite well judging from the results of the
~
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4
~
P.O.S. exams. Though it needs some fine tuning,
there is a danger of tampering too much and compromising its objectives.
PRINCIPLES
It is to be noted that the University of Montreal and McGill
were the first two medical schools in Canada to institute such
Core Curricula in their surgical postgraduate programs. •
OF
SURGERY
1994
1995
Residents
Training In
Total
No.
Number
Passed
Percent
Passed
Total
No.
Number
Passed
Percent
Passed
Cardiothoracic
Surgery
2
0
0.0
2
1
50.0
General surgery
117
106
90.5
138
135
97.8
Neurosurgery
12
11
91.6
23
21
91.3
Orthopedic
Surgery
57
48
84.2
73
67
91.7
Otolaryngology
24
22
91.6
30
28
93.3
Plastic Surgery
10
8
80.0
17
17
100.0
Urology
23
20
86.9
28
26
92.8
TOTAL
245
215
87.7
311
295
94.8
Results of the P.O.S. exam of the Royal College by Specialty AFTER the institution of Core
Program in Surgery in General.
~
Tassos brings expertise in free flap reconstruction after his fellowship training at Sloan Kettering in New York.
Maynard is very much involved in the administrative functions of the department and the hospital.
Dave Elkin and Jack Cohen continue their
from pg.l)
varied and busy plastic surgical practices.
The JGH
(continued
The Colorectal Unit is strong academically and now has
three surgeons in the group. Phil Gordon has profoundly
distinguished himself and most recently chaired the meeting of the American College of Colorectal Surgeons, in Montreal, as its President. Phil has been a tower of strength in
our department being actively involved in all affairs. CarolAnn Vasilevsky continues in active practice after having had
her firstborn, a girl, one year ago. The division has been
strengthened by Barry Stein who returned to the JGH after
completion of a fellowship at the Lahey Clinic in Boston.
Barry has established an Anal Physiology Laboratory and is
very much involved in surgical teaching.
Harvey Sigman, recently appointed as Full Professor, is our
Chief of General Surgery. He has a very full schedule being
the Assistant Dean of Medical Education and Student Affairs at McGill and carries on an active surgical practice as
well as being responsible for the teaching program in General Surgery. He also has important responsibilities in
national and international
medical education societies.
Harvey has great energy and still has time to enjoy his
grandchildren who live in Montreal and enrich his life. AI
Spanier busily runs the ICU and is responsible for CTU 1. He
has been very involved in international critical care societies, writing and lecturing throughout the world. Ben
Mitmaker and Jacob Garzon carry a heavy surgical load doing a full range of general surgery while carrying
~
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5
~ a large responsibility for teaching.
Jacob's grandchildren are a joy and Ben's young family continues to mature. Roger Fenster, whose first child was recently
married, and Issie Shanfield who was recently married,
both continue in active surgical practice. Richard Margolese is the Chief of Oncology at the hospital and is in
active surgical practice within our department.
Richard
participates in teaching while actively maintaining his
high profile in oncology. Steve Karp has been awarded the
Chercheur Boursier and substantial peer reviewed grants
for his immuno-oncology
program in surgery and the Department of Oncology. Steve's expertise and distinguished
record enhances both departments.
Our staff is rounded out with the participation of Drs. Harry
Glick, Arthur Freedman, Bernard Rothstein, Jeff Rivilis and
Henry Korman. They contribute to the department
tinuing and ongoing fashion.
in a con-
Dr. Robert Levine has retired from active surgical practice. He
continues to be associated with the department and the hospital in his position as DPS at the Jewish Hospital of Hope.
In 1993, Martin Black was appointed Chief of Surgery. He
is Chief of Head and Neck Oncology at McGill and has pursued a vigorous recruitment campaign to augment the
full-time academic staff of the department.
He remains in
active surgical oncologic practice at McGill.
Many changes in the health care system are on the horizon.
The Department of Surgery at the JGH looks forward to being an active participant in fulfilling its university role. •
...............................................................................................................................
The JGH Department of Surgery
Seated, Left to Right:
Center Row, Left to Right:
TopRow, Left to Right:
Missing from photo:
Dr. David Elkin, Dr. Robert Levine,
Dr. Harvey Sigman, Dr. Barry Stein,
Dr. TassosDionisopoulos, Dr. Jacob
Dr. Nathan Sheiner, Dr. Allen Spanier,
Dr. Bernard Rothstein, Dr. Martin Black
Dr. YvesLanglois, Dr. Harry Glick,
Garzon, Dr. Isidore Shanfield, Dr. Philip
Dr. Robert Goodman, Dr. Richard
(Chief), Dr. Carol-Ann Vasilevsky;
Dr. Jeffrey Rivilis, Dr. Arthur Freedman,
Gordon, Dr. Maynard Shapiro,
Margolese, Dr. Stephen Karp,
Dr. Jack Cohen, Dr. Roger Fenster,
Dr. Normand Miller;
Dr. Henry Korman.
Dr. Ben Mitmaker, Ms Judy Pollack
(Admin. Assistant);
...
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D
Pnin. Brodt is the editor of a new book entitled Cell Adhesion
and Invasion in Cancer Metastasis published by the Landes Co. (Austin) and
Springer (Berlin). The
book provides up to
date reviews on cellular and molecular
mechanisms in the process of cancer
metastasis and is geared to both clinicians and basic scientists in oncology and
related disciplines. In addition to Dr.
Brodt, review chapters in this book were
also contributed by Dr. Orest Blaschuk
from the Division of Urology and by Drs.
KUDOS !!
John S. Mort and Anneliese Recklies
of the Joint Diseases Laboratory at the
Shriners Hospital.
the Royal College as a representative of
General Surgery on the Plastic Surgery
Examinations Board.
Dr. Carroll Laurin has received
the
Order of Canada.
Dr. Jonathan L. Meakins was invited to
be a speaker at the Hong Kong Surgical
Forum held at the end of January at
Queen Mary Hospital at the University of
Hong Kong. This is a postgraduate meeting held twice a year and all presentations
are given by invited guest speakers including leading surgeons from overseas.
Jo's topics were as follows:
• Art and Medicine - Medicine in Art
• Intraabdominal abscess:modem management
• Biliary pancreatitis in the modern era
• Peritonitis- 7996
Dr. John R. Moore has just celebrated his
80th birthday in Gagetown, New Brunswick.
Dr. Ray Chiu was an Invited Speaker at
the following International Conferences:
Congestive Heart Failure: From Molecular
Biology to the Clinic, in Venice, July 1st,
1995; World Conference in Surgical Efficiency and Economy, in Kiel, Germany,
September 15th, 1995; Symposium on
Current Perspectives in Cardiovascular Disease, in Saint John, New Brunswick, October 14, 1995; Surgical Workshop on New
Approaches
to Cardiomyopathy,
in
Toronto, October 26, 1995; and Symposium on Heart Failure and Transplantation, at UCLA,Los Angeles, November 11,
1995. He was a Visiting Professor at Jichi
Medical College in Japan on November
6th, 1995, and a Guest Lecturer at the
Japanese Society for Artificial Organs in
Osaka, Japan on November 9th, 1995.
Dr. Nick Christou has been appointed
an examiner in General Surgery by the
Royal College.
Dr. R.L. Cruess has been named to the
Order of Canada.
Dr. David M. Fleiszer has been named by
Dr. Harry S. Morton in the Canadian
Medical Association Journal, December 1
1995, published a paper At One Time, Operations Outside The Hospital Were Not Uncommon. Dr. Harry Morton, a 1932
General Surgery graduate of the University of London, is retired and lives in
Lunenberg, Nova Scotia with his wife
Rachel. He used to be an Attending Surgeon at the RVH.
Dr. Anie Philip of the Division of Plastic
Surgery at The Montreal General Hospital
has won the Fraser, Monat and McPherson
Medical Research Award for 1995 to 1998.
Dr. Hani Shennib was nominated as
member of the Program Committee of the
Society of Thoracic Surgeons. A new text
edited by Dr. Shennib, Immunology of the
Lung Allograft, has been released by
Springer-Verlad.
Dr. Jean Tchervenkov was honoured at
the Milos Restaurant on Park Avenue during the Royal Victoria Hospital Transplant
First Annual Fundraising Dinner on No-
vember 5 1995. The honorary presidents
of the gala evening were the husband and
wife team of Dr. Julius Metrakos and Dr.
Kay Metrakos (uncle and aunt of Dr. Peter Metrakos). An amount of $40,000
was raised for the Liver Transplant Fund.
The Masters of Ceremonies were Mr.
George Balcan, CJAD morning man, and
sportscaster Ted Blackman. Blackman
who received a liver transplant asked his
wife, Lyane, to thank his surgeon, Dr.
Tchervenkov. He quipped, "I am not really
qualified to tell you about the doctor's
fine work since I was in a coma at the
time he was doing it':
In November 1995, Dr. Marvin Wexler
addressed the 46th Annual McGill Refresher Course for Family Physicians on
"Surgical Treatment of Breast Cancer Past, Present and Future - A New Paradigm': He also gave a Workshop on
"Problems in Breast Cancer Management': This was his 20th consecutive
year in addressing this gathering of
300-400
family physicians
from
throughout Canada. Marvin was the
1995 A.J. Grace Memorial Lecturer of
the Southwestern Ontario Surgical Association which met in London, Ontario
in November. The title of his address
was "Will Bassini, McVay and Shouldice
Rise From the Ashes". Also, after dinner,
he was the Guest Speaker at the London
Hunt and Country Club, and showed a
video entitled "Living and Dying in
Ethiopia" based on travels there several
years ago. Previous McGiliians accorded
this honor have included Donald Webster 1956, l.D. Maclean 1973, Dave
Mulder 1992, and lMeakins 1994. As
a Guest of the Detroit Academy of
Surgery in January 1996, he spoke on
"Laparoscopic Versus Open Inguinal
Herniorrhaphy: A Methodical Evaluation
Through Phase 7, 2 and 3 Controlled Clinical Trials" Recently he was the Visiting
Professor - William Beaumont Hospital Royal Oak, Michigan January 1996.
~
(KUDOS continued on pg. 22)
THE SQUARE,.
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7
Dr. A.P. Mclean
Royal Victoria Hospital
w.,
Network for International
5u~"y (CN151
was established and incorporated in August 1995. Its purpose
is to promote the delivery of essential surgical care in developing countries. Therefore, the CNISwill be a forum for those con-
Tcaoadiao
cerned with surgical
care and training in
the developing world.
It will also be a bank
of technical and theoretical expertise, a means of raising funds and an organization
to support and implement specific projects.
The Canadian Network
for International Surgery
17"
'<
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.....
o
687 Pine Avenue
Room S7.30
Montreal, Quebec H3A 1A1
Fax: (514) 843-1503
Dr. Antoine loutfi
Royal Victoria Hospital
w.,
687 Pine Avenue
Room S10.22
Montreal, Quebec H3A 1A1
Fax: (514) 843-1503
e-mail: emulfati@is.rvh.mcgill.ca
I hope that the CNISwill become the medium bringing together
all those interested in working in developing countries .•
s·
~o
~
~
?
It had its first meeting in Ottawa in November
the 2nd Canadian Conference for International
first directors are Dr. R. Lett, Dr. P. McLean and
Dum. They were elected for a one year term.
chosen to be President.
1995 during
Health. Its
Mrs. J. VanDr. Lett was
During the Ottawa meeting, it was felt that the CNIS should
establish links with the Canadian Society for International
Health and should provide representation on its Executive
Board for Obstetrics, Orthopedics and Anesthesia.
We are actively seeking members to join. The cost for individuals is $50.00 CDN. Anyone interested should contact one
of the following:
Dr. A. Loutfi with Dr. Haile Legasse and the OR. Staff in Bale, Ethiopia.
Dr. Ron lett
1669 Victoria St., #310
Prince George, British Columbia V2L 2L5
Tel.: (604) 561-1280
Fax: (604) 561-1286
e-mail: lett@unbc.edu
Propranolol
for Small
Abdominal Aortic
Aneurysm Trial
MGHDr. J. Morin (514) 937-6011, ext. 4324
lise Morin, RN (514) 988-7007(pager)
Dr. A. Hill (514) 937-6011, ext. 4326
ENTRY CRITERIA
Asymptomatic Infrarenal AAA
between 3.0 - 4.5 cm
RVHDr. O. Steinmetz (514) 842-1231,
ext. 4981
EXCLUSION CRITERIA
o Contraindications to Propranolol
0) HR ::; 50 BPM
b) Asthma
c) Symptomatic CODP d) IDDM
o BETABLOCKERS
o LIFEEXPECTANCY::;1 YR
For further information or to refer
a patient please contact:
JGHDr. N. Miller (514) 340-8304
Stephanie Goyette, RN
(514) 340-8232 (pager)
"lUaWUlaA06Aq lloddns JO ~)el pue 6u!punJ 4l!M swalqOld
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the MD Anderson Cancer Center in Houston, Texas studying
gene therapy for lung cancer under the supervision of Dr.Jack
Roth, will return to McGill University and The Montreal General Hospital as an Assistant Professor in the Division of Cardiovascular and Thoracic Surgery on July 1st, 1996. +
C
ONT/NUATION OF THE HISTORY
EDM
OF PLASTIC SURGERY AT McGILL
In 1967, Drs. Drummond and Woolhouse worked to create a
combined McGill Plastic Surgery Resident Training Program.
•
Dr. Robert Midgley, MGH
and MCH trained, was
appointed geographical
full-time to the staff of the RVH. This appointment broke
with tradition. The resulting amalgamation and integration
of resident rotations was a first for any Division of Surgery
at McGill. Residents started rotating through the MGH, RVH
and MCH in equal aliquots and the stimulating Wednesday
afternoon Plastic Surgery Rounds of case presentations, discussions, arguments and bravado were held in equal rotation
through the three hospitals. In 1976, Dr. Midgley resigned
his Associate Professorship at McGill and his staff positions
at the RVH, also Queen Elizabeth and Queen Mary's where
he was Director of Plastic Surgery. During his nine years on
staff at McGill, Dr. Midgley served as Examiner in Plastic
Surgery for both the Quebec College and the Royal College.
In 1988, he was elected President of the Canadian Society of
Plastic Surgeons. He may be remembered at McGill for his
clinical teaching, acquiring RVH Ward-10E exclusively for
plastic surgery patients and collaborating with Drs. Daniel
and Terzis in the 1976 publication of the first recorded clinical microneurovascular free flap in the Western world.
Dr. Robert D. Midgley
For the past twenty years, Dr. Midgley has been doing Plastic,
Reconstructive and Hand Surgery in Charlottetown, P.E.I. He
is married to hematologist, Dr. Elizabeth Ross. +
EDM
................................................................. .
Welcome Aboard On July 11996, Dr. Peter Metrakos
will join the McGill section in Organ
Transplantation
headed
by
Dr. Lawrence Rosenberg at the
RVH. He will be involved in transplantation of the liver, pancreas and
kidney and he will join Drs. Jean
Tchervenkov and Jeff Barkun in this capacity. Dr. Metrakos
is a graduate of the McGill Residency Training Program in General Surgery finishing in June 1994. He obtained a McLaughlin Scholarship and went to train in transplantation at the
University of Western Ontario and in Minnesota.
Dr. Dao Nguyen, who is completing a two year fellowship at
.........................................................
DR. EMERSON BROOKS -
A farewell dinner party was held for Dr. Emerson Brooks and
his wife Mary on Jan. 25th, 1996 at the Mount Stephen Club
which was organized by Dr. Ross Murphy's committee. Fiftyfive colleagues and friends attended
the occasion. Dr. Ross Murphy recounted Emerson's career as an orthopedic surgeon at The Montreal General Hospital and his many
contributions to the academic community of McGill University.
Dr. Dennis Bobyn, Director of Orthopedic Research at the MGH,
detailed the growth of the Orthopedic Lab under Dr. Brooks'
guidance which is recognized nationally and internationally
for hip arthroplasty research. Dr. Brooks' secretary, Diane
Motherwell, who has worked for him since he came to the
MGH, talked about the excitement of working with such a dynamic person and how sad his departure will be to the whole
McGill community. Dr. Max Aebi, Chairman of the Division of
Orthopedic Surgery at McGill, presented Emerson with a
plaque acknowledging his outstanding work as Program Director of the Orthopedic Residency Training Program. Dr. Rea
Brown recounted the beginning of Dr. Brooks' era at McGill and
his commitment to building an outstanding group of orthopedic surgeons, especially related to trauma. Drs. Michael
Tanzer, Dave Burke, Eric Lenczner, Larry Conochie and Ross
Murphy make up the team that Dr. Brooks put together to
comprise a vibrant Division of Orthopedic Surgery at the MGH.
Dr.Bobyn then closed the evening by presenting Dr.Brooks with
a personal laptop computer. A good time was had by all. +
Departure
==
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"Education by objectives is not possible unless examinations are
constructed to measure attainment of those objectives ..."
The process of evaluation is vitally important in any education
system. Remember, the evaluation of education must begin with
a clear and meaningful definition of its objectives. Once you tell
the learners what you want them to know at the end of the
learning experience (i.e., their objectives) you must then evaluate those objectives to see if they've been met. This sounds so
simple but we frequently overlook this critical relationship between the two. But why do we need to evaluate? Whom are we
evaluating? Or what are we evaluating?
The first thing to realize, is that an evaluation does not mean the
final exam we give the student at the end of his or her learning
period. Rather, evaluation is a process by which we assess not only
the performance of the students but the effectiveness of teachers
and the quality of the program itself.We collect this data and make
judgements in these three areas. For example, our evaluation data
will tell us which students can be promoted (evaluation of the
learner), that we must organize faculty development workshops to
improve our small group teaching (evaluation of the teacher) and
that the time allotted to a surgery rotation may have to be extended to accommodate ambulatory care teaching (evaluation of
the program). As you remember from our discussion about the education spiral, we make these judgements to modify our program
objectives and the process or cycle of education begins again - the
"spiral': In the next issue of the Knot, we'll look more closely at the
various methods of evaluating the learner.
SURGICAL EDUCATOR PROFlLE-
E. D. Monaghan, CD., B.A., M.D., M.Sc., F.R.CS. (0, F.A.CS.
Dr. Monaghan began his training at McGill University back in
1958 after graduating from medical school and he started his
surgical career at the Royal Victoria Hospital in 1965. Since that
time, he has developed a local, national and international reputation as one of Surgery's outstanding educators. He received Education training at the University of Illinois in Chicago shortly
after coming on staff at McGill and was soon awarded "The
Golden Apple'; the Meritorious Award for Teaching by McGill's
graduating class of 1974. Locally,Dr.Monaghan became involved
as Program Director of the McGill Postgraduate Training Program
in General Surgery from 1979 to 1986 and he served as the Coordinator of the Undergraduate Surgical Teaching program at
McGill from 1966 through 1985. Along with other education re-
lated committees, he was an active
member of the Curriculum Committee
at McGill. He started the residency
program in Emergency Medicine at
McGill in 1971 and was its director
until 1980. On the national stage, he
was Chairman of the Committee on
Education and Chairman of the Postgraduate Education Committee, both
of the Canadian Association of General Surgeons. He is or has been a
member or chairman of many other
Dr. E.D.Monaghan
education related committees and societies. He played and continues to
playa key role in the development of
the Core Surgery training program in Canada. He also served as
Examiner in Surgery for the Royal College of Canada and as Chief
Examiner of the Quebec College of Physicians and Surgeons. He
was the Associate Dean for Postgraduate Education at McGillfrom
1986 to 1993. Currently, he is the Chairman of the Specialty Committee in General Surgery of the Royal College.
With a background so rich in Educational activities, it is no wonder why he is considered one of McGill's premier Surgical Educators by both the staff and all trainees who have been fortunate
enough to learn from him. On behalf of all of us who leamed
Surgery from him, thanks for being one of our staff who truly
cares about his students.
BULLETIN BOARD
Not much to add here this edition. Word has it Dr. Gerry Fried
and a few General Surgery residents are furiously preparing
a McGill Department of Surgery homepage for the Internet.
This will allow people around the world to see what we're
doing here at McGill at all levels of Surgical Training. This
will be constantly updated to keep current with program
"upgrades" if you will. I'm told this should be online in early
spring if not sooner. I've had a sneak preview of their efforts and it looks fantastic.
As always, your comments, criticisms and suggestions are always
welcome. If any of you have any good ideas with regards to learning methods, program ideas or anything else related to Surgical
Education, we'd love to hear from you. Keep in touch! •
Until the next edition, here's how you can find us:
McGill Surgical Education
surged@is.mgh.mcgill.ca
Undergraduate Coordinator
gmorgan@medcor.mcgill.ca
Core Surgery Coordinator
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Dr.
Robertso. was born in Victoria.BritishColumbia in 1912. In 1932 he graduated with his B. Sc. and in
1936 he obtained his MD CM from McGill University. His postgraduate surgical training
was done under the direction of Or. Fraser B. Gurd.
Df.H. Rocke Robertson
.... .
British Columbia. Dr. Robertson returned to his Alma Mater in
1959 as Chief of Surgery at The Montreal General Hospital, and
Professor and Chairman of the McGill Department of Surgery.
He has received many awards and honourary degrees in
recognition of all facets of his brilliant career.
The Department of Surgery is pleased to have this Visiting Professorship in Trauma in order to recognize Dr. Robertson's
many accomplishments .•
EDM
He served in the Medical Services of the Canadian Army and
reached the rank of Lieutenant Colonel.
His interest in wound infections led to his work in surgical infections and a data collection system. He became the first
Chairman in the Department of Surgery at the University of
Current and Past Chairmen of The Department of Surgery With Dr. Kimball Maull
From Left: Drs. David Mulder, Lloyd MacLean, Alan G.Thompson, H. RockeRobertson,
Jonathan L. Meakins, Kimball Maull
Principals of McGill
From Left: Dr. Bernard Shapiro, Dr. David Johnston, Dr.Rocke Robertson
Colleagues and Former Residents With Dr. Rocke Robertson
From Left: Drs. Doug McSweeney, E.John Hinchey, Gerald J. Pearl, H. RockeRobertson, Kimball Maull, David Mulder, Joe Meakins,
Harry L. Scott, EdMonaghan, Michael Laplante, Frank Guttman, Joe Stratford, Rea Brown, Alan G.Thompson
....
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THE SQUARE
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your family to potential dangers. In addition, the lack
of universal health care is a veritable nightmare for the
health care consumer (we had a baby while in Houston) but
that is for another article. For the residents reading this, remember that we have excellent hospitals in Canada which
are free and easy to get to at night. •
.......•.......................•...•......••........•.••......•.•......••.•........•.......•................•...........•...•••
I
n the recent years, Su~ical Epidemiology has evolved as
a well defined discipline that integrates Clinical Epidemiology
with surgical research. The development of this new discipline
has been in various directions including health care services
evaluation, outcomes
research, and clinical
trials. The McGill Department of Surgery was one of the pioneers in this area by
conducting numerous clinical trials in cooperation with epidemiologists and by initiating pure epidemiological research
aimed at the study of surgical patients or health care services.
A number of surgeons in the Department have acquired graduate training in Epidemiology, while others have developed
strong interest in the field and are involved in research within
this domain. As the number of such individuals is growing to
a critical mass, the establishment of a forum to allow discussion, exchange of ideas and initiation of a stronger collaboration was considered appropriate.
Surgical Epidemiology
With this objective in mind, early this year a first meeting of
individuals in the Department with an interest in Surgical Epi-
demiology was held. The purpose of the meeting was to bring
together members of the Department who have background
in Epidemiology or who have been involved in research within
the domain of Clinical Surgical Epidemiology in order to discuss common interests as well as perceived needs for the development of research in this area.
The participants identified the need for better interaction, collaboration and training. The possibility of pursuing infra-structure support and the establishment of a formal group within
the Department was discussed. The participants also realized
that it will be essential to recruit others in the Department who
have an interest in Surgical Epidemiology to partake in the
group's activities. In view of this, a second meeting will be held
in the near future. Any member of the Department who has an
interest or background in Epidemiology is invited to attend this
meeting. Those who are interested please call, write, e-mail, or
fax a note to Dr.John Sampalis indicating your availability during February and March at the following coordinates: •
Dr.John Sampalis
Telephone: (MGH) 937-6011 ext. 4715 or 4634
Telephone: (RVH) 842-1231 ext. 4851 or 4848
Fax: 934-8293 or 845-8156
e-mail: mcss@musica.mcgill.ca
...............................................................................................................................
tain the maximum benefit for the scarce health care dollar.
This in turn has increased the demand for ongoing outcome
evaluation, the development of clinical practice guidelines and
other mechanisms of quality assurance.
T
'I
I
"
Damatic
changes are occurring in the delivery
of Canadian Health Care. Technological advances, hospital reorganization and
cuts in funding
have all had a
profound effect
on the way health
care in general and General Surgical services in particular are
delivered. One of the major determinants of these changes is
the reduction in funding which has resulted in a desire to ob-
CAGSPosition Statement
on Ambulatory Care
For General Surgery, one of the most dramatic changes is the
shift in the delivery of service from an in-patient to an outpatient basis. Patients undergoing surgery which previously
required prolonged hospital stays are now being treated as
out-patients.
Patients requiring in-patient treatment frequently are admitted to hospital on the day of surgery. Technological advances such as the advent of laparoscopic surgery
have facilitated this shift to out-patient based surgery. There
are economic and medical advantages which derive
~
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ELEBRAnNG FIFTY YEARS OF EXCELLENCE
I came to McGill in August 1994 from Northick Park Hospital
in England. "You need little time to acquire the McGill spirit';
said to me by an old friend. No specific job description was
handed to me on my first
day. My mandate was to
consolidate
what had
been achieved and enhance the academic strengths of the department. I realized during my initial negotiations with the
Dean of Medicine, who was Dick Cruess at the time, that a
great challenge was waiting for me.
McGill Anaethesia
Having witnessed the reorganization of hospitals in the London area, I was already familiar with such jargon as reengineering, downsizing, rightsizing easily dropped by our
administrative colleagues. During my first few months at
McGill, I became acquainted with the intricacies of the system
which were reminiscent, to some extent, of the European style,
but indoctrinated with North American pragmatism.
The evolution of health care and scientific reasoning together with the budgetary pressures imposed by western
governments have challenged the way we operate and make
decisions. Whether these challenges are related to a worldwide economic and political instability, or a health care redefinition or our academic insecurity, we are compelled to
reflect on one clear issue "00 we need an academic Department of Anesthesia 7': A critical analysis of academic anesthesia in major countries indicates a great difficulty in
recruiting academic chairs, the sharp reduction in postgraduate trainees and decreased research funding.
It is my strong belief that academic anesthesia has a greater
chance to survive this challenge here at McGill than in some
other institutions. 1996 is the year we celebrate fifty years of
existence as an academic department.
Wesley Bourne, the
Founding Chairman, understood the needs of the specialty,
and some of his thoughts expressed in his presidential address
to the American Society of Anesthesiologists' meeting in New
York in 1942 are well worth repeating:
"...the more I contemplate this our institution, the more
convinced I am that it is sound at heart, and that its strength
is the strength of youth. As time goes on, my successors will,
I hope, be able to boast of glorious achievement; they will be
able to vindicate that boast by citing a long list of eminent
men, great masters of experimental science, great artists in
clinical procedure. They will, I hope, mention with high hon-
our some of my young friends who now hear me; and they
will, I also hope, be able to add that their talents and learning were not wasted on selfish or ignoble objects, but were
applied to the service of humanity ... .':
The challenge for anesthesia at this point is to integrate fully
its valuable human and intellectual resources into one academic environment. This way of thinking implies a mind open
to any possibility, including impossibility, a mind profoundly
questioning but buoyantly hopeful. Of course there is a risk
in questioning our performance and in making choices, but
unless there is change by taking the risk of failure, we limit
our opportunity for success.
It must be our choice to be a community of scholars involved
not only internationally but locally as well. We are a great
public anglophone institution in a francophone environment.
Close ties with his French Canadian colleagues were important
to Wesley Bourne. He promoted an inviting and congenial
place for active academic collaboration. McGill and our colleagues at the Universite de Montreal must continue this passionate spirit fostered by Dr. Bourne which will help to carry
us as a strong force into the next millennium.
It is an honour to be part of this historic occasion as we celebrate the 50th year of the Department of Anesthesia at McGill.
I would like to take this opportunity to cordially invite you to
join us at any of the following events, some of which form part
of our celebration activities:
February 27-March 1
CAE Patient Simulator comes to McGill Anesthesia
Virtual Reality in Medical Education - Workshops and Lectures
April 13
McGill Anesthesia Research Day
May 27-30
38th McGill Annual Refresher Course, Montreal
June 14-18
Canadian Anaesthetists' Society Meeting, Montreal
September 20
McGill Anesthesia 50th Celebration
September 21-22
McGill Open House-McGill Anesthesia Display
Also, two books will be published in 1996 - one covering the
History of the Department and the other a Biography of
Dr. Wesley Bourne .•
...................................................
~
Answer to question on page 2: 32 years!
-USA Today
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19
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T.
DECLINE IN THE NUMBER DF APPUCANTS
TO GENERAL SURGERY: DOES THIS AUTOMATICALLY MEAN
A DECLINE IN INTEREST IN GENERAL SURGERY?
Since 1993, the applicant pool of graduating medical students applying to general
surgery has been shrinking. In 1993, the first
match that graduating
students had to select
their specialty direct from medical school, 276 (19.3%) of the
graduates applied to general surgery.
II shows the number of students ranking general surgery and
the ratio of first choices to general surgery positions available in the match. This data also show a decline in the number and proportion of students choosing general surgery as
their PGY-1 training. The ratio of students first choice in general surgery to positions in general surgery has declined dramatically from 1:157 students ranking general surgery first
to every available position in 1993 to .08:1 in 1995.
A Decline in General
Surgery Applicants
Another complicating factor in these ratios, is the significantincrease in the number of positions in general surgery. 1993
was the last year the CaRMS offered a PGY-2 match for general surgery. Up to that time positions were filled at the PGY2 level and in 1993 some entry positions were reserved for
those 1992 graduates who had done a rotating internship.
In 1994 all of the entry positions were put into the PGY-1
As can be seen in Table I, that number and proportion of apmatch increasing the number of entry positions in general
plicants has been declining. This year in the 1996 match 194
surgery for graduating students. At the same time there was
graduates (14.4%) applied to general surgery programs.
a decline in the numbers of graduates choosing general
surgery as their first choice for PGY-1 training consistent
The application patwith the decline in the
terns of graduating
number of graduates
students has changed
Table
1
applying initially to
since the first match
Match Total # of Grade # of Applicants to
% of # Total
# of Applicants to
general surgery. Table
Year
in Match
General Surgery
of Applicants
General Surgery
in 1993. Students are
III demonstrates
that
more focussed on
1993
1432
276
19.2
this results in a higher
1203
particular disciplines
1994
1406
258
proportion of these po18.3
1473
and although they
1995
sitions
being filled by
1415
197
13.9
1158
apply to fewer discistudents
who did not
1996
1348
194
14.4
1429
plines, the numbers
chose general surgery
of applications
per
as their first choice.
student remains the
same. The results of this pattern is shown in Table I, where
All of these data would suggest a declining interest in genthe proportion of students applying to general surgery has deeralsurgery as a career choice for graduate students in Canacreased since 1993, but the number of applications to general
dian medical schools. This however does not take into
surgery has in fact increased. Students are realizing their
account the changes in Royal College training requirements
chance of a successful
for some of the surgical
match to their career
specialties and subspechoice is excellent,
Table
2
cialties. Cardiothoracic
(82% of graduates
surgery has become
# of # of Grads % of Grads
# of
% of
Ratio of
matched
to first
Match Grade
Positions
Positions
Rankin~
Positions
Rankin~
cardiac surgery and
Year
in
Genera
Genera
in General
in General
to
choice discipline) and
thoracic surgery.
Match
Surgery
Surgery
Surgery
Surgery
Applicants
they have responded
1993
1265
78
5.7
48
3.8
11.57
by applying to more
Both of these programs
1994
1274
76
5.7
48
3.8
1 : 1.27
programs within their
have changed to direct
1995
1284
52
3.9
64
4.8
1: 0.08
chosen discipline.
entry specialties mean-
There are two other
measures of student interest in general surgery as a career
choice. The first is how the students rank general surgery.
The data on three matches is available, 1993 to 1995. Table
ing the graduating students can enter these
disciplines at PGY-1 level not requiring general surgery first.
General surgery training as an entry to other surgical disciplines is no longer necessary or perhaps advised.
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22
z
Dr. Lloyd D. MacLean was a Visiting Professor at The Indiana
University School of Medicine in February. On Friday, February
16th he spoke at The Columbia Club on Health-
KU DOS
Upcoming
Events
care Delivery Systems and on February 17th he
was the 1996 John E. Jesseph Memorial Lecturer. His talk after Surgical Grand Rounds, in
the Myers Auditorium, was entitled Recent Advances in the Treat-
(continued from pg.6)
ment of Obesity.
Drs. Gitte Jensen and Sarkis Meterissian received an MRC
operating grand for the study "Molecular Mechanisms of Lym-
phocyte Trafficking." •
EDM
................................................................. .
March 13-17, 1996
SAGES
(Society of American Gastro-intestinal Endoscopic Surgeons)
Postgraduate Course: Problem Solving in Endoscopic Surgery
Pennsylvania Convention Center, Philadelphia.
N.B. "Video-Olympics" - March 17.
March 21, 1996
McGill Division of General Surgery Visiting Professorship.
Dr. Jerry M. Shuck, Case Western Reserve University
in Cleveland. Sponsored by Davis+Geck .
March 28, 1996
The E.J. Tabah Visiting Professorship.
Dr. Norman Wolmark. Dr.Wolmark is a McGill graduate of 1970.
Corrections
to the Fall '95 Issue
May 1996
Dr. Fraser N. Gurd Day - Orthopaedic Surgery.
June 6-7, 1996
Stikeman Visiting Professorship
Dr. Hillel Laks, Chairman, Division of Cardiothoracic Surgery,
University of California in Los Angeles.
September 1998
Surgical Diseases of the Esophagus
Montreal. Chairman: Dr. Andre Duranceau.
The caption under this photograph should have read:
Mrs. Dorothy and Dr. Bruce Williams
• The caption under the photograph
should have read: Dr. Fraser N. Gurd.
•
of the late Dr. Gurd
On page 6, Dr. Hany Daoud was honoured by the Principal in
recognition of his 15 years association with McGill.
-
The Square Knot regrets these errors.
......................................................
T
~%nkWou
here has been a generous response to our appeal
for funds. Almost $9000. has been received by the
McGill Surgery Alumni and Friends. We are most grateful. •
EdMonaghan and David Mulder