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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 L l .6,d UO J0- m ................................................................................................................................ • "alqlssod apew aq am le)16ms le!lUaSSa JO UO!SIAOld a4l le4l os sa!llunO) 6uldolaAap U! san6eall0) lno Ol pue4 6uldla4 e pual Ol anUllUO) ue) aM ad04 aM "palOldxa 6u!aq ale 'SUO!leUOpaleA!ld W01J Alulew '6u!punJ JO mmos aA!leU -lallV "u!elqo Ol ple4 Sl spafold lSo) MOl 4)ns uaAa 10J (VO!) W01J Aauow "a"!) 6u!punJ luawulaA06 'SlnJ la6pnq JO SAep asa4l U! 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A)ua6v luawdolaAao leUO!leUlalul ue!peue) a4l Aq palloddns alaM swe1601d asa41 "e!do!4l3 U! swe1601d uO!le)npa le)16JnS U! paAloAU!uaaq se4 :::E S ::I o ..... III C ·sc CI: >0- m Sit!.I:auno) 6u!dolaAao u! UO!:aelnp3 ll!l!6.1ns 1I!9'W " ,",wns )0 ,uawll,d,O '4' '886L OJUIS 8 ::; z ""3HvnOslHl .. THE SQUARE z o .... 9 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 == P A fter a very warm day, a lady said to Yogi Berra, you look pretty cool. He said to her "you don't look so hot yourself': o,unlnJ a4l JOJ sueld Jno lnoqe nOA Iial pue paJnpnlls 51 weJ60Jd s,1119)W M04 uo aJOW aleJOqela 11,1'anssl lxau Jno UI °llelap UI wa4l sassn)Slp anss! s!4l UI leUOllpa s,ue46euow °JO pue AJa6Jns aJO) JO sIe06 IImAo a4l 6uluJa)uo) a)eld 6ul~el sa6ue4) Auew aJe aJa41 °weJ60Jd aJO) Jno aAoJdwl pue MalAaJ Ol slUaplsaJ Jno JO spaau a4l pue sa)mosaJ 'sp04law 6ul4)eal Jno 6ululwe -xa Alasop aq ILaM 's4lUOW 9 Ol V lxau a4l LH=U JO~ WM 6uIssaJ60Jd 51 slUaplsaJ AJa6Jns aJO) a4l JOJ pauueld salJas aJnpal a41 A1H9HnS 3HO) '»)a AJl~t4)ASd A5010)aUA9 6u!4)!!al SS!!!) °sWSI)llU) pue sassa))ns alo4M mo uo ~)eq 1l0da1 11,1'lOU~ a4l JO uOlllpa aml -nJ e ulosluapnls Jno 10J muauadxa 6uluJeal ap!A01d JaHaq Ol M04 uo sluawa6pnf a~ew pue SlJoJJa mo aZAleue Ol elep JO leap leaJ6 e 6u1Pa1l0) aq ILaM °aAlllsod Am uaaq se4 ~)eqpaaJ Apea lie pue s~aaM Z JOJ MOU 6U1uunJ uaaq se4 pouad W)I a41 °aJnpal e aAI6 Ol M04 uaAa pue 6U1Allou~ pue 6uunlns 's6ulssaJp pue luawa6euew punoM lnoqe lie 'lUllds pue lm Ol M04 'saqnl 'sUleJp 'SJaldels 'sdlp 'samlns lnoqe UJetlI pue SUOIS -sas le)ilmd "uo-spue4" JO slol aAe4 sluapnls a4l 'a)uauadxa 6uluJeal ~aaM OMl SI4l 6uunO °SIII~S le)16ms palle) uOllel -OJ Mau e pa)npOJlUI aAe4 aM °SUOlleUlwexa le)ISA4d pue sau -olsl4 Jla4l MalAaJ Ol AI~aaM wa4l 4llM Slaaw 04M JOlnl e Ol pau61sse aJe Aa41°pouad ~aaM V a4l 6u!J np suoissas asa4l JO 8£ aAe4 Aa41°A6010)UO pue AJa6msomaN 'AJa6ms ~)aN pue peaH -A60106uAJelolO 6ulpnpul sallleDadsqns lie Aq uaAI6 s)!dOl AJa6ms JO a6ue1 aplM e 6UUaAO)suoissas 6uluJeal dnoJ6 lIews UI aledDllled sluapnls a4l 'AJa6Jns uo 4lUOW l Jla4l 6uuna °AJa6ms JO SaldDU!Jd a4l JO s~aaM V pue 'aul)!paw A)ua6JaW3 JO s~aaM Z 'A6oI0!peij JO ~aaM l 'e!Sa4lsau'v' JO ~aaM l sapnp -U! AJa6Jns JO s~aaM a l a4l 'uOileJlSnlll a4l U! aas ue) nOAS'v' 6ul4)eal 11!9)W mOJ a4l le ue6aq AJa6ms UI uOilelOJ aUDI -paw le)!uID Ol uo!pnpoJlul JaAa lsJY a4l966l '~ AJenJqa~ uO °swalqOJd le)16ms luawa6euew Ol M04 pue lUa!led e dn ~JOM Ol M04 uJeal Aa4l d!4s~Jap Jla4l ul °mA e lnoqe JOJ sunJ pue mA PJI4l Jla4l UI sUI6aq s!41°uollelOJ au!)!paw JO a)lpeJd a4l palle) MOU 51 'd!4s~JaD Jla4l 'ase4d leulJ a41 °Slsou6elp leiluaJawp a4l pue A6010!sA4d04led '(sUO!leulwexa le)lsA4d pue sauolsl4) uoqewJOJul 6u1Pa1l0) uo Alulew aleJlUa)UO) pue lellds04 a4l UI ~JOM Ol uI6aq Aa4l w)1 ul °JeaA puom Jla4l 46noJ4l AeM Jle4 su!6aq (W)!) aUI)!paw le)lulI) Ol uOlpnpoJlul palle) 'lJed puO)as a41°leWJoJ uo!ssms!p dnoJ6 lIews JO aml)al a4l °966/ lH=U PO!Jad a,,!pal3 ' Z 3HvnOslHl THE SQUARE ""~ z 17 C 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 UOiiPW JiiJi!d 'ijJno7 iiU!OJUil 'UO!SS!JiiJiiW S!!fJ05 'noJs!J4) !fJ'N 'Ao!fUiiAJii4Jl uOii['un!fJ08 Jii/XiiM U!AJOW 'iiU/!W iiU!Jii4JO) 'SU!!f0iiW u04JOUO['UOiiPOW Jjii{ 'U04oouoW P] 'nOiiA!/Iii8/nOd :lqO!1I OlljiJ7'M0II JP08 pion 'oJoQ!45 iJUiiH :lq6!11 0miJ7 'Moil lUOJ:/ .............................................................................................................................. • 'SUEJ)O J4l -6uOI 6uI4sIIqElSJ ssom sd!4SPUJ!JJ WJJl WJ4l JO AUEW ')!UII) IE)!6ms Al!SJJfqun J4l UI JEJA 4)JEJSJJ )lWJpE)E J!J4l 6u!puJds JJE 04M SlUJP!SJJ UMO mo 4llM AIJSOP l)EJJlU! 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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. 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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