Self-Study Report, University of Toronto, Department of Surgery

Home , Albert Aguayo, Bernard Langer (surgeon), Charles Tator, Unity Health Toronto, William Gallie

SELF-STUDY REPORT Department of Surgery External Review 2020

Submitted by Dr. James T. Rutka RS McLaughlin Professsor and Chair of Surgery TABLE OF CONTENTS

Surgery by the Numbers 2014–2019...... 6 1. Executive Summary ...... 9 2. Introduction...... 13 3. Key Findings From the 2015 External Review.17 4. Chair’s Statement...... 23 4.1 Historical Perspective...... 24 4.2 Developing the Brand...... 25 4.3 Strategic Plan...... 26 4.4 Communications ...... 33 4.5 Academic Performance ...... 33 4.6 Chairs and Chairholders...... 34 4.7 Promotions...... 35 4.8 Appointments...... 36 4.9 Continuing Appointment Reviews...... 38 4.10 Retention...... 39 4.11 Transition...... 39 4.12 Education...... 39 4.13 Research...... 40 4.14 Major Awards Recipients...... 41 4.15 Advancement...... 42 4.16 Departmental Firsts...... 43 4.17 Strengths and Challenges...... 44 4.18 Future Directions...... 45 5. Organization and Financial Structure...... 47 6. Resources and Infrastructure...... 55 7. Education...... 57 8. Research Report...... 65 9. Best Practice in Surgery ...... 71 10. Faculty Development...... 79 11. Continuing Professional Development...... 83 ABBREVIATIONS TABLE OF CONTENTS AAP: Annual assessment of productivity AEF: Academic enrichment fund AFP: Alternate Funding Plan BPiGS: Best Practice in General Surgery 12. Global Surgery...... 87 CACMS: Committee for Accreditation 13. Surgical Skills Centre...... 91 of Canadian Medical Schools 14. Spine Program...... 95 CAR: Continuing appointment review 15. Trauma Program...... 105 CaRMS: Canadian resident 16. Report of Faculty Members...... 111 matching service 17. Report of Learners...... 117 CBC: Competency Based Curriculum 18. Division Reports...... 121 CPD: Continuing Professional 18.1 Anatomy...... 122 Development 18.2 Cardiac Surgery...... 125 CRC: Canada Research Chair 18.3 General Surgery...... 134 FEAC: Fellowship Education 18.4 Neurosurgery...... 142 Advisory Committee 18.5 Orthopaedic Surgery...... 150 18.6 Plastic and Reconstructive Surgery...... 161 IDEAS: Improving & Driving 18.7 Thoracic Surgery ...... 172 Excellence Across Sectors 18.8 Urology...... 177 LCME: Liaison Committee 18.9 Vascular Surgery...... 179 on Medical Education 19. Hospital Reports...... 197 LHIN: Local Health Integration Network 19.1 Michael Garron Hospital...... 198 MAM: Medical Academy of Mississauga 19.2 Mount Sinai Hospital...... 206 MOHLTC: Ministry of Health 19.3 North York General Hospital...... 211 and Long-term Care 19.4 St. Joseph’s, Unity Health Toronto...... 213 19.5 St. Michael’s, Unity Health Toronto...... 215 MOU: Memorandum of understanding 19.6 Sunnybrook Health Sciences Centre.....226 NBME: National Board of 19.7 The Hospital for Sick Childrens...... 235 Medical Examiners 19.8 University Health Network...... 240 NEAL: New and Emerging Leaders 19.9 Women’s College Hospital...... 248 PCC: Patient Centred Care 20. Conclusion...... 255 PGME: Postgraduate Medical Education Appendices (A, B and C)...... 259 Also available electronically Q/BP: Quality and best practice RCPSC: oyal College of Physicians and Surgeons of Canada SEAD: Surgery Exploration and Discovery SIC: Surgeon-in-Chief SLUE: Surgical Leaders of Undergraduate Education SSTP: Surgeon Scientist Training Program TES: Teaching Effectiveness Score UME: Undergraduate Medical Education SURGERY BY THE SURGERYNUMBER BY THE NUMBERS2014–2019 2014-2019

FULL-TIME 296 49 NEW HIRES PART-TIME 079 25 NEW HIRES 40

FACULTY ADJUNCT RESEARCH 545 170 31 NEW HIRES SCIENTISTS Faculty have MEDICAL STUDENTS published more than 225 4-YEAR UNDERGRADUATE CURRICULUM 11 RESIDENCY 8,500 RESIDENT peer-reviewed 277 TRAINEES PROGRAMS publications CLINICAL FELLOWS from 40 countries 249 The largest clinical fellowship program in the country

FACULTY MEMBERS PROMOTED 73 TO HIGHER ACADEMIC RANKS

CITY-WIDE in annual Grant capture: BRAIN TUMOUR ADVANCEMENT 1 BANKING INITIATIVE FUNDING 404M NEW UNIVERSITY 8M up from 4M annually 2 DIVISION CHAIRS NEW SURGEON-IN-CHIEFS 3 NEW PROGRAM DIRECTORS FACULTY 64 Pediatric general surgery SUCCESSFULLY COMPLETED SUB-SPECIALTY Colorectal surgery Continuing Appointment Reviews (CARs) PROGRAMS Surgical oncology 4 Sunnybrook Health Sciences Centre Thoracic surgery St. Michael’s Hospital, Unity Health CANADA RESEARCH Mount Sinai Hospital CHAIR HOLDERS 5 University Health Network FULLY-AFFILIATED Women’s College Hospital TEACHING The Hospital for Sick Children 6 HOSPITALS in annual DIRECT ENTRY RESEARCH ROYAL COLLEGE OF PHYSICIANS AND SURGEONS FUNDING 7 TRAINING PROGRAMS 76M up from 40M annually BEST GLOBAL UNIVERSITIES IN SURGERY

Founded in 1933, the US News and World Report has Analytics InCites, are based on academic research published rankings of top institutions throughout the performance, as well as indicators for global and regional world in education, health, and technology. It is the oldest reputation in each speci c subject. The rankings in surgery and best-known ranker of academic institutions. were based on excellence in such areas as organ transplantation, trauma surgery, minimally invasive surgery, In addition to rankings of the world's top 1,500 surgical technology and academic research performance. universities overall and by region and country, the sixth The bibliometric indicators are based on data from the annual U.S. News Best Global Universities rankings Web of Science for the ve-year period from 2013-2017. include an examination of the leaders in key academic subject areas. U.S. News used a separate methodology to For 2020, the US News and World Report identi ed the publish the top global universities in 28 subject areas. Department of Surgery at the University of Toronto as the fourth best academic institution throughout the world for These subject-speci c rankings, powered by Clarivate surgery.

The Top 5 Best Global Universities in Surgery

EXECUTIVE SUMMARY

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 9 1EXECUTIVE SUMMARY

Executive Committee of the Department of Surgery: Back row – M. Fehlings, O. Rotstein, A. Nathens, S. Keshavjee, R. Richards; Front row – N. Ahmed, J. Rutka, R. McLeod

The Department of Surgery at the University of 249 clinical fellows, and 40 scientists. There Toronto has been ranked fourth in the world for are 7 direct entry Royal College of Physicians global universities in the recent 2020 US News and and Surgeons training programs (Cardiac World Report. Its global reputation is based on a Surgery, General Surgery, Neurosurgery, highly talented faculty who demonstrate exemplary Orthopaedics, Plastic and Reconstructive patient care, excellence in teaching and training Surgery, Urology, Vascular Surgery) and 4 sub- the next generation of surgeons, state-of-the-art specialty programs (Pediatric General Surgery, research across the continuum of investigative Colorectal Surgery, Surgical Oncology, and ideology, and devotion to surgical innovation, Thoracic Surgery). The Division of Anatomy entrepreneurship, and commercialization. is housed within the Department of Surgery in a relationship that has been mutually The Department is the largest across Canada with productive and beneficial for over a decade. 296 full-time faculty members, 277 residents,

10 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 1. Executive Summary 11

Self-Study Report, External 2020 Review | ensures that adequate infrastructure and support can be provided to the exceptionally talented members theof Department to maintain its prized ranking in Canadian surgery, and beyond, and to provide leadership in academic surgery with global impact. adjunct, full 49 time, 25 clinical part-time, and 4 status-only), appointed University 2 new Division Chairs, and supported the appointments 3 new of program directors, and Surgeons-in-Chief3 new at the various hospitals. There 64 were faculty successfullywho completed theirContinuing Appointment Reviews And (CARs). finally, the Department celebrated in the promotion 73 of faculty members to higher academic ranks. I am most the of proud commitment to academic excellence which is demonstrated consistently all by members the of Department. Academic excellence is fostered within a supportive environment that is provided the by University, hospitals, and research institutes in which the faculty conduct their clinical practice and research efforts, and in whichlearners are educated. The organization the of Department with its Executive Committee andSenior Advisory Committee working synchronously with the University Division Chairs and Program Directors, Surgeons-in-Chief, andHospital Division Heads, basis, the Department Surgery of receives $5 – in Advancement10M funds to support Chairs, research investigators, clinical fellows, and the advancement infrastructure. This past year was a banner year the for Department Surgery of in which in Advancement funds$11.8M received. were The Department has developed an ambitious Strategic – 2023 Plan 2018 entitled: for – “Aspire WithinAdvance this – Achieve”. plan, there are 6 well-defined areasof surgical activity including: Education; Research;1) 2) Best 3) practices; 4) Faculty Global 5) Development; Outreach; and 6) Innovation. Progress that has been made along each theseof areas is described in detail within the body thisof 5-year report. The plan and its component parts align well with the Faculty Medicine’s of 2018 – 2023 Strategic Plan – Leadership in Advancing Knowledge,New Better Health and Equity. 2020, - From 2015 the Department has recruited faculty new 109 members clinical (29 adjunct, 2 Department of Surgery, Faculty University of Medicine, of Toronto $150 Million$150 per year funds of that are used to support the academic mission. On an annual Hospitals led to have the creation a myriad of of chairsendowed surgeons by held totaling over courses; advancement funds; and endowment funds. Advancementefforts within Departmentthe Surgery,of the University Divisions and the annually from the University and the Ministry of Health and Long-term revenue Care (MOHLTC); from Continuing Professional (CPD) Development Funding the for Department is derived from multiple sources including: Base funds are received international awards. The Department also lays claim to 5 Canada Research Chair holders. Science, and The Lancet Each to year, name a few. the faculty also distinguish themselves earning by and receiving numerous prestigious national and publish more than 1,000 peer-reviewed publications per year including in high-impact journals such as England New Journal Medicine, of Nature, NSERC), in additionNSERC), to large career awards such as the CIHR Foundations grants, and Program Project awards. The Department Surgery of faculty surgeons engaged in research maximized have who opportunities receiving for operating grants from the Tri-Council agencies (CIHR, SSHRC, and when it was it when average on $40 Million per annum. Credit this for incredible accomplishment goes to all annum in research funding the past over 5 years. The amount funding of has nearly when doubled compared to the previous 5 years, 2009 – 2014, The Department is a research-intensive, and academically productive unit in which the faculty generatedhave Million average on $75 over per Hospital, Unity (St. Joseph’s Health Toronto Hospital), and Trillium HealthPartners. receive excellent receive surgical instruction in particular Generalat North Hospital, York Michael Garron of community-affiliatedof hospitals inand around Residents, Area the Greater (GTA). Toronto fellows and medical students surgical on rotations UniversityHealth Network, and the Hospital Children. Sick for Part time and adjunct faculty members are found in an ever-expanding array teaching hospitals: St Michael’s Hospital, Unity Health, Mount Sinai Hospital, Sunnybrook Health College Hospital,Sciences Centre, Women’s Members the of faculty are distributed at6 major Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

1. Executive Summary 2

INTRODUCTION

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 13 2INTRODUCTION

The Department of Surgery is comprised of a The Department is a research-intensive enterprise strong network of faculty and learners, and traverses which is academically productive and well- six fully-affiliated hospitals and an expanding funded. Over 1,000 peer-reviewed papers are number of community-affiliated hospitals. The published annually by Departmental members, Department is home to 296 full-time faculty, and the annual grant capture ranges from $75- 79 part-time faculty, 170 adjunct faculty and 40 80 M in external funding from peer-reviewed research scientists. The Department is responsible regional, provincial, and national agencies. The for surgical teaching of 225 medical students Surgeon Scientist Training Program (SSTP) is throughout the four years of their undergraduate a unique element of the research training for curriculum, and for overseeing the welfare of eleven residents in the Department, and has been a highly residency programs with a total enrollment of over successful program in training the next generation 250 resident trainees. The Department’s clinical of Surgeon Scientists. The range of scholarly fellowship program is the largest across Canada work has been wide including formal training in with over 200 fellows from 40 countries around the fundamental biology, clinical epidemiology, medical globe coming each year to learn highly specialized education, business administration and ethics. surgical care and techniques from our surgeons.

14 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 2. Introduction 15

Self-Study Report, External 2020 Review | Translation of novel discoveriesTranslation

Optimize patient and clinical clinical and patient Optimize 6. surgicalinto practice 3. of provision the outcomes through care person-centred high-quality, for clinical This Self-Study Reportand External Review bridges two effective StrategicPlanning Processes and Plans that served have the Department well. The first was Strategicthe – TransformingPlan 2012-17 for Surgery: theBeyond Cutting Edge – which was a blueprintbold taking for the Departmentto a higher station. The current Strategic Plan 2018-23 – Aspirefor – Advance – Achieve – builds progress on made during the firstplan, and has the following StrategicDirections which taken have the Department into wholly areas new previously unexplored. These directions are identified follows:as for local, national Integrated research Integrated Consolidate partnerships Consolidate

5. and expertise and international impact 2. excellence academic and Department of Surgery, Faculty University of Medicine, of Toronto through in both both in achieving Educational excellence Faculty members Faculty

4. their maximum potentials professional and personal domains novel approaches to teaching teaching approaches to novel and learner engagements 1. STRATEGIC DIRECTONS programs annually, and these are embedded within all Divisions and benefitmedical students, residents, clinical fellows and faculty alike. research.Finally, the Department offersmyriad a Continuingof Professional (CPD) Development recognition the of value and need technical for skills training outside the clinical setting. In addition, serves it as a platform skills for related and practiced in a simulated, non-threatening environment. continued The Centre’s use the by Universitycommunity underscores the increasing of Toronto Surgical Toronto of Skills Centre atMount Sinai Hospital provides a laboratory setting where basic and surgical complex procedures can be learned From an educational perspective, the University Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto of Surgeryof in the Faculty Medicine of at the asUniversity is it hoped the pages Toronto, of thisof five-year review will clearly illustrate. Division Heads, hospital VP’s Medical of Affairs, Chief Executive Officers,and individual faculty members. While dependency such agreement on with others may seem unwieldly in some environments, this spirit cooperativity of and collaboration works quite well the for Department of theof Department Surgery of exerts influence through the building interactive of networks with the Dean the of Faculty Medicine, of Vice Deans, Surgeons-in-Chief, Research Institute Directors,University Division Chairs, Hospital The Department Surgery of works in close collaboration with the Faculty Medicine, of the hospitals and their research institutes, the various Divisions Surgery of andtheir practice plans, and in many instances, the Ministry Health of and Long-term The Chair Care (MOHLTC). pursuing alternative sources sustainable of funding through Advancement; and promoting faculty members to higher academic standings regional,for national and international awards. Enabling and supporting strategies the for plan include communication and knowledge sharing through the use Department-specific of materials;

2. Introduction 3

KEY FINDINGS FROM THE 2015 EXTERNAL REVIEW

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 17 KEY FINDINGS FROM THE 2015 3EXTERNAL REVIEW

The previous review of the Department of Surgery was undertaken in 2015 close to the end of my Undergraduate first term as Chair of the Department of Surgery. The Review was commissioned by the Dean of Medical Education the Faculty of Medicine, Dean Trevor Young. The two External Reviewers were Professor (UME) John Kortbeek, Professor and Head, Department of Surgery, University of Calgary; and Professor Whereas there was some concern regarding Carlos Pellegrini, the Henry N. Harkins Professor undergraduate medical education (UME) in and Chair, Department of Surgery, University of the previous external review, the 2015 External Washington. On balance, the review by Professors Reviewers stated that systems were put into Kortbeek and Pellegrini was highly laudatory of place to mitigate against the less than optimal the leadership of the Department of Surgery, and prior experience faced by medical students on the quality of its Divisions and many programs. surgical rotations. Some of these systemic changes There were several key suggestions made to included the introduction of “Surgical Leaders of improve the operations of the Department of Undergraduate Education” (SLUEs) at each Hospital, Surgery in all of its facets. These can be broken the establishment of strong student surgical interest down into the following component parts: groups across numerous Divisions, the development

18 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 3. Key Findings From the 2015 External Review 19 Self-Study Report, External 2020 Review |

royalcollege.ca/rcsite/documents/ Findings from the Royal College’s Findings from the Royal College’s employment study - 2013 Too many, many, Too too few doctors? What’s really behind Canada’s unemployed specialists? is real and important. has The RCPSC tackled this directly analyzing by and writing a “white paper” thison topic: health-policy/employment-report-2013-e.pdf Another challenge noted included the identification appropriateof alternate service providers to offset the high service load that typifiesmost resident surgical rotations. The large Fellows of complement in the DepartmentSurgery of was commented asupon strength a overall, interactions but between Residents and Fellows needs continuous monitoring. On the the whole, External Reviewers noted that all Resident and Fellowship programs are robust and well organized. They commented the on challenges facing all graduating residents regarding future employment, a universal Canadian issue; and they underscored the need to preserve and maintain the current physician extender policies to ensure that the resident service/education ratio stays balanced. Response In all Divisions, theinteractions between Residents and Fellows are being continuously monitored through the Residency Program Committees (RPCs), and the Fellowship Program Directors. The issue employment of graduating for residents Department of Surgery, Faculty University of Medicine, of Toronto

to achieve full accreditation related to issues with service/education balance in these two programs. two programs are fully now accredited, joining all remaining fully accredited programs. Failure programs had received mandatory external review status the by Royal College Physicians of and Surgeons Canada of that but (RCPSC), these Education (PGME) The External Reviewers noted that two residency Postgraduate Medical excellence in teaching at the medical student level. the Department recognizing is now and awarding surgical residents distinguish who themselves by the tertiary of way quaternary or rotations. This approach has been widely adopted the by Leads Surgicalof UME at each core hospital. Finally, hospitals to accept additional medical students. At main core hospitals, emphasis placed is now on a core acute care surgical curriculum, and less in the establishment the of Mississauga Academy Medicineof (MAM) and with the desire the of Surgeons-in-Chief at community-affiliated within the various hospitals. Community surgical rotations are more frequently now utilized since their firstyear. Department The continues to financially support SEADthe course with allitsof partscomponent at the Surgical Skills Centre, and Response The SEAD course has been expanded to accommodate more medical students completing greater advantage surgical of residents as teachers of medical students in the Department of Surgery. emphasis medical for studentsheavily on specialized tertiary quaternary or surgery services and taking Reviewers recommendedexpanding the SEAD course to a larger number students, of placement of more medicalstudents at community hospitals, less prior epoch, scores medical by students their for surgical rotations are somewhat than lower their for other rotations in different disciplines. The External course (J Surg Res 2019 235: 315-321), andcourse surgical (J 315-321), 235: Surg Res 2019 rotation debriefingof allmedical studentsby the Director UME.of Although the improved over of theof Surgery Exploration and Discovery (SEAD) members the of various Research Institutes sit theon search committees these for recruits. To enhance collaborative research efforts across the UofT fully affiliated Hospitals, Translational a Research Committee has been formed in the Department Surgery, of with Dr Marc Jeschke The External Reviewers recommended that recruitment processes faculty new for be organized through a collaborative approach between Research Institutes and the Department; that collaborative research programs/projects occur more frequently across hospitals; that research mentoring be provided to surgeons engaged in investigative inquiry; that further philanthropic funds be created to support the academic mission in the Department Surgery;of and that entry criteria and support for residents entering the SSTP be re-evaluated. Response The issue coordinating of recruitment packages especially research for support with the Hospital- based Research Institutes is a difficultone that the Department is continuing to improve upon. The Department Chair has been meeting with the hospital and the Research CEO’s Institute Directors a routine on basis to accomplish this. allFor recruits new requiring research support, and offers periodicupdates progresson in CPD offerings across all Divisions. compared When to many other Departments in the Faculty Medicine of at UofT, the Department Surgery of hosts now among the greatest number CPD of offerings to its community surgeons of and trainees. Research The External Reviewers acknowledged the strong research tradition in the Department, and impressedwere with the support the of Surgeon Scientist Training Program (SSTP), and the research accomplishments of the Surgeon-Scientists and –Investigators at all levels appointment. of The amount funding of attained per annum ($40M), the devotion the of Chair to the research mission, the number peer-reviewed of publications and grants attained within the Department Surgery of would place its ranking in in the the top world. 10 Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto Retreat, and Evening Best of Event Practices in CPD was held. Dr George sits now the on Senior Advisory Committee the of Department Surgery of CPD courses which are targeted at residents, fellows, faculty, and the community. Surplus funds from these CPD courses are shared with the Divisions. A Directornew Dr Ralph CPD, of George, has been appointed in the Department Surgery. of A CPD of Interestof and best (COI), practices in CPD. Response The number CPD of offerings in Department the has increased substantially since the last External VirtuallyReview. all Divisions annual have now of CPDof be identified in of each the Divisions. Finally, was it recommended that the Department Surgeryof would benefit from an active CPD/ CME committee, with the suggestion that a CPD retreat to be address held issues such as Conflict higher They level. noted that the some of for smaller Divisions, there are some barriers to establishing Continuing Professional (CPD) Development Programs. The potential generation revenue for through CPD offerings wasnoted. In addition, the External Reviewers suggested that champions Improvement The External Reviewers commented the on need to espouse ethical issues and principles in surgery to a Continuing Education and Quality fortunate to advocate and for to numerous receive physician extenders across all hospitalsto assist with reducing the resident service load while maximizing their educational opportunities. and By large, these physician extenders been have hiredand paid by for the respective hospitals through their global budgets. its Residents and Fellows towards academic positions, making them highly competitive for any jobs that are posted across the country. The Department Surgery of has been extremely While this is a universalissue across Canada, the Department Surgery of at the University is uniquely positioned Toronto, of to train

3. Key Findings From the 2015 External Review 3. Key Findings From the 2015 External Review 21 Self-Study Report, External 2020 Review | appointment or reappointment to the Department Surgery.of Prospective adjunct part-time or faculty members need to demonstrate an ability to teach surgical trainees, conduct or academic inwork order to be granted a position in the Department Surgery, of thus enhancing its brand. The difficulties obtaining positions after graduation from the residency training programs at the areUniversity unique not to this Toronto of program. That said, Department Surgery of graduates are often the most sought-after recruits across the country. Still, the Department is to with keen work its respective Divisions to determine best how to position itself regarding opportunities residents/fellows for to obtain positions immediately after completion training. of Because the of shrinkage in funds available to the Department Surgery, of annual stipends based Annualon Assessment Productivity of (AAP) scores ceased. now have This enables now the Department Surgery of to use funds support for earlyof surgeon investigators the for research projects, to fund the SSTP higher to a much level than previously possible, and to consider holding “merit awards” surgeon-scientists for investigators or doing research a competitive on basis each year. Finally, the Chair reviews all requests Annual for Relationships Overall, there was support thefor current Chair’s leadership style and response to issues that arise. The overall morale the of Faculty in the Department Surgeryof was considered high. Where there issues,were these related to the market job for graduating residents/fellows which was considered a challenge. In addition, the Faculty genuinely were concerned the by shrinkage in the budget available to the Chair to promote the academic mission. Recommendations included a meeting with key stakeholders regarding the market job in Canada; considerations to reapportion the Departmental academic funds to the Department to successfully implement its Strategic Plan; and continued branding the of Department Surgery of at the University so that all of Toronto appointments meet the criteria required to enhance the brand. Response ). Department of Surgery, Faculty University of Medicine, of Toronto see Appendix Report A -Wright sustainable approach to SSTP applications and funding ( Advisory Committees the of Department Surgeryof leading to a more consistent and by Drby James Wright, former Orthopedic Surgeon in the Department Surgery. of This document has the by been Executive approved and Senior Division Chairs provided one-time only funding thisto overcome shortfall. This led to a “white paper” SSTP on training and funding as written Department Surgery of was in a deficit position $500Kof given the number SSTP of trainees and shortfall funding. of Thankfully, the University a time resident when external research fellowship applications are reaching not funding status. level In fact, a crisis point was the reached when in 2018 establishment funds. newly of endowed That said, this is a costly undertaking the for Department at The Department has enhanced its support the of SSTP trainees an on annual basis through the in the Department, ensures that the research namementor’s is included in the Memorandum Agreementof all of (MOA) recruits. new a research mentor through the mentorship program in the Department Surgery. of Dr Ori Rotstein, Vice-Chair, Faculty Development All surgical new recruits and junior faculty members the have benefitof being assigned is to bring surgeons together across the UofT campus to spawn collaborative new efforts. as the Director. The purpose this of Committee We thankWe the External Reviewers this for high praise. Improving the upon expressed current ranking the of Department Surgery of will be challenging,is but something the current Chair is very interested in doing. opportunities improvement, for and best how to advance in their related areas investigation. of National and International Comparators The External Reviewers stated have that there is questionno that the Department Surgery of at the isUniversity the top Department Toronto of its of kind in Canada and in probably the of one top 10 the world. Its educational programs, in particular residency and fellowship are world-famous and its clinical programs are cutting edge, state the of art that compare favorably with any program such in the world. Response academic faculty to remain competitive at grants panels, and with peer-reviewed publications may becomedifficult. Maintaining Faculty morale may similarly becomeproblematic. Response The continued support the of SSTP remains a major concern in the Department Surgery. of Thankfully, the reapportioning Faculty of stipendiary support back to the Department Surgery of will in help this regard. The Chair remains committed to supporting all Faculty Members engaged in research to be successful in their academic programs. There is the real possibility holding of “merit-based awards” in the Department Surgery of to support the early research and work careers junior of faculty. Regarding faculty morale, the Chair is committed to with work all faculty members to ensure that their academic goals are being realized and met. Each year, the Chair meets with more than half the of entire faculty to discuss Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto in maintaining and growing the SSTP in the Department Surgery. of With shrinking Departmental Budget reserves, convincing Long Range Planning Challenges The External Reviewers noted the challenges for breastfor surgery and vascular surgery that incorporate the relevant hospital partners in the fully affiliated teaching hospitals. VISA trainees and increased returns to the Departments. At this time, this does appear not to be a realistic goal, as the main source VISA of training funding Saudi (i.e. Arabia) has largely disappeared. Efforts are placein specificto develop programs the practice plans across all Divisions provide remuneration surgeons for based the on AAP scores. There been have many discussions at the Clinical Chairs meetings regarding the training IMG/ of Response A sustainable budget has been achieved. now At first, allocation stipendiary of funds was based annual on Assessment Productivity of (AAP) scores. However, thiswhen became untenable, the Department of Surgery has stopped this practice in having of favor the redistribution funds of training for IMG/ VISA trainees was mentioned. Finally, was it recommended that a need multisite for programs in breast surgery, and vascular surgery be realized. of theof Department. In addition, the barriers to promoting multi site programs identified.were The External Reviewers recommended that the Department Surgery of obtain a sustainable budget. Revision the of allocation stipendiary of support to all faculty was suggested. In addition, Financial Structure Financial The External Reviewers noted the diminishing budget available to the Chair to run the operational activities, and strategic priorities Organizational and

3. Key Findings From the 2015 External Review 4

CHAIR’S STATEMENT

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 23 4CHAIR’S STATEMENT

Present and Past Chairs of the Department of Surgery (left to right): J. Rutka, R. Reznick, D. Wilson, J. Wedge, B. Langer, D. Latter

endowed Chair in Surgery in Canada. Dr Bernard 4.1 Historical Langer (1982-92) developed the guidelines for surgical practice plans in the Department of Surgery, Perspective and established the Surgeon Scientist Training Program. Dr John Wedge served as Chair from The Department of Surgery at the University is 1992-2002 and established the Surgical Skills Centre steeped in a rich tradition of academic excellence at Mount Sinai Hospital in 1998. Dr. Richard and innovation dating back to 1843. Dr Clarence L. Reznick served as Chair from 2002 – 2010, and Starr became the first full-time Professor of Surgery was instrumental in creating the Wilson Centre in 1921, which was the first appointment of its kind for Education at the Toronto General Hospital, in Canada. Following Dr Starr there were several The Toronto Bariatric Collaborative, and the luminary Professors of the Department of Surgery Competency Based Curriculum in Orthopaedics. beginning with Dr W.E. Gallie (1929 – 1947), Dr Upon Dr Reznick’s departure from the University Robert Janes (1947 – 1957), Dr Frederick Kergin of Toronto to become Dean of Medicine at Queen’s (1957 – 1966), and Dr William Drucker (1966 – University, David Latter was installed as interim 1972). In more recent times, Dr Donald L. Wilson, Chair from 2010-11, before I was announced as the (Chair from 1972 – 82), helped to establish the RS RS McLaughlin Chair of Surgery in April 2011, McLaughlin Chair in Surgery in 1978, the first and the tenth Chair of Surgery in its history.

24 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 4. Chair’s Statement 25

Self-Study Report, External 2020 Review | The adorns logo now a variety merchandise of in the Department coffeemugs, (e.g. ties, scarves, necklaces, vests, pens, and lanyards), as well as exists letterhead, on e-communications, and presentationsPowerPoint in stylish ways. In this image (Figure will you 4.2), see two suture needles that are slightly offset, one to other, the in space. The suture needles represent our emphasis and focus the on art andpractice surgery. of The suture threads are actually depicted a double by helix double-stranded of deoxyribonucleic acid (DNA) with appropriate nucleotide base pair cross - linking strands. The represents DNA our focus surgical on science and includes our research from work molecule to man. As created we thelogo in its finalform, it did escapenot our notice that the colours the of strands,DNA red and connected were blue, by cross linking bands that white, were making the logo highly reminiscent the of colours the of archetypal “barber from pole” antiquity where representedblue the veins, red represented the arteries, and white was the background that accentuated the spiral the of red and stripes. blue 4.2 Developing the Brand As part recruitment my of to the Department of Surgery as Chair, was it strongly recommended formerby Dean Catharine Whiteside to begin branding the Department inways which would enhance our visibility the on global stage, increase our ranking theon continent, and promote our ability advancement for across all our of Divisions. In creating image a new the for Department Surgery,of effortswere made to underscore our core values Surgery which are: 1) in all of its facets including technical innovation, and education; and Science, 2) given our rich history accomplishmentsof amongst our faculty, and the emphasis that has traditionally been placed our on surgeon scientist training program, which dates back to Dr William Gallie’s tenure as Chairman. Department of Surgery, Faculty University of Medicine, of Toronto Department Surgery of Logo Figure 4.2 Figure Surgery that carried have through it to present time. Shaf Keshavjee in 2008. These milestone events, among others,signal the rich history surgical of pioneering and innovation in the Department of for depression,for Andres Dr. by Lozano in 2007; and the creation lung perfusion the of Ex-Vivo method to improve lung transplantation rates, donor Dr by heterologous human peripheral nerve transplant, by Dr Alan Hudson and Dr Susan MacKinnon in 1988; the first studyof the useof deepbrain stimulation Mustard (1962); the world’s first the world’s Mustard single-lung (1962); transplant, first the world’s Dr by Cooper Joel (1983); complete heart valve transplant, Dr by Raymond the firstprocedure Heimbecker (1962); to repair transposition the of great arteries, Dr by William 1935; the firstmobile 1935; blood transfusion unitby Dr Norman first the world’s electronic Bethune (1936); the firstpacemaker, Dr by Wilfred Bigelow (1951); discovery insulin of Sir by Frederic Banting in the introduction1921; heparin of treatment for vascularof thrombosis Dr by Gordon Murray in Notable firsts in Department the Surgeryof throughout its illustrious history include: The to run its core business and programs from within. The transition to the spacenew has been seamless. 149 College Street,149 5thon floor, March21st, 2013. The office new space was refurbished bythe Faculty Medicineof to enable the Department Surgery of offices ofthe Banting Institute 100 at College Street 80for years was before undertaken a move the for offices to be installed inthe Stewart Building on The Departmental Office had been located inthe

Faculty Lead, NajmaDr. Ahmed Significant Developmental Milestones in Education: of teachingof in annual assessments productivity of (AAP), and giving awards to teachers at all levels. UndergraduateFor Medical Education (UME), refined have we core the undergraduate surgery curriculum to outline the essential learning elements Education Education excellence through novel approaches to teaching and learner engagement. The Department of Surgery is heavily invested in its focus on education with advanced programs in undergraduate, fellowshippostgraduate, and graduate education. strengthened have We the recruitment, development, and support surgeon of teachers increasing by offerings in faculty teachers, for development identifying and nurturing surgical educations in undergraduate and postgraduate education, providing stipendiary support teachers for with leadership positions, and consistently acknowledging the importance Self-Study Report, External 2020 Review | – ). This). Advance – Aspire surgery.utoronto.ca/strategic- – acknowledges the Department’s Department of Surgery, Faculty University of Medicine, of Toronto plan builds a strong on history excellence of in patient care and surgical innovation. challenges It us to push to frontiers new in surgical practice, education and research. There are six major goals theof Department’s Strategic Plan as follows: Plan for 2018 – 2023Plan 2018 – for Achieve position as Canada’s of leading one Departments Surgeryof and the of one top tier Departments in the ( world plan-2018-2023-aspire-advance-achieve The Department Surgery of a Strategic held Planning withthe Retreat March on 7th, 2017, aim developing of a robust roadmap and well- definedpriorities to guide Department’s the efforts nextover the years. five newOur Strategic 4.3 Strategic Plan

4. Chair’s Statement 4. Chair’s Statement 27 Self-Study Report, External 2020 Review | from the teaching our of talented faculty. This has all been aided Ralph Dr. by George, Professor, Division General of Surgery, has who helped to make these offerings as informative and profitableas as possible. The full report CPD on can be found in ContinuingSection 11, Professional Development. “Entrada” smartphone App and housed a secure on server usefor the by RPCs. One the of goals of CBD is to allow earlier for detection surgical of residents facing challenges in their training. enhanced have We career residents, for development and provided have needed career assistance to graduates. Dr Barry Rubin, Vascular Surgery, teaches the residents a course “Practice on management and financialplanning” complete with information on hiring staff, performing accuratebillings, practice incorporation, and finding Across bestthe job. all Divisions, the University Division Chair and Program Director meet with their graduating residents routinely to navigate the market job in a highly advantageous and beneficial way. provided have a robust arrayWe continuing of professional opportunities (CPD) development in Surgery residents, for fellows, and faculty. Virtually every Division hosts specific coursesCPD for learners, faculty, and visitors benefit who enormously Education Scholar's Retreat 2019 Poster 2019 Retreat Scholar's Education Department of Surgery, Faculty University of Medicine, of Toronto EPAs andEPAs providing regular feedback to residents are logged now successfully into UofT’s specialized Activities that (EPAs) serve as milestones surgical for residents to reach their competencies. Mastering have playedhave significant roles in designing forCBD each surgical specialty. In particular, our faculty helpedhave to codify the “Entrustable Professional (CBD) training(CBD) curriculum. Here, achieving competency amongst surgical trainees is the goal. Program Directors from the Department Surgery of All surgical programs are already in heading or towards the “Competency RCPSCs Design” by present their findings to their peers. The Education Scholars Symposium poster is 2019 shown (right). Symposium in which surgeons, residents and fellows, whose primary academic focus is in teaching, curriculum development, surgical or simulation, uro- and neuro-endoscopy, among many other skills. established have We Education a new Scholars Hospital Children. Sick for Simulated surgical skills are assessed now routinely laparoscopic for cholecystectomy, fracture fixation, spinal fusion, centre Surgical for Simulation at Sunnybrook Health Sciences Centre, the Temerty-Chang Simulation Western Hospital,Centre at the and Toronto the Skills Centre at Sinai Mt Hospital, the Li Ka Shing Knowledge Centre at St Michael’s Hospital, the operative cases they are in involved a mobile on app program. Learners at all levels can benefit now from simulation centre experience at the Surgical and advances in simulation. With the assistance theof Postgraduate Medical Education (PGME) office, our residentsnow required are log to all Residency Program Committees have (RPCs). We expanded teaching novel approaches and methods, and capitalized communications on technologies is a tribute to all current Residency Program Directors and highly functional and effective In Postgraduate Medical Education (PGME), all residency11 programs are fully accredited. This placed the on 3rd year 8 week continue clerkship. We towardsto work improving our scores and standing UMEfor in Surgery at UofT and inthe country. learning are sites. movingWe towards a more uniform clerkship experience. UME leads in Surgery beenhave appointed at each site. Focus has been for surgeryfor clerkship and expanded the range of

NEW CHAIRS THE IN DEPARTMENT OF SURGERY braintumourbanknetwork.ca John Ross and Patricia Quigley Chair Chair Quigley Patricia and Ross John Preservation Limb in George Chair Robert Swan Surgery Global in William CocoChair Cancer Lung for Innovation Surgical in Chair & Esther Halpern Harold Neurosurgicalin Stroke Research Labatt Chair Internationalin Neurosurgical Hospital Michael’s St. at Education Innovation Neurosurgical in Chair Network Health University at Wilkins Family Chair Research Neurosurgicalin Brain Tumour GranovskyGluskin Chair Head Orthopaedics, of Division the for Hospital Sinai Mount • • HOSPITAL – UNIVERSITY • • • • • • UNIVERSITY their firstyears 5 practice,of an internal review of grantsprogram, and a mentorship program. A major gift to the Department Surgery of came from Amira and Michael Dan Million ($2 in to support2013) the creation a universityof wide brain tumour biobank in which all hospitals add patient data and specimens (tumour, blood, DNA, RNA, protein, stem cells) to a centralized database ( instituted have We policies new to support the success scientists of in the Department of Surgery. These includefinancial support for recruitsnew from the Department Surgery, of Hospitals, Divisions, and Research Institutes, the continuation the of Roscoe Graham Reid Scholarship as salary support scientists for within Self-Study Report, External 2020 Review |

Faculty Lead, MichaelDr. Fehlings Significant Developmental Milestones: Department of Surgery, Faculty University of Medicine, of Toronto Numerous University/Hospital Chair funds alsohave helped to support research key leaders in the Department Surgery. of The number Chairs new of established in the Department Surgeryof thepast over 5 years is shown. year to support the academic mission these past 5 years which is the double average amount/ year ($4M/year) from the prior 5 years. These monies been have in the form alumni of gifts, industry support, and philanthropic donations. from approximately $40M/year (2009 – In collaboration to $76M/year. 2014) with the Office of Advancement at the University donations to the Department Toronto, of of Surgery averaged have close to $8 Million/ In the past 5 years, research funding in the Department Surgery of has nearly doubled Research Integrated research clinical for and academic excellence.

4. Chair’s Statement 4. Chair’s Statement 29

Self-Study Report, External 2020 Review bestpracticeinsurgery.ca | Faculty Lead, Robin McLeod instituted have We a robust Best Practices program across all Divisions the of Department implementation tools can be used to manage surgical wounds, and surgical site infections. Best Practices Newsletters been have developed, and are sent around electronically to all Department Surgery of Faculty each month featuring a special guest writer. of Surgery.of A Departmental Committee BP has formed with representation from all Divisions, and Chaired Robin by McLeod. Guidelines been have established important for surgical topics as such Enhanced Recovery after Surgery (ERAS), Pre-operative Fasting Recommendations, Surgical Site Infection Prevention, Management of Acute Pancreatitis, Mechanical Preparation, Bowel Surgical Wound Care, Usage, Opioid and Pain Management. A Best Practices website has been created in the Department of Surgery ( A mobile App is also available download for and Best Practices Optimize patient and clinical outcomes through the provision person-centred of high-quality, care. Department of Surgery, Faculty University of Medicine, of Toronto study towards advancing patient care. is now held which held is brings now together surgeons and collaborators across the UofT campus and identifies fruitful fields of interdisciplinary been formed with Dr Marc Jeschke as lead. Each year, a Translational Research Symposia University of Toronto ResearchUniversity Office. A Toronto of Translationalnew Research Committee has through important relationships with key partners at the Medical and Related Sciences (MaRS) Discovery and the Site, Techna, We have enhanced have We knowledge translation and commercialization of surgical inventions Vascular Surgery Co-operative, and the developing Collaborative Breast Surgery program across several hospital sites. formation Aortic of the Collaborative, Toronto the Cardiac database, the Trauma program, the Spine program, the Hand program, the research across disciplines, sites, and types of researchers. This can be demonstrated the by Surgery Wright (see report, Appendix A). pursued have greaterWe integration of increased and expanded research program, the success the of increased enrollment in the SSTP comes at a distinct cost to the Department of trainees from approximately 30 trainees per toyear 46 trainees (2009 – 2014) per year While – 2019). this(2015 is evidence an of We have increased have We the number SSTP of enrolled in theSSTP can funding receive at their and appropriate can their have PGY-level tuition (approximately covered $8,000/year). training program research (see costs It report). approximately – 2.0 Million/year $1.5 of Departmental funds toensure that all residents residents within theSurgeon Scientist Training Program The (SSTP). SSTP is the flagship program the of Department’s postgraduate We have sustained have We and enhanced the training of

Faculty Lead, Ori Rotstein The Department Surgery of has an active Faculty Development and Mentoring program that been established in the Department Surgery of to recognize outstanding mentors. Mentors and mentees are highlighted during the Chair’s Annual Address to the Department Surgery. of Faculty members achieving their maximum potentials in both professional and personal domains. has strengthened and extended faculty support, developed a rigorous mentoring program, fostered the and development succession surgeon of leaders, and has strengthened the academic process. Mentors are named now both for clinical and research domains faculty a new on Letter member’s of Appointment and (LOA), the mentor is invited to attend the Continuing Appointment Review (CAR) the of faculty member at 3-5 years. Mentoring Awards, as such the Charles Tator Surgeon Scientist Trainee Mentoring Award, and Mentoring the Bryce Taylor Award, have Faculty Development Mentoringand Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto collaboratively with the Ministry Health of and Long-term towards Care (MOHLTC) the adoption pragmaticof trials various for surgical procedures. of theof American College Surgeons of and (ACS), through the Society Vascular of Surgeons and the Society Thoracic of Surgeons databases. The Best Practices program continues to work provided to faculty throughout the one-day course. The Best Practices Program has worked collaboratively with the Hospitals to synergistically manage data collected through the National Surgical Quality Improvement Program (NSQIP) Improvement and Patient Safety to a Best develop Practices curriculum all for residents in the Department Surgeryof levels in the Foundations at the PGY1-2 Course. At the Annual Faculty in Day Development BestNovember, Practices lectures and seminars are Program, and to request yearly funding. The Best Practices Program integrated is now across the educational programs in the Department of Surgery. Safieddine, Najib Tim Jackson, and Giuseppe with worked Papia have the Center Quality for Funding the for Best Practices initiatives and infrastructure has been received from the various Hospitals. Rutka and Dr’s McLeod meet annually with all Hospital and VP CEO’s Medical Affairs provideto updates on the Best Practices A unique Person (Patient) Centered Care (PCC) initiative has been developed to increase patient experience and satisfaction, as well as reduce health care costs.

4. Chair’s Statement 4. Chair’s Statement 31 , about The Year of Magical of Magical Year The Self-Study Report, External 2020 Review | Genius of the Edge , by Joan Didion Joan , by Faculty and residents at the home of James Rutka during during Rutka James home of the at residents and Faculty book the about entitled a discussion Thinking Book Club The Department Surgery of Book Club was established Karen by Division Devon, General of Surgery, following the success and of interest in Kerginthe 2013 lecture Gerald Dr. by Imber, author the of book, William Stewart Halsted. The purpose this of isbook club faculty, for residents and fellows to togethercome to discuss books a wide on variety topics,of many which of are non-medical books. they approach the theirend of surgical careers; they should consult with the Surgeon-in-Chief, Hospital Division Head, and University Division Chair in establishing plan; a such they should be encouraged to seek other academic opportunities assuch teaching and mentoring junior colleagues duringthis phase their of careers; and they should forwardmove with plans transition for as they offcome the activeon-call roster at hospital. the the DepartmentRecently, Surgery of has appointed a Lead Faculty for Wellness, Dr Giuseppe Papia. A Faculty-wide survey was administered showing that UofT Surgeons genuinely like their positions and a high have degree satisfaction. job of That said, the survey identifiednumber a of externalpressures adding(e.g. surgical cases, grant and publication deadlines, and administrative burdens as such the electronic medical record) which are affecting wellness. The Faculty program Development in the Department Surgery of will identify and leverage the resources needed promotion for a healthy of lifestyle.

Department of Surgery, Faculty University of Medicine, of Toronto cfd.utoronto.ca/neal members should a transition develop plan as for Latefor Career Transition 60: (Can J Surg 2017 These guidelines355-358). state that Department In the absence a defined of retirement age, the Department Surgery of has developed Guidelines unconscious bias testing before serving. Finally, a Director Diversity, of Equity and Inclusion is beingappointed in the Department Surgery. of identify a diverse array applicants. of Search Committees are comprised balanced of and diverse members. All Search Committee members take the Department Surgery of are the product now a formalizedof search process which seeks to Surgery. The Chair has written this on as topic pertainsit to neurosurgeon faculty members (J Neurosurg 277). All 129: 2018 appointments in Gender Issues” was which in led to held a 2018 heightened awareness the of myriad challenges of facing female surgeons in the Department of Recently, emphasisRecently, has been placed expanding on diversity in the Department Surgery. of The first townhall Advancement: “Academic on Focus on for redistributionfor Academic of Enrichment Fund (AEF) and Alternate Funding Plan (AFP) monies. are then averaged the by Department Chair, and the total score is used to inform the practice plans by theby University Department and Division Chairs, The Hospital Head, the Surgeon-in-Chief, and the ChairsVice Education of and Research. The scores Surgery e-newsletters, the Spotlight, and the Annual Address. Annual For Assessments Academic of Productivity (AAPs), scores are sought and entered faculty achievements and accomplishments in the first years 3-5 practice.of Faculty passing their CARs are acknowledged in the Department of Through the effortsof OriRotstein, the CARs becomehave a robust review effort which tracks We have strengthened have We the Department’s processes for academic support, appointment reviews, assessments academicof performance and promotions. Emerging Leaders (NEAL)course in the Centre Facultyfor ( Development leaders across the Department Surgery. of Several faculty members been have funded through the Department Surgery of to attend the and New We have fostered have and developed theWe nurturing of group surgeons of from around the United Kingdom that travels to various hospitals and surgical departments around the world and in the UK. Academic and clinical meetings encourage educational and surgical exchanges. A global surgicalscholar program surgical for residents available is now through the PGME Global Health Education Initiative. The Department Surgery of has established an annual Ash Prakash Foundation fellowships for surgeons from low-income countries who come to the to University take part Toronto of in active clinical surgical fellowships. Some the of countries where fellows previously have come from include Nigeria, Indonesia, and Ethiopia. SurgicalTravelling Society of Great Britain and Ireland The Traveling Surgical Society (TSS) and the Department Surgery of UofT a Joint Academic held Meeting June 6-8, The in scientific Toronto 2016. sessions at Mount held were Sinai, St. Michael’s, and Princess Margaret Hospitals. All faculty, residents and fellows invited were to attend. The TSS Great of Britain and Ireland is a Allan Okrainec, Terry Irwin, and James Rutka at the the at Rutka James and Irwin, Terry Okrainec, Allan meeting Society Surgical Traveling UK the of presentations thanMore 40 UofT Surgeons are actively engaged in global surgery in countriessuch as China, Ukraine, Botswana, Ethiopia, Jamaica, and Niger. , ). Self-Study Report, External 2020 Review The | Frankenstein

by Joseph Heller. , by Margaret, by Edson, Catch 22 Wit job descriptionjob which by Faculty Faculty Lead, Avery Nathens The Department Surgery of has developed the Global Surgeon , by Abraham, by Verghese, surgery.utoronto.ca/global-surgery Department of Surgery, Faculty University of Medicine, of Toronto newsletter ( The Inaugural Chair in Global Surgery, The George Robert Swan Chair, has been created and fully in endowed the Department Surgery, of with Dr Lee Errett as the inaugural Chairholder. members can be promoted. A Global Surgery website has been developed as has a Global Surgery Consolidated partnerships and expertise for local, national and international impact. Global Outreach by Maryby and Shelley, The takes book club place bi-annually at the home a residentof faculty or member. The inaugural meeting was at the of June on home 2013 24, held Mari and Jim Rutka and chaired Karen by Devon. Some examples previous of books readthe by include:book club Player Tennis

4. Chair’s Statement 4. Chair’s Statement 33 ). Self-Study Report, External 2020 Review ) which the Chair helps | surgery.utoronto.ca , was established I became when Chair to our entire faculty, residents and fellows. @UofTGlobalSurg Excelsior each year, and to dozens competitive of grant awards – too numerousto mention here – these can be found in the Supplementary Materials of this 5-year While review. the vast majority occur in good to excellent specialty journals in surgery, A monthly e-newsletter communications, of known as also Surgery.of the have We capability rapid for e-news communications through the distribution of e-clips The Department quite is now active social on media including Facebook pages and a Twitter feed ( to manage. A full-time assistant in the Department Surgeryof office, Stephanie Neilson, is assigned the task distributing of all communications, and to ensuring that the Department Surgery of website remains up-to-date ( 4.5 Academic Performance The Department Surgery of lays claim to approximately 1,000 peer-reviewed publications Efforts are being directed towards the development Surgeon a of Entrepreneurship description job as a valid academic pathway to promotion. As mentioned, are we well along the with way our goals in the Department Surgery of Strategic Plan. Enabling and supportingstrategies include advanced and enhanced communications; fundraising; and promoting faculty to receive honours and awards which for they are eligible. The Executive Committee the of Department of Surgery provides the implementation oversight and guidance the for plan, and has developed measures and performance key indicators all for pillars been have the of very plan. fortunate We to hired have a full-time strategic planning implementation coordinator, Joanna Giddens, haswho helped us stay course on with the plan. 4.4 Communications

Department of Surgery, Faculty University of Medicine, of Toronto

Guidelines for the introduction innovativeof practices have Faculty Lead, Keshavjee Shaf

surgery.utoronto.ca/translational-research-program ( capacity-building in knowledge translation with linkages to the newly established Translational Research Committee in the Department Surgery of numerous faculty members’ achievements. The Innovation Committee is promoting been created; and a prospectus commercialized of efforts has beenproduced highlighting Innovation of novel discoveriesTranslation into surgical practice. could share knowledge and exchange opinions. formed the Travelling Surgical the Club, object whichof was to travel every year to a foreign country and meet colleagues with they whom Corps. Meeting surgeons from elsewhere they realized that British surgery was somewhat isolated from that other of countries. remedy this, To they of Britishof surgeons had who in worked France during in the First the War Casualty World Clearing Stations the of Royal Army Medical The organization was founded a group by in 1924 Research Chairholders Figure (CRC’s, 4.6B). areCRCs highly competitive research support mechanisms to ensure that faculty surgeons can sufficienthave protected for time their research. enhanced research, teaching, creative professional activity, and surgical innovation.There are currently University 5 endowed Chairs(Langer Chair, General Surgery; Dan Family Chair, Neurosurgery; and Barkin Chair, Urology; John Ross and Patricia Quigley Chair, Vascular Surgery; George Robert Swan Chair, Global Surgery). There are 9 Joint University – Hospital Chairs; 36 Hospital – University Affiliated Chairs; 21 and Hospital Chairs, making a total endowed 71 of Chair position members for the of Department of Surgery, a totalfor Million $150 value over of to support the Academic Mission in the Department. The distribution the of various Chair positions across all the Divisions is shown in Figure 4.6A. Needless the establishment to say, these of Chair positions becomes a very positive and strong recruitment and retention strategy within the Department and enables devotion to research and innovation which otherwise would be not possible. The Department Surgery of has 5 Canada Self-Study Report, External 2020 Review | Endowed Chairs by Division Department of Surgery, Faculty University of Medicine, of Toronto the academic effortsof chairholder the towards 4.6A Figure The Department Surgery of is well endowed with Chairs that been have established at the University, at the various fully affiliated hospitals, and jointly between the two. On average, each chairendowed is valued at $3 Million, and supports 4.6 Chairs and Chairholders Million Grants been have - 2019. from 2014 earned faculty by from major peer review funding agencies as such CIHR, NSERC, Heart and Stroke, Canadian Cancer Society, and Canadian Foundation Innovation, for among several others. Journal Medicine, of Cell, Science Translational Medicine, Lancet, Cancer Cell, and JAMA. Grant capture in the DepartmentSurgery of has averaged $80 Million/year with a total $404 of there are numerous examples faculty of members published have who as firstor senior author in high impact journals as such Nature, England New

4. Chair’s Statement 4. Chair’s Statement 35 1 1 2 1 1 TIER Self-Study Report, External 2020 Review | START-END DATE 2012-03-01 to 2019-02-28 2020-06-30 to 2013-07-01 2022-09-30 to 2017-10-01 2024-09-30 to 2017-10-01 2018-01-01 to 2024-12-31 applications. The distribution faculty of members promoted were who in the Department across the Divisions all over years can be found in Figure 4.7. are then forwarded to the Decanal Committee in the Faculty Medicine of adjudication. for indeed have been fortunateWe with those members theof Department successfully have who gone forward promotion. for - 2020, From 2015 have we had successful 73 applications, and 2 unsuccessful Department of Surgery, Faculty University of Medicine, of Toronto Canada Research Chair in Cardiac Regeneration Cardiac in Research Chair Canada Transplantation Lung in Research Chair Canada Research Stroke Translational in Research Chair Canada Surgery Cardiovascular in Research Chair Canada RESEARCH Neuroscience in Research Chair Canada

Canada Research Chairs Promotions by Division 2015–2019

Tymanski, Michael Tymanski, Verma, Subodh Lozano, Andres M Li, Ren-Ke Cypel, Marcelo NAME

Figure 4.7 Figure year. The applications those of surgeons whose accomplishments are deemed worthy of promotion membership across all Divisions, and reviews applications promotion for in the fall each of academic and all faculty members strive to be promoted the up ranks towards full professor status. The Department of Surgery’s Promotions Committee has stakeholder Academic promotion remains a cornerstone institution in the Department Surgery of in the Faculty Medicine of at the University Toronto, of 4.7 Promotions4.7 Figure 4.6B Figure ). ) is the Appendix B cacms-cafmc.ca/about-cacms renewable successful upon completion a 5-year of term, an for additional 5 years. exceptional Under circumstances, a University Division Chair who has completedtwo 5-year terms may be asked to remain in the position an for additional year two, or another for or term depending circumstances. on The Department Chair leads all University Division Chair searches, with broad representation across the Division serving the on Committee. document from (Committee 2012 Accreditation on Canadianof Medical Schools and the Liaison Committee Medical on Education (LCME) in the US) ( incomplete degree diversity of noted amongst the faculty in many the of Clinical and Basic Science Departments. While the Department Surgeryof has been not singled in out this regard, developed have best we practices in the conduction Search of Committee Processes to include definitions of diversity and implementation strategiesof to ensure that adequatediversity is achieved in searches such ( Appointment of University Division Chairs As is customary in the Clinical Departments at the University University of Toronto, Division Chairs in the Department Surgery of serve at the discretion theof Department Chair a period for 5 years, of Self-Study Report, External 2020 Review | New Full-time Recruits by Year 2015-2019 Year by Recruits New Full-time From 2015 - 2020,From 2015 there 120 were new Department of Surgery, Faculty University of Medicine, of Toronto Review the of Medicine of School Accreditation 4.8A Figure mid- to senior levels. The number recruits new of as a function year of is shown in Figure 4.8A; the distribution recruits new of time over across the different Divisions is shown in Figure4.8B. A concern which has been expressed in the recruits to the Department Surgery. of Of these, 1 Adjunct Lecturer) (+ first were 112 time faculty appointments in the differentUniversity Divisions. 3 Adjunct Professors)4 (+ appointees were at by all.by The composition Search such of Committees typically includes the Department Chair, University Division Chair, Hospital Division Head, Divisional Faculty Members, Chair Vice Research, Hospital Research Institute representative, Hospital Vice President Medical Affairs, Surgeon-in-Chief. and to the Department are the product active, of open, and external search processes. While this can pose some logistical issues in terms gathering of all relevant stakeholders together at search committee meetings, the process is deemed fair and transparent Recruitment New Faculty Unlike many the of Clinical Departments in the Faculty Medicine, of the Department Surgery of is the of one which few mandates that all recruits new 4.8 Appointments

4. Chair’s Statement 4. Chair’s Statement 37 — — — — — — 2020 2020 2020 YEAR

— — — — — — 10-year 10-year 10-year Self-Study Report, External 2020 Review | UPCOMING REVIEW — 2017 2015 2015 2015 2019 2019 2019 2018 YEAR Dr. David – SeptemberDr. Urbach, WCH 2016 JamesDr. Drake, HSC – June 2018 NajmaDr. Ahmed, (Interim) SMH – 2019 — From 2015 – 2020,From 2015 the following SIC appointments occurred: • • • are typically appointed a 5-year for term, renewable satisfactory upon once review another for 5 years. 5-year 5-year 5-year 5-year 5-year 5-year 5-year 5-year COMPLETED REVIEW Department of Surgery, Faculty University of Medicine, of Toronto

New Full-time Recruits by Division 2015-2019 Division by Recruits New Full-time

Orthopaedics Plastics Thoracic Urology Vascular DIVISION Anatomy Surgery Cardiac Surgery General Neurosurgery University Division Chair appointments, the SICs with inputfrom a large hospital-based stakeholder group, and representation the by University by the Department Surgery of Chair. As with the The appointment Surgeon-in-Chiefs of at (SICs) the Hospitals is a process conducted the by Vice President Medical of Affairs at of each hospitals the Appointment of Hospital Surgeon-in-Chiefs From 2015 - 2020, - From 2015 external searches 8 University for held were Chair positions. Figure 4.8B ASA. Annual Her meeting takesplace April – 18, 16 2020, during the 140th Annual meeting the of ASA in Washington, Dr D.C.. McLeod is only the second female surgeon, and the 5th Canadian in history to hold the of office President ofthe ASA. Congratulations Robin! In 2019, Dr Robin McLeod, In 2019, Division General of Surgery, became the President the of Associate Chair Surgery, adjudicatedwho allover CARs in the Department Surgery. of From 2015 - 2020,From 2015 there 64 were faculty successfullywho underwent their CARs. The distribution across the various specialty sections Surgery of is found in Figure 4.9. Special thanks are given to Ori Rotstein, Self-Study Report, External 2020 Review | Director Department the of Promotions Committee Undergraduate of Directo Education Director Undergraduate of Education Vice Education Chair Program Director Cardiac Surgeryof Director Course of Surgical the Foundations Cardiac Surgery of Diviskon Chair, Program Director General of Sugarey POSITION Sciences Health Sunnybrook CentreCEO General of Surgery Division Chair, , Annals of Surgery Howard Clarke Howard Musgrave Melinda Hall Jeremy Najma Ahmed Bobby Yanagawa Wheatcroft Mark Terry Yau Brar Savtaj NAME Andy Smith Carol Swallow 2019 2017 2017 2018 2018 2018 YEAR 2014 2014 2015 2016 Department of Surgery, Faculty University of Medicine, of Toronto this has been not an issue the past over 5 years. of Surgeryof from The CAR 2009-14. is considered an equivalent to tenure at the University clinical for faculty. The CAR is typically performed in years 3 – 5 following a faculty appointment. Failure to pass the CAR could lead to grounds dismissal for from the Hospital, and from the University. Thankfully, 4.9 ContinuingAppointment Reviews While too numerous name by here, many faculty appointees underwent their Continuing Appointment Reviews (CARs) in the Department numerous faculty members arewho active, senior and retired members the of ASA. the foremost authority in surgical publications, the Thesince Department 1885. Surgeryof at the University of is fortunateToronto to have The American Surgical Association (ASA) is the oldest and the of one most prestigious organizations surgery for in the world. Founded in the 1880, ASA lays claim to the publishing of American Surgical Association the and University of Toronto Other LeadershipAppointments

4. Chair’s Statement 4. Chair’s Statement 39 . Self-Study Report, External 2020 Review | surgery.utoronto.ca that the core curriculum in surgery, and student evaluations are at the highest possible. level For all Review, the RCPSC programs will work closely with PGME office to ensure elementsthat assuch Competency Design by and (CBD), service:education ratios are in balanced states. in which its Late Career Faculty can become engaged in Hospital/Departmental activities that are both meaningful and productive to all parties. A Department Surgery of policy has been created. Please see Education 4.12 In the past 5 years, there been have accreditation no reviews either of the Medical the by School Committee Accreditation for Canadian of Medical theor ResidencySchools (CACMS), Training Programs in the Department Surgery of the by RPCSC. That said, both the Medical Schools and the Surgical Residency Training Programs will be undergoing formal accreditation cycles in 2020, at a timepoint where the information will be not available the for External Reviewers thisof report. the For accreditation the of Medical School, the Department will be working diligently with the Faculty Medicine of to ensure Department of Surgery, Faculty University of Medicine, of Toronto

CARs Passed Specialty Surgical by

Surgeon-in-Chief, and the Hospital Division Head. The Department is generating ways new surgeons. Ideally, the conversation begins many years before retirement. The dialogue is initiated with the University Division Chair, the The Department has developed guidelines now Latefor Career Transition planning all for to increase the amount funding of available. Transition 4.11 Given theGiven Department’s evanescing budget, contributionshowever, from the Department may wane unless further strategies are employed package” highly for valued surgeons. This approach has been used several on occasions in the past 5 years to the great benefitof Department. the the University Division Chair, the Surgeon- in-Chief, the Hospital Division Head,and the hospital research institute to produce a “retention challenges losing of distinguished and accomplished faculty to other jurisdictions. Where appropriate, the Department Chair works assiduously with At any given time, the Department faces the 4.10 Retention 4.10 Figure 4.9 Figure of whom almost 118 have enrolled have almost whom of in doctoral 118 programs. The SSTP requires almost $2.0 Million annually support of to run effectively. Sources supportof are being actively sought each year. Of the top 50 most prolific authors/investigators in the Faculty Medicine of at the University of several are appointedToronto, to the Department Surgery.of When ranked against the some of other major institutions in North America, the Department Surgery of at the University compares favourably Toronto of with Harvard Medical College, Duke University, UCLA, UCSF, and University Pittsburgh of (Figure 4.13B). The Department is engaged in all areas research of endeavor including translationally oriented basic and pre-clinical science, clinical epidemiology, health outcomes and policy research, and research into state-of-the-art educational initiatives. The Surgeon Scientist Training Program (SSTP) remains the signature initiative within the Department that continues to train residents in scholarly research and towards higher degrees each is year. It remarkable that since its inception the SSTPin 1983, has trained residents 333 over Self-Study Report, External 2020 Review | Number of Publications by Year (2014-2019) Year by Publications of Number Department of Surgery, Faculty University of Medicine, of Toronto Figure 4.13A Figure number of publications of 8,817. The numbernumber of publications of 8,817. of publications per year are shown in Figure 4.13A. all that has he to done support the Departmental mission accomplishment for in research. An analysis the of publications within the Faculty Medicine of in the University of revealed a total - 2019 between 2014 Toronto as measured peer-reviewed by publications, grant capture, and exemplary clinical practice. The Department has steadily worked towards this goal. Special thanks are given to Michael Fehlings, current Chair Vice Research, of for 4.13 Research 4.13 One the of main goals the of Department since has2015 been towards to work a ranking within the top all 5 of Departments Surgery of worldwide of PGME,of and Jeremy Hall, Director UME. of Their detailed reports are found the on Education Section (pages 58-64) this of 5-year review. The Department is grateful to the time, energy and effort expended by Najma Ahmed, Departmental Vice-Chair Education, of Ronald Levine, Director

4. Chair’s Statement 4. Chair’s Statement 41 Self-Study Report, External 2020 Review | Education Office,and Toronto. In the University of addition, there are numerous Divisional awards for education, research, and exemplary clinical practice. 4.14 Major Awards Major 4.14 Recipients Each year, Department Surgery of Faculty, Residents and Fellows distinguish themselves by receiving numerous awards which bring credit to the standing the of Department within the University, provincially, and across Canada. The Department gives several out awards annually at Gallie The Departmental Day. faculty receives awards from the Faculty Medicine, of Postgraduate Medical EducationUndergraduate Office, Medical Department of Surgery, Faculty University of Medicine, of Toronto Scholarly Output and Citation Count University by 2014-2019* Citation Output and Scholarly comparison across institutions. Data does not reflect total academic productivity for the University of Toronto Department of Surgery. of Department Toronto of University the for productivity academic total does reflect not Data institutions. across comparison *Generated by the Faculty of Medicine, data filtered to subject area "Surgery" in Scopus/Sci Val for 2014-2019, allowing for standardized forstandardized allowing 2014-2019, for Val in Scopus/Sci "Surgery" area subject to filtered data Medicine, of Faculty the by *Generated full report Research of from the Department Surgeryof can be found pages on 65-69. their research accomplishments each year at Gallie duringDay which faculty, residents, fellows, scientists, and trainees present their work. The The Department Surgery of members celebrate in research In the past (Figure 5 years, 4.13A). research funding has grown from Million $38.7 to $80.4 Million(2009 – 2020). 2014), – (2015 some level insome level the Department. more than Since 2015, 8,500 publications emanated have from the hands and hard Departmental of work members engaged More thanMore 200 faculty are engaged in research at Figure 4.13B Figure 4.13B ), which were ), youtube.com/watch?v=qDnpgizz3Oo of Toronto and Mt. Sinai Toronto of Hospital Foundation was created; and The 2) creation the of city-wide Brain BankTumour Network, which led to developing partnerships between four hospitals and securing a million$2 philanthropicdonation this for project. and others. The Department has built lasting relationships with donors, volunteers and alumni. As part the of Billion $2 Boundless campaign at the University the Department of Toronto, supported the creation a campaign of video and case support for ( onlynot extremely effective fundraising tools, and the firstof their kind for Departmentany within the Faculty Medicine, of also but an inspiration and model other for Departments to create similar marketing and campaign fundraising tools. The Department has been focused strengthening on relationships with our fully affiliated hospitals; ensuring Departmental priorities are strategically supported, while creating a foundation of collaboration which on productive fundraising activity can take place. Examples this of activity Support the for Surgicalinclude: 1) Skills Centre, whichfor an updated with MOU Sinai Mt Hospital and joint-fundraising agreement with the University Self-Study Report, External 2020 Review | Advancement by the Numbers (2014-2019) Numbers the by Advancement Department of Surgery, Faculty University of Medicine, of Toronto Figure 4.15 Figure Advancement funds take the form direct of donations, alumni appeals, support from Industry, fellowship funds, support Chairs, endowed of Divisions Chairs, among others with fundraising strategic goals. Mr. David Grieco was the appointed SDO and in with 2015, his and assistance help, from the University Division Chairs, a total $36.12 of Million was raised in the Department Surgery. of 4.15 Advancement 4.15 The Department Surgery of employs a full-time Senior Officer Development (SDO) fromthe Faculty Medicineof assists who the Department Chair, and major awards recipients from - 2020 2015 can be found in the supplementary information at: surgery.utoronto.ca/gallie-day-award-recipients into the Canadian Medical Hall Fame, of Royal College Physiciansof and Surgeons, Canadian Institutes Health of Research, Order Ontario, of Order Canada, of Canadian Cancer Society, and Heart and Stroke Foundation. A listing the of Department Surgery of Faculty are worthy recipients Ontario’s some of of and Canada’s top awards and honours as such Canada Research Chairs, Induction

4. Chair’s Statement 4. Chair’s Statement 43 Self-Study Report, External 2020 Review | according to Academic Role and Job Description Job and Role Academic to according , Canadian Journal of Surgery 2017 60(5):355-358 Surgery of 2017 Journal , Canadian at the Hospitals and University and Hospitals the at Department of Surgery, Faculty University of Medicine, of Toronto Annual Lectureships: Balfour Lectureship in Surgical Ethics; Robin Robin Ethics; Surgical in Lectureship Balfour Lectureships: Annual Education Symposium Scholar’s Annual Faculty Development Anesthesiology with Day Faculty Annual $3M Endowment Fund to support the Surgeon Scientists Training Program Training support to Scientists Surgeon the Fund Endowment $3M Ash Prakash Fellowships in Global Surgery Global in Fellowships Ash Prakash Award Achievement Lifetime Annual Lavina Lickley Translational Research CommitteeTranslational Research and Symposia Annual Translational Initiative Banking Tumour Brain City-Wide of Toronto University Annual Surgical Ethics Course Ethics Surgical Annual Directorship in Diversity, Equity and Inclusion Joint DepartmentJoint – Department of Medicine of Surgery Lectureship 14 new Chairs in Surgery in Chairs new 14 Departmental for Parental Guidelines Leave Respectful Relationships Guidelines Growth UK Traveling Surgical Society June 2016 Society June Surgical Traveling UK “Late Career Transition Guidelines” “Late Career Transition Surgical Wellness Program, and appointment of Departmental Leads in Surgical Wellness of Departmental Surgical appointment Leads in and Program, Wellness Surgical 2018 Bethune Roundtable at Women’s College Hospital College Women’s at Roundtable Bethune 2018

Development of of Development a of Creation the of Approval Harmonization of Departmental Academic Salaries a of Establishment Establishment of conjoint conjoint of Establishment the of Establishment of Publication Hosting the the Hosting the of Hosting the of Establishment Establishment of the the of Establishment a new of Establishment Establishment of the the of Establishment of Establishment Establishment of a of Establishment named 3 new of Inauguration Research Surgical in Lectureship Alman Ben and Epidemiology; Clinical in Lectureship McLeod annual the of Establishment the of Development

• • • WELLNESS • • FACULTY DEVELOPMENT • • • • • • • • GLOBAL SURGERY RESEARCH • • • • • • EDUCATION

mission, and to reach its strategic goals. Some the of more important and interesting ones are outlined below: 4.16 Departmental4.16 Firsts Several initiatives new into put were place within the Department Surgery of to support help its vision and from the Faculty Medicine, of the Department has contrived an alternate meansbusiness of modeling to stay financially nextover the years. solvent 5 streams will be essential to continue to offer and run this program which has been so successful for the Department. Thankfully, did we a deep dive into the issues with SSTP funding through the production the of “Wright Report” which enabled us to devise ways new to consider successfully and sustainably funding the SSTP long into the future. Ongoing financialconstraints present significant challenges the for Department. At this time, the Department Surgery of is the only Clinical Department that pays a stipend to all full-time faculty, a practice that was based “historic on hard dollars” which allocated were to individual faculty members many years ago without significant accountabilities. the Given large number new of recruits to the faculty in the Department, the various retention packages that been have offered to valued faculty members, the health care benefits that have been offered to faculty, expensesthe associated with successfully implementing the goals the of strategic plan, and the reduction inthe support and perception that the the of role Surgeon- may be under-appreciatedTeacher devalued. or Restoring the importance and value in the large cohort educators of in the Department, and providingthem with the support they need to be successful has been a core mission the of Department. Accordingly, an annual Education Scholars Symposium has been created to bolster the support Surgeon for teachers in the Department. changesRecent in health research funding has created risks all for surgeons and scientistsin their careers. The creation alternate of funding streams and mechanisms will thus be an important goal the for Department in the years ahead. The SSTP is currently at risk being of inadequately funded. Thisis in part to due the numbers of residents are who enrolled in the program, and the reality that a higher percentage residents of are receiving not externally funded awards as they did in the past. Here again, alternate revenue Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto are academically productive, there is a concern of theseof reductions will within be felt years. a few Because the Department has traditionally been a highly academic enterprise that values and supports surgeons conducting research and who pronounced resource-intensive for specialists such as surgeons. Perhaps as part the of perception that there may be too many underemployed specialists in Ontario, is reducing the MOHLTC the number of residency positions in surgery the next over 5 – 10 years. While an not immediate challenge, the impact the market. job The Royal College Physicians of and Surgeons produced a report which has examined employment issues in specialties across Canada. wasIt noted that employment issues are most Learners are fearful the of dire market job in General Surgery and all surgical specialties. This has prevented talented medicalstudents from considering careerpaths in surgery, and has created significant angst for residents who are about to enter Department of Surgery, Departmental organization continues to be a challenge. The Chair works in synchrony with the Executive Committee and the Senior Advisory Committee to ensure that the Department remains operational and synergistic. strategic plan. With size and demonstrated strengths, there are definitelychallenges that are faced. Challenges theGiven size and the complexity the of medical students, residents, fellows, and faculty who are a part its of programs. virtue By its of size and talent pool, the Department lays claim annually to an enormous number high of impact peer-reviewed publications, grants, honours and awards.Innovation is evident at a high in level virtually all pillars the of Challenges Strengths The Department Surgery of is the largest its of kind across Canada considers one when the number of 4.17 Strengths and Strengths and 4.17

4. Chair’s Statement 4. Chair’s Statement 45 Self-Study Report, External 2020 Review | of Healthof and Long-term Care to set help the agenda surgical for care Ontarians of through adherence initiatives to Q/BP that been have led Departmental by Faculty members. already been some good examples “graceful” of transitions to retirement in several Divisions. To accomplish successful such transitions will require an early dialogue with all faculty members, and with clear-cut expectations about planning for exiting clinical practice increasing by teaching researchor mentoring or opportunities while clinicalone’s practice is diminishing design. by The Department will continue to explore the use communicationsof and social media opportunities to advance its global outreach and impact. Promulgation the of Department’s core values through the activities and accomplishments of its talented faculty members has already begun and will be continued. The hiring a Medial of Artist has assisted significantly withDepartmental branding, packaging content, of and providing professionalism to all communications. Finally, the Department will continue to leverage its proximity Park and the to Ministry Queen’s J Bohnen, Dean T Young and J Rutka at Faculty Faculty at J Rutka and Dean T Young J Bohnen, 2015 Day Development in Surgery and other Departments in achieving a competency-based assessment curriculum. The Department is eager to implement its “Late Career Transition” Guidelines as part of its efforts in Faculty Development. There have Department of Surgery, Faculty University of Medicine, of Toronto

Department can be a leader in assisting all Divisions There can be question no that based its on major investment in competency-based training, the Li Ka Shing Knowledge Institute, Sunnybrook Health Sciences Centre, SickKids, and UHN. Anesthesiology, Medicine, Obstetrics/Gynecology), the Department has to give much to this effort with ongoing projects at the Surgical Skills Centre, the a leader in future simulation efforts in Facultythe Medicine.of With the assistance the of Dean, and with collaboration other of Departments (e.g. There is an opportunity the for Department to be used to support the SSTP an on ongoing basis, in addition to strategic “Merit for Awards” deserving faculty members application. upon to all faculty members irrespective their of contributions to Departmental activities. Funds that are through recovered this strategy will be stipendiary support faculty for in the Department will just have terminated need to be developed. We the practice providing of historic hard dollars the Divisions under business a new model CPD. for alsoIt seems clear that model a new providing for of unrestrictedof educational gifts; and some will be derived from the offeringnew of coursesCPD by additional efforts in advancement directedby the Department and by the various Divisions; some will from come industry partnerships in the form research endeavours, education, as such the SSTP, faculty development, and Best Practice initiatives. Some these of streams revenue will from come There is question no that identificationof alternate streamsrevenue will be an extremely important future direction the of Department to support existence, and ones that continue to evolve. bright and promising given the tremendous talent pool and academic achievements of individual faculty members, the programs that are in Departments at the and University Toronto, of perhaps across all Universities in Canada, the future the of Department continues to look 4.18 Future Directions 4.18 Despite the fiscalconcerns that face all academic Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto UK Traveling Surgical Society and members of the Department of Surgery at the Annual Banquet, Banquet, Annual the at Surgery of Department the of members and Society Surgical Traveling UK 2016 10, June Friday, Estates, Vaughan

4. Chair’s Statement 5

ORGANIZATION AND FINANCIAL STRUCTURE

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 47 ORGANIZATION AND 5FINANCIAL STRUCTURE

Organization

The Department of Surgery is comprised of a strong Surgery, Surgical Oncology, and Thoracic Surgery) network of faculty and learners, and traverses six with a total enrollment of 277 trainees. The fully-affiliated hospitals and an expanding number Department of Surgery has the largest fellowship of community-affiliated hospitals. We have 295 training program across Canada with 250 fellows full-time clinical faculty, 80 part-time clinical from over 15 countries coming each year to learn faculty, 160 adjunct clinical faculty, 8 anatomists the nuances of specialty surgery. The Division and 26 research scientists. We are responsible for of Anatomy is housed within the Department of the surgical teaching of our 225 medical students Surgery in a relationship that has been mutually throughout the four years of the undergraduate productive and beneficial for over a decade. curriculum. We oversee eleven residency programs including 7 CaRMS entry Royal College of Clinical faculty members in the Department Physicians and Surgeons (RCPSC) programs of Surgery hold concurrent appointments in (Cardiac Surgery, General Surgery, Neurosurgery, either fully-affiliated or community-affiliated Orthopaedics, Plastic and Reconstructive Surgery, hospitals. The faculty are also organized into eight Urology, Vascular Surgery) and 4 sub-specialty entry Department-wide specialties (Cardiac Surgery, programs (Pediatric General Surgery, Colorectal General Surgery, Neurosurgery, Orthopaedics,

48 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 5. Organization and Financial Structure 49 21.5 21.5 21.5 21.5 MAX TOTAL 0-0.5 0-0.5 0-0.5 0-0.5 AT ROUNDSAT ATTENDANCE Self-Study Report, External 2020 Review | RANK 0-3 x .5 0-3 x .5 0-3 x .5 0-3 x .5 Markedly Exceeds Expectations Markedly 3

ADMIN 0-3 x .5 0-3 x .5 0-3 x .5 0-3 x .5 Anatomy); Directors Undergraduate, of Postgraduate and Continuing Professional Development; Surgeons-in-Chief; and Hospital Heads. domains in which surgeons score points include research, teaching,creative professional activity, administration, academic rank, and attendance at university/divisional rounds. Each category is assessed a point on scale 0-3, of as per Figure 5.1 with the exceptionbelow, the of attendance at university/divisional rounds category. This score is then weighted in variable a fashion in each category depending an on individual’s academic example, For role. a Surgeon-Scientist will be given a score in research and that score will be multiplied a factor by whereas 3, of his/her score in teaching will be multiplied a factor by 1. of With a large such Department, including multiple hospitals and large numbers faculty of and students, the governance structure that has is evolved one a matrixof authority. The Department leadership consists the of Chair; Associate Chair; Vice-Chairs Research,of Education, Clinical, Innovation, Global Outreach/Integration and Quality/Best Practices; Chairs all of nine divisions (including 0-3 x 2 0-3 x 2 0-3 x 2 0-3 x 3 ACTIVITY Exceeds Expectations CREATIVE 2

PROFESSIONAL Department of Surgery, Faculty University of Medicine, of Toronto 0-3 x 3 0-3 x 2 0-3 x 1 0-3 x 2 TEACHING Meets Expectations* 1 0-3 x 1 0-3 x 1 0-3 x 3 0-3 x 2 RESEARCH Academic Point System Academic Point Below Expectations Below Health Surgeon- Investigator Surgeon- Teacher Surgeon-Global ACADEMIC ROLE Surgeon- Scientist 0 Figure 5.1 Figure 5.1 and assigned an academic score based their on activities the for calendar year in The review. Each year, the full-time clinical faculty are reviewed (76 faculty);(76 Surgeon-Investigator faculty); (127 (90 faculty); Surgeon-GlobalSurgeon-Teacher Surgery faculty); (2 and Surgeon-Ethicist faculty). (2 research and administration. At present, there are academicfive roles from which facultymembers can choose. They include: Surgeon-Scientist Chief, Hospital Division Head, University Division Chair and Department Chair, and determines the distribution time of between clinical care, education, role withrole a corresponding description. job The job description is developed jointly the by Surgeon-in- to their Hospital Division Head and Surgeon-in- Chief their for clinical activities. Each full-time clinical faculty member is assigned an academic Departments Surgery. of Faculty membersare accountable to their University Division Chair and Department Chair their for academic activities and Surgery, and Urology, Vascular Surgery).There is a close working relationship between the University Department Surgery of and the Hospital Plastic and Reconstructive Surgery, Thoracic C. Simone J. Drake The Hospital for Sick Children S. Keshavjee University Health Network Michael Garron Hospital N. Ahmed (Interim) St. Michael’s, Unity Health Toronto D. Urbach Women’s College Hospital L. Smith A. Nathens North York General Hospital SURGEONS-IN-CHIEF (BY HOSPITAL LOCATION) SURGEONS-IN-CHIEF Sunnybrook Health Sciences Centre J. Wunder Oces C. Compeau St. Joseph’s, Unity Health Toronto J. T. Rutka Mount Sinai Hospital Department of Surgery Committee A. Nathens Appointments Chair, Departmental Research A. Kapus T. Forbes M. Fehlings G. Oreopoulos Vascular Surgery Vascular Surgery Program Director, Vice-Chair, Research Associate Vice-Chair, J. Lee Urology Urology N. Fleshner Innovation Program Director, S. Keshavjee Vice-Chair, Surgical A. Pierre T. Waddell Thoracic Surgery Thoracic Surgery Program Director, R. R. Richards Vice-Chair, Clinical Director, J. T. Rutka C. Forrest K. Wanzel Evaluations and M. Musgrave Plastic Surgery Plastic Surgery PROGRAM DIRECTORS Teaching Innovation Program Director, Committee H. Clarke R. S. McLaughlin Professor and Chair Professor and R. S. McLaughlin Chair, Promotions P. Ferguson J. Hall Director, M. Nousiainen Education Program Director, Orthopaedic Surgery Orthopaedic Surgery Undergraduate Surgery G. Azzie Pediatric General Program Director, N. Ahmed A. Lozano Self-Study Report, External 2020 Review | Vice-Chair, Education A. Kulkarni Neurosurgery Neurosurgery Program Director, Director, Education R. Levine Postgraduate F. Wright Program Director, Surgical Oncology C. Swallow R. McLeod General Surgery Vice-Chair, Quality Director, H. MacRae R. George Program Director, Colorectal Surgery Continuing Education T. Yau B. Yanagawa Cardiac Surgery Cardiac Surgery Program Director, O. Rotstein Associate Chair S. Brar General Surgery Program Director, Department of Surgery, Faculty University of Medicine, of Toronto Anatomy C. Morshead UNIVERSITY DIVISIONS CHAIRS DIRECTORS EXECUTIVE COMMITTEE

5. Organization and Financial Structure 5. Organization and Financial Structure 51 C. Simone J. Drake The Hospital for Sick Children S. Keshavjee University Health Network Michael Garron Hospital N. Ahmed (Interim) St. Michael’s, Unity Health Toronto Self-Study Report, External 2020 Review | D. Urbach Women’s College Hospital Department of Surgery Organizational Chart L. Smith Figure 5.2 Figure A. Nathens North York General Hospital SURGEONS-IN-CHIEF (BY HOSPITAL LOCATION) SURGEONS-IN-CHIEF Sunnybrook Health Sciences Centre J. Wunder Oces Department of Surgery, Faculty University of Medicine, of Toronto C. Compeau St. Joseph’s, Unity Health Toronto J. T. Rutka Mount Sinai Hospital Department of Surgery Committee A. Nathens Appointments Chair, Departmental

Research A. Kapus T. Forbes M. Fehlings G. Oreopoulos Vascular Surgery Vascular Surgery Program Director, Vice-Chair, Research Associate Vice-Chair, J. Lee Urology Urology N. Fleshner Innovation Program Director, S. Keshavjee Vice-Chair, Surgical A. Pierre T. Waddell Thoracic Surgery Thoracic Surgery Program Director, R. R. Richards Vice-Chair, Clinical Director, J. T. Rutka C. Forrest K. Wanzel Evaluations and M. Musgrave Plastic Surgery Plastic Surgery PROGRAM DIRECTORS Teaching Innovation Program Director, Committee H. Clarke R. S. McLaughlin Professor and Chair Professor and R. S. McLaughlin Chair, Promotions P. Ferguson J. Hall Director, M. Nousiainen Education Program Director, Orthopaedic Surgery Orthopaedic Surgery Undergraduate Surgery G. Azzie Pediatric General Program Director, N. Ahmed A. Lozano Vice-Chair, Education A. Kulkarni Neurosurgery Neurosurgery Program Director, Director, Education R. Levine Postgraduate F. Wright Program Director, Surgical Oncology C. Swallow R. McLeod General Surgery Vice-Chair, Quality Director, H. MacRae R. George Program Director, Colorectal Surgery Continuing Education T. Yau B. Yanagawa Cardiac Surgery Cardiac Surgery Program Director, O. Rotstein Associate Chair S. Brar General Surgery Program Director, Anatomy C. Morshead EXECUTIVE COMMITTEE DIRECTORS UNIVERSITY DIVISIONS CHAIRS

development experience clinical practice partnerships nationally and globally departmental programs of revenue Strengthen, support and renew faculty Enhance teaching and enrich the student Enhance productivity and impact research of Promote innovation in research, teaching and Build international outreach and strengthen Integrate best practices and quality across Explore and establish alternative sources the Departmental budget an on annual basis to reflectpriorities. the above realignmentThe of funds allows the Department to implement programs and initiatives according to our strategic plan. The Department continues to invest efforts in increasing jurisdictions, the Department does tax not practice plan/clinical earnings in any its of Divisions. Notwithstanding the diminution in base budget funding each year, the Department has used these funds to: 1. 2. 3. 4. 5. 6. 7. achieve this,To funds are re-allocated from within Financial Structure Financial The Department’s operating budget consists of Universitybase funds specifically earmarked for Departmental expenditures and the Division of Anatomy; (teaching T&R and rehabilitation) funds received from the Ministry Health of and Long and postgraduate Care (MOHLTC); Term expansion funds residency (Pool A), education support funds (formerly B IMG funding), Pool and funds received Visa-sponsoredfor trainees These (Pool C). funds are used to administer the operational expenses and academicfor stipends provided to all faculty new members within their first years five of clinical practice and to those serving in leadership positions. the budget the for DepartmentIn 2018-19, of Surgery, considering all sources was revenue, of $5.6 million. Unlike other Departments Surgery of in other

. Self-Study Report, External 2020 Review | (Figure (Figure and a Dr. Lloyd Smith Dr. CarolDr. Swallow Urbach David Dr. Thomas Waddell Dr. Jay Wunder Dr. Yau Terry Dr. Dr. Robin McLeod Robin Dr. Morshead Cindi Dr. Musgrave Melinda Dr. AveryDr. Nathens Richards Robin Dr. OriDr. Rotstein Simone Carmine Dr. Dr. AndresDr. Lozano Executive Committee Finance Committee Senior Advisory Committee Senior Advisory Committee Dr. Ronald Levine Ronald Dr. Dr. Jeremy Hall Dr. Jeschke Marc Dr. AndrasDr. Kapus Shaf KeshavjeeDr. Dr. Neil Fleshner Neil Dr. Thomas Forbes Dr. Christopher ForrestDr. George Ralph Dr. Dr. ChristopherDr. Compeau James Drake Dr. Dr. Michael Fehlings Peter Ferguson Dr. Dr. James Rutka (Chair) James Rutka Dr. Ahmed Najma Dr. Department of Surgery, Faculty University of Medicine, of Toronto at 149 College Streetat 149 5th floor, West, along with the senior academic administrative leaders. These individuals oversee the following areas administration:of finance,human resources, academic appointments, faculty promotions, postgraduate education, undergraduate education, communications, and strategic initiatives. The administrative staff locatedis in Stewartthe Building The Department administrative staffconsists full-time 10 of employees the of University. Figure 5.3 Chairs; a consisting5.3) approximately of 25 individuals in leadership key positions in the Department Surgery;of a Departmental Appointments Committee flat hierarchicalorganization, Department the has developed several organizational structures (Figure 5.2 the on previous These pages). include a number mainof committees: An consisting the of Chair, Associate Chair and Vice- All major decisions made in the Department stem from broad consultation across our leadership assistteam. with To the implementation a fairly of

5. Organization and Financial Structure 5. Organization and Financial Structure 53 Self-Study Report, External 2020 Review | Practice plans are instrumental to the viability of the academic surgical mission. Every full-time faculty member in the Department Surgery of must belong to a conforming practice plan one of theof fully-affiliated hospitals by andapproved the Department Chair. is It the practice plan that provides the base salary support members for of the Department Surgery. of The purpose these of practice plan agreements is to ensure transfer of funding to an Academic Enrichment Fund (AEF) to offset clinicalthe loss income for those surgeons arewho actively participating in research and teaching roles in the Department Surgery. of

Department of Surgery, Faculty University of Medicine, of Toronto Surgery faculty members; and Faculty Medicine. of directions; Training Program; annual increases in administrative staff salaries; retention packages Department key for of reduced central budget allocation from the high recruitment level packages faculty; new for expenditures strategic new for goals and fluctuations in funding for Surgeon the Scientist 5. 6. 4. 2. 3. multifactorial, include but the following: 1. at the each end of fiscalyear, this amount is being reduced annually. The reasons for the reduction in annual carry forward is While the Department Surgery of has had, and continues to a carry have forward amount and appropriately with industry, and identifying philanthropicnew pools donor funding. of endowment funding, working collaboratively Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

5. Organization and Financial Structure 6

RESOURCES AND INFRASTRUCTURE

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 55 6RESOURCES AND INFRASTRUCTURE

In 2013, the administrative offices of the Department open-concept for the administrative staff, of Surgery were relocated to the Stewart Building with enclosed offices for the Chair, Business (149 College Street) after having been in the Manager, and Divisional Offices. Semi-private Banting Institute (100 College Street) for over 80 work-modules exist for the Education and years. Renovation and refurbishing of the space was Research leads. A state-of-the-art conference generously provided by the Faculty of Medicine room has been fully equipped for telephone who also provides funding to pay for the rental fees and videoconferencing, and is the location for on an annual basis. The Chair, the Departmental all Executive and Senior Advisory Committee administrative staff, the University Divisional Meetings, along with meetings for Continuing offices for General Surgery, Orthopaedics, Plastic Appointment Reviews, Departmental Searches, and Reconstructive Surgery and Urology, along and Strategic Planning Committee among with the Educational Directors are located on the several others. All Divisions in the Department 5th floor of the Stewart Building. The office space of Surgery have access to booking the conference is comprised of 4,210 square feet that is primarily room as required for their activities.

56 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 7

EDUCATION

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 57 7EDUCATION

Report Provided by Najma Ahmed Vice-Chair Education

With input from Jeremy Hall, Undergraduate Education; Mark Wheatcroft, Jory Simpson and Ronald Levine, Director, Postgraduate Education, and various program directors.

Preamble Dr Ahmed is also Clinician-Educator at the Royal College, one of only two surgeons on this national The training, mentorship and career success of committee of Royal College career educators. medical students, residents and fellows remains Under Dr Rutka’s leadership the surgical education core business of the Department of Surgery. The mission in all domains, undergraduate, post- education mission is led by Dr Rutka, together with graduate, fellowships and faculty development have the Vice Chair Education, Dr Najma Ahmed. flourished, with thought leaders and innovation Dr Ahmed is a recognized national leader in driving impact. The goals of the Educational Pillar surgical education, and recipient of the D. R. of the Department of Surgery, Strategic Plan: Wilson Award in Post Graduate Education, a Aspire, Advance. Achieve are detailed herein. national leadership award given by the Royal surgery.utoronto.ca/strategic-plan-2018- College for excellence in postgraduate education. 2023-aspire-advance-achieve

58 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 7. Education 59 ) Self-Study Report, External 2020 Review | Appendix C well as constant advancements in technology. A number exciting, of learner focused innovations and programs new been have introduced into the curriculum, and Undergraduate education in the Department reflects thesechanges. core The surgical rotation undergraduate for students continues as surgery-related programs, initiatives and courses 4-year MD/ the Universityover Toronto’s of programPh.D. as well as to medical students from within Canada and various parts the of world. The Undergraduate Office of Education is headed bythe Director Undergraduate of Education, Dr Jeremy Hall, and is supported a full-time by coordinator as well as several other hospital site administrative staff.Undergraduate The Education Committee has representation across the various Divisions and welcomes participation of medical students. Undergraduate Education is an essential part the of Department of Surgery’s Education portfolio and seek towe provide the highest levels surgical of instruction and exposure to the brightest minds that make the up medical students within Canada and across the world. The Department Surgery of has made significant investments related to improving the learning climate and training outcomes of undergraduate students. Surgical education is an exciting and dynamic field that has evolved learningnovel techniques and teaching styles as In addition, Dr Ahmed, Chair Vice Education is a Royal College Clinician Educator, only of one two surgeons across the country this to hold post. Educational scholarship,leadership and creative professional activity related to surgical education is an area significant of focus our for facultymembers. Many faculty members pursue promotion based in a portfolio focused high-level on achievement in these areas, having achieved national or international recognitions their for efforts. Each year, Faculty members and trainees garner significant recognition through their teaching and leadership awards in the domain surgicalof education. ( Undergraduate Medical Education The Department of Surgery’s Undergraduate Educationoversees Office and coordinates various Department of Surgery, Faculty University of Medicine, of Toronto

for late-career transitioning Surgeon-Scientist Training Program career-planning resources array support of services to reflect learning the experience Education in all resident specialties led teams during clerkship rotations Develop a well-guidedDevelop approach Seek alternative sustainable funding the for Connect residents to accessible Provide faculty memberswith an Update the undergraduate written exams Implement Competency-Based Medical Institute consistency across all fellowships Organize medical students into resident- - To support faculty- To members through promote physical and mental- To wellness - To assist surgical- To trainees with - To provide medical - To students with

Education Scholars Program in the last 5 years. for careerfor success as a clinician Khalid teacher. JorySyed, Simpson, Sebastian and Tomescu, Sarah are Ward members completed have who the members completed have the Education Scholar Program, This program at T. U of training of is intended competencies to key develop necessary career junior of faculty surgeon-teachers through faculty The development. following faculty Clinical Full-time = 32 The Department Surgery of enables the successful Surgeon-Teachers or Surgeon-EducatorsSurgeon-Teachers as follows: Clinical adjunct = 34; Clinical Part-time = 9; Over the last 5 years, faculty 73 members have been successfully recruited to our Department as • • • • • • • Strategies • 4 in trainees and faculty members middle and later-career transition periods navigating the Canadian market job 3 high-quality clinical experiences 2 Objectives 1 piece in piece (royalcollege.ca/ creative reflection is a reflection session facilitated resident and student representatives as well as Academy coordinator attend and discuss issues surrounding rotations, evaluations and upcoming accreditation issues. The the of role SLUE has recently expanded. These leaders are now instrumental in ensuring preceptor evaluations are including various elective clinics, the emergency/ trauma room as well as operating room. The finalweekof course the includes review sessions, didactic teaching brief sessions and student evaluations. Assessments include mid-rotation and final clinical evaluationscompleted preceptorsby as well a multiple-choicequestion examination and oral case presentation. The multiple-choice question platforms changed have from the NBME exam to derived a University exam Toronto of bank administered through ExamSoft. Multiple- questionschoice been have developed through faculty input as well as resident offerings using blueprint.the MCQ University We Toronto of continue to expand this exam bank with formal and informal meetings. All questions are vetted through our subspecialty faculty representatives. The Undergraduate Education Committee continues to meet regularly. Division, Surgical leader in undergraduate education (SLUE), Workshop 3 Workshop a clinicalby educator and faculty memberthat will provide a safe space students for to critically reflecton personal experiences and assumptions, theon effectsof surgery chronic and illness, and the on patient-surgeon relationship. After participating in the first workshops, two students will produce a rcsite/canmeds/canmeds-framework-e) which they juxtapose what they learned from the first workshops two with or experiencean event duringtheir surgery clerkship. The reflection willpiece form the basis the for group discussion during this last this In workshop. 2018, innovative program has been expanded to include all sites and is being replicated other by medical schools. The core surgical rotations consist two of 3-week clinical opportunities including a mandatory 3- generalweek surgery rotation as well as a 3-week surgical subspecialty selective. Students are expected to attend a number learning of environments Self-Study Report, External 2020 Review | are patient-driven sessions Department of Surgery, Faculty University of Medicine, of Toronto expand their understanding illness how of impacts patients and their families through engaging with patients and learning from their personal stories. are facilitated a trained by facilitator in health care, patient teachers will discuss illness how has impacted their lives and reflecton their experiences with the health care system. Students will the have chance to engage in dialogue with patient teachers and ask questions. In doing students so, will be able to (of 60-75 minutes(of and each) a reflectionpiece. 1 andWorkshops 2 led 2 cancer by survivors become who valuable teachers to medical students. In these sessions that partners in teaching, feedback, and evaluation. programThe Patient as Teacher has been integrated into the 3rd year surgical clerkship undergraduate for medical students at the University of Toronto. The program consists 3 interactive of workshops stories, experiences with the health care system, and perspectives their how on illness has impacted their lives. Students listen, engage in dialogue, and ask questions. This collaboration actively involves patients and survivors in the education process as perspective in surgery. These sessions occur during the prelude course as well as in the finalweekof program The Patientreview. as Teacher uses this patient-centred approach to promoteand foster humanism in medicine. Patient-driven sessions are led 2-3 by cancer survivors share who their personal commitment to the education students. UG of The “Humanism in Surgery” programhas been met with great success. This program involves patients as teachers to give clerks a sense the of patient technical skills acquisition resources. Students continue to reportthat residents are great of value during this and week further emphasis will be placed the on training and a of development resident-based learning platform. are of proud We our post-graduate trainees, their for skill, talent and opportunity to practice skills essential their for surgical rotations. Over the last year the prelude course has been assessed and monitored and will increasingly utilize electronic resources, as such the e-learning modules,case-based learning, and an 8-week platform. This rotation is divided into a “Prelude week to Surgery”1- preparatory course, which has been designed to give the students an

7. Education 7. Education 61

Self-Study Report, External 2020 Review | Reconstructive Surgery Dr. AndrewDr. Pierre – Thoracic Surgery GeorgesDr. Azzie – Pediatric General Surgery Dr. SavtajDr. Brar – General Surgery GeorgeDr. Oreopoulos – Vascular Surgery MarkkuDr. Nousiainen – Orthopaedic Surgery AbhayaDr. Kulkarni – Neurosurgery Bobby YanagawaDr. – Cardiac Surgery FrancesDr. Wright – Surgical Oncology MacRae Helen Dr. – Colorectal Surgery Dr. CarolDr. Swallow – General Surgery ChristopherDr. Forrest – Plastic and Forbes – Vascular Tom SurgeryDr. Ferguson Peter Dr. – Orthopaedic Surgery AgostinoDr. Pierro – Paediatric General Surgery NeilDr. Fleshner – Urology AndresDr. Lozano - Neurosurgery - Cardiac Terry Yau Dr. Surgery • • The firstyear of training is calledSurgical Foundations, all for surgical trainees. In addition to attending the specialty-specific academic residents ranked the training University Toronto of programs as theirWe arefortunate first choice. to attract an unparalleled group committed of and talented trainees. Many the of surgical specialties also take international medical graduates (IMGs) and visa trainees from aroundthe world. The Program Directors and their administrative assistants taken have the on herculean task of leading, innovating and administrating the largest and arguably most training complex program in the This county. task is especially challenging during this period transition of The to CBD. current Program Directors are listed below: • • • • • • • • • • • • • • • The University Divisions together comprise the largest post graduate surgical training enterprise in North America,with approximately residents 274 in total, assigned to 7 fully affiliated trainingsites and a larger number community of and more remote rural sites. surgical There are 11 programs; 7 CaRMS entry andsub-specialty 4 programs. Our surgical positions all for our of CaRMS entry specialty programs are highly sought after and all CaRMS entry surgical positions filled were in the firstiteration, everyyear in the lastyears. 5 Most Department of Surgery, Faculty University of Medicine, of Toronto

The University Division Chairs are listed here: in leveraging the unique strengths their of Hospital divisions, enabling strategic facultyrecruitment and elevating the mission training of and education. search committees and appointments, led Dr. by Rutka, University new for Division Chairs. These newly appointed Chairs been have highly effective program at the University Toronto. of Over the recent 5 years, there been have several a tremendous supporter the of surgeon- scientist program, an enormously successful Post-graduate directors and trainees have thefelt sustained support Rutka’s Dr. of leadership throughout his term. has He been Education R. Levine and M.Brown, Awards Ceremony 2018 Gallie Day Gallie 2018 Ceremony Awards M.Brown, and Levine R. Postgraduate Medical Interest to name Groups (SiG), a few. and the Surgical Longitudinal Experience (SurgicLE), Student Surgical Skills Development and(S3D) the activities the of Surgical Finally, the undergraduate education committee continues to provide pre-clerkship advice and innovation to programs as such the SEAD point contacts student for concerns and ensuring that faculty members at large are apprised kept changesof in the undergraduate curriculum. completed in timely a fashion and are designated

Cardiac Surgery, is the course director. allfor surgical residents. The Program Directors can monitor the operative experience Residentof at the various training sites. development and implementation. Most programs attended have the 2 Royal College workshops relevant to Competency Design By implementation.(CBD) CBD implementation and smart design continue to be an important area all for endeavor of Program Directors. and residents PGY3 taught Dr by John Murnaghan, which is a workshop to teach residents to be better how teachers. Ronald Levine all for our of first new year residents. first-year residents. group, started to support female medical students in their to consider choice training in Surgery. This was established Carol-Anne by Moulton, General Surgery, and has now evolved into what is known as the “Life in Surgery” ThisGroup. Group meets several times a year. isIt open to all medical students, residents, fellows and faculty. Dr Maral Ouzounian, Foundations written all by residents across Canada has been developed. andTeaching Assessment within all Divisions in the Department Surgery. of Each the of various programs are in various stages of Case tracking log POWER on mandatory is now The Resident as Teacher Day for the PGY1 the for Day PGY1 The Resident as Teacher A Resident Orientation organized Day Dr by ATLS training which is mandated all for The establishment in Surgery” a “Women of A national in-service exam Surgical for The introduction Competency of Based • • • • • Surgical Skills Camp – knot tying & suturing tying – knot Camp Skills Surgical There been have a number initiatives of in Surgical Foundations. These include: • • Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto UofT to be guest speakers at our lecture series. work, the residents attend the Surgical Foundations lecture series every morning Tuesday throughout their firstyear preparationin Royal for the College Surgical Foundations exam. The strong interdisciplinary links that the Department of Surgery has enables us to engage many experts from Following Prep-Camp, residents enterthe clinical domain where they can begin achieving on work competency in their Entrustable Professional Activities the for Surgical (EPAs) Foundations Program. Running in parallel to their clinical Centre, a class leading facility specializing in surgical simulation and assessment practical of skills. An examination at the completion theof Prep-Camp is required successful for completion the of Surgical Foundations year. week-long intensiveweek-long course delivered in early July basic on practical techniques, ranging from tube thoracostomy insertion, through skin suturing anastomosis. tobowel Prep-Camp takesplace at the Mount Sinai Surgical Skills how surgeonshow can influence have on a societal level in addition to the individual patients they help. Previous landmark topics included have Firearms related trauma and gun control, and the opiate crisis. Induction continues with “Prep-Camp”, a Program is the largest in Canada, welcoming approximately surgical new 65 residents per year. Each academic year commences with an induction program that includes “Surgeon the novel in Society” event, a series lectures of highlighting professional activities as (EPAs) well as establishing a competence committee headed Levine. Dr by Ron Dr MarkIn 2018, Wheatcroft the creation took over and delivery the of Foundations Curriculum. The University Surgical of Toronto Foundations fundamental surgical skills. Surgical foundations is also the first surgicalprogram to transition to Competency Design, by successfully led Dr by Levine.Ron This transition included the seminal tasks developing of and implementingentrusted endeavors, the Residents attend a series didactic of lectures to prepare them Royal for College Surgical Foundations exam, and to provide training in

7. Education 7. Education 63

Self-Study Report, External 2020 Review | ). Under Dr Under Latter’s leadership,). – organized Dhruvin by Hirpara + Fayez Quereshy with Hala Muaddi and Dr Brenneman with a planned 3 session course the for year. date literature are we re-designing the selection process to reduce help bias including Multiple mini interviews, blinding applications of and reference letters, equity and diversity in the selections committee, and training in bias. We did MMI and bias training, this but year we are taking the next step to blinding etcetera. catheterization. This experience would not be possible in our academic hospitals to due excessive competition from cardiology fellows. request from the residents wanted who an opportunity to meet specific surgeons, hearto their stories and to get advice fellowship, on staff positions,work-life balance on.and so The mentors been have UofT and non-UofT surgeons the who residents would otherwise not get to interact with in a more social setting. Govindarajan; combination of multiple mini-interviews and longer interviews. ourfor combined General Surgical Oncology/ HPB position. LeaPS course (Leadership Proficiency Surgery)in selectionNew process – using the most up-to- Competency Committee. Mentorship dinners. This was started by Re-developed interview process with Anand Re-accreditation from Fellowship Council Initiated competency committee.

pg.postmd.utoronto.ca/about-pgme/boards- lead the for Department is Najma Ahmed ( committees previously, clinical fellowship training goals and objectives advanced have enormously. The different Clinical Departments adapted have the policies General Surgery • • • Clinical Fellows The Department offers training 250over to clinical fellows each year across all different specialty areas in Surgery. The current fellowship • Surgical Oncology • • • Department of Surgery, Faculty University of Medicine, of Toronto

Shing) and pump disasters (Michener Institute). Thisat Thunder Bay. was initiated as an out- of-the-box elective where our residents become the primary operators diagnostic for coronary simulation isolated of coronary anastomoses, valve replacements pig on hearts (Mt. Sinai Skills Center) and offpump CABGpigon models (SickKids Animal as Lab) well as scenario-based team simulationincluding disasters OR (Li Ka surgery residents across the country. This bootcamp has been running locally for UofT traineesabout 5 years. for Competency Committee. runJuly, nationally all for thoracic new Unique cardiac catheterization lab experience Surgical Simulation including technique-based Developed andDeveloped implemented “Thoracic surgery boot camp” every Poster Presentations 2018 Gallie Day Gallie 2018 Presentations Poster

•

Cardiac SurgeryCardiac •

• • Listed are below examples: a few Thoracic surgery A number post of grad-training programs undertakenhave significant innovations. training: general surgery, orthopedic surgery, pediatric surgery, and plastic surgery. to ensure their secure transition. In 2020, we forwardlook to seeing the following programs into a competencymove design by model of successfully transitionedsaw the 2019 to CBD. successfultransitioning Cardiac of Surgeryand Neurosurgery, with many processes in place As mentioned, Surgical in 2018, foundations ) surgery.utoronto.ca/faculty-development-day-2019 experience our for residents. This mandate called Distributed Medical Education and the Department Surgeryof has been crucial in the success this of initiative. meet this mandate, To the Department Surgeryof has increased the exposure trainees of to training at Community affiliated Hospitals. Faculty was Day Development introduced in and is it annually held 2011 Over in November. the years, has it grown to attract a large number faculty.of Faculty has Day Development evolved to include the Departments Anesthesia, of Otolaryngology and Head and Surgery. Neck ( the DepartmentIn 2018, of November Surgery of first it held CareerWorkshopAdvancement with a specificfocus on Gender issues within the Department. This workshop was attended seniorby leaders, as well as mid and junior faculty.level This along workshop, with many concurrent forces within the University have enabled safer conversations about equity and diversity issues within the Department Surgery. of RoyalThe College University of Toronto, of Physicians and Surgeons and the Ministry of Health all have mandated an increased community be hugely informative and assist themto improve their performance an on ongoing basis. Self-Study Report, External 2020 Review | ). Links). to

surgery.utoronto.ca/fellowship-program Department of Surgery, Faculty University of Medicine, of Toronto PGME Director to discuss strategies to improve teaching performance. Our Faculty members find these data and especially comments the to effectiveness score (TES), wellas as narrative comments. These data are collated to create an individualized report to each University Division Chair, Surgeon-in-Chief and Program Director, as well as Dr Rutka. Faculty with chronically poor scores meet with the Departmental Chair and Faculty Development effectivenessTeaching and faculty development is supported Effectiveness Teaching by data. All teachers in the Department Surgery of are evaluated theby residents POWER on to generate a teaching Fellows and training experience each of group of learners is monitored. Many training programs developedhave guiding principles, that such neither group learners of is disadvantaged, and that each is able to achieve their training and career goals. of teaching,of and availability procedures. of In addition, these fellowships provide outstanding opportunities academic for development. The relationship between Residents and Clinical Surgery, is fortunate to be a magnet fellowship for training in essentially all aspects Surgical of Training. The majority clinical of fellows rank their educational experience expectation as above outstandingor in the fieldsof mix and diversityof cases, quality patient of care experiences, quality found on this site. In 2017, Trauma Surgeryfound this on site. In became 2017, the first surgical discipline to achieve statusthe of an Area Focused of Competence the by Royal College. The University Department of Toronto, of continue to be respected all by Fellowship Directors. The Department has developed its own website information of Clinical on Fellowships ( all Divisions which offer ClinicalFellowships are Fellows; Remuneration Clinical of Fellows; Offer Letters to Clinical Fellows; Access to Primary Care Clinical New for Fellows; and Safety Workplace and Insurance Board Coverage Clinical for Fellows. The guidelines, developed and enacted Latter Dr. by espousedFEAC important by such on topics as the Guidelines for Educational Responsibilities in Clinical Fellowships; Evaluations Clinical of

7. Education 8

RESEARCH REPORT

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 65 8RESEARCH REPORT

F. Rudzicz and M. Fehlings, 2020 Ben Alman Research and Science Rounds

Prepared by Michael G. Fehlings MD PhD FRCSC FACS FRSC FCAHS, Vice Chair Research, Department of Surgery

The Research Committee in the Department of Surgery is led by the Vice-Chair of Research, Dr. Michael G. Fehlings.

In addition to the Department’s notable research activities as part of their day-to-day work. Our productivity, its Surgeon Scientist Training faculty members produce research of the highest Program (SSTP), now in its 35th year, provides quality, resulting in publications in journals such as the infrastructure for residents from all surgical Nature and the New England Journal of Medicine. specialties to receive graduate training in the Indeed, the Department of Surgery consistently highest quality research programs available in ranks in the top three academic institutions Toronto. Over 330 trainees have graduated worldwide in terms of number of publications each from our SSTP, two thirds of whom have year. This research work is focused on improving gone on to academic faculty positions. the outcome for the patients we treat, and has resulted in scores of improvements in patient care There are over 110 clinician scientists or non- that have become common practice worldwide. clinician scientists in the Department, who direct research programs across all research disciplines Research plays a central role in our Department and clinical areas. In addition, there are close to and our research activities are a distinguishing 150 clinician-investigators who include research characteristic of the Department of Surgery.

66 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 8. Research Report 67 Self-Study Report, External 2020 Review | Regenerative Medicine symposium was entitled, “Generative Medicine Solutions Human for Disease: The Where Going”. Where Are Now? Are We We Gordon Murray Lecturer was Allan Kirk, D. (David C. Sabiston, Professor Jr. and Chairman, Department Surgeryof Duke University Medicine; of School Based Orthopaedics, McMaster University, Hamilton, Ontario, Canada). His talk was entitled, Must Often Succeed, We Fail”. Professor“To Bhandari’s lecture was an inspiring account of his experiences as a successful academic surgeon. His central message was that should one be not discouraged failure—but by use these challenges as learning opportunities to drive success. Over 80 e-posters judged were oral and 10 presentations. Translational Research retreats organized were theby newly named Chair Translational of Research, Marc Dr. Jeschke. Translational The 1st Research Retreat was in held with March 2018 an excellent external invited speaker and an amazingly stimulating agenda. Translational Research retreats will continue to on be held a yearly basis. The April Retreat was 2019 also attended an by outstanding speaker. The Gallie theme was “Transplantation/ 2017 Day Regenerative The Transplantation Medicine”. and Research Institutes grow and continue to flourish a local,on national, and international scale was discussed. With continued success in publications, citations, funding, and patents, the Department of Surgery’s Strategic Plan prioritizes the sustained and expanded support the of SSTP and faculty Deanscientists. the of Faculty Young, Trevor Dr. Medicine,of the of spoke importance the of Department’s within work the Faculty Medicine’s of contribution to the Canadian medical landscape. commentedHe the on growth in clinical and research output during term Rutka’s as Dr. Chair. GallieThe 2016 theme Day was “Knowledge Translation (KT): Making Research The Matter”. symposium, “Knowledge Translation: The Next featured Ocean’” ‘Blue 4 exceptional speakers. KT represents an enormous opportunity “Blue or Ocean” academic for surgeons to link discovery with practical translation and real have hence impact. The Gordon Murray Lecturer wasMohit Dr. Bhandari (Canada Research Chair in Evidence- Department of Surgery, Faculty University of Medicine, of Toronto J. Rutka and A. Kirk, Gallie Day 2017 Day Gallie A. and Kirk, Rutka J. importance surgical of research as the foundation whichupon the Department and hospital-affiliated theme the of retreat was “The University-Hospital Collaborationin Fostering Excellence in Surgical Research: Better Alignment Better for The Results”. The second Research Strategic Planning Retreat inheld January was extremely 2016 successful. The participating throughout The theme the day. was “Embracingthe Continuum from Surgeon Scientist Trainee to Faculty Scientist”. The first StrategicPlanning retreat was held in January with staff 65 2015 over and residents Electronic posters introduced were the for poster sessions, which was extremely well received. Better? Opportunities, Challenges and Limitations Bigof Data in Health Clifford Research”. Dr. Ko from UCLA, was the Gordon Murray Lecturer. Dr. GeoffreyDr. C. Gurtner from StanfordUniversity. theIn Gallie 2015, theme Day was “Is Bigger in discoveries and leads to translation to practical clinical solutions. The Gordon Murray Lecturer was In 2014 we celebrated we the 40thIn 2014 Gallie The Day. theme was “Commercialization and Research”. Commercialization and innovationare driving forces to increase the breadthand depth our of work, ultimately improving the our for outcome patients. research activities will continue to expand, with investigation of avenues new being developed, and improvements in our research infrastructure There is in doubt no theupcoming years our to give perspectives and insights regarding training in science while a resident embarks a careeron as a surgeon scientist. SSTP residents plus stakeholders key is annuallyheld as an informative meeting intended as an informal discussion forum of issueskey related to research and research training in the Department Surgery. of A PGY 1 & PGY 2 Research Orientation A Town HallA Town meeting all of staff and

b) Murray Lecturer was Diane M.Simeone (Laura and Isaac Perlmutter Professor Surgery of and Pathology; Director, Pancreatic Cancer Center; Associate Director Translational of Research; Perlmutter Cancer Center; NYU Langone Health; NY). outstanding Her York, New talk, new “A paradigm clinical for trials in pancreatic cancer”, enlightened the audience the on hypothesis new around treatments surrounding pancreatic cancer. The Department Surgery of places tremendous emphasis the on research training its of surgical residents. the Under leadership Dr of Fehlings, a number innovative of resident-focused research initiatives been have initiated: a) Gallie Day 2019 Dr. Diane Simeone and Dr. James Rutka James Dr. and Simeone Diane Dr. 2019 Day Gallie symposium was entitled, in Cancer “Advances Research: From Cell to the The Clinic”. Gordon Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto Gallie Day 2019 Diane Simeone Lecture Simeone Diane 2019 Day Gallie of Surgeryof at The the University Toronto. of this year with two Translational Research oral presentations and several e-poster presentations. This theme cancer on year’s care from to bench bedside was a triumphant success. Our Gordon Murray Lecturer, symposium speakers and complete day complemented the brilliance the of Department path from graduate student to Chief and Professor. GallieThe 2019 theme Day was “Cancer Care: Advances in Cancer Research from Cell tothe TranslationalClinic”. Research was introduced Washington University Medicine, of School Barnes-Jewish Hospital, St. Louis, Missouri, magnificent Her USA), talk,celebration“A academicof surgery and the path to successful only not highlightedinnovation”, amazing her scientific but journey, us a gave glimpse herinto Pushing the Boundaries Surgical of The Care”. Gordon Murray Lecturer was Susan E. Mackinnon M. Shoenberg,(Sydney and Robert Jr. H. Shoenberg Professor, SurgeryChief, Plastic and Reconstructive Surgery, Department of Surgery, 2018 Gallie2018 theme Day was“Innovation: Pushing the Boundaries Surgical of Our Gordon Care”. Murray Lecturer, symposium speakers and complete day complemented the brilliance of the Department Surgery of at the University of The symposiumToronto. was entitled, “Innovation: One the of articles Kirk Dr. about was spoke “More surgeons must start doing basic science – They say time have incentive or they don’t to do research – and dangerous that’s translational for medicine”. Surgeon-in-Chief, Duke University Health System, Durham, His USA). NC lecture was entitled, “Co- stimulation blockade organ for transplantation”.

8. Research Report 8. Research Report 69 Self-Study Report, External 2020 Review | B. Langer and J. Langer and J. Langer B. Finally, the DepartmentSurgery of Faculty continue to distinguish themselves through the receipt of numerous prestigious international and national awards: The Order Canada of awards continue to be awarded to Surgical staff: Geoffrey Fernie, John Hagen, Johnston, Wayne Shaf Keshavjee, Laurence Klotz, Bernard Langer, Andres Lozano, Agostino Pierro, Rutka, James Charles T. Tator, John Trachtenberg, JamesBryceWaddell. Taylor, Bernard Langer and Charlesinducted were Tator into the Canadian Medical Hall Fame. of Several faculty been have made Fellows the of Royal Society Canada: of Eleftherios Diamandis, Peter Dirks, Michael Fehlings, G. Wolfgang Kuebler, Andres Lozano, Rutka, James Subodh T. Verma. With this report, is it clear that the Research Enterprise in the Department Surgery of continues to do extremely well, and is a continued source great of pride and accomplishment the for entire Department. Department of Surgery, Faculty University of Medicine, of Toronto $87,439,358

$74,832,070 $62,989,834 $93,553,660 $88,260,483 Annual SSTP Career Night the for SSTP successfully received grants invited were speakers as well as the Grants & Awards Editor, and Research and Business Manager. Development annually. TheWorkshop first was held in April SSTP2018. residents strongly were encouraged to attend these workshops. Staff who have new andnew continuing SSTP residents to meet each other and to interact with surgical staff. Many fundamental points are made including SSTP how residents should choose their supervisors and projects carefully. Funding salary for support is critical. how to besthow plan your fellowships, to how be successful looking when jobs, to for how maintain work-life balance, and more. trainees. The focus here to is plan how the next steps a combined of research and clinical practice career. Other items include covered An SSTP Meet and Greet evening the for An SSTP Grant Writing held is now Workshop

2018-19: 2015-16: 2016-17: 2017-18: impact research endeavours as enumerated below: 2014-15: In the past 5 years, the faculty in the Department of Surgery been have successful in receiving multiple millions dollars of a yearly on basis their for high e) d) c) Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

8. Research Report 9

BEST PRACTICE IN SURGERY

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 71 9BEST PRACTICE IN SURGERY

R. McLeod and J. Rutka, Lavina Lickley Lifetime Achievement Award

Prepared by Robin McLeod, MD, FRCSC, Vice Chair Quality and Best Practices

Best Practice in Surgery is the University of Surgery Strategic Plan which named Quality and Toronto (U of T), Department of Surgery’s Best Practices as a strategic pillar in 2012. The Best quality improvement program. Best Practice in Practice in Surgery program is based on the success Surgery provides resources for practicing and of and lessons learned from the Division of General in-training surgeons as well as other members of Surgery’s quality initiative, Best Practice in General the perioperative team. Best Practice in Surgery Surgery (BPIGS). Best Practice in Surgery is led aims to be a comprehensive repository for quality- by Dr. Robin McLeod, Vice Chair of Quality and related surgical initiatives, programs and research Best Practices, and includes representatives from that are undertaken at the University of Toronto all Divisions of Surgery as well as the Departments affiliated hospitals. Best Practice in Surgery was of Anaesthesia, Gynaecology as well as other created in response to the U of T Department of health professionals from the U of T hospitals.

72 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 9. Best Practice in Surgery 73 Self-Study Report, External 2020 Review | In 2008, the Best Practice in General Surgery group developed a guideline the on use Mechanical of PreparationBowel (MBP) prior to elective colorectal surgery. Our recommendations were simple: MBP no patients for having colorectal procedures with the exception patients of guideline patients for undergoing colorectal surgery was developed in a multidisciplinary by 2012 group general of surgeons, anaesthesiologists, nurses, dieticians and physiotherapists. With a grant from the Council Academic of Hospitals of Ontario, the ERAS guideline was implemented in fifteenhospitals as a in Ontario. In 2017, result our of successful implementation an of ERAS Guideline Elective for Colorectal Surgical Patients, the Best Practice in Surgery developed an ERAS All for Surgical Patients Guideline as well as Guidelines ERAS for Pancreatic for Surgery and ERAS patients for with a Stoma. Currently, the Best Practice in Surgery is undertaking a study to assess whether ERAS is sustained at the University Toronto of affiliated teaching hospitals. It is expected that this study will be completed in 2020. Mechanical Bowel Preparation patients. Other ongoing targeted implementation strategies include providing slides, educational rounds, newsletter blasts and audit feedback. Enhanced Recovery After Surgery The Enhanced Recovery After Surgery (ERAS) Department of Surgery, Faculty University of Medicine, of Toronto

and fellows so they can undertake or participate in quality initiatives trials evidence when is lacking care to optimize our patients’ experience Departments and Institutions to ensure patients highreceive quality multidisciplinary care and implementing clinical practice guidelines Measure ourperformance and outcomes Provide education to our residents Use this platform to perform clinical Encourage a person-centered approach to surgical Collaborate with stakeholders in hospitals, other Promote the use best-evidence of developing by form lanyards of all for frontline staff to assist in reducing the length fasting of elective for surgical patients to fast longer a much for period than is necessary. The Best Practice in Surgery has developed a guideline and reminder cards in the decades old, a recent survey practice of illustrated that almost all hospitals are still encouraging Preoperative Fasting Although the evidence supporting this guideline is adopted across all T hospitals U of and this guideline was published in the Canadian Journal Surgery. of acute pancreatitis was completed in 2012. Surgeons, critical care physicians and gastroenterologists collaborated. Guideline recommendations been have Management of Acute Pancreatitis A guideline with recommendations managing for brief overview the of clinical practice guidelines: Over the past 5 years, the Best Practice in Surgery has developed and implemented several locally tailored clinical practice guidelines. is Below a • • • • • Goals •

U of T affiliatedU of hospitals receive high quality, person-centered care resulting in optimal clinical and outcomes patient experience. Vision Statement ensurethat To all patients having surgery at the resolving the obstruction. A guideline is being developed in collaboration with radiologists. GI In addition to developing and implementing guidelines, the Best Practice in Surgery also oversaw the following quality improvement programs: considerable proportion is unnecessary. A guideline which standardizes preoperative management of anemia and the perioperative use red of blood cell transfusions elective for surgery in order to reduce the use unnecessary of red blood cell transfusions was developed. Implementation strategies are being now developed. Management of Small Bowel Obstruction Small obstructions bowel are (SBOs) the of one most common indications for hospitalization. there is greatHowever, variability in the management SBOs. of While most are adhesive in nature and can be managed conservatively, delays in care can result in ischemia, bowel sepsis, and mortality. The ideal approach to patients such involves identifying the right patients the for right treatment early on. There is evidence that the use Gastrografin of can be used identifyto the site the of obstruction and potentially in help surgical residents and nurses represented who the hospitals; leaders Central from the Toronto LHIN; community nurses and patient advisors. At this meeting, the guideline recommendations were discussed and finalized and an implementation strategy developed and provided input a on knowledge translation strategy to implement the guideline. The guideline has been recently submitted publicationfor in the Canadian Journal Pain. of Blood Conservation bloodRed cell transfusions been have identified as an overused treatment. The need judicious for restrictive use red of blood cell transfusions to improve patient outcomes, enhance post-operative limitrecovery, healthcare costs, and optimize the use limited of resources, has been highlighted theby Choosing Wisely Campaign. Despite these recommendations evidence and level-1 supporting a restrictive approach to red blood cell transfusions, transfusion vary practices significantly. While transfusions are necessary in some cases, a Self-Study Report, External 2020 Review | Staphylococcus aureus decolonization Antibiotic use, type, duration and dose Perioperative normothermia Preoperative skin preparation and hair removal Department of Surgery, Faculty University of Medicine, of Toronto for thefor management care of surgical of wounds. a meeting 2018 On May was 16, which held included the members the of working group; surgeons, nurses, Central members the of Toronto LHIN as well as community care nurses. An evidentiary search was performed there but was limited evidence available this on The topic. working group came to consensus the on recommendations Surgical Care Wound In collaboration Central with the Toronto LHIN, a guideline the on postoperative management of surgical wounds has been completed. The working group consisted surgeons of from a variety of disciplines from the T hospitals, U of wound care of Anaesthesia.of A survey current of prescribing habits opioids has for been completed. A systematic review has been undertaken and guideline recommendations are being developed. In response epidemic, to the opioid the Best Practice in Surgery is undertaking the development a guidelineof to reduce help the amount opioids prescribed after surgery. This is being developed in conjunction with members the of Department • Management and Prescription of Opioids for Patients after Elective Surgery all patients undergoing elective surgery. The guideline provides recommendations on: • • • Surgical Site Infection (SSI) Prevention the Best Practice inIn 2017, Surgery in collaboration with the Antimicrobial Stewardship developed a guideline SSIs to prevent help for successfulin changing practice. This guideline was revised because in evidence new of 2017 supporting the use both of oral and intravenous antibiotics in patients having preparation. a bowel having anterior a low resection (LAR). These recommendations were implemented city-wide using a knowledge translations strategy, which was

9. Best Practice in Surgery 9. Best Practice in Surgery 75 . On Self-Study Report, External 2020 Review | bestpracticeinsurgery.ca the website and an have we average 3,000 of unique visitors per month. The Best Practice in Surgery hasnow an app available in both the Google Play Store and Store. Apple These apps are meant to be used healthcare by professionals at point care. of The 2017-18 academic year also sawThe the 2017-18 launch pilot a of surgery QI course T surgical of U for fellows. The course includeda total 8 fellows from different specialties. course The was tailored to better consider clinical of the level maturity of the participants and allow a more self-directed for learning approach.This pilot waswell received theby fellows certainly but an experience with lessons to learn. forward look We to building on and learning fromthis experience to expand and improve the course the for upcoming academic year. Expanding our Scope expand our scope andTo reach, the Best Practice in Surgery has developed a website and as app, well as started we account. In a Twitter September 2017, launched our website, the provide site, we access to all our of guidelines and associated implementation tools. The Best Practice in Surgery newsletters and publications are also easily accessible. Since our launch, 300 over signedpeople have our for up newsletter through Department of Surgery, Faculty University of Medicine, of Toronto Ontario Surgical Quality Conference Erin where Dr. event Kennedy gave a talk theon value patient of involvement meeting. Two representativesmeeting. told their Two stories about their post-operative wound care. All three participated in the discussion and provided the patient perspective. were involved in involved were grant the IMPACTS participated in Health Quality Ontario’s attended the Surgical Care Guideline Wound thanks go to our faculty mentors their for time, our judges, and the staff at Department the of Surgery without which this would be not possible. inoculate in our trainees a commitment to QI and encourage and those empower an have who interest in research to pursue it. As always, many a mature understanding of level challenges of and process. is It our that hope this experience will working and collaborating with colleagues towards a shared goal. Despite trainees being in their first year training, of projects completed demonstrated implementation equally but the on “learning by experience” that occurs in the process formulating of an aims statement, qualitative data collection and a QI projecta QI andwork do some field and data collection with the and help supervision mentors. of The course does focus not solely successful on seminars starting in October the of academic year and in between trainees are expected to develop largest cohort thus far. A total thirteen of teams/ small groups, which supervised were a faculty by The coursementor. consists two of interactive Education for Surgical Trainees The Surgery CurriculumQI has completed now its third year and sixty-four involved residents, its continue to provide input all on guidelines and their implementation. The members the of patient group • • • to be part an of advisory group the for Best Practice in Surgery. This year the patient advisors: The overall goal was to understand patients experience and identify gaps in care. Following these meetings, most the of patient advisors agreed During academic three held year, we the 2016-17 patient engagement meetings which included patients, surgeons, and other health care providers. Patient Experience Advisory Committee

Measure and evaluate quality initiatives Improve the quality patient of care and Incorporate research and evaluation in Establish the Department Surgery of as in quality improvement experience through the guidelines of development and patient experiences a leader in quality improvement the quality improvement framework Expand opportunities education for

current barriers that exist in the current clinical trial paradigm using approaches to research novel methodology and technology. IMPACTS incorporates several innovations as platform trials, response-adaptive randomization, and an integrated- High-quality randomized clinical trials provide the stimulus quality for improvement and are critical for the generation best of practices in surgery. However, despite their profound impact patient on care there remains a scarcity these of studies. While this is well recognized, the considerable time commitment and prerequisite research infrastructure are significant challenges to their design and execution. The paucity high-quality of clinical trials to guide help surgical and perioperative care has led to substantial healthcare practice variability and inefficiency. The Innovative, Multicentre, Patient-centred Approach to Clinical Trials in Surgery (IMPACTS) program was established with the purpose of conducting patient-important and pragmatic clinical trials more efficiently by addressingthe 5. Grant IMPACTS New Ongoing Initiatives and Departmentof Surgery’s 2018-2023 Strategic Plan This year, the T Department U of of Surgery released its 2018-2023 Strategic Plan: Aspire, Advance, Achieve. As part theof plan, the Best Practice in Surgery 5 goalsset out the for next 5 years. 1. 2. 3. 4. Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto Over the past 5 years, the Best Practice in Surgery has peer-reviewed published 10 over journal articles relating to quality improvement in surgery. at local and national meetings including the Ontario Surgical Quality Conference hosted Healthby Quality Ontario; Perioperative Care Congress; Canadian Anesthesia Society; and the Canadian Surgery Forum. globe and its content has gained approximately 20,000 impressions views) since (or January 2018. forget to tweet to usDon’t @UofTBPS and to use the #UofTBestPractice hashtag to label your tweets! also have beenWe invited to present work out collaboration towards quality improvement. Dhruvin Hirpara, our social media manager and second year surgical resident at UofT, has been spearheading this effort.Since its launch, the account has accrued nearly 200 followers from around the In 2018, we launched we In the 2018, Best Practice in Surgery pageTwitter (@UofTBPS), as a platform for instant communication, dissemination, and global

9. Best Practice in Surgery 9. Best Practice in Surgery 77 Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

audit practice to assess update the of guidelines. recommendations. The goal this of collaboration is to determine if there are gaps in care, address these gaps with evidence-based guidelines and then affiliated hospitals which participate inNSQIP. This is expanding will so we collect data through NSQIP to assess uptake guideline of NSQIP continue to collaborateWe with theT U of database high of impact issues that exist currently in the surgical community and patient care. IMPACTS isIMPACTS currently collecting data areas on of perioperative and surgical practice heterogeneity and clinical uncertainty in order to create a increased patient accrual, optimizedthus efficiency, reducing the time to achieve meaningful results. consent model. These methods will allow for Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

9. Best Practice in Surgery 10

FACULTY DEVELOPMENT

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 79 10FACULTY DEVELOPMENT

Continuing appointment review of Dr Jeff Wilson: N. Ahmed, J. Spears, J. Wilson, M. Fehlings, O. Rotstein

Ori Rotstein

The engagement and valued recognition of faculty members was identified as a priority strategic direction. This encompasses the development of a culture in which all faculty have equitable and equal access to achieve their academic potentials. Faculty development initiatives are overseen by Vice Chair Dr. Ori Rotstein. Mentorship

Chair support of a surgery-specific mentoring of Faculty Development in which mentors and program has allowed for the selection of a career- mentees received hands-on skills training for specific mentor in addition to the academic mentor mediating effective mentoring relationships. specified in the Memorandums of Agreement, The Vice Chair and mentoring committee have for the inclusion of this mentor in the MOA, completed the program’s official infrastructure, and for the design of a new clause altogether. It mentor-mentee pairings, and the development has also granted four sessions with the Centre of mechanisms for monitoring the relationships

80 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 10. Faculty Development 81 Self-Study Report, External 2020 Review | Wellness The issue physician of burnout has to come the forefront the of medical career in recent years. the academicHowever, research is lacking with respect to surgeon-specificburnout factors, particularly thoseCanadian of surgeons. Chair support and a select committeeallowed have for significant effortsinto wellbeing the of Department faculty members. These include a complete literature scan to evaluate the current landscape physician/ of surgeon stress and risk factors and a comprehensive faculty-wide survey to evaluate career stressors and satisfaction. Following its interpretation, the Chair and committee established have a partnership with qualitative researchers from the Li Ka Shing Knowledge Institute (St. Michael’s Hospital) who will be conducting focus groups and individual interviews to gain full scope into the issues affectingToronto surgeons, wellas as assisting with the interventional of development strategies. the Department of Surgery, Faculty University of Medicine, of Toronto . Faculty members can now

on workshopson in the upcoming academic year. (A St.(A Michael’s Hospital, Li Ka Shing Knowledge Institute, University and Ryerson collaborative) to execute guest speakers, learning sessions, and hands- allowed newly for forged relationships with the Faculty Engineering of and the Biomedical Zone in accordance with a set newly of developed benchmarks that consider the natural lifecycle productof Chair development. support has also within the Surgeon-Investigator track entitled Surgeon-Entrepreneur reach promotion through their innovative pursuits work, yet withoutwork, yet formal recognition from an academic career standpoint. As such, Chair support has allowed the for creation appointment a new of members been have successful with acquiring patents and intellectual property rights their over surgical demands recognition those of incorporating bioengineering, technology,and entrepreneurial activities into their career paths. Many faculty Innovation The changing landscape medical of collaboratives expectation that the Department may be able to utilize the data from its evaluations to contribute to the academic literature surgical on mentoring. throughoutthe is year. It the Strategic Plan’s Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

10. Faculty Development 11

CONTINUING PROFESSIONAL DEVELOPMENT

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 83 CONTINUING PROFESSIONAL 11DEVELOPMENT

Prepared by Dr. Ralph George MD, FRCSC, Director, CPD

• CPD programing for community • These goals are to be met incorporating up-to- surgical specialists. date adult learning principles and best practices. • Professional/academic development • In working to these goals, we partner with for university surgical specialists. the broader UofT Faculty of Medicine CPD • International events to encourage partnerships, as both provider and accreditor, as well knowledge exchange, and sharing experience. collaborating in scholarship and research.

84 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 11. Continuing Professional Development 85 Self-Study Report, External 2020 Review | professional shared event development with anesthesiology. Emphasis includes procedural based teaching/feedback and adapting to competingthe new based environment. CPD director to complete 6 months of certificateprogram in CPD Leadership. inrole the broader Faculty Medicine of CPD program; participating in the assessment of all surgery-led events, contributing to multi and cross discipline events and academic professional development programs. that include community-based specialists are required now to that have demographic represented their on planning committees. of needs assessment and participant linkedfeedback accreditation. to expected to incorporate elements adult of learning assessment). discussion, reflection, (feedback, Added in past years is an academic focused Department Chair funds supportedsurgical The Department Surgery of plays an active All surgical programs with a target audience All programs enhanced have requirements largeEven auditorium-based programsare • Summary CPD is a major commitment the for Department Surgery.of has It a funded Director appointed by the Chair. Quality programs target community specialists as well as academic faculty development. The Department Surgery of actively participates and contributes to the overall Faculty Medicine of CPD program. That strong connection provides additional and shared expertise and academic oversight our for events and scholarly endeavors. Other Activities Other • • • • • Department of Surgery, Faculty University of Medicine, of Toronto

events skill lab/hands-on training in last year. Department Surgery of members as Course Director. Fluctuation as some events are 24 every 2 years 29 events (i.e. 2017-2018/ events last = 51 2 years). events 2018-2019 Over 3000 registrants in last year alone. 5 25 events per year average on led by to surgical and QI morbidity rounds. safety technology “Black (developed box” Grantcharov’s group, UofT) Teodor Dr. by DeMontbrun – simulation/assessment research). Exciting research new is linking the OR Surgery; including Ivan Silver the Innovation 2018 (Dr.Award Shady Ashamalla – Transanal TME) and the David Fear Fellowship (Dr. Sandra University wide faculty CPD awards been have captured members by the of Department of the Toronto Internationalthe Toronto Sarcoma Conference, and the biannual Breast Cancer Symposium. event inevent Canada. International meetings include BETHUNE in Global Table Round Surgery (with strong underdeveloped nation representation), Ultrasound. A large as such event the Annual Update in General Surgery draws 500 participants and remains the largest General Surgery specific Highlights in the past years few included have the initiation technical of workshops in Transanal TME, Breast Oncoplastics, and Endobronchial

•

2015-2019 • Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

11. Continuing Professional Development 12

GLOBAL SURGERY

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 87 12GLOBAL SURGERY

Henry Marsh Global Surgery Symposium 2016

Report prepared by Andrew Howard, MD, FRCSC, Director Office of International Surgery

The Lancet Commission on Global Health estimates surgical educators, the Department of Surgery is that 5 billion people from low- and middle-income well-positioned to contribute to surgical capacity- countries lack access to safe and affordable surgical building in disadvantaged regions. Through the care. As a result, surgically treatable conditions such support of the McLaughlin Chair and executive as postpartum hemorrhages and burns become life oversight of Drs. Avery Nathens, Andrew Howard sentences; individuals are no longer productive and Lee Errett, the Department of Surgery members of society or perish from unnecessary has significantly increased its commitment to complications. With a robust and talented cadre of international outreach over the past five years.

88 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 12. Global Surgery 89

Self-Study Report, External 2020 Review | in Global Surgery As Lee Dr. spring of Errett is the 2019, (C/S) inaugural George R. Swan Chair in Global Surgery. This position endowed will support sustainable surgical care solutions and learning opportunities in Nunavut, China, Jamaica, and Ukraine. Balogun (Nigeria), Faith (Zimbabwe), Muchemwa ZerfuTewodrus (Ethiopia), Grace Muthoni (Kenya), Geletaw (Ethiopia), Tessema Hanna Getachew (Ethiopia), and Misgana (Ethopia). Workneh Greg Wilkins-Barrick Chair in Global Surgery MarkDr. Bernstein (N/S, TWH) is the inaugural Greg Wilkins-Barrick Chair in Global Surgery, an position endowed that provides salary support internationalfor surgical trainees and learning opportunities in resource-depleted regions. Since 2014, BernsteinDr. has served as mentor and supervisor to trainees from Egypt, Cambodia, Sudan, Kenya, and Indonesia. has He also facilitated the establishment of neurosurgerya new unit at Kiambu District Hospital, supported fellow Anick Dr. Nater in performing outcomes research in Zambia, as well as assisting with travel costs medical for trainees teaching on missions. George R. Swan Chair Career Designation The Chairholder implemented the new appointment Surgeon of role - Global Health This in 2016. career designation allows individuals to reach promotion theon basis leadership of innovation and/or in clinical and academic capacity-building activities andin middle-income low- countries. Endowed Support Prakash Foundation Fellowships The Chairholder and Advancement Office beenhave fortunate to cultivate long-term support donor from A.K. Prakash. The funds surgical aid 1-2 fellows from and middle-income low- countries in receiving training teaching hospitals. Toronto’s of at one Over the pastyears five the Prakash Foundation has Drs. welcomed Samuel Hailu (Ethiopia), James Department of Surgery, Faculty University of Medicine, of Toronto

led to a measurable increase in evidence-based medical knowledge as demonstrated testby scores. (McMaster University), Howard Dr. also oversees interactive learning modules and a journal club thefor COSECSA trainees. These activities have a paediatric orthopaedic surgery curriculum. In conjunction with collaborators Royal College Surgeonsof Ireland of and Brian Dr. Cameron Dr. AndrewDr. Howard serves as the overseas examiner thefor COSECSA orthopaedics examinations. hasHe also traveled to Addis Ababa to implement COSECSA Partnership Health Organization. The largest concentration of users are trainees from the College Surgeons of of East, Central, and Southern Africa (COSECSA). approximately 700 practicing surgeons and in low- middle-income countries as specifiedWorld by the Ptolemy Project Since 2000, the Ptolemy Project offers full text downloads all of libraries University Toronto of to Surgery Africa in activities include the oversight surgical of initiatives in Africa, Prakash Foundation Fellowships, events, and teaching missions. Andrew With Howard Dr. Howard in 1999. serving as current Director, the Department Surgeryof continues to support the OIS. Core The Office ofInternational Surgery(OIS) was established Drs. by Massey Beveridge and OfficeInternational of Surgery Global Surgery logo ). surgery.utoronto.ca/global-surgery For a completeFor overview the of international faculty of work members and trainees, please refer to the prospectus and business case ( Faculty and Trainee Involvement Global Surgical Scholar Program The Department has established a partnership with the Global Health Education Initiative program, overseen the by University’s postgraduate medical education division. Known as the Global Surgical Scholar Program, the partnership supports Department learners in a two-year certificateprogram consisting of formal mentorship from a globally-involved faculty member and an evidence-based curriculum surrounding global health program development. Faculty Resident and Involvement Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto activities, combining the Department’s vision of sustainable capacity-building with stakeholder opportunities and performance key indicators. Investment the Under supervision the of Chair, Nathens,Dr. and Howard,Dr. a business case investment for in global surgery has been developed. The document serves as a comprehensive blueprint all for international piece for advancement for piece efforts well.as The Department will release newly updated version in the upcoming academic year. The Academic Case for Global Surgery Abroad This prospectus highlights the important work undertaken faculty by members in disadvantaged regions around the serves world. It only not as a showcase achievements, of as but a valuable poster displays, and networking opportunities. Publications country from as moved it city to Chair city. support was essential in in Bethune Global Table Round Surgery the of Trainee. The Role Toronto 2018: hosted 250 global participants from June at 5-7 College Hospital andWomen’s provided an exciting trainee of weekend presentations, breakoutgroups, Bethune Table Round anThe Bethune annual Table, Round meeting initiated by University is instrumental of Toronto, in fostering global surgery awareness across the Hospital, Andrew Dr. London), Leather (King’s College Brian Dr. London), Cameron (McMaster University), and Richard Dr. Gardner (CURE Ethiopia). Faculty and trainees also present their on internationalefforts lead and engaging discussion. Annual Symposia The annual Global Surgery Symposium is entering its fifthyear; well-received a initiative spearheaded the by Chair Keynote in 2015. speakers includedhave Henry Dr. Marsh (St. Georges Events

12. Global Surgery 13

SURGICAL SKILLS CENTRE

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 91 13SURGICAL SKILLS CENTRE

Surgical Skills Centre

Prepared by Oleg Safir, Director. Lisa Satterthwaite, Manager, Surgical Skills Centre Mount Sinai

Hospital, Department of Surgery, University of Toronto

The University of Toronto Surgical Skills Centre Since 2014 we have hosted, in conjunction (SSC) at Mount Sinai Hospital is a unique with Mount Sinai Hospital the annual Pair educational institute offering exceptional programs and Share event. This program reflects the for surgical, medical, industry and affiliate interprofessional working and leadership groups within Toronto and extending globally connections within the hospital and its staff. In to international attendees. Since 2012 and under 2014 the program was awarded the Platinum the continued direction of Dr. Oleg Safir, D.H. Level Quality Healthcare Workplace Award. Gales Director, the lab has continued to expand its offerings and as a result established itself as a In July 2014 the inaugural Prepatory Camp was world leader in medical education curricula. initiated. This two-week all-day program engages the new incoming PGY 1 surgical residents (N = Over the past 5 years there have been 68) to basic topics within surgical residency training several milestones met of exemplary value needs such as instrument identification, knot within the Surgical Skills Centre. tying and chest tube insertion to name but a few.

92 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 13. Surgical Skills Centre 93

”. )”. de )”. Establishing Self-Study Report, External 2020 Review | Implementing and evaluating July 2016 - Volume 264 - Issue - Volume 1 - p 1–6.July 2016 Research is a fundamental our of component vision and mission statements which for support we all requests.resident In very were September we to proud 2018 be with honored the Association Medical of Education in Europe (AMEE) ASPIRE Award Simulation.for The award was presented at the annual meeting in Helsinki, Finland. A major achievement the for SSC took place in August with 2018 the publication our of book Satterthwaite, Adam Dubrowski Cureus (): doi: e. Journal theof American10.7759/Cureus. College Surgeons,of deMontbrun September 2014, S., Satterthwaite L., “ Grantcharov T., Passing Scores Technical for Performance in Surgery: Lessons Learned From a 10- ExperienceYear of Resident Assessment Issue and Supplement, Page 3, S122 219, Volume the Annals Surgery of “de July Montbrun, 2016 Sandra L.; Roberts, Patricia L.; Lowry, Ann “ More C.; a national certification technical skills exam: The Colorectal Objective Structured Assessment of Technical Skill (COSATS Montbrun, Sandra L.; Roberts, Patricia L.; Lowry, Ann Burnstein, Ault, C.; Glenn T.; Marcus J.; Cataldo, Dozois, A.; Peter Eric Dunn, J.; Gary D.; Fleshman, James; Isenberg, Gerald Mahmoud, A.; Najjia Reznick, N.; Richard Satterthwaite, K.; Lisa; Schoetz, David Jr; Trudel, Judith L.; Weiss, MacRae, Steven Helen. D.; Eric Wexner, G.; A . Department of Surgery, Faculty University of Medicine, of Toronto Darius Bagli, Rakan Odeh, Frank Penna, Ethan Grober, Nicolas Fernandez, Armando Lorenzo, Lisa Practice Platform Systematic for Development of Micro-Surgical Instrument Technique of researchof supported have projects. several We important journal submissions that include: Bagli D, Odeh et al R, Penna(Lisa F, Satterthwaite). (N/A) The program is in its year 10th delivery. of Our 5-year journey continues with a wide variety faculty. The Toronto Orthopaedicfaculty. The Toronto Boot Camp (TOBC) directly follows PREP camp with a 2-week intensive course orthopaedic for residents. residents to focus surgical on approaches specific to their program and are supported divisional by camps” are supported the summer over months to include Plastics, General Surgery, Neuro, Urology and Vascular. These surgical programs allow enhance the resident education experience. Along with PREP camp divisional specific “boot offering retraining for any skill deficiencies noted from Phase I assessments. PREP camp continues to date with annual appraisals and reviews to PREP camp with a Phase II each component fall as a continuation Phase of focus I but more on skillscomplex engaging faculty educators as well as as well as residents from the Northern Ontario Medicine of School continue (NOSM). We include the Department Oral of and Maxillofacial Surgery, Department Obstetrics of and Gynecology, Department Otolaryngology of Head and Neck All results are reviewed with residents and reported to Program Directors inclusion for within portfolios. Residents from come all surgical disciplines also but Assessment Technical of Skills Exam in (OSATS) which all residents must obtain a pass mark 80%. of consistent feedback and assessments which include a multiple-choice exam and anObjective Structured learning. The program follows the Royal College Physiciansof and Surgeons Competence Design by plan(CBD) and therefore embraces the attitudes of educators, industry leaders, various departments and faculty in order to enrich the programwith an interprofessional approach to teaching and hands technical on skillstraining and competition events. Our residents as educators arethe primary leaders the of program also but included are nurse The session includes didactic lectures along with

Self-Study Report, External 2020 Review | uoftssc.com for more information simsinaicentre.com Department of Surgery, Faculty University of Medicine, of Toronto on programson as well as annual reports. with 300 over programs. Ourdedicated long- time staffcontribute to this success look we and forward to many more successful years ahead. Please feel free to visit our websites and The SSC has been active with surgical and medical education 20 years over for celebrating its 20th anniversary host inSeptember We 2018. annually 10,000 turnstile over learners along and supports the SimSinai Centre which focuses humanon patient simulation training, Advanced Cardiac Life Support and BLS certification and research. The SimSinai Centre utilizes high fidelity mannequins to delivery programs team for training and communications in a variety settings. of College Surgeons of Since 2009 (ACS). the SSC has remained in good standing with and the ACS continues to be with involved all aspects the of Accredited Education Institutes (AEIs) committees and congress meetings. The SSC also manages book has been favorably reviewed and continues with a large global distribution profile. In the fall the SSC in 2018, of conjunction with the Mount Sinai Hospital SimSinai Centre underwent its fourth accreditation with American plethora authors of ranging from practical common-sense approaches to the Feasibility and Management skills of labs to the Future of Medical Education: Simulation-Based Assessment in a Competency Design by Curriculum. The entitled, “Boot Camp Approach to Surgical The book encompassesEducation”. 20 years knowledgeof in surgical education from a

13. Surgical Skills Centre 14

SPINE PROGRAM

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 95 14SPINE PROGRAM

Michael G. Fehlings and Albert Yee, Co-Directors, Spine Program

the Toronto Academic Health Sciences Network Executive Summary (TAHSN), particularly the three main adult hospitals: University Health Network- Toronto The University of Toronto (U of T) has a long- Western Hospital (UHN-TWH); Sunnybrook standing impact in education, research and clinical Health Sciences Centre (SHSC); and St. Michaels management related to spinal disorders. To reflect Hospital (SMH), as well as the Pediatric hospital this impact and in response to an external review The Hospital for Sick Children (SickKids). in 2007 the U of T Department of Surgery Spine Globally, the program has been strengthening Program was established in 2009. This occurred robust relationships with high profile spine thanks to the strong support of the Department of research societies and spine health networks. Surgery, and the two divisions of Neurosurgery and Orthopaedic Surgery. The program has since Driven by its vision of “Innovation, and excellence evolved into an internationally recognized entity in the delivery of spine care with a unique enhancing clinical care, research, and education. collaborative program of clinical expertise, research, Since its inception, the program has focused on teaching, and education”, the program continues collaboration, innovation, education, teaching, to provide a productive framework for city- and research and acted as an important academic wide collaboration in clinical activity, research, platform integrating spinal surgery units and fellow and resident education, advocacy, strategic research programs across the affiliated hospitals in planning, adopting of robust academic calendar

96 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 14. Spine Program 97

], in fellow based the upon Self-Study Report, External 2020 Review | /observership opportunities spine fellowship training fellowship spine rotation surgery.utoronto.ca/sites/default/files/ national training competencies. Additional offering of selective alsohave been facilitated toincoming fellows the lastover 4 years with some fellows choosing to pursue this added educational offering. all the world. Over over 200 fellows been have trained the past over 20 years. in Toronto In addition to the one-year core clinical fellowship our program offersopportunity for training in clinical, translational and basic researchas well as enriched training in a number clinical of subspecialty areas including cervical, complex intradural pathology, oncology, minimally invasive surgery, deformity, pediatric spine and trauma. based a publication on core on In 2017/18, competencies for Canada [ CSS%20Spine%20Fellowship%20Curriculum.pdf adopted have we a more formal curriculum-based approach to the education our of fellows. This opportunity builds competencies upon that may be acquired during a general firstfellowship year, followed a second year by catered to advanced/ focused cognitive and procedural competencies. TheIn program 2015 has established a surgical case-log program integrated multidisciplinary program combines outstanding expertise in Orthopaedic surgery and Neurosurgery with non-operative disciplines drawn from a broad spectrum specialties of from Paediatrics, to adult trauma, spine deformity, spine MIS oncology, surgery, chronic pain, cervical,complex to intradural complex spine pathology. A focussed spine curriculum has been developed to guide training in “general” spine surgery and in a variety focused of subspecialty disciplines. An on-line registry has been developed to cases log completed the by fellows which assists in tracking the case experience. Fellowship The T Spine U of Program offersone-year comprehensive core fellowship training to fellows from Canada and overseas. Each year the Program trains fellows to 15 12 joining our program from Department of Surgery, Faculty University of Medicine, of Toronto

and adult spine surgery. Our comprehensive and research, and excellence educational of programs. Our unit has trained 200 over fellows from around the with world major focus in pediatric complex The T Spine U of Program is the of one world’s largest spine units and is widely respected a high for clinical of level care delivery, translational volume of broad variety relevant of research disciplines. Education engineering, laboratory medicine and pathobiology, injury prevention, pain management, and a paediatric surgery, radiation oncology, radiology, chiropractic, physical and occupational therapy, nursing, physiology, Biomaterial and biomedical areas interest of spanning the continuum from tobench bedside, to community, including not only neurosurgery, orthopaedic surgery also but and educators focused disorders on the of spine and spinal cord. The Program’s uniqueness draws from about 30 interdisciplinary faculty with The Program brings together a broad interdisciplinary array clinicians, of researchers with the support the of Program Council and the two committees education of and research. Professors Michael Fehlings (Neurosurgery) and Albert (Orthopaedic Surgery). Yee The program collegially forward moves initiatives of T Departmentof Surgery of as an integrated program under the two divisions Neurosurgery of and Orthopaedic Surgery and Co-Directed by The Spine Program is co-governed the by U Governance course, a Traumatic Spinal Cord Injury Course as well as a number subspecialty of spine symposia. at the fellowship and residency with level courses on surgical skills, a joint orthopaedic and neurosurgical Royal College Oral Mock examination preparation a key Knowledgea key Translational Research Day “SpineFEST”, Research Update meetings, and Journal Clubs. The program also provides training of eventsof including Visiting Professorship series,

] has Drs Traumatic Co-Chaired Drs by (UHN-Toronto Rehab). (UHN-Toronto Professor Fehlings (Mount Sinai Hospital- surgery.utoronto.ca/spinefest [ Karl Zabjek and included T spine U of fellows city-wide Spine fellows Journal (CME accredited) are every held year. key annual knowledge translation day advances from across the citywide hospitals. SpineFEST isvibrant a academic platform for the spinal community disseminating scientific knowledge translation and advances in spine surgery as well as research. The course is CME accredited and has been nominated several times research fostering awareness the of breadth of fundamental and translational spine research being conducted at Spine University Toronto of Program. The meeting is Co-Chaired by Carlo Ammendolia MSH) and the programIn 2017 initiated an Annual Spinal Cord Injury Course Fehlings and Sukhvinder Kalsi-Ryan. The course trains fellows and senior residents traumatic on andSCI management, clinical trials, trauma room management and classificationof disease severity. The course covers information related to disease and pathology, epidemiology, fracture classification and severityof injury classification. Our “SpineFEST” annualmarked its 11th this year. Co-Chaired by Professors Fehlings the represents Day and Yee, collaborative, innovative and cutting-edge and was co-chaired by and Yee assumedwho educator a key in role presenting cases, leading discussions, and quizzing residents severalon Royal College format cases. Several Club These are Co-Chaired Drs by Fehlings and with participationYee from city-wide surgeons and discussions lead our by spine fellows. The Journal Club discusses hot-off-thepress articles and systematic reviews with controversial issues supported with local case examples. a year the ProgramTwice continuesto organize a research update meeting bringing together scientists, clinicians, nurses, research coordinators, and trainees including fellows, residents, Surgeon Scientist Training Program (SSTP) trainees, postdoctoral fellows, graduate students and under graduate medical students to present current

Self-Study Report, External 2020 Review | Dr. StephenDr. annual courses, for senior for residents. Annual Fellow Surgical has anniversary marked its 11th this -TWH, the-TWH, Department of Surgery, Faculty University of Medicine, of Toronto of Physicianof and Surgeons Canada of (RCPSC) Mock Oral Prep Course The course marked its 5th anniversary this year Dr. ScottDr. Paquette UBC. of The course was focused case-based on discussions and included an intensive exposure to spinal navigation systems. theIn program 2015, initiated its joint city-wide Orthopaedics & Neurosurgery Royal College Canadian Spine Society Annual 19th Scientific Conference in Spring this year, a national surgical skills satellite course was organized Drs. by Eric Massicotte (TWH), Jeff Wilson(SMH), and Jeremie Larouche (SHSC) in collaboration with have beenhave organized Eric Dr. by Massicotte. On a national our level, program continued to engage in the training the of wider community residents,of fellows and staff. As the Program hosted the national spinal community at the in clinics and research. Chaired by Lewis Skill Course year. The Program has also several held hands- courseson residents for the years over which The T Spine U of Program offersmultiple educational opportunities fellows for and residents. The Program organizes several research update meetings, and journal clubs as continues it to foster excellence education of SpineFest 2019 SpineFest Educational Activities

14. Spine Program 14. Spine Program 99 McGill Capetown UCLH Cincinnati Kentucy Chandler BC Switzerland BC Texas Jikei Alberta Thomas Jefferson BC Brown Budapest Anderson-TX BC Milan Cornell (Baltimore) K2M Montreal Tong Jiao Self-Study Report, External 2020 Review | Fackson Mwale Fackson Robert Dunn Choi David Crawford Alwin Alexander Rabchevsky Charles Fisher Mauro Alini Thomas Oxland Charles Johnston Satoshi Tani Greg Kawchuk Greg Ashwini Sharan Marcel Dvorak Ziya Gokaslan Varga Peter Laurence Rhines Charles Fisher Stefano Boriani Mark Bilsky Kostuik John ParentStefan Liang Yu VISITING PROFESSORSHIP VISITING Clinical Trials & Research Studies is being a year once held to connect trialists, 2015 Feb Nov 2014 2014 April Oct 2013 2013 Apr Nov 2012 May 2012 2011 Sep Oct 2010 2009 Oct 2019 Feb May 2018 2018 Feb 2017 Sep May 2016 2016 April Nov 2015 Oct 2015 VERTEX, in acute traumatic VX-210 cervical spinal cord injury; and the successfully completed Lumbar Spinal Stenosis In Study). this respect, a citywide Night fellows and residents, nurses and research managers thoracic acute spinal cord Injury; surgery EPOSO, versus radiotherapy in metastatic disease the of spine; List visiting of professor and keynote speakers below: ,

chaired Botterell Botterell , and the organized Department of Surgery, Faculty University of Medicine, of Toronto The Keith Drs. Yee andDrs. Yee and . Other symposia by Dr. Yee by Dr. to refinecommunication chaired U of T-GTA Spine RoundsU of T-GTA , and the newly initiated Professionalism Rounds co-organized by by co-organized

, collaborates with the T Division of U of the biennial China-UofT MSK/

Dr. Finkelstein Dr. Dr. Fehlings the neuro-spinal scaffold in treatmentof AIS A clinical trials in progress recently or completed across our city-wide clinical research units (RISCIS, Riluzole in Spinal Cord Injury Study; INSPIRE, hub to fosterhub collaborative efforts multi-centrein clinical trials and to improve data sharing between the research institutes. There arenumber a of Clinical Care and Research Perspectives Research and Care Clinical Our Program is evolving as a translational research by and interview skills residents of and fellows. include Spine Symposium recently revived Symposium in Neurosurgery Professorship Symposium Program, through the leadership of Dr. Fehlings Neurosurgery to host spine speakers at the Sunnybrook-Toronto Rehab VisitingSunnybrook-Toronto Professorship Kalsi–Ryan. Periodically, the U of T Spine symposia, special lectures and rounds including SCI Symposia –Turnbull The Tator by In addition, the Program facilitates several associated with the a CME accredited rounds organized Joel Dr. by Finkelstein Sunnybrook of Health Sciences Centre. to collaborate with the multiple hospitals and research units to undertake across Toronto a quarterly hospital-based professorship series Program and Development Coordination. Over the past years, the program hasbeen fortunate for the U of T Woolf Award for Excellence for Award thefor in Woolf T U of Dr. timely . Dr. Avery Dr. Drs Fehlings, Dr. Fehlings have hosted multiple ) and senior author in spine trauma injuredpatients. have recently have completed a study utilizing The UofT Spine Program conducted several strategic planning summits the past over decade revisiting the mandates outlined in the initial external review 2007 of and in the subsequent external2013 While review. examining the Society the past (for several Our years). Program has been ranked as top host site excellence for in hospitality and education and training programs. Our Program through effortsof and other facultyYee high-profile societymeetings withproven excellence and outstanding organization efforts. hosted The AnnualWe meeting the of Cervical Spine Research Spine Society Tumor AO 2015; Knowledge International Forum 2017; Society thefor Advancement Spine of Surgery in 2018; the International Neurotrauma Society 2018; the Canadian Spine Society and most 2019; recently the Global Spine Congress In 2019. this 9-10 November year are we also hosting the Course:AOPEER Principles Clinical of Research which will be directed by Strategic Planning Scientist Training Program (SSTP) resident ( Guttman Matthew Nathens the TQIP (American College Surgeon) of database that further validates the opportunity for surgical fixation Sunnybrook recently established a Division Spine of Surgery (Dr. Finkelstein Joel Division Head Clinical Lead, and Farhad Dr. Pirouzmand Division Quality Lead) to enhance coordination urgent of spine care. Global Outreach Over many years, our program has been selected as a host site training for and knowledge dissemination for multiple travelling fellowships including the Cervical Spine Research Society (CSRS) in 2015, the Canadian Orthopaedic Association (COA) hosted Canadian French Belgium Swiss (CFBS) Fellows , and in the Scoliosis 2019 Research

. The Self-Study Report, External 2020 Review patients | Dr. Fehlings and his team, within the first (TWH-UHN) and , with T Surgeon U of has also led efforts at the AOSpine Clinical journals.sagepub.com/toc/ ] and currently being implemented at Dr. RajDr. Rampersaud timely surgical intervention “Time is Spine” Fehlings Dr. Department of Surgery, Faculty University of Medicine, of Toronto 24 hours after injury as critical minimizing for complications and maximizing recovery for with SCI. Larouche Dr. patients with urgent and emergent spinal conditions. In supported analyses by from the Institute Clinical for Evaluative Sciences (ICES) database, are advocating for Advanced Practice Providers (APPs) link with primary care, Practice Leads (PL) are facilitating the triage potential of surgical patients through to our city-wide adult spinal centres. Moreover, MichaelDr. Fehlings provincial aimed level towards enhancing access to pilot, the Ministry Health of Care and Long-Term - the provincial(MOH-LTC) expansion the of Low Back Pain (LBP) framework is progressing well and garnering interest inter-professional by health professionals. Leveraging the expertise of level, colleagues continue to lead important efforts toward enhancing triage and care manyof our of ‘elective’ patients with degenerative conditions the of spine. Arising from the success Inter-professional of Spine Assessment and Education Clinic (ISAEC) with Degenerative Cervical Myelopathy Guidelines and approved were published in the Global Spine Journal [ gsja/7/3_ suppl the global clinical practice At the level. provincial translation research of discoveries to clinical practice. With collective effortsled by developed have thewe Practice Guidelines the for Management of Patients with Acute Spinal Cord Injury and Guidelines the for Management of Patients Innovation and EffortsAdvocacy Our programhas contributed toward numerous initiatives to enhance innovation and knowledge initiative to enhance translational research in surgery which has been together put Marc Dr. by Jeschke. to raise awareness and openproductive a dialogue around the studies being conducted. The T U of Spine Program also actively participatesin a new

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14. Spine Program 14. Spine Program 101 Self-Study Report, External 2020 Review | Quality and Funding, Central Toronto Regional Cancer Program, Clinical Programs and Quality – Cancer Care Ontario, CritiCall Ontario, and Provincial Neurosurgery Committee, to raise awareness around the challenges related to spine care delivery, including funding and under- fellowship year fellowsfor successfully have who completed their initial general spine fellowship with opportunities to further expertise one’s in subspecialty areas including trauma, MIS, adult paediatricand/or deformity, cervical, complex and intraduralcomplex spine pathology. The Program has also to Areas set develop out Focused of Competence (AFC) Spine Diploma through the Royal College Physicians of and Surgeons of Canada, and efforts are underway with task force formed local of and national faculty working synergistically with the CSS. With our outstanding surgeons, educators, scientists and administrative team our Program is uniquely positioned to leading and coordinating efforts toward the accreditation spineof fellowship at the local and national level. While witnessing the changing environment of spine care our summit also stressed the challenges around optimizing clinical practice and resources. Our Program brought together our members and colleagueskey Health from System MOH-LTC spinal cord injury, aswell as the of development international Guidelines the for Management of spinal cord injury (SCI) and degenerative cervical myelopathy (DCM). Theseefforts positioned have the Program as an international Centre Excellence of advancingfor spine care delivery and education. In the education Summit, session the of 2017 highlightedwe our program’s with involvement the a robust of development competency-based fellowshiptraining curriculum at the national throughlevel the CSS which is complemented electiveby rotation across the citywide spine hospitals and with a currently mandated city-wide spine case The log. fellowship offers a packageof intensive annual courses including a surgical skills cadaver course (Dr. Stephen Lewis), semi-annual research update meetings, hospital-based rounds and Spinal Cord Injury in workshop, addition to quarterly journal clubs and hospital based as well as Annual SpineFEST visiting professorships. Our Program has developed2nd a year subspecialty Department of Surgery, Faculty University of Medicine, of Toronto is Spine” (Dr. Fehlings) pathway to enhance spinal triage and care access to patients with urgent including the ISAEC model to enhance assessment patientsof with degenerative spine issues, “Time Spine Society (NASS). The T Spine U of Program has had success in developing and championing best practice in spine care through initiatives (Dr. Fehlings , the Cervical Spine Research Society (CSRS, Fehlings Dr. Past-President), the Scoliosis Research Society (SRS) and the North American (CSS, Dr. Yee, President 2019-21), Bone and Bone Joint President 2019-21), (CSS, Yee, Dr. Canada Co-Chair) (Dr. Yee, and the global spinal community with organizations including AOSpine strategic emphasis also to leverage interactions at the national with level the Canadian Spine Society Rapid Access Clinics Low Back Pain (e.g. RACs) that leverage the expertise Advanced of Practice Providers (APPs) in spine care triage. There is a the Local Health Integration Networks (LHINs) which being is now restructured provincially with the establishment Ontario of Health and Teams, hospitals. The collaborative efforts extended have to the provincial with level the Ontario Ministry Healthof Care (MOH-LTC), and Long-Term Department Surgery, of the Division Orthopaedic of Surgery, the Division Neurosurgery of and the synergistic collaborations across the affiliated The 2017 summitThe 2017 outlined the Program’s interdisciplinary composition, the support the of T U of the past and current state the of Program and developed a roadmap the for next decade. Program’s Strengths-Weaknesses-Opportunities- Program’s Threats analysis) (SWOT and outlined recommendations, summit the 2017th discussed

]. The ].

] and @UofTSpine ] and Twitter [ ] and Twitter ], publishes], a regular newsletter live-surgery.panth.discoverycommons.ca/spine- in/uoftspine/ surgery.utoronto.ca/spine-newsletter-0 positioning our program brand in the local and global digital arena while raising awareness and Branding and Communication The T Spine U of Program has a logo which conforms to T standards U of andwhich enhances the branding the of program. The T SpineU of Program has a dynamic website [ program [ is active social on media including LinkedIn [ online media has been acting as platform for Funding The Department Surgery of and the two Divisions Orthopaedicof Surgery and Neurosurgery jointly fund the program with $50,000 annually as partial support to the administrative salary and benefit. The Program activities is supported donationsby from four main industry partners (DePuy Synthes, Medtronic, Zimmer Biomet, and Stryker) which total approximately $100,000 and is coordinated through Ms. Nadia Jaber and the T Advancement U of Office.These funds are used to support the T Spine U of Program coordinator (Ms. Nadia partial Jaber), salary support spine one for fellow which is rotated between hospitals, and the various educational and research programs whichundertake. we Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto the empowerment and the support the of key stakeholders at the T and U of the affiliated hospitals is in set to the evolve near future as a potential T Spine U of Division with multiple units education, of clinical training, and research. support from the hospital’s research institutes is foreseen as a potential opportunity to leveraging our collaborative clinicaloutcome research initiatives. At an organizational the level, Program, with in there the remains form RACs of in fiscal 18/19, opportunity to betterharmonize and enhance the coordination spine of care as well as the collection of patient reported outcome measures within (PROMs) the T spinal U of hospitals and beyond. A central funding model the for Program with a partisan leverage more resources data for sharing are being examined at the T - hospitals U of executive levels. With the provincial roll both of out a degenerative spine quality based procedure funding (QBP) model as well as a spine triage assessment model non-surgical intervention and the 2) creation a U of T clinicalof translational research fostered central by database capturing city-wide research and clinical studies from to bench bedside to community. The strategies are in ongoing dialogue. Opportunities to improve REB process around the city and to time dashboards to enable access and improve patient assessment and patient care through evidence-based medicine. This led to two main strategies spine 1) informatics and the data of development sharing and datamanagement platform capturing surgical and provided an exposure to the integrated informatics platform Neurosciences for with context Spine on Informatics and Clinical Research. Brain is a CODE cutting-edge model a standardized of data collection across research institutes which provides pan- provincial data in an open source format with real spine surgery in the care DCM our of for aging population was also taken into consideration for future follow-up funding on and policy making. Through the Ontario Brain Institute the summit capacity fellowship of trained spine surgeons in to care Area a for the Greater (GTA) Toronto population 6 million. of The cost effectiveness of

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14. Spine Program 14. Spine Program 103 Self-Study Report, External 2020 Review | to our excellent program coordinator Ms. Nadia Jaber and to the T DepartmentU of Surgery, of Divisions Orthopedics of and Neurosurgery and our industry sponsors. After his visit to the U of T Spine Program, Daniel Dr. Riew (Professor Orthopedicof Surgery at Columbia University Medical College Center’s Physicians of and Surgeon- NYC, Co-Chief, Spine Division, Director of Cervical Spine Surgery and Co-Director the of Columbia Spine Fellowship) commended the Program and the leadership with the following “Michael,quote: Albert and the entire T U of built have the premier You researchSpine Team! and educational program spine for in the world”. Department of Surgery, Faculty University of Medicine, of Toronto trainees, and committees. The Co-Directors of theT Spine U of Program a debt gratitude of owe unique identity spine for thanks to the remarkable collective effortsof the faculty,program council, In closing, since over its inception in 2009, The SpineUniversity Program Toronto of has created a booth showcasing our UofT Program. The booth attracted considerable trafficand further enhanced the global visibility the of UofT Spine Program. Of note, at the Global Spine Congress in Toronto this meeting year (a which attractedalmost 2000 registrants), our UofT Spine Program exhibited a fostering continuity among our former fellows. Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

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14. Spine Program 15

TRAUMA PROGRAM

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 105 15TRAUMA PROGRAM

2015 Tile Lecture in Trauma: J. Rutka, M. Tile, J. Kellam, A. Nathens

Avery B. Nathens, MD, PhD, MPH, FRCSC, FACS, Director, Trauma Program

The University of Toronto Trauma Program At its inception, the Program was also designed was created in 2011 and is a collaborative within so that the centres can speak with one voice the University Department of Surgery across the in regional planning, working with EMS and three trauma programs at St. Michael’s Hospital, developing local policies related to trauma care. Sunnybrook Health Sciences Centre, and SickKids. In 2016, the Greater Toronto Area Regional It was created to better integrate trauma-related Trauma Network (GTA RTN), which reports activities pertaining to education, outreach, research, through to Critical Care Services Ontario (CCSO) and quality improvement. It also serves to create a within the Ministry of Health assumed selected larger profile for trauma within the University and components of this role. This Network has strong to promote the Department of Surgery externally representation from all of the centres within the as a centre for excellence in trauma. The annual Program and from a practical standpoint, the volumes across the three sites make it one of the GTA RTN takes direction from the University largest trauma programs in North America. of Toronto Trauma Program leadership.

106 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 15. Trauma Program 107 Self-Study Report, External 2020 Review | trauma faculty across the three sites in the form of a city-wide journal and club research symposium a two-dayover period every June. Over academic the Tile Lecturersyears 2014-19, reflected have the diversity the of expertise across the Divisions in the Department included: academic and over 2014-2019 The annual highlight the of University Toronto of Trauma Program is our Tile Lecture in Trauma. The Tile Lecture was named in recognition of MarvinDr. Tile, was who the surgeon-in-chief at Sunnybrook and between and was 1995 1985 the authority world the on treatment pelvic of and acetabular trauma, was past president the of AO Foundation in Switzerland, and has been named to the Order Canada of his for contributions in clinical surgery, teaching, and research. The lectureship was named making in 2014, the sixth 2019 annual Tile Lecture. The Lectureship provides an opportunity to bring renowned world surgeons to Toronto canwho share their experiences with the entire Department as part University of Grand Rounds. In addition, the lectureship brings together all the of McGill, Toronto, Hamilton,McGill, Toronto, Edmonton, and Sherbrooke, with several assuming leadership positions in their respective trauma programs. Tile Lecture in Trauma Dr. Homer Dr. Department of Surgery, Faculty University of Medicine, of Toronto Dr. Sandro Dr. Rizoli (2014- Dr. PaulDr. (Department Wales of

trauma centres across Canada including Winnipeg, 12 fellows12 from across Canada, the United States and Australia. The fellows are successful in obtaining faculty positions and populated have trauma fellowship with in one Critical Care at the Overthe 2014-2019, University Toronto. of program has been very successful in recruiting fellows participate in electives in other Divisions vascular(e.g. surgery, cardiac surgery) to enrich their training and several combined have their all the of trauma surgical faculty both sites over and experience a diverse case mix. Many these of programs to rotate across both adult trauma centres the course over a year. With of a rotation 6 monthsof at each centre, they are exposed to The Trauma University Fellowship Toronto of Program providesan opportunitygeneral for surgeons completed have who their residency Trauma Fellowship Trauma University of Toronto creating stronger collaborations within the Several city. examples follow. The Program has been valuable in moving forward several initiatives and in medical director ORNGE, of the Ontario air ambulance provider in 2016. (Department Emergency of Medicine) assumed Tien Dr. a larger regional as role SickKids: Surgery) with Suzanne Dr. Beno as co-lead Sunnybrook Health SciencesCentre: Avery Nathens Dr. (2016-present) (2014-2016); Tien St. Michael’s Hospital: Bernard Dr. 2018); Lawless (interim, 2019-) been some changes in leadership across the as outlinedcentres below: 2014-19 over of Toronto Trauma Steering Toronto of Committee, chaired Avery Nathens Dr. by with representation from each the of trauma centres. There have Direction the of program is set through a University Dr. Brent HagelDr. (University of Calgary) DennisDr. Durbin (Children’s Fred RivaraDr. keynote address to consolidate the learnings. Over the themes and keynote speakers2014-19, were: Collateral Damage: Helping the helpers cope with traumatic injury (Feb 2015) Keynote: John Carnochan - Former Detective Chief we knowwe and what don’t we With grant funding this ending program in 2017, was folded into the University Toronto of Interdisciplinary Trauma Conference. University of Toronto Interdisciplinary ConferenceTrauma The Interdisciplinary University Toronto of Trauma Conference (ITC) provides an opportunity for continuing education and outreach pertaining to trauma care providers for in South Central Ontario. The conference has and been since held 2011 attracts ~300 physicians, nurses, and paramedics from across the region an on annual basis. While the ITC provides education advances on in trauma care to providers, there is typically a theme and Holland Bloorview Rehabilitation and Toronto Institute), University,York Ryerson University, as well as representatives from the Ministries of Health Promotion andSport and Transportation, creating opportunities new collaboration.for The visiting professorsin injury included: 2015-17 prevention over 2017 Preventing Sport and Recreation Injuries in Children and Adolescents 2016 Hospital of Philadelphia) SafetyMotor Vehicle Research in Children 2015 (University of Washington) Gun violence: research on prevention and its uses in advocacy Sports concussion in what youth: Self-Study Report, External 2020 Review | Dr. GeoffreyT. Dr. Manly Neurosurgeon – JamesDr. Kellam – Dr. ThomasDr. Scalea - General Surgeon Dr. ElonDr. Glassberg– General Surgeon Dr. RochelleDr. Dicker – General Surgeon Department of Surgery, Faculty University of Medicine, of Toronto from the University (including of Toronto Prevention over 2015-2017. In addition to the Prevention 2015-2017. over visiting professor, the grant also provided an opportunity to bring injury together the Toronto prevention community through an annual research symposium. This brought together scientists Injury Prevention The Program was fortunate to a grant receive Pashby Sportsfrom the Tom Safety Dr. Fund to support an annual visiting professor in Injury Orthopaedic Surgeon Orthopedic Trauma: An Care of Evolution Visiting Professor in 2016 Traumatic Brain Injury: A precision medicine approach 2015 to the victims the of Syrian civil war 2017 The past, present, and future of endovascular care trauma for through hospital-based violence intervention 2018 Medical and organizational lessons from the Israeli humanitarian medical aid mission 2019 Closing the revolving door violence: of Addressing social determinants health of

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15. Trauma Program 15. Trauma Program 109 Self-Study Report, External 2020 Review | Trauma app The Trauma University app was made Toronto of available in and 2012 is a collaborative effort across the trauma centres to make available care protocols to the community University Toronto of and has beyond. It 20,000 over downloads from differentcountries. 149 content The is distributed freely the and on web is available both on android and platforms. iPhone is It designed to be used in real time and provides direction evaluation on bluntof and penetrating trauma, resuscitation and supportive careincluding pain management and thromboembolism venous prophylaxis. point injury of to rehabilitation and to beyond better understand the trauma system, and identify opportunities improvement. for This included a discussion a number of processes of including the first the calldifferences between to 9-1-1, urban and ruralresponses paramedics, for and access to trauma centres either directly through or ORNGE. The group considered a number of opportunities toenhance the system including better communication between prehospital and hospital providers, structured feedback to paramedics following a trauma case, access to patient outcomes, and information sharing. As a result this of forum, there are data now sharing agreements between pre-hospital and hospital providers and better communication to enhance quality improvement activities between EMS and the trauma centres. University of Toronto Department of Surgery, Faculty University of Medicine, of Toronto and share information.The purpose the of forum was to bring together stakeholders key from the Trauma Program, prehospital care providers, and government met at the Sunnybrook Centre for Prehospital Medicine to connect individuals key In the spring a group almost of 2016, of 40 trauma leaders from the University Toronto of and Lessons Learned from the Humboldt Tragedy Forum GTA Trauma Context (June 2019) Keynote: Witt, Jon Dr. Department Emergency of Medicine, University Saskatchewan: of Experiences The Pulse Night Club Shooting Mass Casualty in the Canadian in vulnerable populations 2017) (Oct Keynote: Joseph Ibrahim Dr. and Susan OrlandoOno, Regional Medical Center, of healthcareof providers in motorsport safety Violence Close to Intentional Home: injuries Sustainability, Professor of Surgery and Health The critical UniversityPolicy, Toronto: of role sequelae and prevention (Feb 2016) Keynote: Hugh Dr. Scully, Founding Fellow, FIA Institute Motor Sport for Safety and Road Traffic Trauma,Road Traffic Anatomy of a Crash: Fundamental concepts in management, Superintendent at Strathclyde in Police Scotland: “David’s Born Story”: to fail, the perfect storm. ITC Conference ITC Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

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15. Trauma Program 16

REPORT OF FACULTY MEMBERS

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 111 16REPORT OF FACULTY MEMBERS

surgeons are experiencing burnout and 30% display Emphasis on Surgeon symptoms of depression (Shanafelt, 2009). The ACS study was the first of its kind and demonstrated a Stress and Burnout serious epidemic among surgeons with a strong association between burnout and medical error, The Need for Change work-life balance, and career satisfaction. Over the past decade, occupational stress has established itself on the forefront of concerns While stress is an individual experience, burnout in the medical profession. Dr. Charles Balch affects institutions when hospitals expend costs defined burnout as a clinical syndrome with to rectify medical errors and absenteeism from diagnostic criteria of 1) Emotional exhaustion stress leave. In 2012 the Canadian Medical 2) A decreased sense of personal accomplishment Association (CMA) estimated that burnout- and 3) Depersonalization - A detached or associated early retirement and reduced clinical negative response to patient care (Balch, 2009). hours costed Canada $213.1 MN annually. Thus, it is clear that negative stress has a ripple effect A study conducted by the American College of from individual to system, and yet the systems Surgeons (ACS) in 2008 reported that nearly 40% of are currently providing far too little support.

112 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 16. Report of Faculty Members 113 5 5 6 8 4 6 2 17 27 39 26 53 ). 5.05% 5.05% 4.04% 6.06% 6.06% 2.02% 8.08% 17.17% 27.27% 26.26% 39.39% 54.53% RESPONSES RESPONSES Self-Study Report, External 2020 Review | Figures 15.1 to 15.4 Figures 15.1

Every day Never per year or times lessA few or less perOnce month Once per week per week times A few Every day ANSWER CHOICES Never per year or times lessA few or less perOnce month Once per week per week times A few ANSWER CHOICES Figure 15.2 Figure 15.2 patients. my with from closely working exhilarated I feel career. The second used component the PRIME- MD PatientHealth Questionnaire to at look physical wellbeing, depression, anxiety, substance abuse, and detachment from duties. The third component examined individual quality life of through the Questionnaire.SF-12 The final looked component at satisfaction job and sense accomplishment of through the Satisfaction Employee Index. Survey Analysis The majority respondents of did display not high levels exhaustion of depersonalization or with respect to the surgical profession itself. Faculty members genuinely their enjoy clinical and work do allow not external stressors to compromise their quality care of ( 15.1 Figure. I treatI feel some are they patients impersonal as if objects. However, Department of Surgery, Faculty University of Medicine, of Toronto

burnout. These questions examined mental and physical fatigue, and emotional toll the of surgical the most telling dimensions faculty of wellbeing. The firstof component this sectionutilized the Maslach Burnout Inventory to examine occupational (specialty, rank, hours worked, etc.) were overall representative of the Department’s profile. wasit the third section the of survey that provided The reported demographic (gender, age, ethnicity, marital status) and professional characteristics The survey response rate was approximately 41% responseswith 112 from potential 272 participants. survey was administered to all full-time clinical faculty members within the Department Surgery of untilin 2018 of November January 2019. comprehensive survey similar survey to the ACS and successfully obtained REB approval before its dispersion. A comprehensive and anonymous quality life of and evaluate the effectivenessof coping mechanisms. The committee developed a to determine the scope occupational of burnout surgeons, Toronto identifyfor specific stressors, quantify the impact stress of the on surgeon’s A Department-wide survey was administered Surgeon-in-Chiefs and several Division Heads, which was positively received all. by The Survey Department Surgery). of The steering committee initially sought leadership support discussing by the issues and need change for with the hospital Hospital), Giuseppe Dr. Papia (Vascular Surgery, Sunnybrook Health Sciences Center) and Ms. Joanna Giddens (Strategic Plan Coordinator, to the body knowledge of surrounding surgeon wellness. Our steering committee is comprised of OriDr. Rotstein (General Surgery, St. Michael’s goal facilitating of improvement in the stress levels ourof faculty members as well as contributing research within the Canadian surgical context is highly limited. In response to this discrepancy, a steering committee was formed with the ultimate Toronto prioritizedToronto this issue to due the negative threats poses it to patient safety, personal well-being, and system-level stability. academic However, Surgery’s Response Response Surgery’s The Department Surgery of at the University of The Department of 7 5 74 11 17 10 19 13 23 23 22 22 20 29 ). 7.07% 5.05% 11.11% 17.17% 23.71% 19.19% 10.10% 13.13% 76.29% 23.23% 29.29% 22.22% 22.22% 20.20% RESPONSES RESPONSES RESPONSES Figures 15.6 to 15.10 Figures 15.6

No ANSWER CHOICES Never per year or times lessA few or less perOnce month Once per week per week times A few Every day ANSWER CHOICES Yes ANSWER CHOICES Never per year or times lessA few or less perOnce month Once per week per week times A few Every day Figure 15.7 Figure frustratedI feel job. my by 15.8 Figure Over your past the 4 weeks, limited health has emotional your as perform usual? to or as carefully ability work your as optimally There was sufficient evidence to state that our faculty members are indeed experiencing stress and displaying signs depression. of Rates burnout, of frustration, and dissatisfaction with work-life balance fairly were consistent with that the of ACS implyingstudy, that there are stressors unique to the surgical profession ( 15.6 Figure burnedI feel out from work. my 3 8 0 0 1 2 3 4 14 10 13 12 37 70 25 26 29 40 ). Self-Study Report, External 2020 Review | 0% 0% 1.01% 4.04% 2.02% 3.03% 3.03% 8.08% 14.14% 70.71% 37.37% 10.10% 13.13% 12.12% 25.25% 26.26% 29.29% 40.40% RESPONSES RESPONSES RESPONSES Figure 15.5

A few times per week times A few Every day A few times per year or times lessA few or less perOnce month Once per week ANSWER CHOICES Never A few times per week times A few Every day Never per year or times lessA few or less perOnce month Once per week ANSWER CHOICES Once per week per week times A few Every day ANSWER CHOICES Never per year or times lessA few or less perOnce month Department of Surgery, Faculty University of Medicine, of Toronto Figure 15.5 Figure things. worthwhile many accomplished I’ve like I feel dealing with patient concerns and keeping emotional extremes in balance. There is also a great deal personal of satisfaction to due the belief that the is work worthwhile and having a positive impact in the community ( They are able to stay level-headed; effectively Figure 15.4 Figure problems at work emotional veryI deal with calmly. Figure 15.3 concerns patients’ veryI deal with effectively.

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16. Report of Faculty Members 16. Report of Faculty Members 115 Self-Study Report, External 2020 Review | unnoticed poorly or recognized hard for work, and perceived favouritism among senior-level staff. ‘The stress job and expectations not are but high, it’s thejust patients and the volume of work. There are many factors that to add the especially stress, performance expectations, bullying, demands at set all levels, high temper on. go individuals, My working free...could for career will end early because It isof stress. a shame. Never thought this would happen Stigma to me. burnout is a major deterrent dealing for with or recognizing the issue.’ ‘The Clinician-Scientists have contracts that request a majority of time doing clinical work (80%) and university contracts specifying a requirement workingfor weeks to be primarily academic This is(80%). fundamentally in conflict.’ The next stressor was a lack transparency of surrounding expectations role and funding sources. Both survey responses and managerial feedback indicate that our faculty feel burdened competingby academic responsibilities, as well as they how will be compensated and/or recognized research for time. Many reported feeling ‘Bullying is real, especially among in those power who continue to be given a free pass. tell atmosphere.’ a know but don’t It’s ‘My largest frustration comes from the lack of fairness towards new surgeons. I feel taken advantage of and without recourse, since the ones taking advantage also have an excessively large influencemy on future employment.’ The first area wascollegial support, which refers to the support systems provided those by in leadership positions, bullying harassment, and/or and a general sense camaraderie of inthe workplace. Several faculty members disclosed abusive power dynamics, racial gender and/or bullying, and exclusion junior-level of staff. These issueswere also cited in data, the ACS particularly in the smaller surgical divisions. instance, For vascular surgeons consistently demonstrated support systems weaker in addition to higher stress levels and greater tendencies towards suicidal thought patterns. 2 5 9 10 15 15 21 23 45 20 29 5.15% 2.06% 9.28% 10.31% 23.71% 21.65% 15.46% 15.46% 29.90% 20.62% Department of Surgery, Faculty University of Medicine, of Toronto 46.39% RESPONSES RESPONSES

Not at all satisfied all at Not Entirely satisfied Mostly satisfied satisfiedModerately Somewhat satisfied ANSWER CHOICES Once per week per week times A few Every day ANSWER CHOICES Never per year or times lessA few or less perOnce month The feedback also allowed us to identify Department-specific stressors. over theseover domains, can we but certainly aim to strengthen inter-institutional relationships, support systems, and effectivecoping mechanisms. complexities, and patient demands. Unfortunately, the Department Surgery of has minimal jurisdiction Care, the government Ontario, of the hospitals, issues included These institutes. research and assuch constrained hospital resources, scheduling The feedback section provided tremendous insight into these stressors and unsurprisingly the majority lay with the Ministry Health of & Long-Term physician/surgeon seem to be dwindlingphysician/surgeon and causing moral issues and feeling “valued” as health care providers.’ ‘Resources managing for patient care and being a Figure 15.10 Figure 15.10 Howbalance? satisfiedcurrent work-life your with are you Figure 15.9 Figure 15.9 Over past the 4 weeks, downhearted? how often you felt have Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto the first academic studies examiningburnout in Canadian surgeon. This has been a groundbreaking exploration both for the Department Surgery of and Canadian surgical profession, and look we forward to many more future successes. support of the Department of Surgery, Sunnybrook Health Sciences Centre and St. Michael’sHospital. The committee is also looking forward to presenting its initial findings at various events and conferences in 2020, as well as publishing the identified stressors Toronto withinsurgical the environment, evaluate dis/satisfaction job and work-life balance, and inform decision-making surrounding plausible strategies implementation. for This will be made possible from the generous Institute’s Advanced Health & Research Centre thefor next phases qualitative of research analysis. Focus groups and individual interviews will be conducted in early 2020 and facilitated by qualitative researchscientists. The findings will be used to further inform the scope and severity of Following the survey analysis and redaction of identifiers, committee the sharedits findingswith the Department.The committee has also partnered with Drs. JanetParsons, Emma Richardson, and Karen at the Li-Ka Pope ShingKnowledge Looking Ahead

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16. Report of Faculty Members 17

REPORT OF LEARNERS

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 117 17REPORT OF LEARNERS

For the past several years, Dr Rutka has held breakfast meetings with the first year medical students throughout the year. In these sessions, Dr Rutka encourages the medical students to consider career paths in surgery, and answers their many questions about surgery as a profession.

Over the past 6 years, the medical students at UofT have completed survey questions regarding their experience as learners on the various surgical rotations. As can be seen from the various tables, the quality of the education experience has generally improved for medical students since 2014 (Figure 17.1). The variety of patients and procedures accessible to students varied considerably over the past 6 years, and it is an area we are continuing to focus on (Figure 17.2). In recent times, the medical students did not feel as though they were given appropriate responsibility for patient care (Figure 17.3).

We will strive to improve upon the medical students’ perception of safety of the patients they cared for, our ability to observe medical students take a patient history (Figure 17.4), and feedback provided early enough to medical students during their rotations on the various surgical services (Figure 17.6).

118 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 17. Report of Learners 119 — — 9% 0% 177 156 156 1.11 0.59 0.68 1.9% 4.5% 2019 2019 2019 57.7% 31.4% 31.6% 12.4% 59.6% 3.12/5 12.2% 3.53/5 3.22/5 23.2% 28.2% 28.2% — — 0.7 174 174 175 1.13 0.63 7.5% 5.1% 1.7% 2.9% 2018 2018 2018 3.17/5 27.6% 17.2% 11.4% 21.7% 20.7% 35.4% 3.66/5 59.2% 26.3% 2.98/5 63.2% Self-Study Report, External 2020 Review | 0% 153 153 153 34% 1.08 0.88 0.83 7.8% 0.7% 4.6% 8.5% 9.2% 2017 2017 2017 26.1% 28.1% 19.6% 11.8% 3.99/5 20.9% 24.2% 3.64/5 3.82/5 50.3% 54.2% 4% 4% 8% 124 125 127 15% 0.75 0.95 12% 56% 0.98 1.6% 1.6% 3.2% 2016 2016 2016 16.5% 21.8% 4.05/5 38.6% 3.43/5 3.83/5 68.5% 20.8% 28.3% 185 185 185 0.79 1.05 0.83 7.6% 5.4% 0.5% 0.5% 3.2% 2015 2015 2015 21.1% 15.1% 17.3% 17.8% 37.3% 11.9% 57.8% 25.4% 3.63/5 3.94/5 22.2% 3.84/5 56.8% — — — 173 167 166 15% 2.4% 3.6/5 1.2% 3.5/5 9.8% 3.2/5 2014 2014 2014 Department of Surgery, Faculty University of Medicine, of Toronto 18.1% 11.4% 30.1% 13.9% 18.6% 16.8% 13.3% 53.6% 13.2% 54.5% 28.3% Please rate the quality of your educational experience. educational your of Please quality rate the I had sufficient accessthe varietyto experience.my and of education procedurespatients to complete required I was given appropriate responsibility for patient care. for patient I was responsibility appropriate given Mean Standard deviation Neither agreeNeither nor disagree Agree agreeStrongly Count ANSWER CHOICES disagree Strongly Mean Standard deviation Agree agreeStrongly Count Disagree agreeNeither nor disagree Standard deviation Excellent Count Mean Poor Fair Good ANSWER CHOICES Disagree ANSWER CHOICES disagree Strongly Very good Figure 17.3. Figure 17.1. Figure 17.1. Figure 17.2. — — — 156 156 156 0.76 0.75 0.73 50% 3.1/5 1.3% 1.3% 3.8% 2019 2019 2019 47.4% 17.9% 17.3% 30.1% 3.01/5 21.2% 25.6% 3.06/5 30.8% 53.2% — — — 4% 4% 174 173 173 0.71 0.75 0.77 23% 3.5% 2018 2018 2018 19.1% 61.3% 23.7% 20.7% 18.5% 16.2% 52.3% 2.98/5 2.94/5 2.94/5 53.8% 2% 153 153 153 0.97 19% 0.81 0.96 3.9/5 1.3% 1.3% 3.9% 9.8% 2017 2017 2017 47.7% 15.7% 10.5% 3.81/5 55.6% 18.3% 24.8% 24.2% 20.3% 45.8% 3.84/5 125 125 125 0.97 12% 0.87 0.89 1.6% 9.6% 9.6% 2.4% 6.4% 3.9/5 0.8% 8.8% 2016 2016 2016 17.6% 17.6% 57.6% 61.6% 3.79/5 3.78/5 19.2% 54.4% 20.8% 185 185 185 0.93 0.99 20% 20% 0.89 1.1% 8.1% 8.1% 2.7% 9.2% 3.8% 2015 2015 2015 57.3% 11.9% 48.1% 3.76/5 3.79/5 10.8% 18.9% 23.8% 3.84/5 56.2% Self-Study Report, External 2020 Review | — — — 3% 166 164 164 11% 14% 2.4% 0.6% 3.6/5 3.4/5 3.4/5 2014 2014 2014 27.4% 13.4% 42.7% 15.9% 52.4% 19.3% 13.9% 13.9% 26.8% 43.3% A faculty member resident of observed history. a patient me taking A faculty member or resident observed me performing examination. a physical I received feedback early enough to allow me time to improve my performance. my improve to me time I received feedback early allow enough to Mean Standard deviation Neither agreeNeither nor disagree Agree agreeStrongly Count ANSWER CHOICES disagree Strongly Disagree Mean Standard deviation Agree agreeStrongly Count ANSWER CHOICES disagree Strongly Disagree agreeNeither nor disagree Standard deviation Agree agreeStrongly Count Mean Strongly disagree Strongly Disagree agreeNeither nor disagree ANSWER CHOICES Department of Surgery, Faculty University of Medicine, of Toronto Figure 17.6. Figure Figure 17.5. Figure Figure 17.4. Figure

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17. Report of Learners 18

DIVISION REPORTS

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 121 181. ANATOMY

Cindi Morshead, Professor and Chair, Division of Anatomy

The past five years has been an exciting and busy We have just completed a project to revitalize the time in the Division of Anatomy. The Faculty of JCB Grant’s museum housed in the Division of Medicine made Anatomy one of the fund-raising Anatomy. The division has been, and is, the source priorities in order to renovate and rejuvenate of many of the world’s leading anatomical reference our facilities and expand our capacity to provide works, including the “An Atlas of Anatomy” by the new curriculum for the MD program. The Dr. John Charles Boileau Grant, first published $10M renovations are nearing completion and in 1943. Now in its 15th edition, Grant’s Atlas of have provided our Division with state-of-the-art Anatomy remains one of the most widely used facilities for teaching and training more than 2,500 anatomical atlases in the world. The anatomical students that enroll in anatomy each year. The dissections which form the core upon which infrastructure updates to the student and faculty the atlas is based, are housed in the JCB Grant laboratories and facilities will afford new learning Museum, making it a resource that is unique to opportunities for the undergraduate, graduate the University of Toronto. The museum remains and post-graduate students and researchers that a learning space valued by students from a variety undertake anatomical teaching and learning. of programs including Medicine, Dentistry, Enormous gratitude goes to the staff and faculty Rehabilitation Sciences, Physical and Health of our division who have gone to extraordinary Education and Kinesiology, Arts and Science and lengths to ensure that the students continued the School of Graduate Studies at the University to receive excellent training and educational of Toronto. Students from OCAD University, the experience throughout these massive renovations. Michener Institute, Faculty of Medicine Summer

122 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 18. Division Reports 123 Self-Study Report, External 2020 Review | C. Morshead and M. Fehlings M. and C. Morshead trainees and they been have the recipients of many prestigious accolades. Students have received the Canada Vanier Scholarship, CIHR studentships, Heart and Stroke Foundation Graduate Scholarship in Science and Technology, Ontario GraduateScholarships and IMS entrance awards. Graduate students and Post-doctoral fellows received have numerous poster and platform presentation awards at national and international meetings. In the pastyears, five we trainedhave 50 graduate students, 22 postdoctoral fellows 50 and undergraduate over students. Our research faculty has successfully acquired researchnew funding from federal and provincial granting agencies including NSERC, Canadian Institute Health for Research, Ontario Institute Regenerativeof Medicine, Stem Cell Network, Canada First Research Excellence Fund, Connaught Investigators,New Connaught Innovation Award, and the Heart and Stroke Foundation. Three United States patent applications granted were to investigators in the Division. Our research endeavours continue to be recognized nationally and internationally. Hong Sun Dr. is the incoming Chapter - Societypresident the of Toronto for Chinese Bioscientist in America. MaryamDr. Faiz Brainwas Health awarded the Initiative Women’s fromAward the Heart and Stroke Foundation. In the past 5 years, the Division has received over $5 million to support our research endeavours and papers published have in 165 peer-reviewed journals in both basic science and clinical journals. The Division continues to attract outstanding Department of Surgery, Faculty University of Medicine, of Toronto undergraduate students at the University of Toronto. are a part our of initiatives to meet the needs the of bright, passionate and enthusiastic graduate and Science course advanced for anatomical studyand DanielleDr. Bentley designed course a new the for Medical Radiation Science program These courses students in the Biomedical Communications program and other graduate departments. Judi Dr. Laprade undertook the design Arts a new of and the forefront teaching of innovation and design. AnneDr. Agur designed and implemented a new dissection-based anatomy course graduate for Dr. MikeDr. Danielle Wiley/presently Dr. Bentley (embryology), this enormous undertaking is at and histology content has been entirely reformatted and delivered is now through the preclerkship curriculum. Lead Barbara Dr. by Ballyk and With the launch the of Foundations new Curriculum in the MD Program in September of the gross2016, anatomy, neuroanatomy, embryology teaching portfolio and innovative teaching practices make an her excellent addition to the Division. medicine Dr. and stem cell In July biology. 2017, Danielle Bentley joinedthe Division as an Assistant Professor, Stream. Teaching outstanding Her who bringswho expertise and innovative tools and ideas to tackle important issues in regenerative Dr. MaryamDr. Faiz was recruited to the Division Anatomyof asan Assistant Professor, Tenure Stream. is She an exceptional young scientist Bidmos, Assistant Professor, stream. Teaching Dr. Bidmos was with the Division a short for time but his contributions significant. were JanuaryIn 2017, winning educators inspirational were who to all knewwho them, students and faculty alike. We sorrywere to see the departure Mubarak Dr. of Wiley retired and Ian Dr. in Taylor, June of Both exceptional were 2015. teachers and award- as faces new welcomed and fresh ideas that will further our complement vision the for Division going our of professors, forward. Mike Dr. Two technical support changes in the pastyears. five said goodbye toWe staff and faculty who have retired to on and positions, new moved as well Programs are alsosupported the by JCB museum. The Division has undergone administrativeand Student programs and Sheraton College Art 18 Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto support the of Department Surgery, of Faculty Medicineof and MD program, the teaching and research in the Division Anatomy of will continue to grow and flourish over coming the years. Clinical Anatomists. was She also elected Fellow of the American Association Anatomists of (FAAA). The pastyears five been bothhave challenging and rewarding, highlighting the spectacular faculty and staff we have in the Division. With continued the anatomy education the by American Association Anatomistsof and the Member Honored Award distinguished her for career in recognition her of scholarship, mentoring research, of and education students,of from the American Association of Anatomy Training) program, developed and lead Judi Dr. by Laprade, was as honoured a in 2017 community champion program at the University Internationally, Toronto. of Anne Dr. Agur was presented with the Henry Gray Distinguished Educator Award, the highest award human for Teaching andTeaching Mentorship – mid-career award and the Excellence in Undergraduate in Teaching Life sustainedScience for Award excellence in teaching in a Basic Science Department in the Faculty of Medicine. The “FEAT” (Functionally Enhanced in, undergraduate teaching. has She also received the Mary Dr. Hollington Award, The Teaching Class 8T9 of Medical Alumni and Award the ExcellenceTeaching MD Award program. Dr. Cindi Morshead has received the Lister Prize – Department Surgery, of Excellence in Graduate Awards, Excellence for in Individual andTeaching Course for Program Development and Coordinationin Undergraduate Medical Education. This is the Faculty’s most prestigious award sustained for commitment and to, excellence Our outstandingfaculty continueto receive awards their for teaching excellence. Professor Barbara Ballyk Aikins T. has received two W.

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18. Division Reports 18. Division Reports 125 in its Self-Study Report, External 2020 Review | Journal of Thoracic and Cardiovascular Surgery Weisel was appointedWeisel as the eighth Editor-in-Chief of the 88 year history. Our faculty continued longstanding records success of in clinical, translational and basic science research, mentoring surgical residents and students to multiple research awards. (Gopal Bhatnagar). fortunate were We to recruit an outstanding group young of surgeons (Mitesh Badiwala, Bobby Yanagawa, Maral Ouzounian, Christoph Haller, Jennifer Chung, Steve Singh and Ting Zhang) as they commenced their careers in academic cardiac surgery. David Barron, an internationally recognized leader in congenital heart surgery, was recruited from Birmingham, UK, to lead the Division Cardiac of Surgery at the Hospital Children. Sick for Divisional faculty as such Tirone David serve as surgical ambassadors to the global community cardiac of surgeons with continuing international visits to lecture and operate. Richard Department of Surgery, Faculty University of Medicine, of Toronto Terrence Yau, Professor Yau, andTerrence Chair, Division of Cardiac Surgery

University California of – Los Angeles van (Glen Arsdell), and the Cleveland Clinic Abu Dhabi were recognizedwere most concretely as a number of our surgeons recruited were to lead programs at Children’sthe Hospital Texas (Chris Caldarone), and quality metrics as such the Society Thoracic of Surgeons National Database proceeded during this timeframe. The achievements our of faculty outstanding outcomes. In addition to longstanding hospital-based clinical registries, Integration with international resources outcomes for assessment major cardiac operations performed were annually at University Toronto-affiliated of hospitals,with The Division Cardiovascular of Surgery continued its tradition superb of clinical care and excellence in academic endeavours. Approximately 6,000 Overview

2. CARDIAC SURGERY 18 was Journal of was promoted attained retired from the was appointed Surgeon-in-Chief attained Professor Emeritus status was appointed as stepped down as the Division of was appointed as the stepped down as Chair the of attained Professor Emeritus status was named as Director of was appointed as the inaugural was promoted to Associate Professor retired from the Division of for thefor Faculty Medicine. of David Latter Fellowship Educational Advisory Committee, whichon had he served 8 years. for Richard Weisel the Editor-in-Chief the of Thoracic and Cardiovascular Surgery Caldarone Chris and Chief Perioperative of Services at SickKids. Gideon Cohen Cardiac Surgery Residency Program Director after years five of exemplary service.He was appointed Chair the of Endocarditis Working Group as well as Co-Chair the of ECLS Working Group, both at Sunnybrook Health Sciences Centre. RJ Cusimano interim Program Director the for Division of Cardiac Surgery. Lee Errett Cardiac Surgery at St Michael’s Hospital. Stephanie Brister Division Cardiac of Surgery at UHN. 2015-16 David Latter MD Admissions and Student Finances 2017-18 Anthony Ralph-Edwards promoted to Assistant Professor Goldman Bernard Professor Emeritus status 2018-19 Ed Hickey Maral Ouzounian to Associate Professor Lee Errett George Robert Swan Chair in Global Surgery Hugh Scully Richard Weisel Leadership Changes/ Progressions 2014-15 Self-Study Report, External 2020 Review | was recruited to join was recruited to spearhead was recruited to join was recruited to join was recruited to join was promoted to Associate Professor was recruited from was promoted to Assistant Professor was promoted to Associate Professor was promoted to was recruited to join the was recruited to join the Cardiac Department of Surgery, Faculty University of Medicine, of Toronto 2015-16 Osami Honjo Joseph Noora 2014-15 David Latter the rank Full of Professor. Mark Peterson Teacher at TrilliumTeacher Health Partners. Promotions David Barron Birmingham to lead the Division Cardiac of Surgery at the Hospital Children. Sick for Ting Zhang Cardiac Surgery Group as a Surgeon- Jennifer Chung the Cardiac Surgery Group as a Surgeon- Investigator at the University Health Network Munk / Peter Cardiac Centre. Singh Steve Surgery Group at Trillium Health Partners. Christoph Haller the Cardiac Surgery Group as a Surgeon- at the Hospital Children. Sick for Teacher 2018-19 Bobby Yanagawa Bobby the Cardiac Surgery group as a Surgeon- Investigator at St Michael’s Hospital. 2017-18 Cedric Manlhiot the Cardiovascular Data Management Center, which will integrate clinical data cardiovascular on disease from across the University Toronto. of 2015-16 2014-15 Mitesh Badiwala the Cardiac Surgery group as a Surgeon- Investigator at the University Health Network Munk / Peter Cardiac Centre. Recruitment

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18. Division Reports 18. Division Reports 127 Self-Study Report, External 2020 Review | was recruited from Trillium was recruited from was recruited from the was recruited from the 2016 at the Li Ka 2016 Shing Institute. Multiple mentorship and career dinners were the for residents,held with Maral Ouzounian, Jennifer Chung, Ed Hickey and Kevin Teoh featured as resident advisors / mentors. The Division a Retreat held 22, November on to evaluate2014 city-wide performance metrics using risk-adjusted data from the Cardiovascular Data Management Center. Although the data was still in stages, development this was the first time that risk-adjustedcomparative data was directly available amongst the University Cardiacof Toronto Surgery centres. 2015-16 January the members 2016 the of Division Cardiac of Surgery co-hosted and presented at the 4th Annual Symposium Valve 2017-18 The Division hosted a CVS Trainee Education Session in October alongside the Bigelow Lecture. The Division hosted the Heart Centre Retreat in November. 2018-19 The first Divisionalnewsletter waspublished. Chris Calderone Hospital Children Sick For to become the Chief Congenital of Heart Surgery Children’s Hospital.at Texas Edward Hickey Hospital Children Sick For to become the Surgical Director the of Adult CongenitalHeart Program Children’s at the Hospital. Texas Arsdell Van Glen the Hospital Children Sick For to be the ChiefCongenital of Cardiac Surgery at the University Californiaof – Los Angeles. Gopal Bhatnagar Health Partners to become the Chief Cardiac of Surgery in the Heart and Vascular Institute theof Cleveland Clinic, Abu Dhabi. Highlights – Division 2014-15 Department of Surgery, Faculty University of Medicine, of Toronto retired from the Division was appointed as was named as Program was appointed in October 2016 of Southlakeof Regional of Trilliumof Health Partners was appointed as was appointed as the Clinical was named as Chair the of Division Bobby Yanagawa Director the for Residency Program of the Division Cardiac of Surgery. Terry Yau Cardiacof Surgery at the University Toronto. of the University of Toronto. 2018-19 became affiliatedwith Toronto. the University of Stacey O’Blenes Health Centre became affiliatedwith 2017-18 Shafqat Ahmed Bernard Goldman of Cardiac Surgery at Sunnybrook. Robert Cusimano the Program Director the for Division Cardiacof Surgery at T U of Finances, T July 2016 U of 1, John Coles Fellowship Coordinator Cardiac for Surgery, T U of as Chair, Division Cardiac of Surgery, T U of David Latter Director, MD Admissions and Student 2016-17 ArsdellGlen Van helped Mitesh was a part the of team Christopher Feindel launched the Sunnybrook Hybrid and at Sunnybrook Health Sciences Centre which performed the first transeptal mitral valve replacement in Canada. Fuad Moussa Coronary Revascularization Program. approaches to repair mitral Atrial valves); fibrillation (SEARCH-AF trial, evaluating ways to detect novel postoperative atrial fibrillation); peripheral artery disease (EXTINGUISHevaluating - colchicine in secondary prevention and in innovative PAD) community based interventions (ENABL-NPNurse practioner based approach to reduce hospitilizations following cardiovascular surgery). The SEARCH AF trial is funded $600,000 for Industry by partners. 2015-16 Garnering national media attention, Badiwala lead a multi-disciplinary medical team in a complicated ‘marathon’ surgery a 33-year on healthyold and active patient whose heart was extensively damaged endocarditis by andhad to be rebuilt with an operation dubbed ‘UFO surgery’ – underscoring rare just how the more than hour surgical 10 procedure was. Gideon Cohen trial antegrade of cerebral protection strategies), Valvular surgery (CAMARA-1 trial different of Self-Study Report, External 2020 Review | Muhammad Muhammad successfully launched solidified a , in partnership with the together with Terry Yau had his clinical outcomes serves in administrative key roles serves as a Canadian work was work published continues to serve as the director and presented patient care novel of the of Applied Health Research Department of Surgery, Faculty University of Medicine, of Toronto CARDIOLINK platform clinical of trials across pillars. five These include randomizedcontrol trials in five distinct areas. Aneurysm surgery (ACE 3000 patient study tetralogy on Fallot. of This is the firstcongenital cardiac surgical studyof that scope. Subodh Verma Mamdani Centre at St Michael’s Hospital launched the for thefor American College Surgeons. of Arsdell Van Glen McMaster Population Health Research Institute, initiated an international, prospective, 15-20 site, Vivek Rao theof Trillium Gift Life of Network. Hugh Scully representative the on Board Governors of societal meetings in the past year. Maral Ouzounian multidisciplinary team to provide surgical management thoracic for aortic disease. an innovative program to provide long-term mechanical circulatory support to patients with congenital complex heart disease. Osami Honjo research presented at nearly all the significant concepts threat of and error. This “flightplan” approach to care each patient’s has captured the interest a number of major of centers. Ed Hickey including as the Provincial Chair Cardiac of Surgery the for Cardiovascular Care Network. Ed Hickey data at the plenary session the of American Association Thoracic for Surgery using NASA 2014-15 John Coles’ in Nature Communications. Chris Feindel Highlights – Faculty

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18. Division Reports 18. Division Reports 129 Dr. was appointed as the is an Associate Editor for Self-Study Report, External 2020 Review | passed his received the John Provan received First Place in the Chair in Surgery his for ongoing proctored at a was recognized with the is the Editor-in-Chief the for was inducted into the College of was appointed Chairs the of was appointed as a research Journal of Thoracic and Cardiovascular Surgery. He containsHe as Director Undergraduate of Surgical Education, University of Toronto. Gideon Cohen DSMB Edwards Maverick Trial as well as the EdwardsDMC Transcatheter Tricuspid Repair Subodh Verma ScholarsNew at the Royal Society Canada. of Richard Weisel Journal of Thoracic and Cardiovascular Surgery. 2015-16 Daniel Bonneau number Canadian of and US centres in implantation. Perceval Valve Christopher Caldarone Robert B. Salter responsibilities and commitment to world-leading research and academic activities. continues He as Surgeon-in-Chief and Chief Perioperative of Services at the Hospital Children. Sick for ChristakisGeorge Surgical Educator undergraduate for Award medical education across Canada. This award recognizes outstanding contributions to undergraduate surgical education in Canada. 2018-19 Robert Yanagawa continuing appointment review. Faculty Honors/ Awards 2014-15 Christopher Caldarone the Stephen Fremes Charles Mentorship Tator in Award 2015. Maral Ouzounian Moderated Poster Competition at the AATS entitled “David vs. Goliath: Valve-sparing root replacement improves outcomes compared to Bentall procedures in patients with aortic root dilatation”. Krishna Singh scientist and Assistant Professor.

are currently Department of Surgery, Faculty University of Medicine, of Toronto (1930-2017) Subodh Verma Maral Ouzounian , UHN, Assistant establishedthe annual started the St Michael’s conducted a 2.5 hands- day, and and passed July away 2018. 5, John Coles has been recognized his for 3D printed model teaching residents for in CHD. 2017-18 Jimmy Yao Professor successfully passed her CARs her passed successfully Professor passed March away 26, 2017 Maral Ouzounian and the Montalcino Aortic Consortium. Ronald James Baird aortopathies. also She leads collaborations with international registries including the International Registry Aortic of Dissection collaboration among cardiologists, cardiac surgeons and geneticists interested in heritable 2016-17 Maral Ouzounian Heritable Aortic Disorders Symposium, a national axillary artery innominate or artery cannulation cerebralfor protection during aortic arch surgery. conducting a multicenter randomized clinical trial in aortic surgery patients called are 115 Study. the ACE currently being recruited and randomized to either Mark Peterson Aortic Collaborative and the Canadian Thoracic Aortic Collaborative and sit theon Executive both of groups. Mark Peterson are founding members the of Toronto including limited not but to blood, valves, bypass conduits, myocardium and aortic tissue collection for translational studies. Bobby Yanagawa Bobby Hospital Cardiovascular Surgical Tissue bank two differentforms outlet of double right ventricle and hypoplastic left heart syndrome. on theiron own print 3D models, including cases tetralogyof Fallot, of complete transposition of the great arteries with intact ventricular septum, on congenitalon heart disease surgery course with print3D models which provided participants the opportunity to perform surgicalfive procedures Glen Van Arsdell Van Glen continues CIHR-funded was awarded the William received the National Quality, also received an award from has been selected as a member served the on panel the of 2016 : was inducted as membernew a 2014-15 Christopher Caldarone research pulmonary on vein stenosis and participates as site-PI the for CIHR-funded CORRELATE trial. 2018-19 Cutrara Charles Innovation Award, presented and the by Teamwork CCHL (Canadian College Healthcare of Leaders). Cutrara Charles the province Ontario, of the Minister’s Medal, which honors Excellence in Health Quality and Safety. also He the Hazel won McCallion Award in Quality Care, of Place, Improvement New – 1st in recognition – Putting PPATH of patients at the heart: a seamless journey cardiac for surgery. Bobby Yanagawa Horsey Post-Graduate Award. Teaching Research Grants - Faculty Mark Peterson theof American Association Thoracic of Surgery. was He also appointed to the Executive Committee the of Canadian Thoracic Aortic Collaborative as well as the Critical Illness Steering Committee at St. Michael’sHospital. Subodh Verma cohort theof the of 2015 College New of Scholars, Artists and Scientists the of Royal Society Canada. of Subodh is an internationally renowned cardiac surgeon-scientist and holds a Canada Research Chair in Atherosclerosis. Subodh Verma Canadian Cardiovascular Society Guidelines thefor management dyslipidemia of thefor prevention cardiovascular of disease in the adult and sits the on panels the for upcoming updates of the Canadian Cardiovascular Society Guidelines Atrialfor Fibrillation and Canadian Diabetes Association Clinical Practice Guidelines. Self-Study Report, External 2020 Review | received the 2016 Bernard received the 2016 shared his expertise around was appointed as the Program received the 2016 William received the 2016 G. was awarded the Lifetime was James the recipient the of 2016 was also awarded the Ontario received a 3 year grant from the Ontario was appointed the first Professorof Department of Surgery, Faculty University of Medicine, of Toronto Academy Cardiovascular of Sciences. Ren-Ke Li Research Fund – Research Excellence Program, hisfor submission “Pre-clinical of Development Umbilicala Novel Cord Perivascular Cell-based Therapy to Prevent Heart Failure”. Ren-Ke was also elected as Fellow the of International David Latter Excellence for Award Award in CardiacYao Surgery at St. Teaching Michael’s Hospital. Aeronauticsand Space Administration “threat and error” model and pediatric cardiac surgery. Osami Honjo Williams Excellence for Award in Cardiac Surgery at theTeaching Hospital Children. Sick for Bernard S Goldman Chair in Cardiac Surgery. Edward Hickey the as world an invited speaker at many venues. This year drew he parallels between the National Stephen Fremes Goldman Excellence for Award in Cardiac Surgery at SunnybrookTeaching as well as the Charles SurgeonH. Tator Scientist Mentoring Award, was He University reappointed as Toronto. the of Achievement from Award the American Association for Thoracic Surgery. Lee Errett Global Surgery at the UniversityToronto. of Director the for Division Cardiac of Surgery, also He University the 2016 won Toronto. of Lynda L. Mickleborough Excellence for Award in Cardiac Surgery at TGH. Teaching Tirone David John Coles Centre Excellence of 2015. for Award R.J. Cusimano System Early Feasibility became He Study. Director Division of the University of Toronto’s Cardiacof Surgery Program. Wetlab

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18. Division Reports 18. Division Reports 131 Self-Study Report, External 2020 Review | Stephen Fremes : Principal Investigator the of : Developing the Toronto : Developing the Toronto : Principal Investigator Labatt : Principal Investigator “Death : Principal Applicant, “Development : Principal Rogers Applicant, Ted : Principal Investigator and the regulation vascular of disease” and Co- Principal Investigator a HSFO of awarded grant entitled “Randomized trial mitral of valve repair with leaflet resectionversus leaflet preservation–Multicenter Study from the Canadian Mitral Researchers (CAMRA)”. As “Development of a novel device treatment a novel of for “Development of failing Fontan circulation”, Funding Total $32,500. Osami Honjo Fontan Cannula as a Bridge Failing for Fontan Circulation, Grant, Principal Investigator: Total Funding , $50,000 Innovation PMCC Award. Osami Honjo Family Heart Centre Innovations Fund: Efficacy of Exracorporeal Controlled Whole Body Reperfusion with without or a Neuroprotective Agent in Cardiac a Rodent Arrest Model, FundingTotal $25,000 (Canadian dollar). Fuad Moussa Co-Investigator the for “Black study Box” to improve efficiency OR and qualitycontrol. Subodh Verma CIHR-supported grant entitled “In vivo and translational endothelial of role autophagy in project received in $210,000 funding Integrin- for Linked Kinase (ILK) cardiac as a novel target. As Co-Investigator “Screening for was awarded $91,433 and Management Risk factors an in TAVI; interdisciplinary Endeavor(SMARTIE)” by the Sunnybrook AFP Innovation Fund. Osami Honjo after circulatory transplant $150,000 project”, from James Cummings Foundation grant. Osami Honjo Computationalof Models to Aid in the Diagnosis and Failing Treatment of Fontan Circulation”, TheThe Faculty University Toronto, of of Applied Science andthe Faculty Medicine of EMHSeed Program, Funding Total $67,500. Osami Honjo Centre Heart for Research: Ideas New Grant, Department of Surgery, Faculty University of Medicine, of Toronto is Principal Investigator holds grant one as Co- holds grant one from the Canadian , participating as Co-Investigator, is collaboratively leading a research and his group secured approximately Canada through Blueline Biosciences. The can only be treated heart by transplantation. This research project was selected funding for and was among projects the 10 funded across (DCM), which is the most common form heart of muscle disease in children and, in advanced cases, John Coles consortium organized to discover and new develop treatments childhood for dilated cardiomyopathy Vein StenosisVein in Pediatric Labatt Family Patients.”, Heart Centre Innovation Fund, $24,930. Christopher Caldarone theof “Pilot Trial: The Safety and Feasibility of Losartan Therapy treatment for Pulmonary of 2015-16 R. Evans Leaders Fund (“Molecular pathology of cardiovascular disease: understanding gene how expression is perturbed in clinical samples”). promote angiogenesis and attenuate atherosclerosis”). isHe also co-principal investigator a grant on from the Canada Foundation Innovation-John for in cardiovascular disease: to A bench bedside translational approach” and “Elucidating the of role as a targetBRCA1 to improve endothelialfunction, regulation vascular of diseases”) and two from the Heart & Stroke Foundation (“The autophagy of role Subodh Verma Institutes Health of Research (“In vivo and translational endothelial of role autophagy in the care testing and ROTEM/Platelet works tests affect the rate transfusion of after cardiopulmonary bypass. Fuad Moussa continues his CIHR-funded research on “Multicentre study designed to determine if point of Cardiac Surgery (SUSTAIN CSX-trial)”. Appendage Occlusion Study III (LAAOS III) and was Co-Investigator another on CIHR Operating Grant, Administration “SodiUm SeleniTe in Stephen Fremes Investigator from the CIHR, “Left Atrial $1M of research of $1M funding the course over theof last two years, fromvarious sources including commercial opportunities. John Coles , from the Memorial University , from the Brigham and Women’s , from the Northern Ontario , Deputy Minister, Ministry , from the Robarts Research Institute mechanical circulatory assist system failing for single ventricle Fontan physiology. Principle Investigator. Heart and Stroke Foundation Canada. of Grant-in- CAD. Research $284,913.00 Grant.Aid 2018-2019. perfusionex-vivo the of heart in a porcine DCD transplant setting. Co-Principal Investigator (Supervisor). Christoph Dr. PI: Haller. Labatt Family Heart Centre. Labatt Heart Centre CAD. Research Grant. Innovation Fund. $21,527.10 circulatory support failing for Fontan circulation. Principal Investigator. Saving Tiny Heart Society Foundation. Research $41,000.00 USD. Grant. (FUNDED: Since April of Development 2018) (FUNDED: Closed-circuit Since May 2017) (FUNDED: Design Jan - Dec 2018) mechanical of “Angiogenesis - Bench to Bedside and Implications peripheral for artery disease” Neelam Khaper Medicine, of School Lakehead University, delivered joint St Michael’s Hospital Cardiac Robert S. Bell Healthof Care presented and Long-Term Bigelow Lecturethe 2014 entitled “From the perspective Surgeon, of CEO and Deputy Minister, should manage How we public reporting outcomes?” of October on 2014 3, Deepak L Bhatt Hospital,Harvard Medical School, delivered joint St Michael’s Hospital Cardiac Surgery - Heart and Stroke/Richard Lewar Centre of Excellence rounds the on “Innovative topic Agents. Transformative Trials. Healthier Hearts.” Ross D Feldman Newfoundland,of delivered the Fall Asha 2015 Verma Memorial Lecture entitled “Heart Disease a long come way...?” in Women:You’ve David A Hess Westernof University, delivered the Winter Asha2015 Verma Memorial Lecture entitled Dr. OsamiDr. Honji 1. 2. 3. Visiting Professors 2014-15 Self-Study Report, External 2020 Review | : Successful PSI funding : Principal Investigator the of and colleagues are initiating a extracorporeal controlled whole-body reperfusion with without or a neuroprotective agent in a rodent cardiac arrest model. Co- Investigator. Labatt Family Heart Centre. Labatt Heart Centre Innovation Fund. CAD. Research Grant.$24,997.00 focused ultrasound histotripsy to treat congenital cardiac disease. Co-Investigator. Labatt Family Heart Centre. Labatt HeartCentre Innovation CAD. ResearchFund. Grant. $24,781.00 circuit perfusion ex-vivo the of heart in a porcine DCD transplant setting; Principal Investigator. Labatt Family Heart Centre. Labatt Heart Centre Innovation Fund. CAD. Research Grant. $21,527.10 (FUNDED: Efficacy 2015) Since Nov of (FUNDED: High Since May 2017) intensity (FUNDED: Closed- Since May 2017) Department of Surgery, Faculty University of Medicine, of Toronto 3. 2. This project is budgeted approximately for $7M. 2018-19 ChristophDr. Haller: 1. Human Rheumatic Heart Disease”. 2016-17 Subodh Verma randomized clinical trial to evaluate the impact evolocumabof in coronary artery bypass patients. Bobby Yanagawa Bobby Aminefor Mazine with Bobby Yanagawa as $20,000 PI. funding year. Project one for title: Inflammazome of “The Role in and circulating biomarkers in patients with type 2 diabetes” and Co-Investigator the of trial “Post-surgical enhanced monitoring cardiac for arrhythmias and atrial fibrillation(SEARCH- AF)” that has received funding from Bristol- Myers Squibb and Boehringer Ingelheim. function, angiogenesis and atherosclerosis. Subodh Verma Boehringer Ingelheim supported trial “Effects empagliflozinof on cardiac structure, function, Principal Investigator, also he recently closed twoout HSFO-funded projects that focussed on autophagy in and endothelial the BRCA1 of role

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18. Division Reports 18. Division Reports 133 Self-Study Report, External 2020 Review | , MD the of Imperial , MD, Chairman, , MD the of Indiana , MD the of Stanford University Sir Magdi Yacoub Bigelow Lecture 2017 Bigelow MagdiSir Lecture Yacoub College in London, HarefieldHeart Science Centre, and AswanHeart Centre, delivered the Wilfred Bigelow Lecture entitled “The Glory and the Threat Science of and Medicine.” 2018-19 Pedro Del J. Nido Department Cardiovascular of Surgery, Boston Children’s Hospital; William E. Ladd Professor Child of Surgery, Harvard Medical School, delivered the Wilfred Bigelow Lecture entitled “What is a Surgeon Scientist in the Century:21st Lessons from the Banting.” Lessons from at the St FMOQ” Michael’s Hospital Cardiac Surgery Rounds 2015. 3, November on Douglas Zipes P University Medicine of School delivered the 9th Annual Landmark Lecture “The birth and maturation cardiac of electrophysiology asa specialty” October at on the Li 2015 Ka 5, Shing Knowledge Institute St. of Michael’s Hospital. 2016-17 Joseph Woo Medicine of School Norman E. Shumway Professor and Chair, Department of Cardiothoracic Surgery; Professor, courtesy, by Department of Bioengineering delivered the Wilfred Bigelow Lecture entitled “Are Surgeons Going Green?? The Quest Natural for Reconstruction, Recovery and Renewables.” 2017-18 Sir Magdi Yacoub Department of Surgery, Faculty University of Medicine, of Toronto , MD William W.L. , MB BS, MSc of , MD, Director the of Center , MD the of Memorial , MD the of Fédération des , MD, PhD Davis UC of , from the KrannertInstitute of , Chief Cardiac of Surgery and Director médecins omnipraticiens du Québec (FMOQ) spoke theon “Aiming topic a higher for standard in CME: and Cardiology Rounds 2016. May on 16, Daniel Paquette of Inflammationof Metabolicin Syndrome” at the St Michael’s Hospital Joint CardiacSurgery Ishwarlal JialalIshwarlal Medical Center the on “The spoke topic Role a long way...?” at the St Michael’s Hospitala long way...?” Joint Cardiac Surgery, Vascular Surgery and Cardiology Rounds September on 28, 2015. Ross D Feldman University Newfoundland of the on spoke come “Hearttopic Disease You’ve in Women: the Enemy’s Playbook”the Enemy’s October on 2nd, 2015. Director the of Aortic Institute at Yale-New deliveredHaven the Wilfred Bigelow Lecture entitled “Thoracic Aortic Aneurysms: Reading John A. Elefteriades Glenn Professor Cardiothoracic of Surgery and “NOAC antidotes age” of come “NOAC at the St Michael’s Hospital Joint Cardiac Surgery and Cardiology Rounds January on 25, 2016. John W Eikelboom McMaster University the on spoke topic Cardiovascular Devices” at The Sprott Department Surgeryof Surgical Grand Rounds January 2016. 15, for Technology and Technology Innovationfor CHI St. Luke’s Health Medical – Baylor St. Luke’s Center spoke “Fosteringon a Culture Physician of Innovation in Heimbecker Visiting Lecture in Cardiac Surgery. William E. Cohn of Cardiacof Surgery Research at Heart Inova and Vascular Institute Raymond delivered Dr. the 2016 2015-16 Niv Ad Cardiology at Indiana University Medicine, of School delivered Landmark the 2015 Lecture “Birth on and maturation cardiac of electrophysiology as speciality” a “The antiproliferative role of metformin” Douglas Zipes and Vascular Surgery rounds the on topic 183. GENERAL SURGERY

Carol Swallow, Bernard and Ryan Langer Chair, Division of General Surgery Awards Major Extramural, Faculty of Medicine & Department of Surgery Awards to General Surgery Faculty a. for Academic Contributions

2014/15 Teodor Grantcharov, Canada Paul Karanicolas, Department Bernard Langer, inducted into the Research Chair Tier 2 of Surgery Roscoe Reid Canadian Medical Hall of Fame Graham Scholarship Nancy Baxter and David Agostino Pierro, appointed Urbach, CIHR-IHSPR 2015/16 Honorary Officer of the Article of the Year Award Najma Ahmed, Royal College of Most Excellent Order of the Physicians and Surgeons of Canada British Empire (OBE) by John Hagen, Royal College of D.R. Wilson PGME Award Her Majesty the Queen Physicians and Surgeons of Canada, Mentor of the Year, Region 3 Anand Govindarajan, Agostino Pierro, Italian Chamber Department of Surgery Bernard of Commerce of Ontario Arts, Tim Jackson, Faculty of Langer Surgeon-Scientist Award Science and Culture Award Medicine David Fear Fellowship

134 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 18. Division Reports 135 - – Faculty of – Faculty of – Faculty of – Department – Faculty of Medicine Self-Study Report, External 2020 Review | Teaching in Clerkship Jory Simpson of Surgery Award for Tovee Undergraduate Teaching Teodor GrantcharovTeodor University Faculty of Toronto of Medicine Award for excellence in Postgraduate Medical Education: Development and Innovation 2017/18 AshamallaShady Medicine Education Achievement Award: Ian Silver Innovation Award Sandra deMontbrun Medicine Award for Excellence in Postgraduate Medical Education: Development / Innovation Jory Simpson Education Achievement Award: Education Development Fund 2018/19 Fayez Quereshy Medicine WT Aikens Award for Excellence in Individual , St. , , St. Joseph’s – University , Inaugural , Department , Hospital for , North York , North York , Sunnybrook- Michael’s Hospital – Department of Surgery Surgical Skills Lab Teaching Award 2016/17 Najma Ahmed Facultyof Toronto of Medicine Award for Excellence in Postgraduate Medical Education: Teaching Performance, Mentorship and Advocacy Homer Tien Department of Surgery Tovee Award for UndergraduateTeaching 2015/16 Georges Azzie ChildrenSick – Department of Surgery Award for Tovee Postgraduate Teaching Sandra de Montbrun Lloyd Smith General - Special Commendation Integrated Medical Education Awards, Excellence in Community-Based Teaching (Community Hospital setting) Shiva Jayaraman - Special Commendation Integrated Medical Education Awards, Excellence in Community-Based Teaching Avery Nathens of Surgery Bryce Taylor Faculty Mentorship Award Sandra de Montbrun Department of Surgery George- Armstrong Peters Prize b. for Teaching 2014/15 2018/19 Robin McLeod Department of Surgery Lavina Lickley Award for outstanding and sustained contributions Department of Surgery, Faculty University of Medicine, of Toronto , Department , , American , University , Lifetime , Department , James IV , Royal College , The , Department of , Department , Dedication , Department of Carol Swallow Carol Surgery Charles Surgical Tator Scientist Mentorship Award Department of Surgery George- Armstrong Peters Prize Faculty Mentorship Award Catherine O’Brien Nancy Baxter of Surgery Bryce Taylor Frances Wright Travelling Fellowship Ori Rotstein of the American College of Surgeons Surgical 2016 Forum Surgeon-Scientist Award 2017/18 Fayez Quereshy of Surgery Bernard Langer Paul Greig Surgery Bryce Faculty Taylor Mentorship Award of Toronto Arborof Toronto Award for outstanding volunteer service University ofToronto Bernard Langer Bernard Langer Achievement Award, Paul Karanicolas Paul College of Surgeons Traveling Fellowship National Merit Award of the Republic of Colombia Canada Duncan Graham Award Escallon Jaime 2016/17 Robin McLeod of Physicians and Surgeons of of Surgery Charles Surgical Tator Scientist Mentorship Award Teodor GrantcharovTeodor

, Complex , Sup: C. Swallow, Sup: , Sup: M. Jeschke, Sup: , Fixation of traumatic , Sup: M. Jeschke, Sup: , Sup: S. Gallinger, Sup: , Sex-based disparities in ACS TraumaACS Quality Improvement Program database. A. Sup: Nathens Surgical Oncology Fellowship Program – Department of Surgery, Zane Cohen Clinical Fellowship Achievement Award Richardson David Berger – Department of Surgery DR Wilson Award for Undergraduate Teaching by a Resident Gallie Bateman 2st Prize, Oral Presentation: Fahima Dossa the hourly earnings of surgeons in Ontario’s fee-for-service system. Baxter N. Sup: Gallie Bateman Prize, 3rd Oral Presentation: Matthew Guttman spinal fractures within 24 hours reduces complications in the absence of neurologic injury: A retrospective cohort study from the 2017/18 Gallie Bateman 1st Prize, Oral Presentation: Ashton Connor McMurrich Prize, 3rd Oral Presentation: Abdikarim Abdullahi McMurrich 1st Prize, e-Poster Presentation: Hwan Hee Oh McMurrich 2nd Prize, e-Poster Presentation: Olga Brashavitskaya 2018/19 Andrea Covelli

- , - Approach to , Sup: N. Baxter N. , Sup: Self-Study Report, External 2020 Review , Sup: A., Sup: Nathens | - Setting performance - Sup: C. Swallow - Sup: Oral Presentation: James Byrne McMurrich 1st Prize, Oral Presentation: Sergio Acuna injury: A population-based analysis. M. Jeschke,Sup: A. Nathens 2016/17 Cindy Boulanger Gobeil Complex Surgical Oncology Fellowship Program – Department of Surgery, Zane Cohen Clinical Fellowship Achievement Award Gallie Bateman 1st Prize, Gallie Bateman 2nd Prize, Poster Presentation: James Jung asymptomatic paraesophageal hernia: Elective laparoscopic hernia repair orwatchful waiting? Grantcharov T. Sup: Gallie Bateman Prize, 3rd Poster Presentation: Stephanie Mason - Persistent morbidity requiring urgent readmission after major burn Timing of VTE prophylaxis in severe traumatic brain injury: A propensity-matchedcohort A.study. Sup: Nathens Gallie Bateman 1st Prize, Poster Presentation: Peter Szasz standards for technical and non- technical competence in General GrantcharovSurgery. T. Sup: Gallie Bateman Prize, 3rd Oral Presentation: James Byrne McMurrich 2nd Prize, Poster Presentation: David Cyr

- The , Complex , Insights - Practice does not always - Examining health- - When is dead “dead”? Department of Surgery, Faculty University of Medicine, of Toronto training. Grantcharov T. Sup: 2015/16 Gallie Bateman 1st Prize, Oral Presentation: Marisa Louridas make perfect: Need for selection curricula in modern surgical Ashton Conner into tumour evolution from whole genome sequencing of metachronous pancreatic ductal adenocarcinoma. S. Gallinger Sup: Seemann, Natashia Seemann, complex phenomenon of stress in the operating room. C-A Sup: Moulton Gallie Bateman 2st Prize e-Poster(tie), Presentation: for the purpose of performance improvement. A. Sup: Nathens Gallie Bateman 2st Prize e-Poster(tie), Presentation: on the rise. A. Sup: Nathens Gallie Bateman Prize, 3rd Oral Presentation: James Byrne Identifying the unsalvageable patient cancer invasion. C. Swallow Sup: Gallie Bateman 2nd Prize, Oral Presentation: Andrea Covelli beliefs: Why mastectomies are Fellowship Achievement Award Gallie Bateman 1st Prize, Oral Kazazian Karineh Presentation: - The protrusional protein polo- like kinase 4 (PLK4) enhances 2014/15 Hameed Usmaan Surgical Oncology Fellowship Program – Department of Surgery, Zane Cohen Clinical Major FacultyMajor & Department of Medicine of Surgery Awards to GS Residents, Graduate Students Fellows and

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18. Division Reports 18. Division Reports 137 , , Robert , Nicolas Colapinto Self-Study Report, External 2020 Review | McMurrich 2nd Prize, e-Poster Presentation: Stephanie Tung Management of high patient- reported pain scores in non-curative pancreatic adenocarcinoma: A population-based analysis. Hallet J. Sup: University Annual of Toronto Update in General Surgery Stotland Peter Mustard Mentorship Award Haas Barb Teaching Award , Nicolas , Trauma and , Complex Surgical , Robert , Marcus Burnstein , A window into oncolytic – General Surgery Divisional Nominee, Zane Cohen Clinical Fellowship Achievement Award 2018/19 Andrea Covelli Oncology Fellowship Program – Division of General Surgery, Paul Greig Fellowship Award (Divisional Nominee, Zane Cohen Clinical Fellowship Achievement Award) 2018/19 Haas Barb Outstanding Presentation Award, 2017/18 ZiesmannMarkus Acute Care Fellowship Program cancer. J.A. Sup: McCart Nancy Down Mustard Mentorship Award Anand Govindarajan Colapinto Teaching Award Gallie Bateman Prize,3rd e-Poster Presentation: Dave Mealiea virotherapy: Using zebrafish a novel model to quantify the anti-tumor effects of vaccinia virus in colon Department of Surgery, Faculty University of Medicine, of Toronto , , Complex , Robert , Marcus Burnstein

, Expression of theplk4 Zane Cohen Clinical Fellowship Achievement Award Complex Surgical Oncology Fellowship Program – General Surgery Divisional Nominee, 2016/17 Cindy Boulanger Gobeil Divisional Nominee, Zane Cohen Clinical Fellowship Achievement Award Usmaan Hameed Usmaan Surgical Oncology Fellowship Program – General Surgery 2014/15 GS Divisional Awards to Fellows University Annual ofToronto Update in General Surgery 2017/18 Ralph George Outstanding Presentation Award, Peter Stotland Peter Mustard Mentorship Award 2014/15 survival following resection of gastric adenocarcinoma C. SwallowSup: (GCA). GS Divisional Awards to Faculty e-Poster Presentation: Shelly Luu inhibitorfam46c predicts better Gallie Bateman2st Prize, , Pediatric , HPB UHN- , HPB Transplant, York; Milan Ernjakovic, Mississauga; Milan Ernjakovic, York; Laura Vanderbeek, Nallapeni, Sailaya Mississauga; Scarborough General 2015/16 Robert Bendavid, North York; Alexander Iskander, Humber River; Mississauga; Musselman, Laura Bharat Sharma,Barrie; Rupert Abdalian (cross appointment from Dept Medicine, Division Gastroenterology), North York 2016/17 Shima Kassirian, North KaesYork; Al-Ali, Cobourg; Mississauga Kalkidan Belay, 2017/18 Vitaly Bard, Mississauga; Claude Burul, North Mohammad York; ScarboroughTabari, 2018/19 Fahima Osman (Assistant Prof), North Natalya York; Zhang, North 2018/19 ReichmanTrevor TGH, Associate Professor; Director of HPB Fellowship Programs Blayne Sayed Hospital for Children/ Sick Professor Assistant UHN, BaertschigerReto Surgical Oncology, Hospital for Professor Assistant Children, Sick b. Adjunct Clinical Professors , , , Endocrine, , HPB, St. Joseph’s , HSC, Pediatric , Colorectal, , Colorectal, University , ACS/Critical Care, , Trauma/ACS, , Trauma/ACS, Self-Study Report, External 2020 Review | Mentor: David Urbach Alice and Jeff Singh, Wei Critical Care; Mentor: QI Tim Jackson David Gomez Jaramillo ACS/Trauma, St. Michael’s Hospital – Clinical Mentor: Joao Rezende Research Neto; Mentor: Robert Fowler Pasternak Jesse UHN-TGH – Clinical Mentor: Lorne Rotstein; Research – Mentor: Shiva Jayaraman 2017/18 Anthony de Buck van Overstrataen Mount Sinai Hospital – Clinical Mentor: Zane Cohen; Academic Mentor: Erin Kennedy Preeti Dhar UHN-TGH – Clinical Mentors: SunnybrookMentor: - NathensAvery Luis da Luz Teodoro Trauma, Sunnybrook – Mentor: Neil Adhikari (ICU) Sami Chadi Health Network – Mentors: Fayez Quereshy, Nancy Baxter Tsang Melanie P. Greig, S. Gallinger;P. Research KaranicolasMentor:P. ZaniAugusto General Surgery – Clinical Mentor:A. Pierro; Research Mentor: Janet Rossant 2016/17 Haas Barb , , HPB , Surgical , Interventional , Breast Surgical , Breast Surgical , Colorectal, Mount , Surgical Oncology, Department of Surgery, Faculty University of Medicine, of Toronto Gonzalo Sapisochin Surgical Oncology & Transplant, UHN-TGH – Clinical Mentors: Mentors: Baxter, N. E. Kennedy Hameed Usmaan Oncology, General North York Hospital – Clinical Mentor: P. Stotland; Research Yang Mentor: V. Coburn; Academic Education Mentor: Ahmed N. Mantaj Brar Sinai Hospital – Clinical Mentors: Z. Cohen, EH. MacRae; Research 2015/16 Savtaj Brar Mount Sinai Hospital – Clinical Mentor: C. Swallow, N. Jory Simpson Oncology, St. Michael’s Hospital – Clinical Mentor: R. George; Academic Education Mentor: Ahmed N. ACS, University Health Network – Mentor: A. O’Krainec Julie Hendrick-Hallet HPB Surgical Oncology, Sunnybrook Mentor: – C. Law Oncology, St. Michael’s Hospital – Clinical Mentor: R. George; Research Mentor: Baxter N. Eran Shlomovitz Radiology and Advanced MIS/ a. Full Time a. Full 2014/15 Scheer Adena ContinuingAppointment Reviews, Departures, Major Appointments New Faculty Faculty Hires, Promotions, Successful

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18. Division Reports 18. Division Reports 139 Self-Study Report, External 2020 Review | 2017/18 Junaid Bhatti, Sunnybrook Agostino Pierro, Hospital for Children Sick Adena Scheer, St. Michael’s Hospital (Mentors: R. George, Baxter) N. 2018/19 Julie Hallet, Sunnybrook (Mentors: Coburn,N. Wright) N. Augusto Zani, Hospital for ChildrenSick (Mentors: A. Pierro, Rossant) J. Eran Shlomowitz, UHN (Mentor: A. O’Krainec) 2018/19 Associate Professor:To Rebecca Gladdy, Mount Sinai Fayez Quereshy, UHN Alexandra Easson, Mount Sinai Full Professor:To Ian McGilvray, UHN Paul Wales, Hospital for Children Sick Georges Azzie, Hospital for Children Sick Joao Rezende Neto, St. Michael’s Nicole Look Hong, Sunnybrook (Mentor: Wright) F. Jory Simpson, St. Michael’s (Mentors: R. George, Ahmed) N. (Mentors: S. Rizzoli, Kuebler) W. Fayez Quereshy, UHN (Mentor: A. O’Krainec) 2016/17 Sandra deMontbrun, St. Michael’s (Mentors: Robin McLeod, Ori Rotstein, Najma Ahmed, Teodor Grantcharov, Helen MacRae) Bernard Lawless, St. Michael’s Full Professor:To Natalie Coburn, Sunnybrook Barto Nascimento, Sunnybrook (Mentors: H. Tien, A. Nathens) Jaoa RezendeNeto, St. Michael’s To Full Professor:To Najma Ahmed, St. Michael’s Anna Gagliardi, Scientist, University Health Network Frances Wright, Sunnybrook 2017/18 Associate Professor:To Greg Fairn, St. Michael’s Shiva Jayaraman, St. Joseph’s Health Network Anand Govindarajan, Mount Sinai Tim Jackson, University Health Network Department of Surgery, Faculty University of Medicine, of Toronto

Paul Karanicolas, Sunnybrook (Mentors: A. Nathens, G. Guyatt) Anand Govindarajan, Mount Sinai (Mentors: A. McCart, Baxter) N. College (Mentors: L. Rotstein, M. McKneally) Karanicolas, A. Smith) Karen Devon, Women’s 2015/16 Shady Ashamalla, Sunnybrook (Mentors: A. Nathens, P. Sinai (Mentors: J.A. McCart, Baxter,N. R. McLeod) 2014/15 Anand Govindarajan, Mount Successful Faculty Continuing Appointment Reviews To Associate Professor:To Anand Ghanekar, University Paul Karanicolas, Sunnybrook 2016/17 2015/16 Associate Professor:To To Full Professor:To Calvin Sunnybrook Law, Erin Kennedy, Mount Sinai Harmantas,Tom St. Joseph’s Sean Cleary, University Health Network Manuel Gomez 2014/15 Associate Professor:To Faculty Promotions of Canada for 2018-2020 2017/18 Gerstle,Ted appointed Chief of Pediatric Surgery, Memorial Sloan Kettering York New Cancer Center, 2018/19 Alice Co-Director, Wei, Surgical Initiatives, David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York Reichman,Trevor Director of HPB Fellowship Programs, UHN Sandro Rizoli, St. Michael’s (now Chief of Trauma at Doha, Qatar) David Grant (retired) Paul Greig (retired from clinical practice, Professor now Emeritus) Avery Nathens appointed Medical Director, Trauma Quality Programs, American College of Surgeons Sean Cleary,appointed Associate Professor, Mayo Clinic, Rochester Lorraine appointed Tremblay, President, Trauma Association Self-Study Report, External 2020 Review | Dean of Academic Affairs at Dalla Lana School of Public Health David Urbach appointed Surgeon-in-Chief and Medical Director, Perioperative Services, College HospitalWomen’s Najma Ahmed appointed Vice-Chair of Education, Department Surgery of 2016/17 Fred Brenneman appointed Program Director, General Surgery Residency Training Program Madeline Ng, BSc appointed new Program Coordinator, General Surgery Residency Program Training Nancy Baxter named Associate Memorial Sloan-Kettering Cancer Center, New York) Frances Wright, Director, University Divisionof Toronto of General Surgery Fellowship Council Barto Nascimento, Sunnybrook 2018/19 Alice UHN at Wei, (now Department of Surgery, Faculty University of Medicine, of Toronto Tim Jackson, Program Director, MIS Fellowship Paul Sullivan, Head, Division of General Surgery, St. Joseph’s J Andrea McCart, Research Director, University of Toronto Division of General Surgery Shady Ashamalla, Head, Division Generalof Surgery, Sunnybrook Allan Okrainec, Head, Division of General Surgery, UHN Cancer Care Ontario Natalie Coburn, Hanna Family Chair in Surgical Oncology Research 2014/15 Homer Tien, Chief Medical Ornge Officer, Robin McLeod, Clinical VP, Programs and Quality Initiatives, Memorial Sloan-Kettering Cancer Center, New York) FacultyMajor Appointments Sean Cleary, UHN at (now Mayo Clinic, Rochester) 2017/18 Gerstle,Ted at HSC (now Departed Faculty Time – Full 2016/17

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18. Division Reports 18. Division Reports 141 Self-Study Report, External 2020 Review | Department of Surgery hosted a Festschrift in honour of Zane Cohen. Graduates of the U of T Colorectal Fellowship Program came from all around the world to celebrate career. Cohen’s Dr. 2017/18 Ronald DeMatteo, University of Pennsylvania, “The critical contribution of research” translational 2018/19 John C. Alverdy, University of Chicago, “Incorporation of microbiome sciences into your scientific thinking and surgical practice” Mount Sinai Hospital and the University of Toronto Youssef, whoYoussef, also assisted them in adapting to the Canadian milieu. 2016/17 The Division of General Surgery sponsoredSyrian a family of four to relocate to a home of their own in anin effort Toronto, led by Zane Cohen and residents Hala Muaddi, David Berger-Richardson, Khaled Ramadan and Fouad Challenges, disparities, initiatives and prospects – An interim report from a Sub-Saharan perspective” 2016/17 Patricia Roberts, Lahey Clinic, “The development of COSATS (colorectal objective structured assessment of technical skills) – Lessons learned” 2015/16 John Vanderbilt Tarpley, University, “Global surgery: Department of Surgery, Faculty University of Medicine, of Toronto

Zane Cohen Centre Team Cohen Centre Zane by Royal College of Physicians and Surgeons of Canada mandated External October Review, 2015. 2015/16 Full Accreditation of General Surgery residency training program Notable Divisional Events Wisconsin, “Surgical critical care: An essential component of Acute Care Surgery” 2014/15 Lena Napolitano, University of General Surgery Annual Assembly LecturersTovee 184. NEUROSURGERY

Andres Lozano, Dan Family Chair, Division of Neurosurgery

Overview Approximately 6,000 cases were performed each year across our four main teaching hospitals. Over the The Division of Neurosurgery continued in its five-year period, Neurosurgery faculty and residents tradition of strong performance in the academic, published 1,643 papers in top-tier journals including research, clinical and teaching domains with steady Cell (4), Nature (12), Nature Communications (8), continued leadership. Dr. Andres Lozano was Nature Genetics (5), Nature Medicine (3), Nature renewed as Division of Neurosurgery Chairman Neuroscience (4), New England Journal of Medicine (9), for a second five-year term following a successful Lancet, Lancet Neurology (4), Lancet Oncology (4), external review. Under the leadership of Residency Lancet Psychiatry (3), JAMA (2), JAMA Neurology (6) Program Director Dr. Abhaya Kulkarni, our and Science Translational Medicine (2). Our Neurosurgery Residency Program successfully neurosurgeons and affiliated neuroscientists completed its external review held in 2015 continued to enjoy success in highly competitive (following a successful six-year review by the Royal funding competitions, capturing over $162.7M in College of Physicians and Surgeons in 2012). research grant funding. 3 new endowed chairs were

142 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 18. Division Reports 143

Self-Study Report, External 2020 Review | New Endowed Chairs chairs endowed 3 new brought us to a total of chairs endowed 17 in chairs the Division (16 as to due a Faculty Jun of 30, 2019 departure/ loss chair one of at St. Michael’s Hospital). Nir Lipsman, Sunnybrook Hospital Promotions 2014-15 Andres Lozano, to University Professor Abhaya Kulkarni, to Full Professor Valiante, Taufik to Associate Professor Gelareh Zadeh, to Associate Professor 2016-17 Mojgan Hodaie, to Full Professor Farhad Pirouzmand, to Associate Professor 2018-19 Gelareh Zadeh, to Full Professor Sunit Das, to Associate Professor Toronto. We remain We extremelyToronto. grateful to the Dan Family their for strong longstanding commitment to neurosurgical education and excellence in Toronto. program the Toronto ascendedIn to 2014, the numberposition one in terms number of of publications, citations and institutional h-index among neurosurgery programs in North America continue We (J Neurosurg. Sep;123(3):561-70). 2015 to be regarded a premiere program with special stature globally, that one the looks world to leadership for clinical,on research, teaching and leadership fronts. Recruitment 2016-17 Jefferson Wilson, St. Hospital Michael’s 2017-18 George Ibrahim, Hospital Children Sick for Department of Surgery, Faculty University of Medicine, of Toronto has been instrumental in the establishment our of city-wide Brain Bank at Tumor the University of positions are an invaluable addition to our academic mission. In addition, since Dan 2013 Family support Amira Dan Fellowships in Neurosurgery at the originallyUniversity Toronto”, of established in a five-year for period.2011 Thesefellowship training Our city-wide clinical fellows program was very fortunate to benefit from additional“Michael and (Toronto Western Hospital)(Toronto and Leo Dr. Da Costa as Interim Medical Director, Centre for Neurovascular Intervention (Sunnybrook Hospital). Zadeh as Deputy Division Head and asProgram Medical Director, Krembil Neuroscience Centre Hospital), Julian Dr. Spears as Division Head (St. Michael’s Hospital), Dirks Peter Dr. as Division Head (Hospital Children), Sick for Gelareh Dr. appointed as Surgeon-in-Chief (Hospital for Mainprize Children),Sick Todd Dr. as Deputy Surgeon-in-Chief and Division Head (Sunnybrook As well, our Faculty selected were leadership key for positions in their hospitals, with James Dr. Drake with resident one winning in two years) the of 42 Prizes awarded since 2000—in addition to garnering other highly competitive awards and fellowships. awards in the country—in this reporting period. Our residents two-thirds won now have (28 Prizes, were awardedwere 8 McKenzie Prizes in Neuroscience Research (with resident one winning in two years)—the most prestigious neurosurgical resident of Neurologicalof Surgery (Dr. Gelareh Zadeh), SNS Winn Prize and (Dr. AANS Michael Taylor) Cushing Medal(Dr. our 7 of residents Rutka). Michael Cusimano and Karen Canadian Davis), Sports 40 Hall Canada’s Top Fame of (Dr. Tator), 40Under (Dr. George Ibrahim), American Academy Dr. CharlesDr. promoted within Tator the Order as Officer), Canadian Academy of Health Sciences (Drs. including the Royal Society Canada of (Dr. Peter Dirks), Order Canada of (Drs. Rutka and Lozano as Officers,TymianskiDr. Michael as Member,and Neurosurgery Faculty members continued to thesome receive of most prestigious distinctions and appointments in our discipline, with highlights Division (16 chairsDivision (16 as to due a Faculty Jun of 30, 2019 departure/loss chair one of at St. Michael’s Hospital). established chairs a total endowed for 17 of in the In addition, our residents been have successful in winning other highly competitive awards and fellowships, selected highlights which of include the Academy Award, AANS Brian Silber D. Award, AANS Sanford Larson J. Award, AANS Technology won 28 the McKenziewon of 42 Prizes (66.6%) awarded since 2000 Jun of (as 30, 2019). 2014-15 George Ibrahim: Clinical Neuroscience Research Shobhan Vachhrajani: Clinical Neuroscience Research 2015-16 Alkins:Ryan Clinical Neuroscience Research Puzner:Teresa Clinical Neuroscience Research Deep Guha: Clinical Neuroscience Research 2016-17 Deep Guha: Basic Neuroscience Research 2017-18 Christopher Ahuja: Basic Neuroscience Research 2018-19 Farshad Nassiri: Basic Neuroscience Research neurooncology, pain, regenerative medicine and spinal cord injury. Clinical trials funded in this period include those in theareas of Alzheimer’s disease, depression, eating disorders, focused ultrasound, Parkinson’s disease, spinal cord injury, stem cells and stroke. Residents and Fellows Honours/ Awards/ Positions Held our residentsIn each to year 2019, from 2014 awardedwere McKenzie Prizes in Neuroscience Research, the most prestigious neurosurgical resident awards in the country. The 7 winners of 8 Prizes resident winning (one in two years) in this reporting period are listed Toronto below. Neurosurgery continued its historically strong performance in this competition, having now Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto programs in the areas advanced of optic and imaging modalities, biomarkers, cerebrovascular disease, epilepsy, head gene injury therapy, and prevention, disorders, movement neuromodulation, Fox Foundation,Fox Research Terry Fox Institute, among many other granting agencies and philanthropic and private sector organizations. These funds been have used to support research from highly competitive agencies, including the Canadian Institutes Health of Research (CIHR), Natural Sciences and Engineering Research Council National (NSERC), Institutes Health of (NIH), Department U.S. Defense, of Canadian Cancer Society Research Institute, Michael J. Our Faculty neurosurgeons and Division affiliated neuroscientists $162.7M captured over in research grant funding this over 5 year period. They successful were in obtaining funding Crean Hotson Chair in Skull Base Surgery – Fred Gentili Research Grants 2016-17 Harold and Esther Halpern Chair in Neurosurgical Stroke Research – Michael Tymianski 2016-17 2014-15 Wilkins Family Chair in Neurosurgical Brain Research – Gelareh Tumour Zadeh UofT Neurosurgery Team at Baseball Tournament in in Tournament Baseball at Team Neurosurgery UofT NYC. Park, Central

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18. Division Reports 18. Division Reports 145 ). Self-Study Report, External 2020 Review | highlycited.com Surgery’s George Armstrong-Peters Prize. papers featured were in the Journal of Neurosurgery's "Best supplement 2016," of which best includes papers. 10 the year’s European Academy Sciences. of Member the of Order Canada, of and Charles was promoted from Tator Member to Officer ofthe Order of Canada. Grand Cross the of Legion of Honor of Monisaraphon the by Kingdom Cambodia of efforts her for in internationalneurosurgery. from Award the RoyalMentor the of Year College Physicians of andSurgeons. Sports Hall Fame of in the Builder category. Officer ofthe Order of Canada. Biomedical Science Ambassador Award from Partners in Research. of theof Order Canada. of McGill University) co-awarded were the Wings Lifetime Life for 2016 Achievement Spinal for Award Cord Injury. Department of Surgery’s Lister Prize National Brain Disorders Prize. in the to world be named to the Thompson Reuters select list highly of cited researchers in the 2015 for category Neuroscience of and Behavior ( thefor period number for 2010-2012 of of papers published in all areas neuroscience of Elsevierby and Thompson Reuters in their assessment Faculty of Medicine of researchers. Two of Abhaya of KulkarniTwo and James Drake’s Michael Tymianski was appointed as a Mojgan Hodaie was presented with the Michael Fehlings received the 2017 Charles was inducted Tator into Canada’s Andres Lozano was inducted as an Michael Cusimano received the received theVictor Department Yang of James Rutka was elected as an Officer Charles and Albert Tator Aguayo (Neurology, wasMichael awarded the Taylor James Rutkawas awarded Margolese the 2015 Andres Lozano was the only neurosurgeon Michael Fehlings was ranked in #5 the world Andres Lozano was elected to the • 2016-17 • • • • • • • 2015-16 • • • • • • • Department of Surgery, Faculty University of Medicine, of Toronto

from the University of Toronto. degree, from Bahcesehir University, Istanbul. Tumor Association InvestigatorTumor Young Award. Rawls Prize from the Canadian Cancer Society. Fleming Surgical Educator Award Health Research Foundation. Universityof Professor, the highest and most prestigious rank at the University effectiveJuly 1, 2014. Toronto, of Society Robert 2015 L. Prize. Noble Honourof from the Canada’s Research- Based Pharmaceutical Companies (Rx&D) James Rutka received an Honoris Causa Gelareh Zadeh American received the 2015 Brain William received the 2015 Michael Taylor E. Gelareh Zadeh received the Ross Andres Lozano was named to the rank James Rutka the Canadian won Cancer Charles was Medal awarded Tator the 2014 • • • • • • 2014-15 • the American Association Neurological of Surgeons; and naming 40 40 Under list. to Canada’s Top and Canadian Sports Hall Fame; of receipt the of very prestigious Winn Prize from the Society of Neurological Surgeons and Cushing Medal from Society Canada of andOrder Canada of as (2 Officer, 1 as Member, and 1 promotion toinduction Officer); to the Canadian Academy Health of Sciences (2) faculty been have recognized the by receipt of numerous awards and to 2019. honors from 2014 Highlights include appointments to the Royal Awards/Positions Held The remarkable talents and achievements our of Faculty Honours/ PARO Trust Resident Award, Queen Teaching PARO Elizabeth II/William Kerr Scholarshipin Science and and StanfordTechnology, SPARK Scholar Award. Fellowships, CNS Charles Kuntz Scholar Awards, Governor General’s Gold Medal, McKenzie K.G. Prize, NREF Fellowships, Scholarships, NSERC Program Scholarship, Canada Cambridge Scholarship, CIHR Brain StarAward, CIHR Canada Graduate Scholarship, CIHR Vanier Scholarship, CIHR Development Grant,Development Alzheimer Society Research Enfants Malades, Paris, 2016-17 Hospital, Miami, 2018-19 Medical Center, France, 2014-15 Wisconsin,of 2015-16 California, San Francisco, 2016-17 Neurosurgery of Years 95 at the University 2018-19 of Toronto, Medical College, USA, 2014-15 Pittsburgh,of 2015-16 Award fromAward the Canadian Pain Society. 40 40 Under list 2019. for Top Michel Zerah, Hopital Necker Jeffrey York University,2017-18 H. Wisoff, New John Ragheb, Nicklaus Children’s Hugues Duffau,Montpellier University Shekar Kurpad, Medical College Philip A. Starr, University of held,Not 2017-18 to due Celebration held Not of Mark Souweidane, Weill Cornell Ian Pollack, Children’s Hospital Karen Davis received the Distinguished Career George Ibrahim was namedto Canada’s • • • Visiting Professors E. Harry Botterell Visiting Professorship in Neurosurgery • • • • • E. Bruce Hendrick Visiting Professorship in Pediatric Neurosurgery • • Dr Rutka receiving Cushing Medal from the American American the from Medal Cushing receiving Dr Rutka Association of Neurological Surgeons • • Self-Study Report, External 2020 Review | at 2019 AANSat 2019 Annual ScientificMeeting. Richard Winn, Prize. M. D. Impact from Award the University Toronto. of Medal Honour of from the Spanish Society Pediatric of Neurosurgery. Neurovascular Intervention at Sunnybrook Hospital, effectiveJanuary 1st, 2019. Canadian Academy Health of Sciences. as Surgeon-in-Chief Kids at Sick Hospital, effective September 28, 2018. Neurosurgery,of Hospital Children. Sick for Medical Director theof Centre for Elect the of Canadian Pain Society. Hospital Children) Sick for was appointed Society Neuro-Oncology of 2017-2019. for Strauss Prize Excellence for in Dystonia Research. Excellence in Postgraduate Medical Education. Clinical Practice” from theInternational Federation Neuroendoscopy. of fromAward the Isaac Foundation. Medical Director the for Krembil Neuroscience Western Hospital.Centre at Toronto degree from the University Sevilla, of Spain. Outstanding Contribution to Research and Academy Neurological of Surgery. Canadian Academy Health of Sciences. Royal Society Canada. of James Rutka received the AANS Cushing Medal Michael Cusimano received the President’s Abhaya Kulkarni was awarded the Karen Davis was inducted as a fellow the of H. received the 2019 Michael Taylor Peter DirksPeter was appointed as Head, Division Leo Da Costa was named Interim James Drake (Head, Division Neurosurgery, of Andres Lozano Bachmann- received the 2017 Abhaya Kulkarni for Award received the 2018 Karen Davis was elected as President- James Rutka received a Lifetime Achievement Gelareh Zadeh was elected President Vice the of Andres Lozano received a Doctor Honoris causa Life for James Time Drake the “Award won Gelareh Zadeh was elected to the American Michael Cusimano was elected to the Gelareh Zadeh was appointed as Program Peter DirksPeter was electedto the Department of Surgery, Faculty University of Medicine, of Toronto • • • • • • • 2018-19 • • • • • • • • • • • 2017-18 •

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18. Division Reports 18. Division Reports 147 , organized Dr. by We launched a new We Self-Study Report, External 2020 Review | On October our Division 2015 3, monthly e-series “Alumni Focus—Where Are in TheyNow” December 2015. Neurosurgery Faculty a strategic for convened planning retreat at The Crane resort in Barbados. The Annual 1st Alan and Susan Hudson Lectureship Fred Gentili, took place April on 2015. 24, The inaugural lecturer was Hudson, Dr. past President and CEO the of University Health Network, whose talk was entitled life“My and career - lessons learned”. publications,of citationsand institutional h-index among neurosurgery programs in North American. J Neurosurg. Sep;123(3):561-70. 2015 First shooting range/dirt bike outing for residents. a Chairman’sheld residents. for event welcome This activities year’s included a visit to the shooting range tour. and a motorcycle/ATV alumniNew series. California San Diego, 2018-19 Center, USA, 2015-16 California, San Francisco, and Guillaume Lonjon, Paris Descartes University, 2018-19 On February Division 2016, of 12-14, Our Division ranked first in termsnumberof Ole Kiehn,Ole Karolinska Institute, 2014-15 Jan Ohio Schwab, State University, 2015-16 Claes Hultling, Karolinska Institute, 2016-17 Dalton Dietrich, University Miami, of 2017-18 Mark Tuszynski, University of JanOhio Schwab, State University, 2014-15 Daniel Columbia Riew, Medical Ghogawala,Zoher University, Tufts 2016-17 Sandy Virginia Emery, West University, 2017-18 Praveen Mummaneni, University of • Division Firsts 2014-15 • • 2015-16 • • Charles H. Tator-Barbara Turnbull Lectureship Series in Spinal Cord Injury • • • • • University Spine of Toronto Program Visiting Professorship • • • • • Department of Surgery, Faculty University of Medicine, of Toronto British Columbia, 2017-18 University, USA, 2018-19 London, (inaugural) UK, 2015-16 Wisconsin,of 2016-17 Paolo, 2018-19 (Host, Neurosurgery) 2018-19 Paolo, BurnhamInstitute, USA, 2015-16 California, San Francisco, 2018-19 California, San Francisco, 2014-15 Hospita, 2018-19 (inaugural)Hospita, 2018-19 Center, University 2016-17 Texas, of University, 2018-19 Health (inaugural) Network, 2014-15 of Munich, 2015-16 University Munich,of 2017-18 David Fairholm, J. University of Gail Rosseau, George Washington Henry Marsh, Hospital, St. George’s Robert University Dempsey, Guilherme Ribas, University Sao of Robert Wechsler-Reya, Sanford- Jeremy Rich, Cleveland Clinic, 2016-17 Nada Jabado, McGill University, 2017-18 Mitchel Berger, University of William University Weiss, of Miguel Arraez, Carlos Haya University Alan Hudson, Past University CEO, Patrick Gullane, J. 2015-16 University Toronto, of Raymond Sawaya, MD Anderson Cancer Jacques Morcos, J. University Miami, of 2017-18 Aaron A. Cohen-Gadol, Indiana Luca Regli, University Zurich, of 2014-15 Jörg-Christian UniversityTonn, Kee Park, Harvard Medical School, 2016-17 Bernhard Technical Meyer, • • • Labatt Chair in International Lectureship Education Neurosurgical • • Harland-Smith Lectureship • • • • Academic Lectureship • Arthur and Sonia Labatt Brain ResearchTumor Centre Annual • Crean Hotson Lectureship in Skull Base Surgery • • • • Alan and Susan Hudson Lectureship • • • Professorship in Neurosurgery • • William S. Keith Visiting , organized Dr. by . On April 5th, the 2019 for a second five-yearfor term. Dan Family Chair in Neurosurgery a second five-yearfor term. Fred Gentili, took place April on 26, 2019. The inaugural lecturer was Miguel Dr. Arraez, Chairman Neurosurgery, of Carlos Haya University Hospital; Chairman, Federation NeurosurgicalWorld of Societies Foundation, whose talk was entitled “Surgery theof Petrous Apex Region: Lessons learned”. Division Neurosurgery, of St. Michael’s Hospital. the R.S. McLaughlin Professor and Chair the of Department Surgery of convened at the Liconvened Ka Shing Knowledge Institute, St. Michael’s Hospital to hear the achievements our of faculty, residents andalumni. lecture 3D First Harland-Smith Lecture was jointly hosted by the Divisions Anatomy of and Neurosurgery of at This the University specialyear’s Toronto. of visiting professor was Guilherme Dr. Ribas from theUniversity Medical Sao of Paolo School, gave who a highly engaging lecture entitled “Anatomy-guided Microneurosurgery Cerebralfor Intrinsic Lesions” at the Li Ka Shing Institute, St. Michael’s Hospital. Dr. Ribas also presented a second lecture—in 3D—to our residents as part Brain of School. This was the firstlecture3D in the history ourof Division, requiring a specialized silver screen and dual projectors 3D and glasses. The Annual 1st Crean Hotson Lectureship in Skull Base Surgery Andres Lozano was re-appointed as the Julian Spears was selected as Interim Head, James Rutka was re-appointed as • Leadership Changes/ Progressions 2014-15 • 2015-16 • • • Self-Study Report, External 2020 Review | On James Rutka and , organized Julian Dr. by was Justin by won (PGY2, Wang supervisor: GelarahDr. Over participants 100 Zadeh). and Todd Mainprizeand Todd and the afternoon session (Alumni) co-chaired Drs. by James Rutka, Julian Spears and James Drake. In between the sessions, our held annual we Horsey Resident Prize Competition Clinical for Research—which Stone, Harvard and Adrienne Univ.; Weeks, Andres Dr. Dalhousie Lozano Univ.). provided an opening Chairman’s overview and update on Neurosurgery.Toronto This was followed by the morning session Faculty) (new co-chaired Drs.by Michael Tymianski, Abhaya Kulkarni Ivan Radovanovic, Suneil Kalia, Jefferson Wilson, Nir Victor Lipsman Yang, and George Ibrahim) and superstar Alumni (Drs. Lily ClevelandAngelov, Clinic; Adrian Laxton, Wake AllanForest Univ.; Levi, Miami; of Univ. Scellig 95th Anniversary of Neurosurgery. Friday October celebrated of we 12 Years 95 Neurosurgery in Canada at the University of with a day fullToronto presentations of our by outstanding Faculty new (Drs. Paul Kongkham, scores in 2016-17 (Michaelscores Fehlings, in 2016-17 Todd Mainprize, Farhad Pirouzmand, Taufik Valiante, and Victor Gelareh Yang Zadeh) at a celebratory dinner Dec on 12, 2017. was entitled “The Duty Candour of - Why is so difficult it for doctorshonest?”. to be International Neurosurgical Education Lectureship Spears, took place February on 2016. 19, The inaugural lecturer was Henry Dr. Marsh, Senior Consultant Neurosurgeon, St. Hospital,George’s London, UK, whose talk his wife, Mari Rutka, announced The James and Mari Rutka Surgeon Scientist Training Fund, which will support the Surgeon Scientist Training Program at the University Toronto. of The Annual 1st Annual Labatt Chair in The James and Mari RutkaSurgeon Scientist Training Fund. We recognizedWe our Faculty with high teaching Department of Surgery, Faculty University of Medicine, of Toronto 2018-19 • 2017-18 • • 2016-17 •

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18. Division Reports 18. Division Reports 149 Self-Study Report, External 2020 Review | 2018-19 Naif Alotaibi, Bodani Vivek and Allan Martin University of Toronto Residency Program Graduates 2014-15 Alkins,Ryan Sumit Jhas, Osaama Khan, Safraz Mohammed, Shobhan Vachhrajani and Jefferson Wilson 2015-16 David Cadotte, Brian Drake, George Ibrahim, Anthony Lau, Nir Lipsman and Kashif Parvez 2016-17 Mansouri Alireza and Aldakkan Abdulrahman 2017-18 Shelly and Wang Christopher Witiw Department of Surgery, Faculty University of Medicine, of Toronto Toronto Western Hospital.Toronto Director the of Centre Neurovascular for Intervention at Sunnybrook Hospital. Chief at the Hospital Children. Sick for Neurosurgery,of Hospital Children. Sick for Head, Division Neurosurgery, of of Neurosurgeryof at St. Michael’s Hospital. Medical Director thefor Krembil Neuroscience Western Hospital.Centre at Toronto of theof Division Surgical of Oncology at University Health Network. at Sunnybrook Hospital. Surgeon-in-Chief at Sunnybrook Hospital. Head the of Division Neurosurgery of Gelareh Zadeh was appointed as Deputy Leo Da Costa was named Interim Medical James Drake was appointed as Surgeon-in- DirksPeter was appointed as Head, Division Julian Spears accepted the Division of role Head Gelareh Zadeh was appointed as Program Gelareh Zadeh was appointed the Head Todd MainprizeTodd was appointed the MainprizeTodd was appointed as Deputy • • • 2018-19 • • 2017-18 • • 2016-17 • • 185. ORTHOPAEDIC SURGERY

Peter Ferguson, Albert and Temmy Latner Chair, Division of Orthopaedic Surgery

and was asked to take the position of Interim Introduction Chair while an international search took place. Although I initially did not apply for the position, After 5 years as Chair (preceded by one year several of my senior colleagues, contemporaries as interim Chair) of this incredibly talented, and residents encouraged me to pursue it. After accomplished and world-renowned Orthopaedic much consideration, I ultimately decided to Division, this review allows me the opportunity to apply and was ultimately incredibly humbled reflect on our achievements and accomplishments and honoured to be named the 8th Chairman of along with our challenges and disappointments. Orthopaedic Surgery at the University of Toronto. Although I feel that the former far outweigh the latter, it is imperative to critically appraise One of my initial steps was to meet with all of the the shortcomings of the Division and develop a faculty one-on-one to gain their perspective on cogent plan to rectify them. At the same time, the functioning of the Division and the challenges successes need to be celebrated and built upon. they anticipated facing in the years ahead. Our Division had just completed its pilot Competency In 2013, our Chair Dr. Ben Alman announced that Based Curriculum (CBC) in which a subset of he would be departing the University of Toronto to residents trained in a unique and innovative learning take up the Chairman’s position at Duke University. environment with enhanced technical skills, I was Residency Program Director at the time ongoing formative evaluations, improved rotation

150 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 18. Division Reports 151

Self-Study Report, External 2020 Review | Education DirectorEducation (Jeremy Hall) Chair of committee) Program Director (Markku Nousiainen) Associate Program Director (Veronica Wadey) Associate Program Director and Undergraduate Fellowship Director (Johnny Lau) Division Head, Sunnybrook (Albert Yee) University Chair (Peter Ferguson - Vice-Chair Research (Albert Yee) • • • • • Mount Sinai Hospital, University Health Network- College Western Hospital andToronto Women’s Hospital. Most residents get their Community Orthopaedics experience at the Michael Garron Hospital. There fully are 71 affiliated faculty members at these core hospitals in addition to 8 non-clinician scientists. Furthermore, have we faculty members appointed at St. Hospital, Joseph’s Trillium Hospital, General North Hospital, York Scarborough Hospital and Southlake Hospital, where undergraduate medical students and family medicine residents gain orthopaedic exposure and orthopaedic residents can undertake electives. Orthopaedic Council The Orthopaedic Council meets every second month. Membership includes: • • incredibly enthusiastic about the opportunity to see all components this of plan brought to fruition and to embark the on next phase our of strategic mission. Although the history our of Division is legendary, with the achievements Bob of Salter, Schatzker, Joe Marv Tile and Bob Jackson all part orthopaedic of lore, I am convinced that the future is equally bright. Divisional Administrative Structure The Division Orthopaedic of Surgery at University is part the of Toronto of Department Surgery of and is accountable to the Chair Surgery, of Dr. Jim Rutka. The Division consists 6 core fully- of affiliated teaching hospitals(Sunnybrook Health Sciences Centre including the Holland Centre), Hospital Children, Sick for St. Michael’s Hospital, Department of Surgery, Faculty University of Medicine, of Toronto

effective teamwork and partnerships social responsibility excellence in patient care accountability leadership innovation and objectives in education, research, clinical care, quality improvement and faculty I am development. These statements succinctly summarize our priorities in Now from the 3rd year 2016-2021. the of plan, successfully have we met several the of specific goals • • • • Values • • and dissemination knowledge of leaders, contribute to our communities, and improve health locally and globally through discovery, innovation, application Mission prepare andWe education orthopaedic surgical Leading global transformation orthopaedic of care, education and research. through Innovation and Collaboration”. Vision our priorities the for upcoming 5 years. This bold and ambitious plan is entitled “Global Leadership After an initial period administrative of reorganization and committee restructuring, we embarked a strategic on planning process to define extremely outdated website and emails. These were some of the morecommon comments that I heard. faculty members feared that our residents would no longer be able to findjobs. Communication with faculty was sporadic and rudimentary, relying an on The concern opportunities about job Canadian for Orthopaedic surgeonsis well documented and many for allfor residents across our Division. Furthermore, they that felt the Division had lost connection with its history and roots, which is both long and storied. Competency Design by project. Our faculty largely thatfelt the pilot project was a success, had but some concerns about our plan to institute the curriculum schedule. This curriculum has gainedinternational recognition and has formed the basis the for Royal CollegePhysicians of and Surgeons Canada’s of efficiencycompetency a and rather than time based Sick ChildrenSick (Mark Camp) Western (Jas Chahal) Transitional (Jeremy Years Hall) Site Representative, Sunnybrook (Diane Nam) Site Representative, Hospital for Site Representative, St. Michael’s (Henry Ahn) Site Representative, Mount Sinai (Paul Kuzyk) Site Representative, Toronto Site Representative, Michael Garron (Paul Wong) Chief Administrative Resident (Hilary Felice) Senior Resident Representative (James Wu) Junior Resident Representative (Hayley Spurr) Associate Program Director –

half our of clinical fellows are Canadian and half are international, originating from the United States, Europe, Middle East, Asia, South America and Australasia. The majority our of clinical fellows pursue academic positions completion upon of their training and into develop academic leaders. • • • • • • • • • The function the of Program Committee is to administer the training program, including the formal teaching curriculum, residency evaluations and remediation plans, resident schedules, resident selection and other educational initiatives. Fellowship Committee the of one largest have We Orthopaedic fellowship programs in the world, with 60 clinical over fellows in all orthopaedic subspecialties. Approximately •

Self-Study Report, External 2020 Review | Evaluations (Veronica Wadey) Chair of committee) (Polina Mironova) Hospital (John Theodoropoulos) Hospital (Paul Wong) Hospital (Tim Daniels) (Tim Hospital Hospital (David Backstein) Hospital interim (Rod Davey, head) Children (Andrew Howard) University Chair (Peter Ferguson) Associate Program Director - Program Director (Markku Nousiainen - Assistant Divisional Administrator Division Head, Women’s CollegeDivision Head, Women’s Division Head, Michael Garron Chief Administrative Resident (Hilary Felice) Divisional Administrator (Dan Stojimirovic) Division Head, Mount Sinai Division Western Head, Toronto Division Head, Hospital Sick for Division Head, St. Michael’s Department of Surgery, Faculty University of Medicine, of Toronto • • The program committee meets monthly. Membership includes: • and 2 Visa trainees from the middle east (Saudi Arabia, UAE, Kuwait, Qatar, Bahrain, Oman). or currentlyWe residents 49 have in our training program, 46 are whom of clinical on rotation and are whom 3 of in our Surgeon-Scientist Program, undertaking full time graduate research studies. and the of one largest in North America. have We residents new entering11 our program every year including 7 from North American medical schools (Canadian Medical Graduates), 2 from international medical schools (International Medical Graduates) and Quality Improvement Committee are all reportableto the Orthopaedic Council. Resident Program Committee Our residency program is the largest in Canada develop prioritiesdevelop to achieve the strategic plan, manpowerdevelop initiatives among the hospitals and oversee all components research of and education. Other committees in the Division including Resident Program Committee, Fellowship Committee, Research Committee • The mandate the of Orthopaedic Council is financialto approve decisions in the Division, • • • • • • • •

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18. Division Reports 18. Division Reports 153 Self-Study Report, External 2020 Review | Children (Clinician Scientist) College (Clinician Scientist) (Clinician Scientist) (Clinician Scientist) Clinician Scientist) Research (Committee Chair) (Non-Clinician Scientist) (Clinician Scientist) (Clinician Scientist) (Non-Clinician Scientist) Clinician Scientist) Simon Hospital Kelley, Sick for Paul Kuzyk, Mount Sinai (Clinician Scientist) Diane Nam, Sunnybrook (Clinician Scientist) Aaron Nauth, St. Michael’s (Clinician Scientist) John Theodoropoulos, Women’s Sunnybrook Wadey, Veronica David Wasserstein, Sunnybrook Danny Whelan, St. Michael’s (Clinician Scientist) Cari Whyne, Sunnybrook (Non- Hilary Felice (Chief Resident) Albert Sunnybrook, Chair Vice Yee, Ferguson,Peter Mount Sinai (University Chair) Jas Chahal, Western (Clinician Toronto Scientist) Aileen Western Davis, Toronto College Tim Dwyer, Women’s Rajiv Gandhi, Western Toronto Marc Grynpas, Mount Sinai Rita Kandel, Mount Sinai (Non-

• • • • • • • • • • The function the of research committee is to coordinate and promote collaborative research efforts across organization the city, of the annual resident research offer internal day, review pendingof peer review grants, and promote research opportunities to medical students. biology and fracture healing, nanotechnology, biomechanics, tissue engineering, clinical epidemiology,surgical education, heath policy and administration and ethics are all members our of faculty either as clinicians non-clinician or scientists. Membership the of research committee includes: • • • • • • • •

Department of Surgery, Faculty University of Medicine, of Toronto Director, Committee Chair) (Residency Program Director) Marissa Bonyun, fellow Ibrahim AlShaygy, fellow Evangelos fellow Tyrpenou, Jackie Ngai, fellow Unni Narayanan, Hospital Children Sick for Paul Kuzyk, Mount Sinai Bill Kraemer, Michael Garron Hospital Justues Chang, fellow Aaron Frombach, fellow Tosanwumi fellow Okoro, Michael Najfeld, fellow Danny Whelan, St. Michael’s College John Theodoropoulos, Women’s John Murnaghan, Sunnybrook Sunnybrook Wadey, Veronica Johnny Lau, Toronto Western (FellowshipJohnny Lau, Toronto Ferguson,Peter Mount Sinai (University Chair) Markku Nousiainen, Sunnybrook

Ortho Residents Class of 2016 of Class Residents Ortho varied. Experts in research in stem cell therapy, developmental genetics, cancer bone biology, Our Division continues to a significant have impact in orthopaedic research worldwide. Opportunities basic,for clinical and translational research are the University Division, monitoring the educational quality fellowships of and planning theof annual fellowshipresearch day. Research Committee The fellowship committee is responsible for approving fellowship new requests within • • • • • • • • • • • • • • • • • and membership includes: • The fellowship committee meets quarterly ). Key features). include faculty uoftorthopaedics.ca Extensive branding campaign. Creation user-friendly a new of divisional website ( and resident profiles, research initiatives, Hall Administrative Achievements Restructuring Divisional of administration with establishment Vice-Chair of Research position, 2 Associate Program Director positions and an assistant Divisional administrator position. In particular the 2 Associate Program Director positions and second administrator position positions us to meet the University’s recommended guidelines program on support. Completion a comprehensive of and ambitious Strategic Plan entitled “Global Leadership through Innovation and Collaboration” to establish divisional priorities from (Appendix 2016-2021 1). Establishment a divisional of logo and motto (Leadership. Innovation. Impact.) Our division has a large alumni contingent in the orthopaedic community in Canada and across the world. When considers one both our large fellowshipand residency programs,our outreach is significant. Our ability connectto withour alumni remainshowever limited. The University does not a completehave to up date list our of alumni and the only method currently have we communicating of with this group remains via email. begun have We developing our own list through advertisement in the Canadian Orthopaedic Association website. also have beenWe able to engage our alumni through our website new and will be starting a “Where are section they now?” to feature alumni a regularon basis. In the past 4 years have we been recognizing alumni 20 and 15, 25 years after graduation from our program our on resident graduation also have begun We day. recognizing our most esteemed alumni establishment by Orthopaedic theof Toronto Hall Fame. of Self-Study Report, External 2020 Review | (Committee Chair) Maryse Bouchard, Hospital Children Sick for Western Toronto Davey, Rod Raj Rampersaud, Western Toronto Ferguson,Peter Mount Sinai (University Chair) Sarah St. Ward, Michael’s Hospital Jesse Wolfstadt, Mount Sinai Hans Kreder, Sunnybrook Jeremie Larouche, Sunnybrook Department of Surgery, Faculty University of Medicine, of Toronto wellness, medico-legal issues and mentorship. Our faculty members been have invariably successful at this 3 year review and ultimately at the very rigorous academic promotion process. the faculty annual member’s appointment becomes automatic. There is an annual faculty development day organized the by Department and have we recently instituted a junior faculty development workshop to address topics as such promotion, members meet with their hospital division head, surgeon-in-chief, defined academicmentor and the University Chair 1 and 2 years after their appointment to ensure that commitments the on part both of the faculty member and the relevant institutions are being met. There is a formal 3 year after review, which Faculty development and mentorship are important factors in the successful academic promotion our of staff. There is a clearly defined early career review process administered the by Department, the Continuing Appointment Early Review. career faculty The mandate this of committee is to monitor and coordinate quality efforts across University the Division, strategic develop priorities in and QI patient safety, liaise with the departmental QI committeeand the resident program committee. • • • • • • • • in and QI our initial 2 faculty member graduates thisof program will spearhead our initiatives. The committee meets quarterly and membership includes: enable our Division to meet its goals Quality of inImprovement (QI) the strategic plan. With a Department of development Surgery of QI committee, realized we that Orthopaedic representation was crucial. The University of has recentlyToronto developed a Master’s Program Quality Improvement Committee This committee has recently been formed to

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Self-Study Report, External 2020 Review | Recognition 20 and 15, of 25 year alumni at graduation day Establishment Orthopaedic the of Toronto Hall of Fame to recognize our most esteemed alumni. Review for 10 facultyReview 10 for members – Mark Camp (Hospital Children), Sick for Jas Chahal Western), (Toronto College), PatrickTim Dwyer Henry (Women’s (Sunnybrook), Richard Jenkinson (Sunnybrook), Simon Kelley (Hospital Children), Sick for Paul Kuzyk (Mount Sinai), Aaron Sarah Nauth (St. Michael’s), David (St. Wasserstein Michael’s), Ward (Sunnybrook) Successful Promotion to Associate Professor 10 for faculty (Sunnybrook), members Wadey – Veronica Rajiv Gandhi Oleg Safir Western), (Toronto (Mount Sinai), Sevan Hopyan (Hospital Children), Sick for Amr Elmaraghy Danny Whelan (St. Joseph’s), (St. Michael’s), Simon Kelley (Hospital Children), Sick for Markku Nousiainen (Sunnybrook), Diane Nam (Sunnybrook) Successful Promotion to Professor 7 facultyfor members – Albert (Sunnybrook), Tim Daniels Yee (St. Michael’s), Andrew Howard (Hospital Children), Sick for Darrell Ogilvie-Harris Raj Rampersaud Western), (Toronto Unni Western), Narayanan(Toronto (Hospital Sick for Children), Ferguson Peter (Mount Sinai Hospital) of Fame,of resident/faculty schedules automatically linked devices, to iOS/Android educational material undergraduate/postgraduatefor students. Establishment of named lectureships (Gordon Hunter Memorial Lecture, Stefansky Lecture) Establishment partnerships of with industry (Stryker, Zimmer/Biomet, RBC, etc.) to support divisional activities. Creation junior of faculty workshop development to address topics as such practice management, promotion, wellness, medico-legal issues and mentorship. Creation and adoption standardized of academic search and interview process. Recruitment 23 of Faculty new members, all whom of formerwere residents fellows or inour program. Successful completion of Continuing Appointment Department of Surgery, Faculty University of Medicine, of Toronto Orthopaedic - Hall of Fame Award Fame of - Hall Orthopaedic Orthopaedic Grad Day Brochure 2016 Brochure Day Grad Orthopaedic Orthopaedic Surgery Strat Plan Strat Surgery Orthopaedic New Division of Orthopaedics Logo Orthopaedics of Division New initiatives. The undergraduate surgical education director is from our division (Dr. Jeremy Hall), and plays he the dual Associate of role Program Director with a portfolio that includes the transition, junioror years therefore residency. He of has the unique opportunity to interact with undergraduate Transition Program”, developed and piloted by the orthopaedic surgeons at Sunnybrook Hospital, establishes a senior-junior surgeon mentorship model whereby elective operating resources gradually transition from the senior to the junior surgeon over a 2-6 year period time. of Several our of faculty members been have hired under this model. has It garnered interest across Canada within orthopaedics and other specialties. Although are we still facing the challenge underemployed of orthopaedists, the future is appearing brighter than in the past. There been have significantchanges to the undergraduate education curriculum at the the past over University several years. Toronto of The majority these of changes conspire toreduce the exposure medical of students to the musculoskeletal system and treatment disorders of thereof. As a result, medical students often to have opportunities seek out theiron own often with little guidance or been have able tomentorship. continue to train We high quality students and residents through several several senior surgeons continued have to utilize hospital resources that otherwise would been have used to hire younger surgeons training. of out This trend has changed at least recently for however, trainees our of program. The significant majority traineesof from our program in the past 5 years 80%) are(over currently in permanent hospital jobs, mostly in southern Ontario. The “Sunnybrook Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto surgeons to continue working; the second being the successful challenge to forced retirement the on basis discrimination of age. by As a result these, of The most significant issue in resident training over the past several years has been the perceived lack of jobs graduating for orthopaedic surgeons in Canada. There essentially were 2 reasons this for – the first beingthe global financial crisis in 2007-2008, which increased the financialpressure on senior on the topic. We have also have the publishedon We topic. extensively on our experience. Our program has formed the basis thefor Royal College Physicians of and Surgeons Canadaof Competency Design By initiative. all residents passing their Royal College exams theon first attempt. Thisprogram hasmet with significant international interest our and faculty members, recognized now as authorities in CBME, travelledhave throughout the lecturing world to orthopaedic and non-orthopaedic specialty groups role of Interim of role Chair made we in 2013, the decision to institute this Competency Based Education paradigm all for residents new entering our program and continued have we this throughout mandate. my This continues to be a resounding success with After extensive internal and external review our by University and the Royal College Surgeons of of Canada, I can confidently state that thispilot was an overwhelming success, with all our of trainees passing their Royal College exam, the majority after only 4 years training. of assuming my Upon the first surgicalprogram worldin to the undertake a pilot study a completely on Competency Based curriculum, starting with 3 trainees per year. For the next 4 years these trainees participated as a parallel steam to our regular training program. Medical Education (CBME), a recent worldwide pedagogical initiative. This educationalparadigm shifts the focus from the teacher to the learner and is essentially a program that is developed around observable activitiescompetencies, or that can be evaluated rigorously. In 2009, our Division was the Our Division has historically been acknowledged as leaders world in orthopaedic education and this reputation has continued, if been not enhanced, over the past 5 years. The most important contribution has been in theof field Competency Based Education

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18. Division Reports 18. Division Reports 157 Self-Study Report, External 2020 Review | Establishment Orthopaedic of Career Night/Job Fair residents. for Establishment Orthopaedic of Career Night medical for students. international recognition (Society Surgical for Education award) and that several orthopaedic programs internationally adopted. have CanMEDS novel of Development OSCE to assess intrinsic roles as communicator, collaborator, manager, scholar, advocate and professional centralized of Development assessment process to mitigate “assessment fatigue” faculty. for High success of level annual on CaRMS residency match. Re-establishment of middle- east residency partnerships. 100% success residents of Royal on College Surgeonsof Canada of specialty exam. Over 80% graduating of residents over past 5 years in permanent jobs. Education Achievements Adoption program-wide a of Competency- Based-Curriculum, the first surgical CBME Curriculum worldwide. Successful transition from our inaugural pilot project from 2009-2013. a smartphone of Development based evaluation platform (Elentra), pilot program development thefor Postgraduate Medical Education office. Establishment our of faculty as leaders world in CBME, various publications and invited lectures. Membership in the International Competency Based Medical Educators collaborative (Dr. Ferguson, Nousiainen). Dr. our of SurgicalDevelopment Boot Camp, a novel surgical skills curriculum, that has garnered Department of Surgery, Faculty University of Medicine, of Toronto Departments are at the exploring University. We optionsto increase our profile in CME, which could also potentially increase divisional revenues. including the annual Extremity Upper Update and the biennial Foot and Ankle course. Several other MSK-related courses are run other by There are several Continuing Medical Education courses that are longstanding inour division formal fellow education program, focusing on practice-related issues, is being developed. with establishment awards new of in fellowship education and research, has increased the profile fellowof contributions to the Division. A take the important over coordinating of job fellowship education across the Initiatives city. including the annual Fellowship Research Day, Department Surgery of at the University of Divisional A new Toronto. Fellowship Director (Dr. Johnny has Lau) recently been named to largest in North America. Furthermore, we are the largest fellowship program in the aroundthe to world our various subspecialty programs. far by have the largest We orthopaedic fellowshipprogram in Canada and the of one also introduced in Orthopaedics a Women Night. continue to attractWe clinical fellows from Orthopaedic Career Night medical for students early in their year 1st to introduce them to our specialty. In an attempt to broaden our diversity, have we medical studentsall of developed have an levels. We the jewels in the Department’s crown. This program enables residents interested in an academic career to pursue either an MSc PhD or in the middle of their clinical training. Residents take time to away dedicate their time to research and recommence their training completion. on This program has Given theGiven decreasing amount peer of review funds that are available through these agencies, the future the of surgeon-scientist remains somewhat uncertain. Clinician scientists, often with extensive clinical obligations, to have compete with full time scientists the for limited amount of funding that is available. A collaborative model, whereby clinician scientists form partnerships with basic translational or researchers, remains the most viable option going forward to continue maintaining high quality research. Publications and invited lectures also continue to be significant, a signourof significant academic footprint and our strong clinical units. Established Bernie Dr. by Langer in the Department Surgeryof the Surgeon-Scientist in the 1970’s, Training Program (SSTP) continues to of be one Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto stable the past over 6 years. The majority this of funding has been obtained our by non-clinician scientists a select or number clinician of scientists. productive Orthopaedic units in North America. our faculty 2018/2019 For members secured have almost million $9.6 in peer reviewed funding, mostly from major agencies as such the CIHR This NSERC. or number has remained largely Research Regardless the of metric utilized, our Division continues to the of be one most academically awards to recognize outstanding fellows and fellowship educators. Creation of formal junior resident- junior faculty partnerships. Establishment of Preparation for Practice curriculum for fellows. Establishment teaching of and education Bruce Tovee UndergraduateBruce Teaching Tovee (DepartmentAward Surgery) of 2016 Dipasquale, Hall – J. – D. 2017 WilsonDR Outstanding for Award Resident (DepartmentTeacher Surgery) of – R. Perlus 2018 of Canada) 2015 – P. Ferguson Canada)of – P. 2015 Surgical Skills Center Distinguished Hall – J. Educator 2015 Award Excellence in Community Based Teaching Kraemer, F. – W. (University 2015 Toronto) of Mastrogiacomo, Dipasquale, – D. 2018 Mayne I. Donald R. Wilson (RoyalAward College Physicians of and Surgeons Numerous teaching awards residents for and faculty: Excellence in Postgraduate Education (University of Safir Ferguson, - O. 2014 - P. 2019 2013, Toronto) Establishment in Orthopaedics Women of Night Case the of Month medical for studentsWebsite on

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18. Division Reports 18. Division Reports 159 Self-Study Report, External 2020 Review | Successful completion Surgeon of Scientist Training Program 9 trainees by including 6 MScand 3 PhD. Leadership Canadian of Orthopaedic Research Association several by faculty members. Research Achievements Appointment of Vice-Chair research and reorganization research of committee to include significantnumber non-clinicianof scientists. Maintenance high of peer of reviewed level annually). $10,000,000 (approaching funding Numerous publications and invited lectures faculty by members. Numerous publications trainees. by researchNovel day curriculum including research boot camp junior for residents, lectures clinicalon epidemiology, quality improvement and surgical education, appraisal literature. of at least 2 well known musculoskeletal researchers) and because the other research institutes ultimately did board on come not with financial support. This has ultimately resulted in challenges in developing formalized cooperative research initiatives across the Thecity. position Vice-Chair of Research of in the Division was created with a mandate to navigate help the significantlogistical challenges that includes different REBs in hospital each variableand strategic foci the of differenthospital based research institutes, that may include not musculoskeletal health. Despite these current challenges, continue we to be a highly productive division that produces more academic orthopaedic surgeons that any other university in Canada and than many in North America. are developing strategies We to allow us to adapt to the changing environment of research and to increase our collaborative efforts so that output is under the brand Toronto of Orthopaedics rather than individual hospital units. Department of Surgery, Faculty University of Medicine, of Toronto my tenure,my ostensibly because a director could not be recruited the (despite position being offered to that others would follow suit. This University- based Unit unfortunately was disbanded early in formed to coordinate musculoskeletal research across the The city. initial budget was largely provided 2 by hospital based research institutes, in the anticipation Under BenUnder Alman, our former Chair, the Toronto Musculoskeletal Extra-Departmental Unit was projects. These projects, supported supervisors, by often result in multiple publications our for trainees and positions them well academic for careers. annual Resident Research in Day where November senior residents present their longitudinal research commitment $50,000 of the by Chair, to offset help thesome of costs to the division. The research by our trainees continues to be highlighted in our resulted in diversion funds of from other activities. The Orthopaedic Surgeon Scientist Training Fund has been founded, starting with a personal As a result, our Division is faced with an additional $60,000 expense per year, which is currently provided our by annual tithe, which but has include limiting the number residents of entering the program and transfer the of salary support funding to the surgical division and the supervisor. several changes in the financial administration thisof program to enable to it continue. These recent years, the budget has become unsustainable. A recent report carried James Dr. by out Wright the of Division Orthopaedic of Surgery has recommended responsible funding for the salaries these of trainees at a clinical of the level resident. With increased numbers residents of seeking this experience in advantages in developing academic surgeons, thishowever, program is expensive to maintain. The Department Surgery of has traditionallybeen quality improvement, surgical education, medical leadership and medical ethics. Despite its enormous The definitionof “Surgeon-scientist” has expanded in recent years to include experts only not inbasic and translational research clinical but epidemiology, positions our trainees a career for in academic orthopaedics and has allowed us to continue to remain at the forefront inquiry of and innovation. in our Division – approximately 40% our of faculty are graduates this of program and almost 60% new of recruits in the past 5 years. This experience uniquely produced an enormous number surgeon-scientists of 18 Albert Latner and Chair Temmy this of talented and impressive achieved Division. have much We in the past 5 years I am yet satisfied not with the status I would like quo. to see significantprogress in the areas highlighted in this reports. I believe that the have people inwe place to see many these of changes to come fruition. I am most the of proud large number recruits new of that in have we our division, the 23 past over 5 years. These individuals, all are whom of products our of residency or fellowship programs, are well positioned to take our division to greater even heights in the future. forwardI look to helping them grow and develop into established academic orthopaedic surgeons over the next 5 years. enormous I have pride in the past accomplishements our of storied division am but more enthusiasticeven about its future achievements. establishment of standardized perioperative orders sets common for procedures across the university. Achievements Formation Divisional of Committee QI with representation from all divisional teaching hospitals. Recruitment 3 faculty of members with Master’s training level in quality improvement and patient safety. Several faculty publications pertaining to quality improvement. Summary remainsIt a privilege and an honour to serve as the Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto a mandate to oversee and prioritize initiatives within our division. Planned activities include standardization reporting of adverse of events and members completed have who this program and therefore an have academic interest in QI. With this critical mass specialists QI of have we recently formed a divisional committee with has perhaps been somewhat that slower other divisions to adopt initiatives, QI ostensibly because members our of division, albeit committed to QI, lacked any formal training. A Master’s Program in has QI recently to fruition and within the past 3 years recruited have we faculty 3 new as a crucial the of component daily function of health organizations. The Department Surgery of has committee a QI under the direction Dr. of Robin MacLeod, with representation from all divisions in the Department. Orthopaedics Quality Improvement Patientand Safety Quality Improvement has (QI) recently emerged Participation in the CREMSs program undergraduatefor medical summer student research projects. Creation the of Junior Faculty Research most for promisingAward academic career. Lawson Fund seed grants for researchresident projects. Program Training Fund with $50,000 personal commitment from Chair. Robin Richards in Award Upper Extremity Research established. Recruitment non-clinician of scientists to faculty at Western HospitalToronto and Sunnybrook Hospital. Creation Orthopaedic of Surgical Scientist Appointment of Endowed Chairs in Musculoskeletal Research, Spine Research and Sports Research at Sunnybrook Hospital.

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18. Division Reports 18. Division Reports 161 Self-Study Report, External 2020 Review | The geography ranges from Michael Garron Hospital in the east the end of city to Trillium Health Sciences Centre in the west (56 km) and from St. Michael’s Hospital in the south to GeneralNorth Hospital York as the northern boundary This (23 km). can be a challenge. Divisional Organization This is the largest academic division in North America. grown have during We tenure my staffto 59 surgeons, 3 senior scientists, 28 residents fellows and and teaching 19 12 have sites. Currently there are full 13 professors, professors assistant 20 professors, associate 8 lecturersand 17 that make the up division. Department of Surgery, Faculty University of Medicine, of Toronto Christopher Forrest, Chair, Division of Plastic and Reconstructive Surgery

and research break-throughs and discoveries. This program has a large academic footprint and the division can boast a strong of global connection. paradigms. has It been integral in the creation the of Surgeon-Scientist training program and has been the origin important of and highly relevant clinical program in North America. has It produced leaders and innovators had have who significant and major influenceson training, research and clinical at the has University a rich and Toronto of storied heritage. is It the largest Plastic Surgery teaching Overview The Division Plastic of and Reconstructive Surgery Introduction and Plasticand Reconstructive Surgery Residents

SURGERY 6. PLASTIC6. AND RECONSTRUCTIVE 18 The teaching sites include: that meets as needed but is always available for • The Hospital for Sick Children consultation and discussion. Furthermore, I feel that • University Health Network: Toronto General as the most crucial business of the division happens Hospital and Mount Sinai University Health at the monthly RPC meetings, it is important as the Network: Toronto Western: The Hand Unit Chair to be present and appropriately interactive. I • St. Michael’s Hospital Sunnybrook Health have also created a position of Director of Alumni Sciences Centre Ross Relations and appointed Dr. Ron Zuker to this • Tilley Burn Centre post. With the addition of new teaching sites, the • Women’s College Hospital RPC has grown accordingly. As Competency • St. Joseph’s Health Science Centre By Design filters in to the division over the next • Michael Garron Hospital (formerly Toronto East year, there will be the need for an additional General Hospital) North York General Hospital committee that may dove- tail into the RPC. • Trillium Health Partners • Resident Aesthetic Clinic (The Mississauga Clinic) I meet every 2 weeks with our Program Administrator, Ms. Kathy Pavlovic and we continue twice a year General Assembly Meetings. These have sporadic attendance from the staff, I suspect in part Divisional due to geography. Executive meetings are held prior to the General Assembly Meetings and as needed. Administration Furthermore, I maintain the philosophy that the combination of good food and fine wine in an off- I have always held the philosophy of trying to site location can facilitate the opportunities for high include everyone in the functioning of the division level discussion and focused productivity and as the and give each person some level of responsibility result I host a series of dinner meetings throughout and accountability. I have felt that this provides the year with targeted staff that I have found very an important opportunity for engagement and useful. As such, I would state that the administrative connectivity. To this end, during my term, I have organization of the division is robust and effective. created an Executive Committee (see next page)

162 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 18. Division Reports 163 Self-Study Report, External 2020 Review | Hospital for Sick Children Sick for Hospital Garron Hospital Michael General North York Resident Aesthetic Clinic Centre Burn Ross Tilley Centre Science Health Josephs' St. Hospital Michael's St. Centre Sciences Health Sunnybrook Hospital General Toronto Program Hospital/Hand Western Toronto Trillium Health Partners Hospital College Women's

• • • • • • • • • • • • PLASTIC SURGERY ASSEMBLY PLASTIC SURGERY Chair scientists senior and surgeons All RESIDENCY PROGRAM COMMITTEE Program Director—Chair of Committee the Chair Division Directdor Research Administrator Program Representative Resident Junior Senior Representative Resident Hospital and Program Representatives: Revenue sourcesRevenue to the division also include CME events (50% comes back to the division), industry support, donations. I am grateful to the Department Surgery of partial for administrative support. There is divisional no Chair at this time. $3300 per year to $1900 per staff. Staffcompliance has been close Divisional to routinely. 96% dues are used specifically for administrative salary support and the annual graduation dinner. They are used not to support other line items in the annual budget as such social events, etc.

Department of Surgery, Faculty University of Medicine, of Toronto Kathy Pavlovic, CMEA Christopher R. Forrest, MD, MSc, MSc, Forrest, MD, R. Christopher

Resident Wellness Director Wellness Resident FRCSC PhD, Cross,Karen MD, Research Director Research FAAP FACS, MD, Gregory Borschell, H. Quality Improvement Coordinator FRCSC MSc, MD, Wong, W. Karen Clinical Fellowship Director FRCSC MD, Zhong, Toni CoordinatorUndergraduate FRCSC PhD, MD, Musgrave, Melinda Senior and Education Resident Coordinator FRCSC, FACS MD, MSc, Lipa, Joan Junior Resident and Education Coordinator FRCSC MD, MSc, Baltzer, Heather Executive Committee Chair & Division Chair & Division Committee Chair Executive FRCSC, FACS MSc, Forrest, MD, R. Christopher Director Program FRSC(C) MEd, MD, Wanzel, Kyle Chair: FRCSC, FACS Administrator: Program EXECUTIVE COMMITTEE DIVISION INFRASTRUCTURE

distribution a tax of receipt to each staff. I have also been successful in lowering this amount from been successful administering of this through the Advancement Office inthe Faculty of Medicine at the resulting University Toronto, of in the in the division through administration a of divisional membership “dues” has supplanted the a “tithe” of concept “levy” or and I have The running a division of this size requires some capital. philosophy My having of an investment Division Finances uoftplasticsurgery.ca George Armstrong-Peters Prize Greg Borschel - George Armstrong-Peters Prize AlumniAward, Dean’s Award Toni Zhong - BelindaToni Stronach Chair, Zuker - CSPSRon Lifetime Achievement • • Enhanced and improved communication strategies with Newsletter, (What’s WGO Going social On), media appendices) (see Increased profile throughpresence and participation at national and international meetings (Alumni and Friends events) Staff recognition with creationof annual awards and Above Award Beyond Early Career Lifetime Award Recognition Award Chairs Recognition Ronald Award Zuker Award Enhanced opportunity non-downtown for hospitals to participate in rounds (Professors Rounds, M&M rounds, with etc) web links and teleconferencing access. Awards recognition and CPSO proceedings). There been have 3 retirements and 9 recruitments in addition to the addition a of teachingnew site General (North Hospital). York Accomplishments of the Chair have included: Reconfigurationof the divisional administrative infra-structure Complete overhaul the of divisional website Enhancement the of teaching and scheduling activities the on website the for residents Strong campaign engagement for at all levels (under-graduate, post-graduate, fellow, alumni, community partners, industry) Philanthropic strategic engagement Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto program training in the US, transferred one into an editorial and role the other lost his licence through international stage, provision the of best educational experience possiblethe for residents and fellows and engagement alumni of and community partners on a foundation excellence of in patient care. Turnover staffof has been minimal. There been 3 staffhave departures into went Plastic (one Surgery residency during term my focused have the on creation an of effectivecommunication platform and enhanced presence,web improved divisional engagement/ sense community of and a strong emphasis on divisional profile through the career advancement itsof staff, increasedpresence on a national and During My as Term Chair I would characterize the primary accomplishments Major Accomplishments through the fund I established 3 years ago with a personal 5-year $100K commitment and creative divisional financial re-organization.Traditionally, support SSTP for trainees is guaranteed their by supervisors this but has been inconsistent. came this past year with a sudden loss support of for trainees in the Surgeon-Scientist Training Program, previously funded through Department Rutka’s Dr. Surgery.of This past year left the division with an $80K shortfall that I had to resolve in part the impact these of efforts has beenmeagre I but continue to solicit these for and avenues would hope that the division is positioned well an for endowed Chair other or form giving of opportunity. The biggest threat to divisional financial stability I have spentI have a considerable amount time of and effortworking with Advancement the Office in the Faculty Medicine of raising the profile theof division in promoting opportunities for philanthropic date, I would support. say that To I have supplementedI have the Program Directors salary an additional per year from$10K divisional funds.

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Division Reports 165 Self-Study Report, External 2020 Review | numbers residents of entering SSTP Symposium, Obstetrical Brachial Plexus Palsy Pediatric Workshop, Extremity Upper Symposium, Robin Sequence Symposium of Surgery (divisionof members won have at UoT the George-Armstrong Peters Prize 3 times and Lister Prize during once tenure) my Recognition division of greats (Hall Fame of and CSPS) Successful promotions staff key of David Fisher Professor - Mitch - Brow Professor Cartotto Rob - Professor Jeff Fialkov - AssociateToni Zhong - Professor Associate Professor Jim Mahoney - Professor Michael - Assistant Weinberg Professor Annual meetings with all staff - Goals Objectivesand in SurgeryFocus Women on and Diversity (Dr. Laura Snell) Creation of Medical Student Career Night Promotion divisional new of leaders (NEAL, Rotman programs) Growth the of Creation a social of program (cooking classes, sketch night, sportsactivities, wine tasting, communication and career planning) Creation annual of dinner with the Chair each for the of PGY years Creation of Resident-Fellow Interaction Policy Creation Social of Media Policy Creation a Resident-Fellow of Interaction Committee Creation Quality of Improvement position (Refer to Karen Riff’s Dr. Wong report in Appendix)Creation SSTPof fund personal ($100K 5-year donation) Post-graduation employment initiative to help residents obtain jobs Stipends RD for and PD Reconfiguration ofResident Aesthetic Clinic Enhanced research profile withinDepartment Department of Surgery, Faculty University of Medicine, of Toronto Laura Snell - SBHSC Anne O’Neill - TGH Anne O’Neill Alan TGH - Rogers - RTBC Siba Haykal Sharon - TGH Kim - Trillium Achievement Award Davidge - HSC Karen Cross - SMH Prize, Lister Prize, Chair, Burn Research Award Mitch Brown - Bruce Tovee Toni Zhong Karen - TGH RiffToni Wong - HSC Blake Murphy - SMH Heather Baltzer - TWH Nancy - CSPS McKee Lifetime Karen Riff Wong - HSC Kristen Marc Jeschke - George Armstrong-Peters for craniofacialfor and flap educationalopportunities Resident enhancements: Retreat, divisional branding (labcoats and outerwear), out-sourcing Growth community of teaching centres with acquisition NYGH of people in our specialty to see what is going here on Reduction of divisional dues Rounds with focus national on and internationally recognized speakers: creation important for a hub of Complex Wound, Burn,Complex Wound, Peripheral Nerve, Breast) Generation Lecture GTA of series and Professors Creation special of interest groups (Research, Successful Continuing Appointment Reviews Steve McCabe - TWH • • Recruitment strategic of staff new • • • Gallie Day ReceptionGallie the residents included have an annual Resident Retreat in June as well as a Social Program where educational opportunities cooking, on photography, communication etc. been have provided for them. Attendance at meetings and CME events is facilitated these when are local all (eg: our residents the educational experience the for medical students. A report is her by included in the Appendix. Post-graduate I believe that provide we the best possible educational experience to our residents given the scope practice of that exists in our program. The Boot Camp, Surgical Skills Labs, Journal Clubs, M&M Rounds, CanMeds seminars and Monday morning Plastic Surgery provide School a fertile opportunity superb for didactic teaching. This has been with coupled two dedicated and passionate Program Directors (Mitch Wanzel) Brown and Kyle hard worked have who to engage the residents and ensure success. the opportunity enjoyed I have to withwork them both and appreciated have their support experience. and focus the resident’s on facilitatedI have the opportunity all for senior residents to attend the ASMS Craniofacial Course and the Duke Flap course the for purposes of practical training. Additional experiences for ago, I started the Medical Student Career Night which was designed to provide beer and pizza and showcase the depth and breadth whatEach of do. we year had have we between students 120 to 135 from medical schools across the province attend and we seenhave an increase in numbers applicants. of We beenhave blessed with superb residents of choices and routinely match well eachyear in CaRMS. Unfortunately, this past year wasassociated with a failure10% to match rate in the graduating class UoT which I consider to be a huge failure government. of Several excellent candidates Plastic for Surgery did match not (likely as the result focusing of a on single program without backup plan) and I worry that as the result, potential applicants may think before applying to a competitive program. We also had a reduction from 4 to 3 resident positions which impacted us. I am hopeful this coming year will restore our numbers. Melinda Dr. Musgrave is the Undergraduate Education Coordinator the for Department Surgery of and is focused enhancing on Self-Study Report, External 2020 Review | eir surgical rotations. A study h Department of Surgery, Faculty University of Medicine, of Toronto medical students 1 hour have less or exposure to our specialty. There was also a decline in the number people applyingof to our program. Three years student exposure to Plastic and Reconstructive Surgery was limited to those had who an interest in a career and did electives and those used who it as an elective during their clerkship years as an easy toway get through t our by done Program Director that showed of 85% to provide an exceptional educational experience to any trainee in almost any clinical arena. Undergraduate Some years ago, became it apparent that medical Education The biggest strength this of division lies in its clinical diversity and high volume and the opportunity Division Research Assistance Research Division New programs: Gender Confirmation Program CVA of Chair’sof Medal alumni for recognition Appointment Zuker as Ron Dr. of Director Alumniof Relations Global Outreach Appointment Chris Dr. of Novak: K. Davidge and J. Semple J. and K. Davidge 100% success rate in Royal College Exams for graduates Successful transition PD (Mitch of Wanzel) CreationBrown Division to of Kyle Research Whiteboard website on Creation

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18. Division Reports 18. Division Reports 167 Self-Study Report, External 2020 Review | Karen Wong CAR Wong Karen understand the working relationship with the residents. the For most part, resident-fellow interactions been have synergistic and beneficial to both parties. is It crucial that fellows be made aware theof extent their of duties which may extend to include call and coverage the of residents when attending educational sessions. This occasionally can be problematic at specific teaching sites. I am happy that our division continues to attract a wide range fellows of from around the funding but world will remain a challenge. Fellowship We providefellowships Office. in craniofacial (pediatric and burn adult), surgery, hand surgery, breast surgery, pediatric plastic surgery, general plastic surgery and microsurgery. Support fellowship for salary is enabled by hiring Canadian trained surgeons can who bill theirfor services. Through industry support and with the the of help Advancement Office, funding has been generated fellowships for at Sunnybrook Health Sciences Centre, Women’s CollegeHospital, The Hospital Sick for Children General and Toronto Hospital. hasIt become apparent that there is a growth opportunity Aesthetic to Surgery create a UoT Fellowship. There is fellowship such no in Canada and I am confident that we expertisethe have this Zhongto this. develop end, Toni Dr. To and I are coordinating a series meetings of this fall to make this a reality in the next year. isIt important that fellows arriving in Toronto Department of Surgery, Faculty University of Medicine, of Toronto

Dr. Toni Zhong as the Divisional Toni Dr. Fellowship Director and helps she coordinate with the UoT Hand Unit, Toronto General Hand Unit, Hospital, Toronto Women’s College Hospital, Ross Tilley Burn Centre and Sunnybrook Health Sciences Centre. I appointed where the influenceof the division felt.not is Fellowships are offered SickKids,at St. Mikes, The global currently basis. We a network have fellows of that extends to all continents and there is nowhere the best possible experience during their stay in our division. I also feel that this is the of one best ways that a program can extend its influenceon a individuals uprooted have who their families, travelled many miles and in many cases, incurred financial disadvantage Toronto, comingby have to Fellowship Our division has to 23 between fellows each 17 year. I am passionate about making sure these passionate and effective advocate for thisprocess. have begunhave to run and this 1’s with out the PGY- willit a more complete have introduction in 2020. been have fortunateWe in having Wanzel as Dr. a And finally, CompetenceDesign By has begun in the resident education system and will obviously a significanthave impacton learning the We process. and return to base hospital to start the day. traffic are challengeswhen residents are expected to be present at Friday Professor’s Rounds and (downtown at PrincessM&M’s Margaret Hospital) sufficient to providecomprehensive a experience and would advocate 6 months. for There are some where perhaps 3 months is enough. Geography and North York General). isNorth It likely York sustainable not to maintain resident presence at all these sites. I also feel that some rotations, for 4 months is not opportunities community for experience(Trillium, Michael Garron, St. Joes and most recently Challenges in resident education include the number rotations of available seniors for including 4 Jamil Ahmad runs who the ResidentAesthetic Clinic has also be instrumental in facilitating resident attendance at a number aesthetic of meetings. when thewhen CSPS meeting in was in held Toronto Registration Aesthetic2012). and the for Toronto Breast Meetings are waived local for residents. Dr. were providedwere registration courtesy the of division Divisional Research Day 2018 - Dr. J. Catapano won for for won Catapano J. - Dr. 2018 Day Research Divisional best for Ziolkowski N. Dr. paper and science basic best clinical paper for craniofacialfor and cleft surgery as well as the creation highof fidelity surgical simulation trainingmodels. The research in done the division is highlighted yearly with presentations the by residents at the Annual Resident Research featuring Day the Hoyle Campbell Visiting Professor. This has attracted a remarkable parade well-known of and iconic researchers. A model support of was developed in theDivision Vascular of Surgery where philanthropic investment has allowed a 3-year substantial salarysupport package staff. new for This is an enviable model and I am working with the Advancement Office to see ifthere are similar opportunities that could be applied to division. my expectationsMy all of staff are that theycontribute in tosome way the profileof the division and the easiest isway through research and publications. I do regular searches PubMedon to review what publications from come have our division members and try and highlight them in the for purpose the WGO of recognition. As the Chair, I try and lead example by and continue appointment my in the Institute of Medical Sciences and maintain a busy agenda of mentorship and supervision. During the past 5 years, supervisedI have PhD candidates Alex Gordon and SSTP- graduate Dale Dr. Podolosky in addition to having a series summer of research students. My research has focussed developing on a robotic platform Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto This is a particular challenge appointees new for and I regret that our division does the have not financial resources provideto supportour for institution as such SickKids and the Ross Tilley Burn Centre where salary support allows the opportunity investmentfor time of in research. continues It to remain a challenge where a drive fee-for-service for and clinical demands may divert the focus staff. of The Departmental description job Surgeon- of Scientist with a minimum designation 50% of time of devoted to research would suggest that 8 have we staff that fall into this category. of concept The the “Surgeon-Scientist” works exceptionally well at an development of app-based technologies, outcomes and epidemiologic studies, qualitative research, surgical simulation and education, and innovative areas study of as such “Black analysis Box” OR of procedures and the use drones of in the OR. chicken model. foot This into evolved the Surgeon Scientist Training Program thatcurrently we betweenhave 3 to our 5 of resident trainees engaged in. The scope research of within done the division is broad ranging from basic science, Research The division has a rich history in research extending back to the original “Chicken Club” formed by a group K. residents of with worked who W. Dr. Lindsay investigating healingtendon flexor using a from these events are evenlydivided between the Department Surgery of and the division and represent stream a revenue $25K to of $40K per year. Thomson Pediatric Plastic Surgery Symposium, Breast Aesthetic Symposium,Toronto Toronto Symposium, Obstetrical Brachial Plexus Palsy PediatricWorkshop, Extremity Upper Symposium, Robin Sequence Symposium. Profits generated CME brand events and with is it a great the UoT chance to showcase the talent that in have we our faculty and attract a number visitors of to the program. These annual courses and events include the Canadian Burn Association, Ralph Manktelow Extremity Upper Lindsay- Day, CME The division has a high activity of level in local

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18. Division Reports 18. Division Reports 169 Self-Study Report, External 2020 Review | at national and international meetings, the creation theof unique “Chair’s Medal” given to all alumni with a unique identifying number, regular WGO and Newsletter emails, creation an of “Alumni Hall Fame”of the on website and annual invitations to all alumni the for Graduation Gala Dinner in June. academic careers. I feel that the I put priorities of the division and the individual members my above own. also I have made sure maintained I have a busy clinical practice and maintain volumes commensurate with FTE the other staff. 1.0 yearly I have Goals and Objectives meetings with all the of staff and have an open-door policy with respect to communication. best my done I have to engage with residents in the program. Until years of a couple ago, I would yearlyhold meetings with found each but that one these particularly not were fruitful. host I now annual small group dinners with each resident year which has more effective to be much proven in helping establish and generate relationships with the house-staff. I also set an exampleby attending all rounds, Journal M&M’s, Clubs, social events, etc. I am when travelling. not alsoI have hard worked to instill a sense belonging of and loyalty to the division our for alumni, through the establishment of “Alumni and Friends” events evidenced research by publications in peer reviewed journals, grants held, and students trained) being won Gregby Borschel, Marc Zhong Jeschke and Toni and the Lister Prize (awarded to an investigator who has shown outstanding and continuing productivity internationalof stature as evidenced research by publications, grants held, students trained and other evidence stature of the of produced) work being awarded to Marc Jeschke in the past 5 years. No other surgical division can boast profile. such of Leadership I am the of proud organization and coordination that exists within division. my I feel that my leadership style is democratic and collaborative and promotes collegiality and an open opportunity communication.for I would that hope leading by example has satisfactorily worked in allowing the members the of division to flourish and develop their Department of Surgery, Faculty University of Medicine, of Toronto has shown outstanding productivity during his/ initialher period as an independent investigator as had high visibility with the George Armstrong- Peters (awarded to a young Award investigator who and assist staff across the division needed.as from a researchHowever, profile pointof view within the Department Surgery, of the division has been the case. To thisbeen the case. end, appointed I have To Senior Scientist Christine Dr. Novak to a 0.2 FTE divisional position with the mandate to coordinate help I had hoped that the position Research of Director would afford energysome and time to assist with the research profileof division staffbut this nothas emphasis supervisors on guaranteeing support. Strategies to the help SSTP included have early selection trainees of to maximize the opportunity scholarshipfor and grant application as well as more Former Mitch PD Dr. Brown has very generously donated 5 years $50K over otherwise, to but help there has been little traction to support this initiative. designed to support our trainees in research. I have made a personal donation 5 years $100K over and have had very limited in buy- from other staffor alumni. have supervisorshave in other divisions. Three years ago, working with the Advancement Office, I established a SSTP Fund and created a campaign donations for resident trainee’s time with them in but reality, this alwaysdoesn’t happen, especially our when residents trainees that resulted in the division having to back- fill $80K in salary for this pastyear.Ideally supervisors agreedhave to provide funding the for duration of The biggest threat to research has been the sudden loss Departmental of salary support our for SSTP going in on the division may foster collaboration and spawn research. for avenues new These occur twice a year and are well attended. Research Dinner nights where an informal get- together to share ideas and discuss what is quality the has of done work been superb. With Borschel, Dr. started I the of concept Research Director annually to discuss their research projects. All staff(academic community) and thehave opportunity to superviseresidents. The Andrea Pusic, Maxwell Pat to name a few. Residents meet with Greg Dr. Borschel, the division names during tenure my including MikeBentz, our best to improve efficienciesopportunities and for our patients. I feel that will it be crucial to “rest on not our laurels” to but take the opportunity to re-evaluate the traditional “program-based” approach and examine the traditional that way things. done have we As Plastic and Reconstructive Surgeons, are we used the that way all division members extend themselves there is a However, andto beyond”. go “above price to be paid and I think is it very important to recognize the sacrifices that been have made in terms life-style of and the associated stresses an of academic appointment. Physician wellness is an area that deserves attention. much Despite these challenges, I am that proud are we able to recruit the best and brightest as faculty and trainees. During term my as division chair, administrative changes within the institutions, program and personnel contractions, funding restrictions, increased demands time on and administrative responsibilities and external pressures our on health care system addedhave to the day to day challenges working of in academic surgery. is I feel it crucial to continue to foster recruitment the of best and brightest as staff and trainees and to continue to lead the academic mission theof division training by the next generation of surgeon-scientists. As such, I think is it necessary to take a close at look the care that provide we and do grateful assistance. her for I am alsoimmensely grateful the for remarkable support and mentorship ourby Department Chair, Jim Dr. Rutka whose leadership has beeninspiring and innovative. Divisional Priorities Directions: Future and 2018-2023 In preparing this report, has it been a useful exercise to allow to me reflecton journey the our division has taken the past over 5 years and I am very proud to had have the opportunity to lead a remarkable group dedicated of and highly talented individuals. I believe are we stronger than 7 years were we ago. a division have We that is class world and highly focused improving on the lives our of patients and providing the best educational opportunity possible allfor levels trainees. of I am continually impressed by Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto administrative assistant at SickKids, Dyanne Bechard takes who the some of on responsibilities associated with the Chair position and I am most Kathy every Pavlovic two weeks. According to her estimates, spends she 90% time her of administering to the needs the of residency program and the rest to the needs the of division and myself. I am very fortunate in having an effective working relationship and functions well. in I work the same practice group as the divisional Research Director, Greg Dr. Borschel and access have to him need to we when communicate. I also meet with our divisional administrative coordinator Ms. Committee which maytwice or meet once a year. This group may be called together at short notice to discuss any relevant issues as needed. My main divisional interaction is with the Program Director (Dr. Mitch Brown until and July 2017 This Wanzel). is Kyle a highly Dr. now effective I represent The Hospital Children Sick for at the monthly Residency Program Committee meetings chaired Program by Wanzel. Director, Kyle Dr. This is the of where resident much related business theof divisionis carried an I have out. Executive aboutcommon problems and issues. Division I hold GeneralAssembly meetings twice a year in which all staffmembers are invited. This is poorly attended and despite attempts to reconfigure thismeeting, doesit attract not a high engagement.of level the Department Surgery of Executive. This meeting is hosted Department by Surgery of Chair Jim Dr. Rutka. created I have an informal get-together of the Surgical Chairs which meets dinner for twice a year. This is a very useful opportunity to brain-storm communication and mutualrespect each for other and sort through any issues in a satisfactory manner. theI sit on Senior Advisory Committee which meets monthly during the academic year and consists the of division Chairs, institutional Surgeons-in-Chief and there are times where consensus does exist not but the impact these of infrequent situations istransient and I am the of proud fact that there been have no significant divisive issues duringmy term as division areChair. able to maintain We open channels of I would say that our division works very well as a group. Like most close relationships with a large number unique of and opinionated personalities,

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18. Division Reports 18. Division Reports 171 Self-Study Report, External 2020 Review | assistant Dyanne Bechard and am immensely grateful insights, her for observations and support in allowing tome do the that job And I do. perhaps, the best thing about this position is enjoying the success of the trainees that the I have privilege influencing of and training to be the best that they can be. inspiration a routine on basis. been I have blessed with two superbProgram Directors, Drs. Mitch Wanzel do who theBrown heavy and Kyle lifting comes it when to running the program. Research Directors Fish Joel and Greg Borschel been have passionate about the resident research experience and elevatedhave the quality hereto done the work of highest through level the Surgeon Scientist Training Program and Annual Resident I have Research Day. thoroughly working enjoyed with the Department Surgeryof staff at Stewartthe Building would and like to acknowledge the support both of Sylvia Perry and Nancy Condo are who a delight to with. work JamilDr. Ahmad runs who the Resident Aesthetic Clinic and seems to know every important Plastic Surgeon in the has world a remarkable done of job coordinating Lecture the GTA Series, enhancing industry support and being a terrific ambassadorfor this program. Thanks to Darina Landa and David Grieco from the Faculty Medicine of Advancement Officecontinuous for and sustainedeffort in promoting this division. I rely heavily admin my on important achievements and potential challenges that developed have during tenure. my However, takes one when a more in-depth focus what on actually goes in on this division, is it a truly remarkable andout-standing entity and very hard to quantify in the confinesof this report. Acknowledgements and Thanks hasIt been a privilege and a pleasure being at the helm thisof division the for past 7 years and am grateful to many their people for hard work, sage advice, emotional support and dedication. Kathy Pavlovic has a terrific done job as the ProgramAdministrator during tenure my with great her organization of level and parenting skills the for residents. I am grateful to Department Surgery of Chair, Jim Dr. Rutka provideswho terrific support, encouragement and Department of Surgery, Faculty University of Medicine, of Toronto I have attemptedI have to provide a high-level overview theof division in this report and highlight the Royal College Review 2021 Reliance on institutional and departmental financial support new for staff appointments Diversity Focus MD on wellness and burnout Succession planning encroachment other competing by specialties MD for Need enhancers/extenders between academic and community surgeons Challenges with special interest groups and Disconnect between site Chiefs-of-Surgery and Chair position Site issues: Hand Unit, leadership for SMH, RTBC, TGH/TWH, Income disparity WCH of a Chairof Inadequate financial support PD andfor RD Impact CBD of Lack financial of support for Chair/lack size and extent community of partners Number incoming of residents Fellowship support Growth the of program- continuing to attract the best and the brightest Divisional These represent important areas focus of the for comingyears 5 Financial support SSTP for to being flexible and creative I and suspect next the yearsfew in health care will call these on talents. and Reconstructive Surgery Research Symposium Research Surgery Reconstructive and Drs. M. Roy and K. Zuo for winning best clinical and best best and clinical best winning for K. Zuo and Roy M. Drs. Plastic of Division Annual 35th the at awards science basic 187. THORACIC SURGERY

2nd Vienna-Toronto Lung Transplant Academy in Toronto, Nov 2019

Thomas Waddell, Pearson-Ginsberg Chair, Division of Thoracic Surgery

in 2016 and in 2018 received the American Society Awards and of Transplantation Innovation Award, the Canadian Community Society of Transplantation Lifetime Achievement Award. In 2019, Drs Kershavjee and Cypel Leadership shared the UHN Inventor of the Year Award.

Dr. Shaf Keshavjee was appointed to the Council for Dr. Yasufuku was awarded the Gustav Killian the American Association for Thoracic Surgery for Centenary Medal at the World Congress of the second time in 2015 as Secretary-Treasurer and Bronchology and Interventional Pulmonology in was recently elected to become President in 2021. 2016 and delivered the Pasquale Ciaglia Memorial He has been recognized with honorary degrees from Lecture at the CHEST meeting in 2018. The both Queen’s and Ryerson Universities and elected a Japanese Canadian Cultural Centre and Toronto Fellow of the Canadian Academy of Health Sciences. General and Western Hospital Foundation co- Dr. Keshavjee was made an Officer of the Order of hosted the Ninth Sakura Gala in 2018 at the Royal Canada in 2014. He received the Dr. Joel Cooper Ontario Museum in honour of Dr. Kazuhiro Award from the Canadian Society of Transplantation Yasufuku. Dr. Kazuhiro Yasufuku has been

172 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 18. Division Reports 173 Self-Study Report, External 2020 Review | dysfunction after lung transplantation; to a bench bedside Drs. $433K. Liu, approach.” Keshavjee and Cypel shared approximately in funding 1.1M from the Medicine Design by Canada First Research Excellence Fund in 1 round. the Cycle first recipientsof new the UHN Innovation Funds in Surgical Oncology his for project “Localized Therapies Pulmonaryfor Metastases Combining Immunotherapy with Interleukin-12 and Chemotherapy using in vivo Lung Perfusion”. KeshavjeeDr. continued to expand his very large research enterprise with grants from CIHR – therapeutic“Advanced strategies ex vivo for repair lungsof transplantation” for – 2015-2019), ($1.25M Genome Canada Rapid Diagnostic – “Novel Lung for Transplantation:Tools Bringing Omics the Cystic ($6M – 2015-19), to the Bedside”, Fibrosis Foundation Gene Therapy US – “IL-10 & Halofuginol lung for allograft dysfunction & Cystic and fibrosis”, Fibrosis Canada withmultiple operating, training, and infrastructure grants. As an important basic scientist partner in our division, Mingyao Dr. Liu continued his string continuousof CIHR funding with 5 a new year grant “Prevention in primary of 2016 graft Reid GrahamReid Scholarship to fund help that research During the most(2014-15). recent year 5 period he onlynot renewed his Canada Research Chair in Lung Transplantation (term5 years, total amount $500,000 CAD) was but granted a Ontario Ministry Researchof and Innovation Early Researcher award. Cypel Dr. was the Principal Investigator a Canadianon Cancer Society Research Institute grant Lung “In on Vivo Perfusion (IVLP) as an Adjuvant Patients Treatment for Undergoing Surgical Resection Pulmonary of Metastases of andBone Soft Tissues Sarcomas” and a co-applicant a CIHRon grantentitled “Supervised in vivo lung perfusion trategy treatment for cancer of metastases to the lungs. Real time monitoring chemotherapy of on-siteby analytical Dr Cypel platform”. received a CIHR Project Grant as the Principal Investigator, entitled: Lung Transplantation using Hepatitis C Positive Donors to Hepatitis C negative Recipients: A Safety trial (term 5 years, total amount $612,000 CAD) and recently renewedand extended this project. Cypel Dr. was the of one Department of Surgery, Faculty University of Medicine, of Toronto

Dr. Atul Humar and Dr. Marcelo Cypel, Surgical Director of of Director Surgical Cypel, Marcelo Dr. and Humar Atul Dr. the Program UHN Multi-Organ Transplant for hisfor success as a Surgeon-Scientist in the early phase his of career and also was awarded a Roscoe Dr. Cypel theDr. George won Armstrong Peters Prize Research and Innovation Dr. MarceloDr. Cypel was appointed as Surgical Director the of UHN Multi- Organ Transplant Program in 2018. awarded from a Pioneer Award the Mesothelioma Applied Research Foundation (USA) in 2019. Association the for Study Lung of Cancer and became the Lung Site Group leader the for Princess Margaret Cancer was He Program in 2017. Dr. MarcDr. Perrot De was appointed a member of the Mesothelioma the for Force International Task surgery all but aspects lung of cancer care, including screening, radiation, and systemic treatments. Dr. GailDr. Darling was appointed to a very important withinrole Cancer Care Ontario as the Clinical Liaison Lead lung for cancer, advising only not on UHN and Deputy in 2016 Head the of Division Surgicalof Oncology at UHN in 2017. appointed as Head Endoscopy of program at signficant investsments organin perfusion research here and around the other for world organs as well. MarcDr. Perrot De has led the the of development Surgical Pulmonary Hypertension the last over decade. has He built many aspects this of program, in August Over the last 2016. 5 years the Pearson VisitingDay Colson Professors Yolonda Dr. were from Brigham Hospital in Boston, and Women’s from D’Amico Duke University, Tommy Dr. Shrager Joe Dr. from Stanford University, Dr. Jean Deslauriers from Laval University and DennisDr. Wigle from the May Clinic. Creative Professional Activity Drs Shaf Keshavjee and Marcelo Cypel have received international recognition their for role in organ of development perfusion technologies in clinical transplantation, including founding of several companies and recognized were as UHN this for inInventors 2019 work. the This of Year program has more than the doubled clinical volume theof UHN Lung Transplant Porgram and inspired Lung transplant Lung clinicalof and laboratory research trainees by in Pearsonour Division. was in a pioneer F.G. Dr. General Thoracic Surgery, establishing as Toronto a leading center and training many the of future leaders the of specialty. was He most famous surgicalfor innovations in the staging lung of cancer via mediastiniscopy, tracheal for surgery, and management for gastro-esophageal of reflux disease. Pearson Dr. unfortunately passed away Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto The academic year our of Division always concludes with an Pearson annual Day, celebration Dr. MarcDr. Perrot De continues his research into the basic biology mesothelioma, of funded for example the by Mesothelioma Applied Research Foundation in the US with his grant “Optimizing the radiation approach to mesothelioma with targeted immunomodulation therapy”. (C$75,000) and a 2 year research award from the STS (US$80,000) his for project “Personalizing Therapy Esophageal for Adenocarinoma Using Patient Derived Cancer Organoids, 2018 – “Exploiting2018 Clonal Heterogeneity the for Genomic Study Esophageal of Adenocarcinoma, an internal grant from the Division Surgical of Oncology at UHN entitled “Exploiting Intra- HeterogeneityTumoral the for Study of Carcinogenesis in Esophageal Adenocarcinoma” JonathanDr. was recently Yeung recruited to our division as a very promising Surgeon-Scientist. isHe off to a great start having received US50,000 from the AATS a 1 year for research project in awarded a National Sanitarium Association grant “Transbronchial Nanotechnology-mediated PDT Peripheralof Lung Cancer” and ($1M) a CIHR project grant “Improving lung cancer patient efficiencybronchoscopy through novel pairing a biosensorsof ($688,500). with EBUS-TBNA” “Image-guided localization platform minimally for invasive lung surgery” and then in again 2014 in a 5 year for project “Ultra-minimally on 2016 invasive multi-modal image guided therapeutics of Yasufuku Dr. lung cancer” was recently ($1.25M). Fibrosis Using Induced Progenitor-Like Cells via Rejuvenation Stemof Cells” 2018-2023. $735K, YasufukuDr. continues to grow his research program with funding from the Canadian Cancer Society in the form an of Impact Grant ($200K) which led to a CIHR/NSERC Collaborative Health Research Program grant with Co-PI Cristina Dr. Amon “Systematic – Optimization Regeneration of Airwayof He Scaffolds”. also newCIHR received a grant – “Amelioration in Pulmonary of 2018 Dr. Waddell as receivedDr. $724K a Medicine of PI Designby project – “Decellularization and recellularization lung for and airway regeneration”

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18. Division Reports 18. Division Reports 175 Self-Study Report, External 2020 Review | S. Keshavjee, 2016 in the teaching enterprise. These prizes include: E.Gail Darling Award for Excellence in Undergraduate Teaching: AndrewDr. and 2017-18), Pierre (2014-15 Gail Darling and 2016-17), (2015-16 Robert J. Ginsberg Award for Excellence in Postgraduate Teaching: Tom Dr. MarceloDr. Cypel (2014-15), and 2018- 2016-17, Waddell (2015-16, Kazuhiro Dr. 19), Yasufuku (2017-18) teaching curriculum residents for in surgical programs Marc Dr. de Perrot in developed 2014-15, firstthe world’s pulmonary endarterectomy simulator in an effort to decrease length the of time takes it surgeons new to learn this complex technique, and Laura Dr. Donahoe successful organized Postgraduate a CATS Course at the Canadian2017 Surgery Forum in Victoria, BC. Most importantly, Yasufuku Dr. and others have established a national Boot Camp to introduce Thoracicnew Surgery trainees from across the entire country to technologies new in our specialty as such EBUS, navigation bronchoscopy and others. Drs. In 2018, Kazuhiro Yasufuku and Laura Donahoe received Educational a DSO Grant ($20,000) to evaluate this program. Each year the Division awards a number of AwardsTeaching internally based an on exit poll departingof trainees. The Ernie Spratt Award was initiated to recognize in 2017 the special contribution our of community hospital partners Department of Surgery, Faculty University of Medicine, of Toronto

tools, including Safieddine Dr. who established the Department Surgery of Quality Improvement Division members also have contributed through establishment several of programs, new courses or Health Partners, was awarded the Norman Dr. Hill Leadership for Award in Education (2015-16). won the Dr. J.H. Fowler Excellence the J.H. Fowler Dr. won in Teaching fromAward the Department Family of Medicine Abdollah Dr. in Behzadi, 2014-15). from Trillium Tovee Award in 2014-15 , recognizing in Award 2014-15 manyTovee years commitmentof to teaching Dr. surgery of (2014-15). Safieddine,Najib from the Michael GarronHospital, Dr. AndrewDr. Pierre the Department won Surgery of and 2018). He also He the Michael Dr. won and Robinette 2018). Surgeon Educator from Award the Department of Surgery at University Health Network in 2018. He alsoHe received the Distinguished CHEST Educator – a international Award recognition of excellence in continuing medical education (2017 Silver Innovationfrom Award the University Faculty Annual Toronto of Medicine’s of 14th Education Achievement Celebration (2016-17). Individual from Award Teaching the Wightman- Berris also He the Ivan won Academy (2014-15). and recognized. Several members received have awards their for contributions to education. example,For Kazuhiro Dr. Yasufuku an won Teaching remainsTeaching a very important priority ourfor Division. The contribution Division of members collectively and individually is celebrated Teaching program in Pulmonary Thromboendarterectomy. 5 year commitment financial for support from Bayer Inc, to continue to build this as a leading global received additional funding from the Ministry of Health, in recognition its of important position as a national resource. This program also attracted a large in the lab with both basic and translational aspects, and important collaborations with pulmonary medicine and interventional radiology. This program specifically for thisprocedure, of development an international reputation attracting observersfrom all the world,over a complementary research program including recruitment surgical of fellows to train 18 Dr. De Perrot De Dr. continues to organize a very well received course thromboembolic on lung disease a variety for physicians of including respirologists and primary care physicians. Mercier from Paris (2016-17), Dr. Joel D. Cooper D. Joel Dr. Mercier from Paris (2016-17), from Philadelphia, Joshua Dr. R. Sonett from New Patrick Dr. and John Dr. ReynoldsYork, (2017-18). Forde from Johns Hopkins University, Donald Dr. E. Low from Seattle, Tiago Dr. Machucafrom Gainesville, Mark Dr. Onaitis from San Diego, and Dirk RaemdonckDr. from Van Leuven (2018-19). Over the last years few also have we expanded our Continuing Professional beginning Development with offering a specialcourse in Endobronchial EBUS, Kazuhiro led Dr. by Yasufuku. MarceloDr. Cypel has also developed significantlearnig opportunities in field the lungof transplantation and extracorporeal life support. Hiroshi Dr. Dr. Date from Kyoto was our first Visiting Faculty for thiscourse in follwed Cooper and Joel Dr. by in 2018 2017, Drs. Tiago Machuca, Michael Dr. McMullen, and Dirk van Raemdonck in 2019. Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto Dr. John D. Mitchell JohnDr. D. from and David Denver Dr. Hiroshi Dr. C. Rice from Date Houston (2015-16), Moishe Liberman Dr. from Kyoto, from Montreal, RajaDr. Shanda Flores Dr. from York, New Blackman from the Mayo Clinic, and Olaf Dr. has been the course Co-Director. Visiting Faculty Miltoninclude: Dr. Saute from Israel, Rob Dr. McKenna from Los Angeles, and Sean Dr. Grondin from Calgary James Dr. Bond from (2014-15), British Columbia, Klepetko Walter Dr. from Vienna, For manyFor decades, the Division has hosted the annual Thoracic Surgery Toronto Refresher Course theand last over 5 years a wide range visiting of faculty attended have from all the world over offering a global perspective with stateof the art lectures. the For last 5 years Marcelo Dr. Cypel Professional Development Teaching at a CommunityTeaching Hospital and 2018-19) 2017-18, MichaelDr. (2016-17, Ko Continuing Dr. Jonathan Yeung (2014-15), Dr. Biniam Dr. JonathanDr. (2014-15), Yeung Armen Dr. Kidane Parajian (2015-16), Anne-Sophie Dr. Laliberte(2016-17), (2017- (2018-19). and Perez Pablo Dr. 18), Ernie Spratt Excellence for Award in Postgraduate F. GriffithF. Pearson Award for BestResident/ Teacher: Fellow

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18. Division Reports 18. Division Reports 177 Self-Study Report, External 2020 Review | Dr. BrianDr. Lane was our Menkes Professor and Albertsen Peter Dr. was our Professor. Robson During grant the 2015-2016, capture totaled over million4.8 dollars in part to due the effortsof Michael Jewett, Neil Fleshner, Robert Hamilton, (Associate), Armando Lorenzo (Associate), Walid Farhat (Full) and Dean Elterman (Assistant) were promoted to higher ranks at the University. Drs. Raj Satkunasivam, joined our faculty at the Sunnybrook. Laurence Dr. Klotz, was endowed with a Chair in prostate cancer research. Drs. Pippe-Salle and John Trachtenberg retired from our Division. our of Five residents enrolled were in the Surgeon Scientist Training Program (SSTP). Department of Surgery, Faculty University of Medicine, of Toronto Neil Fleshner, Martin Barkin Chair, Division of Urology

grants. Our Division collectively published 230 peer-reviewed papers. Drs. Robert Stewart Hamilton, Girish Kulkarni, Andrew Matthew, Bharti Bapat, Darius Bagli, Keith Jarvi, who peer-reviewed on served CO-PI’s or as PI’s During year, grant the 2014-15 capture totaled sixover million dollars in part to due the efforts Michaelof Jewett, Neil Fleshner, Robert time trained have we 20 residents and 28 fellows. The following are some highlights this of period: well as 3 full-time PhD scientists spanning six fully affiliated University-based hospitals. During this The Division Urology of has continued to be productive the pastyears, over five to pointthe currentlywhere we consist 28 of full time faculty as

8. UROLOGY 18 18 Dr. MonicaDr. Farcas joined the faculty at the St Michael’s site. Michael Dr, Robinette retired. Five ourof residents are currently Dr. in the SSTP. Steven Nakada was our Menkes Professor and Dr. Martin served Gleave as our Professor. Robson During year, grant the capture 2018-19 was just under 4 million dollars. Our faculty published 229 peer-reviewed papers. Venketeswaran Drs. Vasu Finelliand Tony promoted were to Full Professor and Andrew Dr. Matthew to Associate. Dr. Michael Fraser joined our faculty as to assist us in the area informatics of and biocomputing. hosted Simon Dr. TanguayWe in February as our Menkes lecturer and Antoine Dr. Khoury as our VisitingRobson Professor in April. As a Division arewe grateful the Em for Life Hold for Oncology Program. The final highlightyearof the cameby Million$10 a of way donation from the McCain Family, which will allow forward us to move with the McCain Centre Urologic for Innovation. Elterman CAR 2017 year, grantDuring capture the 2017-2018 totaled 4 million over dollars in part to due the effortsof MichaelJewett, Neil Fleshner,Robert Hamilton, Girish Kulkarni, Antonio Finelli, AndrewMatthew, Keith Jarvi, served who as PI’s peer-reviewed on Co-PI’s or grants. Our Division collectively published 264 peer-reviewed papers. Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto Division of Urology Hockey Team, Department of of Department Team, Hockey Urology of Division Tournament Surgery Four our of residents enrolled were in the SSTP. PaulDr. Russo was our Menkes Professor and Dr. Francesco Montorsi was our Professor. Robson University of Toronto. Dr. John retired Dr. Honey University Toronto. of and was Pace Ken Dr. appointed Vice-Chair of the Division Robert Dr. Urology. of Stewart from Award PGME.received the Bruce Tovee Drs. Raj Satkunasivam departed the faculty at the Sunnybrook and Nathan Dr. Perlis joined at the UHN site. Drs. Michael Ordon and Robert Hamilton successfully completed their continuing appointment reviews. Laurence Dr. Klotz was Achievementawarded award the by a Dean’s Neil Fleshner, Robert Hamilton, Girish Kulkarni, AndrewMatthew, Keith Jarvi, served or as PI’s peer-reviewed on Co-PI’s grants. Our Division collectively published 290 peer-reviewed papers. our residents enrolled were in the SSTP with two Krakowskycompleting Yonah Dr. PhD’s. joined our faculty College Hospital. based at Women’s During year, grant the 2016-2017 capture totaled five over million dollars. Drs. MichaelJewett, collectively published 229 peer-reviewed papers. Klotz,Dr. was awarded the Order Canada. of Drs. Patrick Luke and Schelgel Peter our were Menkes and lecturers Robson respectively. Four of Girish Kulkarni, Andrew Matthew, Bharti Bapat, Antonio Finelliand Keith Jarvi, served who as PI’s peer-reviewed on CO-PI’s or grants. Ourdivision

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18. Division Reports 18. Division Reports 179 Self-Study Report, External 2020 Review | the first Division Chair. Our clinical Division’s activities are based at three academic hospitals, St. Michael’s Hospital, Sunnybrook Health Sciences Centre and University Health Network and three affiliate teachingsites, Humber River Hospital, Scarborough Hospital and Trillium. and innovation achieved in our academic hospitals has benefitted patients nation-wide. The Division Vascular of Surgery was formed as a separate Division at the University Toronto of within Johnston 1982 K. Dr. Wayne named Department of Surgery, Faculty University of Medicine, of Toronto Thomas Forbes, Chair, Division of VascularSurgery

Canadian thought leaders in vascular surgery trainedhave and research, in Toronto discovery Toronto’s Division Vascular of SurgeryToronto’s was the of one first, and currently the largest, in Canada. Over the last 30 years many the of Chair since following September 2014, in the footsteps Thomas Dr. of Lindsay, and previously, Johnston. K.Dr. Wayne The University of Introduction hasIt been a distinct honour to serve as Division

Division of Vascular Surgery Faculty and spouses at 2016 Gallie Day Dinner event Dinner Day Gallie 2016 at spouses and Faculty Surgery Vascular of Division

9. VASCULARSURGERY 18

2014 – 2019 These highlights are expanded in upon subsequent pages the but following is a brief list of the accomplishments Division’s and highlights the last over four and a half years. 260 full-time faculty, 50 part-time faculty, 140 adjunct faculty and 40 research scientists located both campus on and at six fully affiliated teaching hospitals and two partially affiliated teaching hospitals. Our department’s large faculty contributes extensively to three core missions: excellent clinical care, outstanding research productivity and the delivery state of the of art educational programs under the outstanding leadership of our Department Chair, James Dr. Rutka. The T Division U of Vascular of Surgery is very our of proud past accomplishments, are we but eager to accomplish more in even the future as pursuewe our Vision – United of in a Tradition Leadership,of Discovery and Excellence. Highlights from the Last Five Years including the newly developed Advanced Aortic Surgery Fellowship, a uniquecollaborative effort withour CardiacSurgery colleagues. As to look the we future, are we uniquely positioned to be a premier vascular unit globally and achieve research discoveries that unlock the mysteries vascular of disease and the solve problems that our patients face. The centralization academicof and research activity at the University makes this Toronto of vision possible. Toronto is the 4th largest city in North America and unlike the larger cities Mexico of New City, and Los Angeles,York has medical one school with a single Vascular Surgery program. Our surgeons treat patients at leading hospitals with top notch facilities, while performing research and teaching in academic one unit at a University that is consistently ranked in top the 20. world’s are blessedWe to with work colleagues in the U of T Department Surgery of which has approximately Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto the best candidates across the country who will leaders be tomorrow’s in our specialty. We also provide several fellowship opportunities Canadianfor and international candidates, development, among many others. The academic year culminates with our annual Research and Day the keynote, Johnston K. Wayne Visiting Lecture. Our vascular surgery residency program attracts expand our research contributions which range from animal models aneurysm of pathogenesis, clinical trials and health methodology research, advanced imaging techniques and peripheral arterial disease, and collaborations with mechanical engineering regarding endovascular device as leadership positions with the Vascular Surgery Specialty Committee the of Royal College of Physicians & Surgeons Canada of (RCPSC). continue to buildWe our academic footprint and international acclaim with members having served in many leadership positions and as Presidents of major vascular surgery societies (CSVS, PVSS, Editor-in-ChiefSVS), the of Journal Vascular of Surgery and Editor the of preeminent textbook in the field,Rutherfords Vascular Surgery, wellas The Division Vascular of Surgery at the University has a long and established Toronto of track record clinicalof excellence, academic productivity, and leadership in education. The Division has received Vascular Surgery Group 2015 Group Surgery Vascular

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18. Division Reports 18. Division Reports 181 Self-Study Report, External 2020 Review | the continued support our of SSTP residents. Research Support for New Faculty Recruits: Division Vascular of The University Toronto’s of Surgery had previously not provided Research Support to recruits new within the Division. This Blair FoundationBlair Innovation Fund The Blair Foundation enhanced its ongoing commitment to research and within development the Vascular Surgery community through a research fund with for The University Toronto, of a three year term. This Fund supports investigator sponsored research in vascular disease, with recipients subject to internal T peer U of review. Goerc Scholarships for Residents Enrolled in the Surgeon-Scientist Program Training (SSTP) The T Department U of Surgery’s of Surgeon- Scientist Training Program is a unique program where surgical residents top receive notch research training as they pursue a career as an academic surgeon.In support these of future leaders and academic vascular surgeons introducedwe a scholarship program made possible through the generous donation from the estate Mr. of Frank Goerc. These Goerc Scholarships are awarded annually and ensure Advanced Aortic Surgery Fellowship In collaboration with the Division Cardiac of Surgery, began we offering Advancedan Aortic Surgery Fellowship in This July 2016. two year clinical and research fellowship is open to cardiac and vascular trained surgeons and includes training in open and endovascular surgery diseases for theof thoracoabdominal aorta. This is a unique fellowshipthat involves the two Divisions (Cardiac Surgery and Vascular Surgery) and Fellows rotate equally among the three academic hospitals. Research Day The pinnacle our of academic year is our annual Research which Day is highlighted our by K. JohnstonWayne Lectureship. The stature this of day and quality the of presented work our by faculty and trainees as exponentially grown and as a result a focused of fund raising program, our Research will Day continue to be the highlight theof academic year, many for years to come. Department of Surgery, Faculty University of Medicine, of Toronto beingbased hospital, at one the fellows rotate now equally through the three teaching hospitals. clinical fellow positions allowing small for and equal contributions from the three academic enrichment funds to make the up gap. Rather than our Residency and Fellowship Program Directors, the three Surgeons-in-Chief contributed have significant amounts to the two unsupported externally supported. Thanks to the effortsof the Division Heads at the three academic hospitals and through differentmechanisms. Beginning in academic year adopted we a model the 2015/16 3 Clinical have where we Fellows, which of one is Historically, the international fellowship program was hospital based with each teaching hospital recruiting their own fellow and financing them International Fellowships These rounds are supported unrestricted by educational grants from industry and include several invited guest speakers each year. an opportunity vascular for surgeons and trainees to together come to discuss various topics and to meet and listen to visiting professors. City-Wide Rounds City Wide Rounds are quarterly held and offer to obtain courtesy privileges at the other two to assist and learn from their colleagues. and the credentialing offices ofthe three academic hospitals, permitting vascular surgeons with a primary appointment these of at one hospitals City-Wide Privileges An expedited process was developed with TAHSN MacCoy First of Leadership Ltd. Theresulting strategic plan document is included as Appendix II and is mentioned throughout thisreport. perspective and guidance. The process would not beenhave possible without the expertise David of stand Thanks inthe way. James to Dr. Rutka, Chair the of Department Surgery, of kicking for off the day providing and some important On Saturday a cold in February 23 enthusiastic 2015, surgeons from 5 hospitals came together to discuss our goals, our aspirations and the hurdles that Strategic Plan $52,207 $34,356.01 $84,842.97 $276,592.24 $798,893.06 $1,705,625.53 $2,601,733.64 TOTAL REVENUE (Fiscal year not complete)* FISCAL YEAR 2012-2013 2013-2014 2014-2015* 2015-2016* 2016-2017* 2017-2018* 2018-2019 Division of Vascular Surgery Fundraising Totals 2012 - Present 2012 Totals Surgery Fundraising Vascular of Division Al-Omran CAR, March 2017 March CAR, Al-Omran Advancement & Philanthropy Report prepared by Faculty of Medicine Advancement Office (see Appendix IV) foundations, comprise thehealthy pipeline of supporters to the Division Vascular of Surgery. The most significantphilanthropic partnerof the Division is the Bill and Vicky Blair Foundation, committed have who $2.25 million years 10 over *Years under Dr. Forbes’ term as Chair of the Division the of as Chair term Forbes’ Dr. under *Years There has been a significant, sustained increase in fundraising activity and success as illustrated in chart, the above as well as the figure below. Fifty (55) unique five donors to the Division, including industry partners, T vascular U of alumni and faculty, grateful patients, and family

Blair Self-Study Report, External 2020 Review | , one each, one at Sunnybrook Blair Early Career Professorship Surgeon-Teacher $3,000 per year × 3 yearsSurgeon-Teacher Surgeon-Scientist $15,000 per year × 3 years Surgeon-Investigator per $10,000 year × 3 years Department of Surgery, Faculty University of Medicine, of Toronto advances our vision becoming of premier the world’s academic vascular surgery program; the place where the most talented surgeons and researchers want to train and work, and where patients with vascularcomplex conditions want to be treated. provides $75,000 per year support of a vascular for surgeon researcher and/or within the firstyears 5 theirof careersyear a five for term.By making this donation the Blair Foundation continued its tradition supporting of excellence and discovery that Health Sciences Centre, St. Michael’s Hospital and University Health Network. This commitment is in addition to the existing Blair Foundation Innovation Fund, jointly established with the andUniversity the T Division U of Toronto of of Vascular Surgery. Each Office secured amajor gift that providessupport earlyfor career vascular surgeons and researchers. The Blair Foundation madea commitment of $2.25 million, years, 10 over to establish three Early Career Professorships • EarlyBlair Career Professors Vascular in Surgery Division Vascular of The University Toronto’s of Surgery and the Faculty Medicine’s of Advancement Division providesthe following Research Support depending Academic on Category: Role • • Sunnybrook Health Sciences Centre and University Health Network. The terms Research of Support are three years (3) initial upon date appointment, of renewableeach year subject to successfulcompletion theof individual’s annual in review, which the Division Chair participates. The University Hospital Research Institutes, Hospital Departments and Surgeons-in-Chief to provide Research Support earlyfor career academic surgeons with full- time academic appointments within the Division Vascularof Surgery at St. Michael’s Hospital, is similar to other Divisions within the Department Surgery.of This changed with our efforts to partner with the University Department, Hospital Divisions,

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18. Division Reports 18. Division Reports 183 Self-Study Report, External 2020 Review | The Division Vascular of Surgery is the of one top performing Division in the Department of Surgery from a fundraising standpoint. The Division has been tremendous a champion thefor Department Surgery’s of top fundraising priority,the Surgeon-Scientist Training Program, establishing his own scholarshipto support trainees in the Division, and inspiring other faculty to give, leading in to $110,000 scholarship vascular for trainees in the program. The John Ross and Patricia Quigley Chair in Limb Preservation best exemplifies this effort.A year limited10 term chair was established in 2017- gift with2018 a $1.5M to recognize top faculty talent to the develop sub-specialty, putting the Division track on to become a leader in field. In addition to these larger partnerships, the Division has been instrumental in pursuing and securing annual support from industry partners toward Rounds, City-Wide the Division’s Research Day and Advanced Aortic Fellowship; all which of are components key the of Divisions ongoing education, research and clinical activity.

). Department of Surgery, Faculty University of Medicine, of Toronto medicine.utoronto.ca/news/ 2017-2018 Impact Report. 2017-2018 : Division of Vascular Surgery Philanthropic Revenue Summary: 2012 – Present 2012 Summary: Revenue Surgery Philanthropic Vascular of : Division Figure 18.9 on theon impact this of partnership can be referenced in Appendix IV – Vascular Surgery that leverage of U of the power collaborativeT’s medical network. A full report a Division wide call applications for two for annual grants $25,000 of in support cutting-edge of research and projects being led faculty by the of Division of The Blair Foundation originally made a $150,000 gift to in establish 2015 first the Division’s ever Innovation Fund. The Innovation Fund facilitated This program came as a result the of successful stewardship the of Bill and Vicky Blair Foundation. Vascular Surgeons ( supporting-next-generation-vascular-surgeons three fully-affiliated teaching hospitals at of the U A profile was T. writtenon this ground-breaking gift - Supporting in 2017 the Next Generation of before has the Division received a gift this of amount, has nor there beenprogram a established to support early career faculty, in partnership with researchers at Toronto’s three mainresearchers vascular at Toronto’s centres: University Health Network, St. Michael’s Hospital, and Sunnybrook HealthSciences Centre. Never to establish three professorships early-career for Peripheral Arterial Disease The division performs the majority percutaneous of interventions in the cardiac cath lab, in a room specifically designed peripheralfor interventions. There are roughly peripheral 275 interventions per year including iliac, superficialfemoral comprised blocks 5 OR of per week, and days1.5 in the cardiac cath lab to perform peripheral interventions Within week. per this the divisionenvelop, does a healthy volume of aortic, peripheral, and carotid interventions. Roughly 30% operative of interventions are asdone urgent, unscheduled activity. Aortic Interventions The endovascular volume of aneurysm repair is roughly per 100 year, with an additional 40 open aortic procedures. the division Since 2014, implemented a formalized approach to advanced aortic interventions thoracoabdominal (i.e. aortic aneurysm repairs) involving pre-planning and co-treatment patients of in collaboration with cardiac surgery, the CV intensivists, ICU the anaesthesiology team, perfusionists and nursing. This has been effective Sunnybrook and is in the decile lowest mortality for in the NSQIP database advanced for aortic interventions. health services research, economic evaluation, knowledge translation, vascular biology basic and translational research, undergraduate and postgraduate curriculum development, and quality. Sunnybrook Health Sciences Centre Report provided Andrew by Dr. Dueck – Division Head, Sunnybrook the divisionIn 2014 was comprised 4 full of time surgeons. surgeon Subsequently, one retiredfrom operating and call, continues but to be active in clinic, teaching and fundraising. A fifth surgeon was recruited following fellowship training in advanced limb preservation techniques. Sunnybrook has an active division vascular of surgery that treats the entire spectrum of vascular disease. The divisional resource is Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto as well as many undergraduate research students and postdoctoral fellows playing an active inrole our research projects. These include who trainwho with us at St. Michael’s Hospital. In addition to the clinical services provide, we alsowe a wide have range research of and education endeavors that have are active. We students completing master's and PhD programs St. Michael’s Hospital Division Vascular of surgery plays in role a key training residents and fellows invascular surgery. The Vascular Surgery Residency Program is accredited through the Royal College Physicians of and Surgeons of Canada. also many have We international fellows flow flow laboratoryprovides an excellent training environment students for at the Michener Institute as well as the for training vascular of surgery trainees in diagnostic theory and technique. vascular laboratory site on at St. Michael's Hospital. The Vascular Laboratory is fully accredited the by Inter-societal Commission for the Accreditation Vascular of Laboratories. As well as providing valuable high-quality diagnostic services, the non-invasive diagnostic blood aneurysmal endovascular a have therapies. We very active endovascular program in combination with our interventional radiology colleagues. directWe a large-volume non-invasive diagnostic and aneurysmal disease, peripheral artery disease, hemodialysis access, vascular trauma, venous, and lymphatic disease. particular have We expertise in thoracic outlet syndrome, hemodialysis access, wound care with limb salvage, carotid body tumor, vascular trauma and advanced aortic The Division Vascular of Surgery at St. Michael’s Hospital comprises five facultymembers at the OurUniversity scope practice of Toronto. of includes, isbut limited not cerebrovascular to, disease, thoracic and abdominal aortic occlusive St. Michael’s HospitalSt. Michael’s Report provided Mohammed by Dr. Al- Omran – Division Head, St. Michael’s Hospital Clinical Activity Clinical

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18. Division Reports 18. Division Reports 185 Self-Study Report, External 2020 Review | Dr. BarryDr. Rubin, currently the Medical Director the Munkof Peter Cardiac Centre at UHN. As part the Munk of Peter Cardiac Centre our division works very closely with our Cardiology, Interventional Radiology and Cardiac Surgery Hospital and Women’s CollegeHospital Hospital. and There Women’s is also a relationship with St. Health Joseph’s Centre where hemodialysis access clinics, as well as general vascular surgery clinics, are staffed and surgeons perform regularly scheduled dialysis access procedures. There is relationship a new with GeneralNorth Hospital York whereby UHNhas committed to provide emergency vascular coverage. Over the lastyears five surgicalthe staff has seen some turnover moving with Tse to a community Dr. practice and the recruitment Drs. of Forbes, Byrne is the newest division’s Howe recruit Dr. and Howe. and joins Byrne Dr. as a Surgeon-Scientist with three days protected of a week academic time which in case her is dedicated to the pathophysiology of atherosclerosis. academic Byrne’s Dr. career explores small animalmodels aneurysmal of disease and washe recently awarded with the Wylie Scholar andAward became only the 2nd non-U.S. based surgeon to this receive recognition. Coincidentally, the firstnon-U.S. recipient wasour very own Dr. T. Forbes and Dr. J. Rutka at Casa Loma 2017 Loma Casa at Rutka J. Dr. and Forbes T. Dr. the operating room, and 3 senior surgeons who contribute more administratively and academically with less clinical activity. Surgical activity is primarily General sited Hospital, at Toronto but the division provides onsite coverage other for hospitals including, in downtownToronto Hospital Children, Sick for Mount Sinai Hospital, Princess Margaret Western Cancer Centre, Toronto Department of Surgery, Faculty University of Medicine, of Toronto division is comprised 6 surgeons of fill who on call responsibilities and are clinically active in The Division Vascular of Surgery at UHN is the largest, single site division in the country. The Report provided Thomas by Dr. Forbes – Division Head, UHN for carotidfor body tumor resections, and general support to all services in the bleeding. of event Network Health University transfemoral aortic valve team, hepatobiliary service for portal reconstructions, urology service for caval reconstructions, otolaryngology Support other for operative services Our division offer routine to support to other surgical services including cardiac surgery, the access patients for to operative interventions. clinic, attended vascular by surgery, nephrology and nursing. This has improved patient care by streamlining decision making and enabling faster Dialysis Access The division has collaborated with nephrology to create a multidisciplinary dialysis access collaboration with other services, particularly orthopedic surgery and trauma (general) surgery. bleeding and occluded extremity arterial cases. Many these of cases are performed in concert and volume of traumaticvolume of injury. Roughly 70% the of trauma volume is blunt trauma. The division has a high blunt volume of aortic injury, as well as Trauma Sunnybrook is the largest trauma centre in Canada, and therefore the division isexposed to a high as either scheduled unscheduled or activity. strokes and TIAs. The division an enjoys excellent relationship with neurology and neurosurgery and does roughly carotid 50-75 interventions Carotid ArteryCarotid Disease Sunnybrook is a regional stroke centre, and therefore sees a high patients volume of suffering from roughly hybrid 150 open or bypass procedures per year which are in done the operating room. and tibial interventions. The division performs curriculum consisted 8 weeks of surgery of – 3 weeks general of surgery, and 2 2-week subspecialty rotations. Greco Dr. taking Upon as over the Division Director Undergraduate of surgery for Vascular surgery many in 2015 changes made. were depend on. relationships New and networks are being developed with these challenges in mind. Education Undergraduate Medical Education Report provided Elisa by Dr. Greco – Director of Undergraduate Medical Education Undergraduate surgery the last over 5 years has taken dramatic on changes both at the pre-clerk and clerkship Prior level. the pre-clerkship to 2016, curriculum was a series didactic of lectures. Vascular surgery was granted during 1 week the first-year curriculum. Thelectures standardized not were the were nor multiple-choiceyearly, questions thefor examinations. The third-year clerkship From an education perspective, UHN continues to be site a key all for levels vascular of training at There the University is a steady Toronto. of stream of medical students,residents and fellows and our Program Director, George Dr. Oreopoulos, continues to make good use the of breadth clinical of experience at UHN, as well as opportunities with a newly acquired simulator, to ensure an optimal learning environment. also He leads all postgraduate surgical education at UHN in his as role Postgraduate Education Director. As with other large, university affiliated, tertiary and quaternary care hospitals, our UHN division faces some challenges in the coming years. These include structures new and strategies to allow the division to prosper in an environment of increasing multi-hospital urgent and emergent commitments, increased complexity and resource intensity scheduled of clinical activity and decreasing numbers primary of vascular procedures which our training programs and clinical practices Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto arena taking by this on portfolio nationally with the Canadian Society Vascular for Surgery. initiatives which includes now our northern Ontario community partner, Thunder Bay Regional Health Sciences Centre. The UHN registryVQI is supported a full by time registry coordinator, Naomi Eisenberg. Roche-Nagle Dr. has extended now his leadership in the quality entire UHN Munk Peter Cardiac Centre. Our division was the of one firstcenters outside of the United States to participate in the Vascular Quality Initiative and continue we toDr. do so. Graham Roche-Nagle is the lead our on quality radiologists and several the of vascular surgeons in dedicated interventional suites and patients continue to be enrolled in the important trial.BEST-CLI Continuing quality improvement and performance measurement is a priority our of division and the optimization. In addition, there continues strong working relationships with Interventional Radiology especially in the area peripheral of vascular disease. Both open surgery and peripheral vascular interventions are performed by interventional of Engineeringof through the Center Applied for Vascular Engineering. is led Drs. by CAVE Forbes and Cristina Amon (Dean, T Engineering) U of and students and researchers use engineering principles and tools to investigate aortic complex and cardiac problems and medical device and development The first graduateof thisfellowship, Jennifer Dr. Chung, has joined the UHN Division Cardiac of Surgery, thereby strengthening this relationship. Another major research initiative is the collaboration between our division and the T Department U of programs including an outcomes and population health research program led Drs. by Thomas Lindsay (Vascular Surgery) and Maral Ouzounian (Cardiac Surgery) and the T Advanced U of Aortic Surgery Fellowship which of UHN is a leading site. aorticpatients are treated in a multidisciplinary environment where all options whether it therapy, of be open endovascular or surgery, are considered and performed. This clinical collaboration is supported and advanced parallel by academic and educational colleagues. The main clinical collaboration with Cardiac Surgery and Interventional Radiology is the Advanced Aortic Surgery Program where complex

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18. Division Reports 18. Division Reports 187 Self-Study Report, External 2020 Review | allow firstyear second medical and/or students to spend a day in the operating room. We encourage all students to shadow and spend time in both clinic and in the operating room days on they ‘white have space’ (academic free time). As wrote, such, we in collaboration with cardiology, a case that combined arrythmia and vascular surgery encompassing many CaNMEDS roles, introducing concepts, new and asking thoughtful questions the have opportunity to the group. We at each site to be the stafflead on this CBL as part ourof educational duties to the University. Again, the videos are complementary also to the case. We collaborated with our endocrinology colleagues to include the vascular of role surgery in the treatment diabeticof ulcers foot the for endocrinology CBL. There are several initiatives that Vascular Surgery continues to be involved. The vascular surgery Notes continuessection the to of be Toronto edited members by our of division. The Vascular surgery interest group meetings continue to be supported the by division Vascular of Surgery. In addition, the SEAD (Surgical Exploration and Discovery) Program, and the program new now “the Surgical Session” are fully supported the by Division Vascular of Surgery. Both programs topics aortic of disease, peripheral vascular disease, carotid disease, insufficiency, venous aorticand dissection. The lecture has become standardized and case based to engage the students intheir learning. In addition, developed have a bank we for MCQs of the pre-clerks as well following the standard MCQ guide the for University.Along with theMCQs, lectureand video, also we re-wrote the history and physical examguide book (Integrated Clinical Exam course) the clerks received Vascular for Surgery. Their current guide was written many years ago a by dermatology student. This was updated with history and physical exam information the for different vascular diseases. This was edited the by whole division and all had a chance to input and change what they saw fit. As consensussuch, a documentof sorts came from this which for the clerks use. now Finally, Problem Based Learning was changed to Case-Based Learning A CBL was developed (CBL). each the of for week pre-clerkship curriculum. Department of Surgery, Faculty University of Medicine, of Toronto such, Dr. Wheatcroftsuch, Dr. and Greco Dr. developed 10 core vascular surgery video lectures reviewing the were taskedwere at creating content video lectures the for students to watch during their ‘vascular As week’. surgery hours was given lecture of now only 1-1.5 time. became It very challenging to teach vascular surgery and engage the students. In addition, we in those 1 of weeks shared with Arrythmia. Unfortunately, as part the of over-haul, Vascular was divided Vascular into ‘blocks’, surgery fitting into the Heart and Vascular block. This block was divided into 5 weeks, and Vascular had a part receive. Withreceive. this the objectives Vascular of surgery clearlywere laid and out updated. The curriculum in 2015 for implementation in the 2016/17 academic implementation for in 2015 in the 2016/17 Grecoyear. Dr. had very a large part in shaping the Vascular surgery curriculum these students With respect to the pre-clerkship curriculum, most change has occurred The here. University of had an entireToronto over-haul the of curriculum designed the questions in concordance with the writing MCQ University Toronto of standard. question bank. Vascular surgery has had a very large contribution to this have process. We and some common emergency room consultations. also have beganWe developing continue (and to expand) a surgical on clerkship multiple choice incoming clerks to our rotation that is available at all the core sites. This guide reviews the pertinent history and physical exam the for vascular patient rotation schedule changed to 3 2-week rotations (general surgery and 1 sub-specialty). also We developed a ‘Guide to Vascular Surgery’ for With respect to the clerkship curriculum, the oral exam questions re-written were and updated. The Vascular Anastomoses Day, PGY1 Skills Teaching Session Teaching Skills PGY1 Day, Anastomoses Vascular Vascular Surgery - Residents Surgery Vascular Previously, Vascular Surgery residents 5+2 only Generalrotated at Hospital the Toronto and St. Michael’s Hospital sites. With the start of the integrated program the program in 2011, expanded its training sites to include Sunnybrook Health Sciences Centre, Trillium Health Partners (Mississauga), Humber River Regional Hospital, and The Scarborough Hospital. The last 3 sites are community practice settings. Each site has a different case mix, allowing residents to experience the entire breadth Vascular of Surgery including open surgical and endovascular cases (standard and advanced as well EVAR as peripheral intervention). Along with this change to accepting beginner surgical trainees, the faculty had have to shift their focus to include teaching directed towards those at a junior This level. includes foundational training off-serviceon rotations such as: general surgery, thoracic surgery, cardiovascular surgery,critical care, medical subspecialty nephrology), (CCU, wound care, as well as interventional radiology and vascular laboratory (all residents become eligible RPVIfor exams) rotations as well as a vascular surgery bootcamp in their firstmonth of residency. and 2 residents participatePGY-1 in the mandatory Royal College Physician of and Surgeons Surgical Foundations Program which for the program director happens to our of be one own Vascular Surgery Faculty (Dr. Mark Wheatcroft). The Surgical Foundations Program has converted now to a Competency Design by training (CBD) model. b. Expansion of program to include multiple training sites no Self-Study Report, External 2020 Review | by the by Royal ’ and has also successfully fully accredited (September Appendix 2018, III). regular review cycle Department of Surgery, Faculty University of Medicine, of Toronto trainees applying and for being accepted when compared to the previous paradigm female 6/7 (ie. applicants CaRMS 2019 for application cycle). more academically focused set applicants, of most whichof completed have multiple vascular surgery electives, and often who vascular have surgery mentors with they whom had completed research projects relevant to vascular surgery. In addition, the program has noted a greater proportion female of and often has also accepted a sponsored IMG, all at the For level. firstyears 3 the PGY-1 of program, the transfer also were residents accepted and until 5+2’s had ‘senior’reached a timesuch as our first PGY-1’s In general, (PGY-3). level the program has noted a Medical Education (PGME) internal review with weaknesses identified In 2012, the program took in its first PGY-1 residents and each for subsequent year, the program has acceptedCanadian 2 Medical Graduates (CMGs) candidates was in The held the summer 2011. of program is currently College Physicians of and Surgeons Canada of with a ‘ Postgraduatecompleted a University Toronto’s of an integrated Vascular (0+5) Surgery Residency Program. Prior to that, the program was focused on pathway trainees(5+2) had who the for most part completed a general surgery residency program. Dr. George Oreopoulos was selected as the inaugural program director after a division wide search for – Residency Program Director a. Transition to Integrated (0+5) Pathway the embarked University upon In 2011, Toronto of Vascular SurgeryVascular Residency Program Report provided George by Dr. Oreopoulos Undergraduate surgery has had someradical changes Vascular but to 2019 Surgery from 2014 has been at the forefront these of changes to ensure our curriculum is disseminated. Finally, during this time Greco Dr. became the AssistantDirector of Undergraduate Surgery for the Department Surgery of at the University level.

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18. Division Reports 18. Division Reports 189 Self-Study Report, External 2020 Review | Division’s regularDivision’s Citywide rounds and are often actively participating in these events with case presentations. Residents also attend their individual hospital academic site’s rounds and regularly meet with their assigned faculty mentors. Vascular Surgery residents are required to complete a number assessments of during their training including the annual VSite exam, biannual joint OSCE examinations shared with McMaster University’s Vascular Surgery Residency Program, CanMeds Portfolio review with Medical PD, Professionalism Essay competition, as well as outpatient clinic, ward collaborator, and in-training evaluation reports (ITERs). This data is reviewed twice per year the by PD with the residents and per year once the by Residency Program’s Resident Promotions Committee which is run and chaired our by associate PD (Dr. Vucemelo). Vascular Surgery residents are each expected to complete a research project and are required to submit their presentation for work at the program’s annual Resident Research with Day competitions best for presentations from SSTP and clinical stream residents. Residents are strongly encouraged to attend the Vascular Surgery our specialty specific bootcamp when residents are introduced to basic vascular techniques with open surgical and endovascular training models (now including systems a 3D endovascular simulator). The specialty specific bootcamp has been positively reviewed and expanded to be offered at the national to residents level from across the country. In addition to faculty instructors, senior residents participatein peer to peer training which is seen as a critical to the success the of vascular bootcamp. Residents attend a number courses of and including: training their throughout meetings ATLS, a foundations clinical of research course, The Winnipeg Vascular Meeting, and the Canadian Society Vascular for Surgery (CSVS). Residents are financially supported to attend scientificmeetings to which their research has been accepted presentation. for In addition, senior residents are funded to attend a Vascular Surgery review course as such the Course’ ‘Moore the by on Societyput Vascular for Surgery. Department of Surgery, Faculty University of Medicine, of Toronto Beginner Vascular Surgery residents participate in the Department Surgery’s of ‘bootcamp’ followed by are left the clinical to cover responsibilities the of vascular service at the differenthospital sites. protected time to attend the academic half day faculty,when fellows, and off-service trainees topics is with covered the aim preparing of residents their for Royal College Vascular Surgery certification exams.Residents receive In addition all to the SSTP, residents participate in the mandatory academic half-day (Friday mornings) a 2 year when cycle rotating of seminar Engineering, and several are completing degrees in Surgical Education related topics. Surgery faculty members, as well as faculty from other divisions departments. or Residents have completed degrees in Clinical Epidemiology, Surgery residents complete SSTP training with a SSTPPhD. residents are all supervised Vascular by (MSc or PhD). Typically, residents(MSc Typically, PhD). or enter this training stream lasting 2-3 for years after PGY-2, entered have a few but Most after Vascular PGY-3. Program This (SSTP). program is a minimum of 2 years and allows residents to research receive training and complete a graduate thesis and degree Surgery residents from pathway the have 0+5 participated in the University Toronto’s of Department of Surgery Surgeon-Scientist Training Most significantly,Vascular approximately of 1/2 c. Vascular Surgeryc. Vascular Residency Program Academic Activities half Residency day, Program Committee (RPC), CaRMS resident selection, and mentorship of University Vascular of Toronto Surgery residents. Program broad enjoys engagement faculty by from across all sites participate who in the academic Malformation clinics and operative procedures. Four the of six training sites include exposure to well-developed surgical venous practices. The participate in combined vascular and oncology cases,as well as less common clinical experiences assuch Thoracic Outlet Syndrome and Vascular Hospital) are Level I adult trauma centres that afford residents the opportunity to participate in the care patientsof with vascular injuries. Residents also Two of these of sites (SunnybrookTwo and St. Michael’s that is used, is it but closely regulated the by PD and his staff to ensure University the rules are followed. A course fee is charged to the candidates programhome and with educational grant support from industry, the course is run for a not on profit basis.were we able to significantly In 2018 Bootcamp Report provided Mark by Dr. Wheatcroft – Bootcamp Director The National University Vascular Toronto of Bootcamp first place took Julyin and was 2016 the natural extension the of introductory course previously provided only to University Toronto of vascular trainees. The aim Bootcamp of is to provide a comprehensive practical introduction to endovascular and open vascular surgery to new trainees entering All level. at the PGY1 PGY1s in vascular surgery across Canada are eligible to attend. The course runs 5 full for days and provides stressa low learning environment in which to learn and practice skills specific to vascular surgery. A combination high of and fidelity low simulation is used with ratio low supervision by both experienced Faculty and senior residents from the T program. U of Industry support is essential todue the cost nature the of equipment much of engaged at the of the national level specialty committee in driving these changes. The committee is currently chaired Thomas Dr. by Lindsay and both the PD (Dr. Oreopoulos) as well as the St. Michael’s Hospital Vascular Educational Site lead (Dr. Elisa are Greco) working with the committee to formulate CBD ‘entrustable professional activities’ and(EPAs) required training experiences (RTEs) according to CBD principles. Residents and faculty already complete CBD evaluations as part the of Surgical Foundations Program and will we be trialing residents for EPAs and faculty as part a of ‘soft start’ to our CBD transition. The Postgraduate Medical Education office (PGME) hasinvested in and is building the up IT platform that will be required to track resident evaluations and milestones (‘Elentra’), andthe RPC has already established the terms reference of our for ‘Competency Committee’. National Vascular Surgery Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto mandated the by Royal College Physicians of and Surgeons Canada of This (RCPSC). is scheduled to occur our for specialty in 2020 and University Vascular Surgery Toronto of Faculty are actively f. Future changesf. The biggest incoming challenge is the shift to a competency based training paradigm as (CBD) fellowships in areas that include limb salvage surgery and advanced aortic interventions. A number Vascular University of Surgery Toronto of training program alumni sought have and out hired graduates newer from the program, attesting to the desirability the of training provide. we residents can graduate and immediately be employed without having to undergo fellowship training with almost all our of graduates moving to on permanent jobs within 6 months graduating of and a smaller number choosing to do international on theiron first attempt. Almost everyourof one residents has successfully completed their RPVI examination either while still in the program, or shortly after graduation. The Vascular Surgery Residency Program at the University Toronto of is the last program in subspecialty surgery where e. Program Successes Thus far, 100% our of graduating residents have passed their Royal College Physicians of and Surgeons Vascular Surgery certification examination academic half day teaching format, elimination rotationsof that meetingnot were expectations interventional(ie. cardiology) and the addition of electivenew rotations (ie- transplant surgery). all active participants the on committee.The RPC meets regularly to review and evaluate program activities and feedback from trainees has resulted in modifications to the curriculum including: selection specific of sites for bestthe off-service training experiences, alteration of The RPC is in involved and accountable for all aspects program of delivery, evaluation, and innovation. The RPC is chaired the by Program Director and has faculty representation from each our of 6 training sites as well as junior, mid, and senior resident representatives are who d. Residency Program Committee(RPC)

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18. Division Reports 18. Division Reports 191 BIDMC, Harvard BIDMC, University Forest Baptist Wake Medical Center University of Leicester University of Arizona University of Chicago Dartmouth University Stanford University Northwestern University Self-Study Report, External 2020 Review | Marc Schermerhorn Julie Freischlag A. Ross Naylor Joseph L. Mills Schwartz B. Lewis Philip Goodney P. Ronald L. Dalman Kibbe R. Melina 2017 2018 2019 2012 2013 2014 2015 2016 in-Chief the of Journal Vascular of Surgery and Co-Editor two of editions Rutherford’s of Textbook Vascularof Surgery. other No Canadian, and few internationally, contributed have more to academic vascular surgery than Johnston. Dr. In 2009 was he withhonored the Lifetime Achievement Award theby Society Vascular for Surgery. Dr. In 2018 Johnston was as honored a Member the of Order of Canada his for outstanding achievement, dedication to the communityand service to the nation. This lectureship was made possible through the generous donations faculty, of students and alumni. of Bootcamp’s successof and strengthening national reputation, supporting its continued important inrole training Canada’s vascular surgeons. Research Research Appendices Day (See for programs) V-VIII K. Wayne Johnston Lecturer Vascular in Surgery In recognition unprecedented Johnston’s Dr. of contributions to our specialty Vascular of Surgery and the an University annual Toronto of lecture began in his name. Johnston Dr. was a founding member and President the of Canadian Society Vascularfor Surgery and later became President theof Society Vascular for Surgery. is He a preeminent academic surgeon served who as Editor- Department of Surgery, Faculty University of Medicine, of Toronto Surgery, multiple Faculty, residents all of levels and administrative support been have superb, and instrumental to its success. The Division is proud Bootcamp has received tremendous support from the entire Division; the Chair Vascular of hands practice. on This extremely proved popular with the candidates, least not because they can keep the material future for Since its review. inception, thus removing the necessity having of a live seminar at the start each of session. This freed average on up 1 hour per session which could be used extra for began using video seminars to precede each practical session. Videos are provided to candidates ahead of time so they can be viewed outside course of time, questionnaires, the format Bootcamp of is constantly changing in order to best suit their needs. In the course2018 a major change was instituted where we Based feedback on from the candidate’s it isit signed off in their BootcampPassports which they are able to keep and submit to their residency program director return upon from the course. anastomosis. Throughout the course,candidates are closely observed and given in-the-moment feedback faculty. by As each session is completed Canada. Candidates do a 30 question exam MCQ at the start and finishof course the and they are also formally assessed performing on an end-to-side peripheral angioplasty and stenting. The course usually has candidates 8 to 10 per year from across open AAA repair, SFJ dissection, radiation safety, operation note dictation, trauma and injury, IVC ultrasound guided vessel access, closure devices, endovascular equipment, non-invasive vascular imaging, cross-sectional imaging, end to side anastomosis, carotid endarterectomy, EVAR, created the by previous success. 2 year’s to begood a include: How covered resident, Topics reduce the course fee to due the financial stability Vascular Surgery SSTP Residents Vascular Dimitrios Oreopoulos Scholarship Goerc Scholarship Jim Woodford Scholarship ScholarshipTAVS

Nagle – Quality & Best Practices At present all 3 core academic sites input data into an international risk-adjusted, outcomes-based program to measure and improve the quality of surgical care with a quality database. Toronto to a direct entry residency training model we seenhave an exponential increase in thenumber vascularof surgery residents entered have who Thisthe SSTP. has resulted in financial stresses to both our Division and the Department and, as a result, this has been a major fundraising initiative with several scholarships and funds being developed in support our of residents. These include: • • • • Quality & Best Practices Report provided Graham by Dr. Roche- for clinicalfor training, and comes from a variety of sources, the main ones being the Department of Surgery, the supervisor(s), the university division, research awards and external funding sources. The T Division U of Vascular of Surgery prides itself developing on the next generation of academic leaders and Surgeon-Scientists. Many residents choose our training program specifically thisfor opportunity. Since transitioned have we Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto provide minimal if any clinical support. Funding and salary support during the SSTP program is separate from the usual resident’s Ministry Health of funding 300 MSc and 110 Ph.D. students. Ph.D. 300 Vascular MSc and 110 Surgery residents enter the SSTP most commonly after their first years two of clinical surgery training and then spend 2-4 years in the SSTP pursuing a Masters or PhD thesis level, based graduate degree. During their graduate studies the residents are required to The Surgeon Scientist Training Program (SSTP) has been vital to establishing the Department Surgery of at the as University the of one leading Toronto of academic Surgery Departments in the world. The SSTP began and in has 1983 trained residents with 410 Surgeon-Scientist Training Program Publications provides the receipt, processing, evaluation and decision-making infrastructure the for Program, and administers the funds to theselected recipient(s). year term, with a gift $150,000. of This commitment established the Blair Foundation Vascular Surgery Innovation Fund atwhich the University Toronto, of aims to support investigator sponsored research in vascular disease, with recipients subject to internal The T peerU of University review. Toronto of The Blair Foundation has continued its consistent commitment to research and within development the Vascular Surgery communitythrough a research fund with a threeThe for University Toronto, of Blair Foundation Vascular Foundation Blair Surgery Innovation Fund

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18. Division Reports 18. Division Reports 193 Self-Study Report, External 2020 Review | for” andfor” working “how best out to get there”. Members in worked facilitated large and small group sessions to identify challenges, priorities key and actions to be taken the nextyears over five and beyond. Strategic themes and activities were after extremity lower amputations in Canada. Mar;63(3):688-95 Surg. 2016 J Vasc Faculty Development Strategic Plan A one-day, Division retreat was conducted at Hart House the on campus University on Toronto of February Guests 28, 2015. included Department Surgeryof Chair, James Dr. Rutka, and the retreat was facilitated David by MacCoy First of Leadership Ltd. members Twenty-three the of Division, from 5 hospitals, attended to engage in review and dialogue the of issues and shape a strategic plan for the future. Prior to the retreat interviews had been completed an by external consultant with twelve Division members and an on-line survey engaged twenty-one members. Any strategic process has two strategic key elements: deciding “what to go de Mestral C, Salata K, Hussain MA, Kayssi A, Al-Omran M, Roche-Nagle Evaluating G. Quality Metrics and Cost After Discharge: A Population-basedCohort Study Value of in Health Care Following Elective Major Vascular Surgery. Ann Apr 18. Surg. 2018 de Mestral C, Croxford R, Eisenberg N, Roche-Nagle The G. Impact Compliance of with Imaging Follow-up Mortality on After Endovascular Abdominal Aortic Aneurysm Repair: A Population Based Cohort EurStudy. Sep;54(3):315-323. EndovascJ Vasc Surg. 2017 MJ, MontbriandTao JM, Eisenberg Sniderman N, Roche-NagleKW, Temporary G. inferior vena cava filter indications, retrieval rates, follow- and managementup at a multicenter tertiary care institution. Aug;64(2):430-437. Surg. 2016 J Vasc Kayssi A, de Mestral C, Forbes TL, Roche- Nagle Predictors G. hospital of readmissions Department of Surgery, Faculty University of Medicine, of Toronto surgery. Can Feb 1;62(1):66-69 J Surg. 2019 Quality Initiative in improving quality of care in Canadian patients undergoing vascular Liao E, Eisenberg Kaushal N, A, Montbriand J, Roche-Nagle KT, Utility G. Tan the of Vascular N, deN, Mestral C, Roche-Nagle G, Unplanned Early Hospital Readmissions in a Vascular Surgery Population. Can (In J Surg. print). 2019 publications. The most pertinent are listed below. Papadopoulos A, Devries S, Montbriand J, Eisenberg study, actstudy, method. Quality projects resulted have in multiple national and international presentations and need to undertake a quality project in their first year to become acquainted with quality research techniques; testing process a new using the plan, do, cessation strategies. Furthermore, huge emphasis has been placed follow with up 1-year on rates > of being95% achieved. All residents in the program endovascular aneurysm repair and investigation of medium-term data outcome peripheral on vascular interventions, risk factor modification and smoking These include reduction in the length stay of after endovascular aneurysm repair with a cost saving 6.6%,of decrease in the contrast volume used in Using General data Hospital Toronto from VQI, has a number concluded quality of projects. quality data is reviewed bimonthly and opportunities improvementfor identified and actedupon. served as the Best Practice & Quality representative with Graham Dr. 2014-2017 Roche-Nagle taking In in addition 2018. over at the departmental level, from 2014-2016 but now enter data now but from into 2014-2016 NSQUIP. There are monthlyDivisional Executive Conference Calls where quality is a standing item. Papia Joe Dr. been entering data into NSQUIP previously. St. Michael’s Hospital had beenmember a VQI of position Best of Practice & Quality Chair the on Canadian Society Vascular for Surgery Executive. Sunnybrook Hospital havingjust have joined VQI which includes sites from Ontario, Quebec, Nova Scotia and Alberta. Graham Dr. Roche-Nagle is the lead clinician as the well for CVQI as holding the United States to inputdata into the Vascular Quality Initiative commencing in August In 2017 2010. a Canadianthe CVQI regional groupwas formed General Hospital became the first outsidesite the implications, just the right it’s thing to do! recognizeWe that diversity and equity goes sex andbeyond gender, in but an effort promoteto inwomen vascular surgery adopted have we several plans action. of First all of is recognition interests the chair holder is a vascular surgeon at Sunnybrook Health Sciences Centre, with an interest and expertise in limb preservation iswho responsible leading for a program that includes affiliated Toronto hospitalsUniversity of within the Division Vascular of Surgery. The Chair funds support the individual chair holder as well as a limb preservation program under his/her direction. The total annual available funds are expected to be $300,000 in the firstyear $250,000 and in subsequentyears. Diversity and Equity organizationNo can reach its potential without taking advantage all of its of members, or potential members, contributions and skills. Diversity within an organization has consistently shown to improve decisions, outcomes and overall performance. Besides these practical with the ultimate goal advancing of long-term health outcomes and quality life of Canadian for patients with vascular disease. The primary focus theof Professorships is to support research in the of vascular field surgery – in Department the of Surgery – at each the of threeacademic hospitals affiliatedwith Toronto the Division University of Vascularof Surgery. Professorship recipients are expected to demonstrate improved understanding theof specific researchcontribute area and/or to improving patient care. Each Professorship provides $75,000 support of per year 5 years. for b. J. Ross & PatriciaQuigley Limb in Chair Preservation The Ross J. & Patricia Quigley Chair in Limb Preservation, a limited term chair, is a result a of generous donation in support the of advancement clinicalof care, research and education in the prevention, diagnosis and treatment in the area of limb preservation. In aligning with the donor’s Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto Harland-Smith Lecture Poster, 2018 Poster, Lecture Harland-Smith in Vascular Surgery program is to support an individual vascular surgeon scientist or in pursuit of multiyear, longitudinal programs investigation of three main academic hospitals affiliatedwith theT Division U of Vascular of Surgery: St. Michaels Hospital, Sunnybrook Health Sciences Centre and University Health Network. The objective the of Blair Early Career Professor Toronto, for a ten for year term withToronto, an annual donation $225,000 of (total donation = $2.25 million). This commitment establishes three (3) Blair Early Career Professors in Vascular Surgery atat each the one the of University Toronto, of Vascular Surgery The Vicky and Bill Blair Foundation continues its commitment to research and development within the Vascular Surgery community through a Professorship program at The University of New Academic Chairs & Professorships a. Early Blair Career Professors in developed to contribute to the preparation thisof plan the and Division move toward the Vision.

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with Self-Study Report, External 2020 Review | Twitter account surgery.utoronto.ca/division-vascular-surgery Our division has also been engaged in social media and has an active 2,400over followers! Wayne JohnstonWayne Lectureship programs. Also, interested faculty and residents been have supported to attend the University Michigan of in Women Surgery Leadership Conference. Development Following conference two the our of 2017 residents, Drs. submitted Gordon and the Roy, following report that was circulated to our division. Communications During the last several years a regular communication strategy has been introduced in our Division. Regular newsletter and e-News blasts are sent electronically to trainees, division members and alumni to inform them important of news, events and accomplishments. Examples of these communications are included throughout these pages. Our website division’s has also been updated and is being current. kept

Department of Surgery, Faculty University of Medicine, of Toronto comments and physical contact that has been widely reported in other industries. What group one individual or may see as good natured fun or can be seen as spiteful, mean and intimidating another. by the inappropriate sexual language, by some patients. common in our everyday interactions. and referral patterns, whereas male residents and surgeons are more apt to be givenfurther chances. on selection committees. for independentfor operating than male residents. One adverseoutcome benefitof willdoubt”. the disproportionately impact resident evaluations positions, possibly because asthey encounter opportunities career for advancement they encounter barriers that present their for aren’t male colleagues. where “it’s easierwhere “it’s to a family”. have These takeconversations place as don’t often with men. Women physiciansWomen and residents experience There are biases against surgeons women Subtle examples intimidation of are Women physiciansWomen need better representation Women residents opportunities fewer receive Women residents andWomen surgeons are given the “not Women are underrepresentedWomen in leadership Women are frequentlyWomen steered towards specialties and dinners and inviting both male and female speakers as part our of Visiting Professor and K. Our division has supported several initiatives including in Vascular Women Surgery events opportunities, regardless sex, of gender, religion, race, beliefs, background socioeconomic or factors. about these important issues as our division strives to become a true meritocracy where the best and brightest advance, and all are given similar We need to open have and safeWe conversations • • • • • • • traineesare confronted with. These include: • of theof challenges our female surgeons and Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

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HOSPITAL REPORTS

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 197 191. MICHAEL GARRON HOSPITAL

Photo: tehn.ca/about-us/redevelopment

Carmine Simone, Surgeon-in-Chief, Michael Garron Hospital

The Michael Garron Hospital (MGH), is a proud programs. This will enable us to continue to set a member of the Toronto East Health Network. new standard in surgical care and surgical education. We are amid construction on our new patient- care tower and hospital campus scheduled to be Our Department vision is simple. We want MGH completed by 2021. In 2015, the former Toronto to be the best place to work as a community East General Hospital received an unprecedented surgeon, the best place for our loved ones and 50 million dollars from the Michael Garron patients to receive surgical care and the best Foundation, making history as the largest donation place for our surgical learners to train. ever in Canada to a single community hospital. The re-naming of our hospital did not change The Department of Surgery at MGH has 4 core our primary focus of being a community hospital divisions, a shared division of critical care and providing exceptional care but instead it brought a pediatric dentistry program. The Surgical an additional focus of research to our organization Health Service completes approximately 11,500 – and to our Department of Surgery. The new 12,000 operative cases per Fiscal Year (FY). The facility, coupled with the MGH commitment to Department of Surgery accounts for the largest community-based healthcare, will ensure state- proportion of cases within the Health Service. of-the-art equipment and patient –centered care

198 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 19. Hospital Reports 199 Dr. PaulDr. to Self-Study Report, External 2020 Review | continues to grow our Dr. Peter Weiler Dr. in 2017. Dr. Weiler continues Weiler Dr. to lead in 2017. the group in resident education as evidenced by EffectivenessTeaching Wong Scores (TES). Dr. is working programs to new develop as such surgicalnovel approaches to hip replacement and same-day discharge after joint replacement. WilliamDr. Kraemer Our Division Orthopedic of Surgery sets the standard fiscally for responsible quality patient- focused care. They successfully have reduced the length stay of (LOS) post- for operative patients standardizingby surgical care, postoperative care plans and engaging the entire multiprofessional team. Our Division Orthopedic of surgery has been recognized outstanding for in work reducing the length hospital of stay total of knee arthroplasty patients and at MGH presented have their outcomes at the Quality Improvement and Patient Safety Forum and (October at the 23, 2017) Health Quality Transformation (October 2017). 24, IDEAS presentation TEGH of multidisciplinary transition plan our for post-operative hip fracture patients. The Head the of Division Orthopeadic of Surgery transitioned from Wong mainly to due the collaboration between the Departments Surgery, of Anesthesia and Nursing.

Department of Surgery, Faculty University of Medicine, of Toronto is the site MGH lead for

Innovation in models care of and care delivery Quality integrated surgical care Multidisciplinary oncology care

Teaching care surgical care and at MGH throughout Toronto. This initiative has been successful at TEGH of Toronto hospitals. Aarts Toronto of Dr. has been instrumental in launching the Enhanced Recovery after Surgery (ERAS) initiative that improved multidisciplinary Dr. Mary-Anne Aarts Mary-Anne Dr. whichBPIGS, encompasses multiple safety and quality initiatives standardized across the University Surgical Care Quality Integrated 4. 1. 2. 3. embodies the spirit “Setting of Standard” a New by focusing our scholarly activity to the following areas: as falls prevention, skin ulcer prevention, ventilator- associated pneumonia prevention and blood borne central line-related infections. OurDepartment Along with the rest the of organization, our Department supports patient safety initiatives such and L. Dr. Erlich representing (Ophtho) in MGH challenge photo The Yorker New in April 2017 Dr. L. Tate, Dr. M.A. Dr. L.Dr. Aarts, Tate, L. Dr. Dvali

Dr. Najib Dr. lead and Chest Centre Dr. M.A.Dr. Aarts joined the Thoracic Surgery team Dr. SayfDr. Gazala , and ) is three of one Level 1 thoracic surgery improvement projects throughout the country. Cyriac J. Dr. our Bariatric Surgery Program which is now reaching to primary out care to transition post operative follow into up the community. Dr. SimonDr. Iu Safieddine programs The thoracic MGH surgeons in Toronto. and the Division Respirology of launched have first multidisciplinaryToronto’s which will serve patients for as shop” a ”one-stop with any thoracic respiratory or health problem. SayfDr. Gazala and brings inat MGH 2017 further expertise in minimally invasive techniques. The thoracic surgery team has joined the National Positive Deviance Initiative participating by in the University of Ottawa outcomes database. This initiative aims at improving the national reporting complications of and facilitates the quality of development is , to Self-Study Report, External 2020 Review | Dr. Dr. JihadDr. Abouali Dr. PaulDr. Bernick , joined us in July 2017. Dr. CarmineDr. Simone , in 2017. Dr. Bernick Dr. continues in 2017. , a GP-oncologist, to in 2018 Dr. RobertDr. Zeldin Department of Surgery, Faculty University of Medicine, of Toronto or servicesor provided in to women our BDC. The Department Surgery’s of thoracic surgery team ( focuses breast on cancer diagnosis and treatment as well as welcoming patients with any and all breast health concerns. welcomed We Pilmer Caileigh our Breast Diagnostic Clinic, broadening our list Dr. HanyDr. Sawires to be a leader in education in General Surgery evidenced his by profile in Department the of Family Medicine Annual Review Dr. in 2018. Sawires leads the growth our of multidisciplinary Breast Diagnostic Clinic (BDC). The clinic member the of Division Orthopeadic of Surgery, DmitryDr. Tsvetkof The Head Division of General of and Thoracic Surgery transitioned from spinal surgery program and growing our Sports Medicine practice. Our newest

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19. Hospital Reports 19. Hospital Reports 201 ), ). Dr. , Dr. C. Dr. Dr. R.Dr. Zeldin Dr. R.Dr. Singal sits the on Postgraduate Dr. N. Safieddine N. Dr. Self-Study Report, External 2020 Review | is in involved the Aesthetic has established a core thoracic ) and Prostate Biopsy( Department of Anesthesia and ), Lung), Cancer Screening ( Dr. JamieDr. Cyriac Dr. AtulDr. Kesarwani Surgery Resident Program Teaching was invited as a visiting professor at the University Rochester of Medical Centre facial for plastic surgery (Nov 2016). The Department MGH Surgery of is still of one the most popular Departments learners for and is recognized within the as University a Toronto of leader in surgical education. The Department accepts medical students, surgical residents, family medicine residents, internal medicine residents, and surgical fellows from within Canada and internationally. The Department TES residents for has been higher than the University mean Every since year 2013. at least our of one surgeons achieved have the highest University TES within their respective Division. Of note, the Division Orthopedics of was the highest ranked divisionorthopedic by surgery trainees at the twice University in Toronto of the last 5 years. The MGH Pain Management anesthesia rotation PGY5 anesthesia for residents that serves as an example the of collaborative spirit our of Health Service members. Lung Cancer Treatment ( C. Simone The Thoracic Surgery program continues to be a major oncology focus forthe organization. With strong collaborations with our Division Medical of Oncology and Respirology, and our partnerships with Odette Cancer Centre, General North York Hospital, Royal Victoria Hospital and theUniversity Division Thoracic of Toronto of Surgery, the MGH Thoracic Surgery Program is recognized as a shining example collaborative, of multidisciplinary, inter- hospital care providing exceptional service to the the of one largest geographic areas in the province. Teaching Cancer, Cancer Colon and Palliative Care. MGH surgeons are participating in working CCO groups developing quality standards Endoscopy for ( Simone Department of Surgery, Faculty University of Medicine, of Toronto

Nephrology Clinic in the Dialysis Clinic; comprehensive cardiology program; Department Surgery) of as part our of thoracic, breast, colon and prostate oncology programs. Vascular surgery our for Vascular Access/ Robotic Urology Surgery program; Cardiac Surgery as part our of Radiation Oncology (credentialed through such assuch Lung Cancer, Esophageal Cancer, Prostate We are to proud representWe our organization at Cancer Care Ontario and representation have (CCO) severalon quality improvement committees in areas spectrum care to patients in Northeast and Toronto in the Barrie area. Our surgical oncology program continues to be a major focus our for Department. Regional Cancer Centre (Royal Victoria Hospital) to strengthen our partnerships to provide full- Odette Cancer Centre (Sunnybrook Health Sciences the RSCentre), McLaughlin Regional Cancer Centre (Lakeridge Health) and the Simcoe Muskoka Surgical Oncology continue to with work We our partners at the Multidisciplinary 4. 3. 1. 2. offeredMGH. at Our partnership with Sunnybrook Health Sciences Centre continues to grow and will expand to include: multidisciplinary surgical care to our community and strives to expand our services to include areas specialization of otherwise not Our Department is committed to supporting has been instrumental live-tweeted a robotic-assisted Improvement Curriculum that has become an important addition to surgical residency training at the University Toronto. of Innovation R.Dr. Singal prostatectomy and continues to lead our Department in social media influence, which has heightened our profile.He has successfully co-ordinated case reviews, journal club discussions and reviews topic Twitter. on Dr. N. Safieddine N. Dr. in the creation theof Surgery Quality leads Self-Study Report, External 2020 Review | Dr. Dr. Dr. BrettDr. Dr. Najib Dr. Dr. P. Bernick P. Dr. leads the fellowship in was awarded a MGH was a visiting professor has spent significant timeworking received the Arnis Freiberg Faculty sits the on Postgraduate Resident sits the on Postgraduate Education Dr. RajivDr. Singal is the Resident Wellness Director at Dr. JihadDr. Abouali Department of Surgery, Faculty University of Medicine, of Toronto helped create. a team In 2018, surgeons, MGH of nurses and anesthesiologists traveled to and Kenya Singal Dr. now is expanding his focus to include quality improvement in all surgical subspecialties. develop programsdevelop enhancing surgical safety throughout Africa. Singal Dr. has established the Urology Global Health Fund at the University to support and expand Toronto of the urology training program in Zomba, Malawi, which also he Dr. R.Dr. Zeldin at Mt. Sinai Medical System, St. Luke’s Hospital, NY (May York, New 2017). R.Dr. Singal in Malawi, and Kenya Uganda to explore and and Collaborative Education Research Grant. Linda Dvali outstanding for Award Teaching contributions to Plastic Surgery Resident Education. Committee Thoracic for Surgery. Beber the Division University Plastic of Toronto of Surgery. Endourology and MIS. GU the fellowship in Community General Surgery Education Committee General for Surgery, Paul Wong Committee Orthopedics for and Safieddine Dr. R. Zeldin, Dr.Ornstein (Obs/Gyn), Dr. D. Lam (Anesthesia), Dr. R. Singal with the OR team in Kenya in OR team the with Singal R. Dr. (Anesthesia), Lam D. Dr. (Obs/Gyn), Dr.Ornstein Zeldin, R. Dr.

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19. Hospital Reports 19. Hospital Reports 203 Self-Study Report, External 2020 Review | ERAS Across Multiple Hospitals. Aarts MA, Rotstein Pearsall OD, EA, Victor JC, Okrainec A, McKenzie M, McCluskey SA, Conn LG, McLeod RS; iERAS group. Ann Jun;267(6):992-997. Surg. 2018 primary care. Giudice Del ME, SM, Young Ash M, Bansal Robinson ET, Vella A, P, Skrastins Zeldin R, R, Levitt Ung Y, C. Can Fam Physician. Aug;60(8):e395-404. 2014 lung cancer family by physicians and other primary care providers. Giudice Del ME, Young Ash M,Bansal SM, Robinson ET, Vella A, P, Skrastins Zeldin R, R, Levitt Ung Y, C. Can e376-82. Fam Physician. Aug;60(8):711-6, 2014 bronchial tracheal for blocker repair after a rare complication percutaneous of dilatational tracheostomy. Luyet C, Boudah R, McCartney CJ, Zeldin R, Rizoli S. J Cardiothorac Feb;27(1):108-10. Anesth. 2013 Vasc the Greatest Impact Optimal on Recovery: Experience With Implementation of and long-term survival after surgical resection thymoma. of SafieddineN, Liu G, Cuningham K, Ming Hwang D, T, Brade A, Bezjak Azad A, Fischer S, W, Xu S, Cypel M, Darling G, Yasufuku K, Pierre A, Keshavjee de Perrot M, Waddell S. T, Jul;9(7):1018-22. J Thorac Oncol. 2014 operative report lung for cancer surgery. Schneider L, Shargall Schieman C, Y, Seely AJ, Srinathan S, Malthaner RA, Pierre AF, SafieddineVaillancourtN, PlourdeR, M, BondJ, Johnson S, Smith SE, Finley CJ. Ann Thorac Apr;97(4):1163-8. Surg. 2014 management suspected of lung cancer in Guideline referral for patients of with suspected Low-frequency ventilation jet through a Postoperative ERAS Interventions Have Prognostic factors cure, for recurrence Design a consensus-derived of synoptic Systematic review guidelines of the for 4. 5. 6. Publications 1. 2. 3. Department of Surgery, Faculty University of Medicine, of Toronto outline the accomplishments our of Department and I am looking forward to working with all our University colleagues and partners in the future. as “innovative and groundbreaking”. I am very grateful to the have opportunity to “one-stop shop” for patients for “one-stop shop” in our community. Our effortswere recognized by MOHLTC the and Nursing. As a result, been have able we to maximize efficiency in staff and equipment thereby driving down our costs and making a dedicated space creating a self-contained “surgicentre”. This was a combined effort from Departments Surgery, of Medicine, Anesthesia We have re-located the endoscopy, bronchoscopy, re-located have bronchoscopy, We the endoscopy, cystoscopy and minor surgery suites to a large Hon. Deb MatthewsHon. East General’s at Toronto MGH) SurgiCentre,(now recognized as innovative, groundbreaking and patient-centered on eVisits through eVisits on the OTNHub that is completely secure 2-way video conferencing enabling patients and physicians to meet from anywhere. Video Conferencing (PCVC) which enable the physician to be anywhere while the patient still registers at OTN clinics. embarked now have We been participating in Ontario Network Telehealth (OTN) clinics, like many centers, several for years. successfully have We launched PersonalComputer We are expandingWe our telemedicine have focus. We incontinence after radical prostatectomy: a study protocol. Santa Mina Alibhai D, Au D, SM, Jamnicky L, Faghani Hilton N, WJ, Stefanyk LE, Jones J, Elterman Ritvo P, Fleshner D, NE, Finelli A, Singal RK, Trachtenberg J, SepMatthew 16;15:94. 2015 Urol. BMC AG. RK, Satkunavisam R, Chin JL, Izawa J, R,Trachtenberg J, Rendon Bell Singal D, R, Sherman C, Sugar L, Chagin K, Kattan MW. Can Assoc Feb;12(2):E64-E70. Urol 2018 J. cancer screening: A national survey of Canadian primary care physicians' opinions and practices. Goldenberg SC, Skeldon MG, L, Chow FrymlNayan M, Suppiah Y, E, Greenberg Singal D, RK, Goldenberg SL. Can Dec;11(12):396-403. Assoc Urol 2017 J. - a multidisciplinary, formal, consensus- based approach. Loblaw A, Barkin J, Buckley R, Chung H, Kell J, Singal R, Spodek J, Vesprini Flax D, S. Can Feb;24(1):8646-8650. 2017 J Urol. advanced pelvic floor exercises to treat urinary EA, Victor JC, Aarts MA, Okrainec A, McLeod RS. Jul-Aug;71(4):632-8. J Surg Educ. 2014 barriers and enablers in implementing an enhanced recovery after surgery program. Pearsall EA, Meghji Z, Pitzul KB, Aarts MA, McKenzie M, McLeod RS, Okrainec A. Ann Surg. Jan;261(1):92-6. 2015 in Canada. Singal RK. Can Urol Assoc J. 2019 Jun;13(6):190-191. the community: Implementation shared of access model in Canadian healthcare. Goldenberg Kerbel MG, B, Singal R. Can Assoc Jan Urol 21. 2019 J. calculatorprimary for care physicians. Nam Prostate-specific antigen testingprostate for Improving prostate cancer care collaboratively A pilot randomizedtrial conventional of versus A qualitative study to understand the Ensuring a future robotic for surgery Improving accessto surgical innovation in Next-generation prostate cancer risk 18. 19. 20. 14. 15. 16. 17. Self-Study Report, External 2020 Review | practices and barriers and enablers to the implementation an of Enhanced Recovery After Surgery (ERAS) Guideline. Nadler A, Pearsall bowel preparation.bowel Eskicioglu C, Pearsall E, Victor JC, Aarts MA, Okrainec A, McLeod RS. J Gastrointest Surg. 2015 discussion 44-5.Jan;19(1):39-44; Wood T. Ann Surg. Dec;262(6):1016-25. T. 2015 Wood strategy can increase compliance with guideline recommendations mechanical for After Surgery Guideline and Implementation Strategy Based the on Knowledge-to-action McLeod RS,Cycle. Aarts MA, Chung F, Eskicioglu C, Forbes SS, Conn LG, McCluskey S, McKenzie M, Morningstar B, Nadler A, Okrainec A, Pearsall EA, Sawyer J, Siddique N, M, Aliarzadeh Robinson W, B, Wang S, Sockalingam S, Aarts MA. SurgObes Relat Feb;12(2):350-6. Dis. 2016 SE, Serodio K, Sockalingam S, Conn LG. Mar;27(3):730-736. Obes Surg. 2017 multidisciplinary follow-up care postbariatric surgery. Larjani S, Spivak I, Hao Guo J Gastrointest Aug;21(8):1309-1317. Surg. 2017 a FocusFollow-up: Patient-Centered on Care. Aarts MA, Sivapalan Nikzad N, Guidelines Leads to Improved Outcome in Enhanced Recovery After Surgery Patients. Okrainec A, Aarts MA, Conn LG, McCluskey S, McKenzie M, Pearsall EA, Rotstein Victor O, JC, McLeod RS; members the of iERAS Group. Program. Wood T, AartsProgram. T, MA, Wood Okrainec A, Pearsall E, Victor JC, McKenzie M, Rotstein McLeod O, RS; iERAS group. J Gastrointest Feb;22(2):259- Surg. 2018 Following Implementation an of Enhanced Recovery After Surgery (iERAS) Understanding surgical residents' postoperative A multifaceted knowledge translation Development of an of Development Enhanced Recovery Preoperative predictors adherence of to Optimizing Bariatric Surgery Multidisciplinary Compliance with Urinary Catheter Removal EmergencyVisits Room andReadmissions Department of Surgery, Faculty University of Medicine, of Toronto 13. 12. 11. 10. 9. 8. 7.

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19. Hospital Reports 19. Hospital Reports 205 Self-Study Report, External 2020 Review | injuries among medical trainees at a community teaching hospital: A cross- sectional Ouyang study. B, Li L, Mount J, Jamal A, Berry L, Simone C, M. Law M, Tai (2016). 63-73 Health Occup. J. 20: 59(1): Recurrent Anterior Shoulder Instability. TheodoropoulosSheth U, J, Abouali J. Arthrosc Jul 20;4(4):e311-6. 2015 Tech. Abouali JA, Hatzantoni K, Holtby R, Veillette C, Theodoropoulos J. Arthroscopy. 2013 Sep;29(9):1572-8. knee.of Abouali J, Farrokhyar F, OgilviePeterson D, Indian R, O. Ayeni J Orthop. Mar;47(2):168-73. 2013 ultrasonography in Ontario: a population- based retrospective cohort James study. Hegagi M,P, Antonova L, Tinmouth J, E.Heitman E, S, Yong Simone C, Young CMAJ Open 5(2):E437-E443 (2017). Reconstruction: Reliability of Measuring LengthsTunnel and Intra-articular Distance. BristowDwyer L, T, Bayley Sheth N, U, Abouali J, Murnaghan ML, Wasserstein D, Ogilvie-Harris Fine B, D, Theodoropoulos J, Chahal Orthop J. J Sports Med. 2018 Dec 21;6(12):2325967118816317. Rates After Primary Shoulder Dislocations? A Systematic Review Comparing Prospective and Retrospective Studies. Gohal C, Rofaiel J, Abouali OR, Pinsker J, Ayeni E, Whelan Arthroscopy. Oct;33(10):1876-1881. D. 2017 patient management. Abouali J, Stoller Can J. Fam Physician. Feb;63(2):135-136. 2017 Preoperative Planning in the Treatment of Revision arthroscopic Bankart repair. Thromboprophylaxis in routine arthroscopy Regional differences in useof endoscopic Incidence and characteristics needlestick of Graft-Tunnel MismatchGraft-Tunnel in Endoscopic ACL Does Study Design AffectRedislocation Electronic consultation services: to help Tool Use 3-Dimensional of Printing for 32. 33. 34. 35. 28. 29. 30. 31. Department of Surgery, Faculty University of Medicine, of Toronto Group. Trials.Group. Oct 28;14:356. 2013 Matrix Trial study (MCCAT): protocol a for randomized controlled trial in implant-based breast reconstruction. Temple- Zhong T, BeberOberle B, C, Semple SO, J, Hofer Brown M, Macadam Panzarella S, Lennox P, McCarthyT, C, Baxter Study MCCAT N; Zhong T, Hu J, Bagher Hu S,Zhong O'Neill T, Beber AC, Metcalfe SO, B, Hofer KA. Plast Reconstr Surg. 2013 Nov;132(5):724e-734e. DR, Hofer SO, IrishDR, SO, Hofer JC, Baxter NN. J Clin Jul 10;32(20):2133-41. Oncol. 2014 the self-efficacy of role and satisfactionwith information in the preoperative period. in the Canadian universal health care system. FernandesZhong T, KA, Saskin R, Sutradhar R, Platt J, Beber BA, Novak CB, McCready Study Trials. Group. Jan 20;17:39. 2016 Measurements Used Preoperatively in Aesthetic Breast Surgery. Murphy Isaac Beber B, BD, KV, Brown M. Aesthet Apr;36(4):431-7. Surg 2016 J. study protocol a randomized for controlled trial in implant-based breast reconstruction. Beber C, SO, Hofer Temple-Oberle Zhong T, B, Semple J, Brown M,Macadam S, Lennox P, Panzarella McCarthy T, C, Baxter MCCAT N; Randomized Clinical Trial. Armstrong KA, Coyte PC, Brown M, Beber B, Semple JL. JAMA Jul 1;152(7):622-627. Surg. 2017 Acellular Dermal Matrix Trial (MCCAT): Aesthet May 15;38(6):616-622. Surg 2018 J. App the on Number In-Person of Visits Following Ambulatory Surgery: A Measurements: Predictable How Steen Are We? K, Murphy Isaac Beber B, Brown BD, KV, M. The Multi Centre Canadian Acellular Dermal Decision regret following breast reconstruction: Barriers to immediate breast reconstruction The Reliability Anthropometric of Erratum The Multi to: Centre Canadian EffectMonitoring Home of viaMobile Three-Dimensional Imaging and Breast 27. 26. 25. 24. 23. 22. 21. 192. MOUNT SINAI HOSPITAL

Photo: Courtesy of Department of Medicine

Jay Wunder, Surgeon-in-Chief, Mount Sinai Hospital

The Department of Surgery at Mount Sinai Hospital We are in the midst of a major multi-year structural has continued to be a leader in health care, clinical renovation project throughout the hospital which and translational research, and education in our will update a multitude of clinical program spaces. unique programs as judged by the annual divisional A new although temporary elective outpatient reports documenting publications, grants, invited surgery department just opened. However on a lectureships and awards. We have a core group of much larger scale, an entirely new perioperative area clinician scientists whose research is integrated is currently being built which will include 19 new between the hospital and the Lunenfeld-Tanenbaum operating rooms including an integrated guided Research Institute in support of translational research therapeutics (GTx) suite, a new PACU with space with the goal of improving patient outcomes. The for a block program, a new patient and family- educational experience at a the hospital is supported centered area for same day surgical admissions as by having both the University of Toronto Surgical well as a family waiting area, and new shared space Skills Lab and it’s Director at Mount Sinai Hospital, for all the clinical staff and as well as a new Medical and this has led to improved skills acquisition Device Reprocessing Department (MDRD). This and clinical competence of our trainees through will not only modernize surgical services but will development of novel models of education. also allow expansion of our core surgical programs.

206 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 19. Hospital Reports 207 Self-Study Report, External 2020 Review | – colorectal surgeon – colorectal surgeon recruited Clinical Investigator from Award the Society of Surgical is She Oncology. part multiple of grants includinggrant a $1.5M related to development precisionof treatment protocols patients for with sarcoma and received a major CIHR grant this year to investigate the genetics leiomyosarcoma. of the which University will Toronto of him help in future of development clinical trials in IBD. Carol Swallow is both Division Head General of Surgery at Mount Sinai Hospital, and the Bernard Langer& Ryna Chair the of Division General of Surgery, Department of Surgery, University of was She elected to the AmericanToronto. College Surgeonsof Board Governors of and received the Charles Surgeon Tator Scientist Mentoring Award. is She known to be an excellent educator all for levels traineesof including at the graduate and level, her students awards won have research for presentations at multiple national and international meetings. Rebecca Gladdy was promoted to Associate Professor. is She a surgeon-scientist runs who her own translational molecular biology laboratory focusing sarcoma. on recently She published an important research paper in Oncogene identifying therapeutic pathways in rhabdomyosarcoma using transgenic mouse tumor models, and received a and Collaborator 2 grants on investigating health- related quality life of in patients with retroperitoneal sarcoma. received the He Colapinto Award Teaching from the University Division General of Surgery. 2. Mantaj Brar from theUniversity Calgary of and specializing in Inflammatory Disease, Bowel minimally invasive procedures including total mesorectal excision (TME) colorectal for cancer, as well as epidemiology and health economics. Mantaj introduced the technique minimally-invasive of transanal excision early of rectal neoplasms using the TEMS platform to the hospital. Anthony3. de Buck recruited from Brussels, Belgium and specializing in Inflammatory Disease Bowel colorectal and cancer with a special interest in developing new laparoscopically assisted surgical techniques. During his firstcompletedTorontohe a yearMasters in in Clinical Epidemiology through IHPME at Department of Surgery, Faculty University of Medicine, of Toronto – surgical oncologist, specializing in

University and was recently of Toronto, appointed as the Residency Program Director. Sav is a PI the hospital. Sav was Chair the of Competency Committee the for General Surgery Residency Program inthe Department Surgery of at the at Mount Sinai Hospital as in part 2018 his of inrole promoting the gastric surgery program at sarcoma, colorectal cancer and gastric cancer. Sav co-hosted the Feeling Gut My Conference theof Stomach Cancer Foundation Canada of New recruits Sav Brar1. the management patients of with retroperitoneal General Surgery Past 5 Years coordination and provision services of and improve the academic standing and output this of group. Highlights Over the review and received strong recommendations changefor that been have endorsed the by senior leadership team and if enacted could lead to better improve outcomes and the patient experience. This group recently also completed an external and a well known IBD-focused gastroenterology the programgroup. However is fragmented and lacking in resources, which if rectifiedcould In a similar fashion, an have we academically very strong group colorectal of surgeons focusing largely Inflammatory on Disease Bowel (IBD) surgical oncology and aimed at improving patient outcomes and the patient and family experience. move forwardmove with an of development integrated cancer program supporting both medicaland internationally recognized reviewers and received very positive recommendations. Asresult a the senior executive team that approved the hospital for cancerfor patients. With senior executive team sponsorship coordinated we aninternal followed anby external review our of cancer services by strong surgical oncology presence at Mount Sinai Hospital, the medical oncology program has not pacekept and there are limited support programs Although developed have and we grown a very acclaimed as a leader in the understanding and treatment gastrointestinal of diseases. The researchCentre’s focus is to determine the causes hereditaryof familial cancers and Inflammatory DiseasesBowel (Ulcerative Colitis and Crohn’s), with an emphasis their on genetic preconditions. to reduce help readmissions following colorectal surgery. Erin is also the Cancer GI CCO Lead, and sits the on American Society Colon and of Rectal Surgeons (ASCRS) Rectal Cancer Coordinating Committee, as well as the Canadian Partnership Against Standards Cancer (CPAC) Committee. Erin is also the NSQIP lead at Mount Sinai Hospital. MacRaeHelen is the Program Director the for Colorectal Residency Program at the University Chair Vice the of Royal College Toronto, of of Physicians and Surgeons Canada of Colorectal Surgery Examination Board, as well as Clerkship Director at Mount Sinai Hospital. developed Helen the Technical Skills Curriculum the for American College Surgeons of is a surveyor (ACS), and reviewer and ACS, for sits committee the on ACS Professionalfor Activities Retired for Surgeons. Zane Cohen retired from clinical practice and leads The Zane Cohen Centre Digestive for Diseases which is a clinical research facility, internationally determine operability HIPEC. for Anand is Vice Chair the of Board Examiners of in General Surgical Oncology the for Royal College of Physicians and Surgeons Canada, of andResearch Director the for General Surgical Oncology Fellowship Program at the University Toronto. of Erin Kennedy was promoted to Associate Professor as a result incredible her of accomplishments. She and colleagues her implemented a physician assistant program at Mount Sinai Hospital to improve inpatient care in response to concerns related to resident workload and rotation dissatisfaction. The positive results this of program published were in the Journal the of American Academy PAs, of and demonstrated reduced resident workload and improved rotation satisfaction and patient care. As an example academic her of productivity, in just the past year was she awarded 2 CIHR grants, as one anothera PI, as a Co-Investigator, and is also part 3 additionalof CIHR grants. One CIHR grant for which is she is PI investigating a mobile app iPhone Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto Work. He holds He a numberWork. grants of supporting investigations into Prehabilitation Surgical for Oncology Patients, and imaging techniques to Project at Cancer Care Ontario. Anand had two publications in the England New Journal of Medicine: was he co-author Introduction on of surgical safety checklists in Ontario, Canada, and first authoron Outcomesof Daytime Procedures Performed Attending by Surgeons after Night Anand Govindarajan was promoted to Associate Professor and was awarded the Langer B. Surgeon Scientist recently Award. He became the Clinical Project Lead the for Survivorship Care Improvement of theseof efforts waspromoted to Associate Professor. Gryfe Rob was awarded an internal Doctors of Cancer Surgery Innovation Fund Grant (Princess Margaret Cancer Centre) investigation for theof genetics of role in cancer. colon important surgeon of topic gender and patient preferences. is She a collaborator 2 CIHR on grants and 3 additional internal grants/clinical trials. Alexandra received a Wightman-Berris Academy Undergraduate Award, and Teaching as a result all of of Generalof Surgery at the University Toronto. of Alexandra Easson had a stellar year with 5 publications including two important senior author papers, related one to interest her in palliative care in surgical oncology and another about the very a translational research laboratory focusing on oncolytic virusesand is part number of large of collaborative research grants from CCSRI and Prostate Canada as well as the Foundation. Terry Fox Andrea is also Director Research of the for Division Andrea McCart is Director the of Ontario Peritoneal Malignancy/HIPEC (hyperthermic intraperitoneal chemotherapy) Program which is initiated she at Mount Sinai Hospital and which serves the entire province Ontario. of continues She to run Toronto InternationalToronto Sarcoma Symposium (TISS), co-founder the of Canadian Sarcoma Research and Clinical Collaborative (CanSarCC), and co-chair the of InternationalTrans-Atlantic Retroperitoneal Sarcoma Working Group. Rebecca was twice recognized with an Outstanding the by Surgical Award Teacher Oncology Fellowship Program. Rebecca is founder the of highly successful

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19. Hospital Reports 19. Hospital Reports 209 Self-Study Report, External 2020 Review | is the orthopaedic division received the Junior Faculty Research is the director the of University of Award at theAward Annual Orthopaedic Research Day at This the University stems Toronto. of from his early career year year accomplishments over in both trauma and arthroplasty in terms of teaching, publications, research supervision and grant attraction. initiated He the young was also selected as a member in the prestigious American Association Hip of and Knee Surgeons. Oleg Safir SurgicalToronto Skills Center at Mount Sinai Hospital,which was chosen to an receive ASPIRE award excellence for in medical education the by International Association for Medical Education. leadership Oleg’s Under the Skills Center successfully underwent re-accreditation the by American College Surgeons. of was Oleg also promoted to Associate Professor in the Department Surgeryof received at He the University Toronto. of an Excellence for Award in Postgraduate Medical Education in the category and Development of Innovation the of development Orthopaedic for Boot Camp training for early year residents. This program has been rolled now across out the university in all surgical disciplines and is being modelled by many orthopaedic programs across the globe. Paul Kuzyk Mount Sinai Hospital/ Lunenfeld-Tanenbaum Research Institute and was appointed as an Assistant Professor in the Department of Surgery atthe University of Toronto. BacksteinDavid head. helped and implement He successful a novel Integrated Hip Fracture Inpatient Co-Management Model together with hospitalists that was associated with reduced length costs, stay, of time to surgery, and increased initiation appropriate of osteoporosis treatment. The positive results of this process improvement published were in the Journal Orthopaedic of Trauma. David secured a major donation the for division which has been rebranded as the Gluskin Granovsky Division Orthopaedics.of This will facilitate research, education and capital initiated He development. a successful outpatient day surgery program for total hip and knee arthroplasty patients at Women’s College Hospital, and received a Distinguished Educator at Sinai Award Health System. David – orthopaedic Department of Surgery, Faculty University of Medicine, of Toronto BSc, MSc, PhD earned her complex primarycomplex and revision knee arthroplasty. Jesse has 1. Jesse1. Wolfstadt surgeon specializing in trauma extremity and lower reconstruction, especially

Engineering from Polytechnique École Montréal. runsShe the orthopaedics biomechanics lab at Bachelor of Scienceof Bachelor in Engineering and Masters Scienceof in Engineering from the University Guelph,of as well in as Biomedical Ph.D. her in the Journal and Bone of Joint Surgery. 2. Adele Changoor preventing unnecessary hospital admissions and reducing trauma length stays. of The results of this successful program recently were published pathway outpatient for ambulatory fracture patients which has been very successful in reduction and internal fixation vs distalfemoral replacement elderly for distal femur fractures. Jesse also developed and implemented a standardized been successful in being awarded grant funding from the Orthopaedic Trauma Society (OTA) a randomizedfor clinical trial comparing open a major clinical and research interest in quality improvement and patient safety. has He already Orthopaedic Surgery New Recruits the society's vision an of ideal physician. Surgery. Robin was also awarded theCollege Physiciansof and Surgeons Ontario of (CPSO) Council excellence for Award which characterizes President the of American Surgical Association, and received the Lavina Lickley Lifetime Achievement from Award the Department of Practices in General Surgery (BPigs) program which is renowned. world was She elected and moved toand Cancer moved Care Ontario as the VP Clinicalof Programs and Quality Initiatives. continuesShe to run the hugely successful Best epidemiologists, pediatricians and IT specialists. Robin McLeod also retired from clinical practice consisting gastroenterologists, of surgeons, psychiatrists, psychologists, pathologists, radiologists, molecular geneticists, genetic counsellors, The unithas a collaborative team structure 19 research has led to two particularly also holds a patent a genetic for was President Vice and then President the journal Nature – ScientificReports. Alex Zlotta’s important publications, in one JNCI identifying Kallikrein-6 as a marker aggressive for prostate cancer, and the other in showing JCO that trimodality therapy bladder for cancer allows bladderfor preservation instead radical of cystectomy. Alex was awarded a University of Division Urology of Toronto Faculty Postgraduate as Award Teaching well as the European Association Urology's of Platinum Award. Urology Our small urology group 3 surgeon of investigators working in the areas male of infertility and oncology consistentlyhave been academic superstars year. year Over the over past year they published 30 peerreviewed papers and were awarded peer 12 reviewed research grants. Keith Jarvi marker to differentiate between different types maleof infertility which was recently licensed to an American as well as a Chinese Laboratory Diagnostics Keith is Company. the Editor on the Canadian Urology Association Journal. Kirk Lo theof American Society Andrology, of as well as President the of Society the for Study Maleof Reproduction. One his of CIHR grants is developing a mobile fertility app for patients. is He an Editorial Board Member for Self-Study Report, External 2020 Review | became the Albert Latner and Chair, Temmy Division Orthopaedic of Surgery in the Department Surgery, of University and just of Toronto completed a very successful Peter Ferguson Peter remains active in the division in was reappointed as Surgeon-in-Chief. Department of Surgery, Faculty University of Medicine, of Toronto research, educational and clinical care society patientsfor with sarcoma and related diseases. Fidani Foundation together with Rebecca Gladdy and Irene Andrulis PhD to support Personalized Precision Medical Patients Treatment for with Soft Tissue Sarcoma. was He President the of Connective Tissue Oncology Society, the foremost international Physicians and Surgeons Canada of AMS Donald R. Wilson integrating for Award CanMEDs roles into the orthopaedic residency training program. Wunder Jay research securedHe grant a $1.5M from the Carlo (CBC) within the Orthopaedic Residency Program, that has gained international recognition and has formed the basis the for Royal College Physicians of and Surgeons Canada’s of Competency Design by project. also He Royal received College the 2015 of 5 year external was Peter also review. promoted to Professor. was Peter largely responsible for establishment the of Competency Based Curriculum patients undergoing total hip arthroplasty. patient care, education and research. continues He to be sought after as aneducator and lecturer nationally and internationally. is He Chairman of Intellijoint Surgical, a Canadian-owned company which has developed an easy to use and practical navigation platform improving for outcomes for hip arthroplasty College program at Women’s Hospital. is He already an associate editor thefor Journal Orthopaedic of Trauma. Allan Gross adult hip preservation clinic, thefemoral head osteochondral allograft program, and played an important in role the of development same day

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19. Hospital Reports 19. Hospital Reports 211 Self-Study Report, External 2020 Review | At NYGH we have worked very worked have At we NYGH hard keeping on our surgical wait have Since times we 2012 low. been the provincial leaders in wait times hip for and knee replacement and cancer surgery. In General North was York again once 2018/19 given areas. This model care of provides better access for our patients and improved surgical care. The acute care service in Urology is the first in Canada. Department of Surgery, Faculty University of Medicine, of Toronto Lloyd C. Smith, Surgeon-in-Chief, General North York Hospital

Orthopedics, Plastic Surgeryand This Urology. includes protected daytime time OR in each these of heavily invested in the Acute Care model care of lookingfor after these urgent cases. have We dedicated acute care services in GeneralSurgery, Department Surgery of General at North York Hospital.The emergency volume of cases has continually General North gone up. is York The pastyears five very been have good for the

Photo: nygh.on.ca

3. NORTHYORK GENERAL HOSPITAL 19 19 Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto the challenges new that they will bring. Canada to start using the “Black to Box” improve quality and safety in our operating rooms. Overall the lastyears five beenchallenging have verybut good our for Surgical Department. forward look We to the nextyears five and The Department Surgery of at North York General is also in involved many other quality initiatives. an were early We participant in NSQIP and had have many successful quality projects as a result this. of the were second hospital We in invested in multidisciplinary approaches to care. We created threehave Integrated Care Collaboratives to promote interdisciplinary(ICC’s) care and Breast for improve Cancer, quality. ICC’s have We Colorectal Cancer, Joint and Assessment. Total The Department Surgery of at is NYGH heavily have madehave an effortkeep fellowsto out orderin interferenceto avoid with our residents learning. The number learners of in the Department of Surgery has been steadily increasing the past over currently5 years. We get residents regularly in General Surgery and Plastic also have Surgery. We been getting many studentselective on from the andUniversity other Universities. Toronto of We consult) also have the for fourth We year in a row. been able to operate greater on than our of 96% hip fractures within 48 been have hrs. the We provincial leaders in this more than for 5 years. the awards Cancer by Care Ontario best for wait times wait for (decision 2 to treat to surgery) for the sixth and year wait for in 1 (referral a row, to

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19. Hospital Reports 19. Hospital Reports 213 Self-Study Report, External 2020 Review | College Physicians of andSurgeons; Kyle Dr. Wanzel - Program Director, Plastic Surgery, U Shiva Dr. Jayaraman T; of – Program Director, Canadian Surgery Forum). Several our of surgeons alsohave received both hospital and University awards in recognition teaching of excellence. Maurice Blitz – Director Surgical of Foundations, Department Levine Ron Dr. Surgery, of – T; U of Director Postgraduate of Education, Department Chris Dr. Surgery,of T; U of Compeau – Chair, Examination Committee Thoracic Surgery, Royal

Department of Surgery, Faculty University of Medicine, of Toronto Christopher Compeau, Surgeon-in-Chief, Health St. Joseph's Centre

arthroplasties). Several our of surgeons held have educational administrative leadership positions (Dr. our surgical subspecialties including our surgical priority programs (hepatobiliary, thoracic surgery, bariatrics, upper extremity surgery and as being an outstanding site undergraduate, for graduate and post-graduate surgical education. This recognition applies to the breadth all of Within the surgical University Toronto of community St. Health Joseph’s Centre has a strong reputation both for clinical excellence as well Photo: en.wikipedia.org/wiki/St._Joseph%27s_Health_Centre

UNITY HEALTH TORONTO 4. ST. JOSEPH’S, ST. 4. 19 19 Self-Study Report, External 2020 Review | Craig Fielding Craig Ashis Chawla Paul Sullivan Paul Michael Ko Vincent George Andres Gantous

Thoracic Surgery Surgery Orthopedic Surgery Plastic Urology Otolaryngology DIVISION HEADS SurgeryGeneral Department of Surgery, Faculty University of Medicine, of Toronto within this network new is exciting. Centre this over time framewas the merger between St. Michael’s St. Hospital Joe’s, and Providence Healthcare. Although the surgical programs currently maintain the autonomy potential clinical for integration and collaboration Melanie (General Tsang and HPB Surgery), Dr. Victoria Cheung (Thoracic Surgery), and Dr. Hanmu (Urology)) and bring Yu to our department clinical expertise and an enthusiasm to teach. A significant event affecting HealthSt. Joseph’s (General Surgery), Shiva Dr. Jayaraman (General Wanzel (PlasticSurgery), Kyle Dr. Surgery), AndresDr. Gantous (Otolaryngology), and Dr. Amr El Maraghy (Orthopedic Surgery). Three surgeons hired were to replace retirees (Dr. Over the pastyears five ourof 5 surgeonswere promoted to Associate of the level Professor at Harmantasthe (Dr. University Tom Toronto of

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19. Hospital Reports 19. Hospital Reports 215 Self-Study Report, External 2020 Review | Divisions, Cardiovascular Surgery,General Surgery (includes Trauma and Neurosurgery, Thoracic), Orthopedic Surgery, Plastic Surgery, Urology and Vascular currently Surgery. We 48 have surgeon- 16 (27%), surgeon-scientists 13 surgeons, investigators surgeon- and 19 teachers (33%), Surgery at SMH and SJH remain separate as there are currently common no programs between the two sites. Provincial centers Hepatobiliary for pancreatic and thoracic surgery located at St. HospitalJoseph’s are strongly collaboration with St. Michael’s Hospital. St. Michael’s currently has 7

Department of Surgery, Faculty University of Medicine, of Toronto Ori Rotstein, Surgeon-in-Chief, Unity Health Toronto

Providence Healthcare(PHC) to become the Unitynew The Departments Health Toronto. of In August 2017, St. Michael’s HospitalIn August (SMH) 2017, merged with St. Hospital Joseph’s (SJH) and emergency room visits per year, and in excess of 15,000 inpatient surgical procedures. There are and 6 ambulatorycurrently Core OR’s 15 ORs. hospital is It the of a University Toronto. of downtown hospital and 1 provincial Tier trauma centre with 486 in-patient beds, averaging 75,000 St Michael’s Hospital (SMH) is a fully-affiliated Photo: Geo Swan via Wikimedia Commons Wikimedia via Geo Swan Photo:

UNITY HEALTH TORONTO 5. ST. MICHAEL’S, MICHAEL’S, ST. 5. 19 School Admissions, University of Toronto Vice-chair Research, of Department of Surgery, University of Toronto Clinicalof Affairs, Facultyof Medicine, University of Toronto CIBC Breast Centre Jan Traumaof ’19) (end Traumaof (internationalsearch underway) Director, Division Cardiac of Surgery, University of Toronto Division of Urology, University of Toronto Program Director,Division of Neurosurgery, University ofToronto Education, Department Surgery, of University of (previous ProgramToronto Director, Division of General Surgery, University of Toronto) Department of Surgery, University of President, Vice ResearchToronto & Innovation, Unity Health Toronto Dr. DavidDr. Head, Latter Medical (C/S): AndrasDr. Kapus Associate (Res): Dean Vice JohnDr. Bohnen (G/S): Head, David Dr. Latter DanielDr. Bonneau MarkDr. Peterson Bobby YanagawaDr. (Recruit 2015) SubodhDr. Verma Dr. RalphDr. Director, George (G/S): SandroDr. Rizoli Director (G/S): BernardDr. Interim, Lawless (G/S): Director Program Bobby YanagawaDr. (C/S): RobertDr. Stewart(U/S): Program Director, JulianDr. Spears Associate (N/S): Chair Vice NajmaDr. Ahmed V: of (G/S) OriDr. Associate Rotstein (G/S): Chair, During the pastyears, five OR the division’s cases and hours numbers grown. have Peaking 1300 cases and >4800 Currently hours in FY19. there are attending five cardiac surgeons. The divisional surgical activity the involved treatment of coronary artery disease and valvular disease. There • • • Activity Clinical Division of Surgery Cardiac Members: • • • • • • • • • • • • • Self-Study Report, External 2020 Review |

Dr. Dr. David Dr. Latter Dr. Julian Dr. Spears Dr. Ken Pace Ken Dr. Interim, Surgeon Vice, Surgeon-in-Chief Vice, Dr. Tim Dr. Daniels Perioperative Services, St. Michael’s Hospital Staff Association, St. Hospital Michael’s Mobility Program, St. Michael’s Hospital Division of Urology: Division of Vascular Surgery: MohammedDr. Al-Omran Jory Simpson effective1, 2019) Sep Division of Neurosurgery: Division of Orthopedic Surgery: Division of Plastic Surgery: JamesDr. Mahoney Dr. OriDr. Rotstein: 2004- 2019) Ken Pace: Dr. Division of Cardiac Surgery: Division of General Surgery: Nancy Baxter (Dr. Aug 30, 2019) (end Dr. NajmaDr. Ahmed: in Chief (Position previously by held Dr. Ken Pace (U/S): President, Medical (U/S): Pace Ken Dr. Dr. Earl Bogoch (O/S): Medical EarlDr. Director, Bogoch (O/S): James MedicalDr. Mahoney(P/S): Director, Department of Surgery, Faculty University of Medicine, of Toronto • of Surgeryof various hold leadership positions at the hospital and the University. • • • • Many members the of St. Michael’s Department • • • • • • network allows quality for patient care. St. Hospital, Michael’s Department of Surgery Leadership • In 2017 St. Michael’s Hospital,In 2017 Providence Healthcare and St. Hospital Joseph’s join the Unity network. Health The goal Toronto of having three health care facilities under one In 2014 St. Michael’s embarkedIn 2014 a series on of projects that would transform care at the hospital, including story a 17 patient care that tower would include state-of-the-art 5 new hybrid operating rooms. A renovated emergency room and several upgrades to improve the existing envelope. It isIt important to note that Otolaryngology, Ophthalmology, Obstetrics/Gynecology are separate surgical departments. (40%). This(40%). matrix faculty of allows us to be a highly productive and vibrant Surgical Department with varying degrees surgical of expertise.

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19. Hospital Reports 19. Hospital Reports 217 Self-Study Report, External 2020 Review | Dr. OriDr. Rotstein AdenaDr. Scheer (Recruit 2014) JoryDr. Simpson Head, Nancy Dr. Baxter NajmaDr. Ahmed JohnDr. Bohnen SandraDr. de Montbrun RalphDr. George DavidDr. Gomez (Recruit 2018) Grantcharov Teodor Dr. BernardDr. Lawless JohnDr. Marshall Rezende Joao Dr. • • • The Division General of Surgery has evolved considerably the pastyears. over five of Much this the Vascular Laboratory is fully accredited the by Inter-societal Commission the for Accreditation of Vascular Laboratories. As well as providing valuable high-quality diagnostic services, the non-invasive diagnostic blood flow laboratoryprovides an excellent training environment students for at the Michener Institute and the for training vascular of surgery trainees in diagnostic theory and technique. Division of General Surgery Members: • • • • • • • • • • surrounding area. Endovascularaortic surgery (EVAR) has reduced significantly at St. Michael’s the pastover cases ten years in FY09from to 117 cases70 down Thein cases to 53 FY15, in FY19. levelling offof thesenumbers is likely attributable to a number factors of including the change in our faculty (Dr. Lossing was provider) a key and also the fact that this technology is being increasingly adopted at other hospitals across the province. The scopepractice of includes, is but limited not cerebrovascularto, disease, thoracic and abdominal aortic occlusive and aneurysmal disease, peripheral artery disease, hemodialysis access, vascular trauma, venous, and lymphatic disease. There is particular expertise in thoracic outlet syndrome, hemodialysis access, wound care with limb salvage, carotid body tumour, vascular trauma and advanced aortic aneurysmal endovascular therapies. The Division directs a large-volume non-invasive diagnostic vascular laboratory site on at St. Michael’s. Department of Surgery, Faculty University of Medicine, of Toronto Dr. ElisaDr. Greco(recruit 2015) MohammedDr. Qadura(Recruit 2016) MarkDr. Wheacroft Head, Mohammed Dr. Al-Omran CharlesDr. de Mestral(recruit 2017) interventional approaches and the change in referral patterns vascular for surgery cases and in the GTA years. This is attributable to a number factors of including departure/retirement busy of clinical surgeons, the change in practice towards more endovascular, the latter in collaboration the of Department Medical of Imaging. The number casesof and hours has diminished the past over 5 sized at present. Care delivery focuses across the range vascular of diseases, both open and Drs. Greco, Qadura and de Mestral to establish themselves alongside Drs. Al-Omran and Wheatcroft, is it that felt the Division is right- over the pastover 5 years. This has been particularly stressful the for junior surgeons starting were who their first faculty position. With the additionsof new facultynew recruited were through international searches. Obviously, these changes represent a considerable flux in the manpowerof the division Mestral) in the past 5 years, the composition of this division has changed entirely since 2004. All With retirement/departures (Drs.Tanner, Campbell,With retirement/departures (Drs.Tanner, and recruitmentMoloney) Qadura, (Greco, de • • • Members: • • for supportfor required) and partly through our Heart and Vascular Program’s existing resource. Division of Vascular Surgery division is alsopart a program of in mitral valve clipping. Funding these for two programs is partly through government sources (special application perform 72 TAVI casesperform and increasing in FY14 TAVI 72 With cardiology in FYto 185 19. as lead, the the institution developed a percutaneous aortic valve program. This program has grown considerably with support fromgovernment and the hospital; activities, and in particular augmented the activity in minimally invasive cardiac surgery. With Dr. David Latter and in collaboration with cardiology, using mitral valve repair rather than placement. The recruitment Mark Dr. of Peterson (2007) had profound influence on divisional clinical is expertise in mitral valve disease, particularly The Over the past surgery. With seen have an increase in breast cancer surgery at the Institution with without or reconstruction, in to in 477 FY19. FY15 435 Division has focused its oncology efforts in two areas; Breast cancer surgery, colorectal surgery and Foregut. is It noteworthy that hepatobiliary pancreatic and thoracic surgery, are electively not performed at St. Michael’s, with but the merger with St. Hospital Joseph’s access have we tothese two provincial programs. Since 2005, delivery of cancer care at St. Michael’s as an integrated service required partnering with external institution, most notably with our neighbouring cancer centre, Princess Margaret Hospital, to ensure expert and timely access to radiation oncology. Breast Cancer Surgery: decade, under the leadership Ralph Dr. of George, the director the of CIBC Breast Centre, multidisciplinary breast cancer care has evolved considerably. The Division recruited two fully trained surgical oncologist with expertise and interest in breast cancer. Jory Dr. Simpson joined the faculty in and Adena 2013 Dr. Scheer in Scheer is Dr. also2014. trained in oncoplastic care as well as academic foci. Over the past 5 years, there has been some changein personnel to due departures, retirements, and focused recruitment. DavidDr. Gomez was recruited and both in 2017 Drs. John Marshall and Ori Rotstein stopped have attending this on service.This has resulted in a shortage manpower of in this area, with only 4 full time faculty surgeons (Drs. Lawless, Ahmed, de Rezende A search and is Gomez). currently underway a director, for as well as trauma a new surgeonsmember. The TACS referrals receive from across the province the for management complex of intraabdominal inflammatory/infectiousproblems as well as soft tissue infections. The number of patients referred service to the ACS through the Emergency Department and from inpatient services has progressively increased, reflecting the increasing numbers patients of evaluated in our Emergency Department and either admitted directly to the serviceACS to or the General Medicine service. Promotion Surgical of Oncology: Self-Study Report, External 2020 Review | St. Michael’s Hospital is 1 a level Department of Surgery, Faculty University of Medicine, of Toronto the institution. Alignment this of program with the trauma team has helped to consolidate clinical both sites) meets quarterly and is committed to continued efforts to harmonize activity. In 2008, The Division established an Acute Care Surgery service designed to manage urgent/ emergent referrals from both outside and inside with a single intake process, rotation between sites and a common evaluation process, establishment of a joint University visiting of Toronto professorship program. The Trauma University Toronto of Committee includes (which leadership from Over the past decade, strongly have we promoted harmonization trauma-related of issues with Sunnybrook Hospital. This includes: harmonization clinicalof care protocols, sharing quality of assurance activities, maintenance a joint of fellowship program of theof Division General of Surgery, departed in January to direct 2019 the national trauma centre in Doha,Qatar. has He been replaced as Trauma Director an on interim basis Bernard Dr. by Lawless until a search is completed Director. a new for cases (ISS>16) risingcases With the (ISS>16) to 620 in FY19. increased density population of and change in epidemiology in trauma it etiology in Toronto, is anticipated that trauma numbers will increase the nextover years. few is It noteworthy that the Director Trauma, of Sandro Dr. Rizoli, a member Surgery. The services Trauma of and Acute Care Surgery are (TACS) very integrated much into the General Surgery activity including resource, OR recruitment, allocation rotations, TACS of sharing Level 1 trauma received faculty.of 541 we In FY14, (TACS): (TACS): Provincial Trauma Centre sharing trauma call with Sunnybrook Hospital. While the Trauma Program per se is formally not under the auspices Generalof Surgery, the cadre dedicated of trauma surgeons reside within the Division General of Care Surgery; Cancer care particularly in colorectal and breast surgery; Foregut and Minimally Invasive Surgery including Bariatric Surgery, and Breast. Trauma and Acute CareSurgery Services change has occurred through targeted recruitment in a number areas. of The major strengths in the Division include: Trauma/Critical Care/ Acute

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19. Hospital Reports 19. Hospital Reports 219 Self-Study Report, External 2020 Review | The hospital has the of one provincial St. Michael’s Hospital was the first Head, Pace Ken Dr. MonicaDr. Farcas (Recruit 2018) MichaelDr. Ordon RobertDr. Stewart oursis unique in that our of 25% cases are performed benignon disease the of renal pelvis, usually particularly ureteral and ureteropelvic strictures. Only cases of 15% prostate for were cancer. affordedour faculty opportunityan to gain clinical expertise as well as investigative renown in this area. Robotics: hospital at the to University a have Toronto of surgical robot. The Da Vinci Robot, purchased in is it used2007, urology by aswell as the Department Obstetrics of we and Gynecology. In FY17, performed robotic 136 procedures. While most centers, use the robot to do prostate cancer surgery, Division of Urology Members: • • • • The Division has expertise in endourology/ stone disease, renal transplantation as well as a lesser focus genitourinaryon The Division oncology. had a manpower issue with the departure Jason Dr. of Lee to the University Health Network to become the Director Robotics of and Simulation and the absence of Robertleave Dr. of Stewart. These departures/reductions has been balanced now by the permanent recruitment Monica Dr. of Farcas. Lithotripsy: litotripsy machines. Surgeons from across the AreaGreater privileges have Toronto in the Lithotripsy unit. The presence the of unit has Department of Surgery, Faculty University of Medicine, of Toronto Over the past Withthe respect to developing advanced laparoscopic skills. quality patient care, this program has provided an excellent educational opportunity especially with This centre will be located a Providence Healthcare, part the of Unity and will Health Toronto open In additionin October to providing 2019. high collaboration with St. Hospital Joseph’s and Michael Garron Hospitalto service the surgical needs for bariatric surgery in the downtown Toronto. core of assessment centres in Windsor, Kingston, Sudbury and been have previously We Thunder Bay. to open a Bariatricapproved Assessment Centre in Hospital, to a telemedicine- evolved now have we based referral system with patients referred from we were initially were we part the of University Toronto of Collaborative, as a surgical site receiving patients from the assessment Western centre at the Toronto surgeons, Drs. Grantcharov and Rotstein have spearheaded the program performing since 2010, cases per the year past over 5 years.145-159 While including BariatricSurgery: years, five the division hasits evolved expertise in advanced MIS procedures. The two bariatric must strive to maintain/grown our case volumes. Gastrointestinal Minimally Invasive Surgery of familyof practitioners. There is considerable competition colorectal for and cases we in Toronto Oncology. TheOncology. service is assisted a part by time navigator helps who with our rapid referral program program,the ‘CRC-STAT’ from our broad network an open Phase II trial recruitment these patients, and a multidisciplinaryhave approach to management patients NOM of with Radiation and Medical technique and a mentorship program has been initiated. The grouop is a city-wide leader in Non- Operative Management Rectal of Cancer- have we group is moving toward the implementation taTME-of surgeons beenhave trained in this transanal excision rectal of cancers with 10 over years experience of with the Transanal Endoscopic Microsurgery(TEMS) platform. The colorectal surgery. The focus this of care is the on treatment of rectalcancers, with approximately half the of cases being rectal cancers. leading have We expertise in recruitment Sandra Dr. of de Montbrun in 2012, three have now we colorectal surgeons faculty on providing both laparoscopic and open approaches to Colorectal Cancer Surgery: Neuro-oncology is an active The spine program at St. Head, Julian Dr. Spears MichaelDr. Cusimano SunitDr. Das HowardDr. Ginsberg RichardDr. Perrin JeffersonDr. Wilson (Recruit 2016) ChristopherDr. Witiw (recruit 2019) the cutting edge intra-operative of imaging, incorporating 3-D navigation and intra-operative ultrasound to enhance patient safety and optimize outcomes. Furthermore, the program offer the most to up date minimally invasive surgical approaches to the spine. These serve to decrease Henry Ahn (Orthopaedic –spine surgeon). Neuro-oncology: participant in the delivery neuro-oncologic of care in the province. As a major referral centre brain for tumours, the Division has progressively increased its annual surgical oncology numbers from 330 in FY05 to 360 in and FY09, to cases 430 in FY resulting2014, in approximately at 20% increase. The referral networks changed have in the past 5 years, with less direct practitioner to practitioner referral andmore system- based rotation referrals. of The vast majority these of are brain cancers, with additional lesser numbers spine of tumours. Spine Program: Michael’s Hospital is comprised four of subspecialty spine surgeons, providing comprehensive surgical management a full of range pathological of conditions affecting the spine. These include traumatic injury, tumours, degenerative conditions, deformity and infections. The program is at this area focuses the on use implants of and oncoplasty for breast reconstruction. Division of Neurosurgery Members: • • • • • • • The Division Neurosurgery of has three areas expertise, of namely neuro-oncology, neurovascular disease and spine. The Division has selectively recruited in these areas to augment its capabilities. Most two recently, neurosurgeons with expertise in spine surgery (Wilson, Witiw) beenhave recruited to compliment the clinical activity Howard Dr. Ginsberg of and Dr. Self-Study Report, External 2020 Review | Under theUnder direction With the recruitment The program at St. Head, James Dr. Mahoney KarenDr. Cross (Recruit 2015) MelindaDr. Musgrave BlakeDr. Murphy (Recruit 2019) Department of Surgery, Faculty University of Medicine, of Toronto Breast Reconstruction: Blake Dr. of the Murphy, divisional in work translational research focus in wound healing which has augmented the clinical care provided the by service. has She a spin-offcompany called MIMOSA which features an innovative device aimed at measuring patterns blood flow healingin wounds. significant complexwound care management group which provides cross hospital care to patients with wound problems. Mahoney Dr. is recognized provincially his for in work this area and leads an interdisciplinary team Advanced of Practice nurses and research assistants. Cross Dr. has a Division is in the area general of plastic surgery, breast reconstruction, care. and wound Care:Complex Wound James Dr. of the Division Mahoney, heads a This is our smallest Division with four full- time faculty, with the recent recruitment being Murphy Dr. BlakeDr. does Murphy (2019). general plastic surgery has but interest and expertise in breast reconstructionas well as facial fracture care. The clinical expertise the of • • • • room availability to due hospital fiscalconstraints. Division of Plastic Surgery Members: In FY14 there wasIn a marked FY14 shift from deceased todonor living there was donor;a 2. In FY19, marked reduction in total cases performed. We attribute this to reduced deceased availability, donor workload issues in the division reducing our on call nights and finally, cutbacks ourin operating Health perform Network. We both cadaveric donor transplantation as well as living transplantation donor in a ration approximately of Our 70:30. surgeons perform laparoscopic organ retrieval in our living points program.donor are noteworthy- Two 1. Renal Transplantation: Michael’s Hospital is the second largest in Canada after our sister the hospital University in Toronto,

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19. Hospital Reports 19. Hospital Reports 221 Four the of Dr. Timothy Dr. Self-Study Report, External 2020 Review | Dr. AmirDr. Khoshbin (recruit 2017) AaronDr. Nauth DanielDr. Whelan SarahDr. (recruit Ward 2016) JamesDr. Waddell Foot andFoot Ankle Surgery: Daniels is internationally known his for expertise in Foot & Ankle Surgery. Over the past five years has he successfully integrated an ankle arthroplasty program into this service. Hip and Knee Arthroplasty: surgeons defined have expertise in hip and knee arthroplasty, three recruited were whom of since (Drs.2015 Khoshbin) Atrey, Ward, Of note, KhoshbinDr. returned from his fellowship with expertise in ‘anterior’ approach to hip replacement, make St. Michael’s two of one centres in the offeringGTA this surgery. The hip and knee arthroplasty program is extremely efficient in achieving their annual numbers- this is to a significant extent due to excellentcollaboration between the Division members, the operating room administration and the Mobility program. • • • • • The Division Orthopaedic of Surgery at St. Michael’s has both depth and breadth orthopedic of expertise with surgeons, 10 three whom of additionalhave expertise in Trauma/fracture. Most the of orthopaedic cases are volume- now based QBP-funded: or Hip/Knee Arthroplasty, Foot and Ankle, Spine and Extremity. Upper This provincial approach to Orthopaedic care has helped decrease the wait times surgery, for all the while ensuring that appropriate hospital resources are directed to Orthopaedic care. Department of Surgery, Faculty University of Medicine, of Toronto The Neurovascular

Head, Tim Dr. Daniels HenryDr. Ahn AmitDr. Atrey (recruit 2017) EarlDr. Bogoch Jeremy HallDr. • • • • • Division of Orthopaedic Surgery Members: with carotid sever artery artherosclerosis. a great success and continues to significantly reduce the burden stroke of in the Province of Ontario, triaging by and treating patients rapidly (ACC), originally(ACC), supported the by Ministry Healthof Innovation Grant, has to be proved The program is very active in the management strokeof prevention and acute stroke Acute Carotidthrombectomy. It’s Clinic from all the world, seek over who minimally invasive cerebrovascular neurosurgery training. This program benefits from an international reputation and receives 2-3 fellows per year Ischemic which Stroke) brings into play rapid early assessment stroke of patients and direct transfer care for in the neuroangiography suite. imaging. One example this of collaboration is the Code (Endovascular ELVIS Large Vessel and allied cerebrovascular pathologies. This program has to be a model collaborative proven for interactions between surgery and medical of aneurysmsof that underwent endovascular repair, in60 in addition 2006; in FY14, 120 in 170 FY09, to carotid revascularization, embolization AVM treat approximately cerebral 180 aneurysms per year. This represents a considerable increase in the number aneurysms of performed previously Province Ontario of and Canada in its ability to treat cerebral complex aneurysms. The program of Medicalof Imaging. This program continues to manage approximately 300 subarachnoid hemorrhages continue per year. It to lead in the Program at St. Michael’s Hospital is considered the benchmark collaborative for care between the Division Neurosurgery of and the Department stay and lessen the risk complications. of Program: Neurovascular post-operative pain, reduce hospital length of Each student Each group students of Under the Under direction of that the learners is receive support of one from the highest our of Department, level and a serious commitment to make their experience the best it can Insights be. from these discussion are brought to our Education Council in the Department of Surgery discussion for and action as appropriate. Pizza with the Professor Rounds: rotating throughsurgery is mandated to present a case to their colleagues, typically a rotation group of These cases10. are ones that their piqued interest, bur overwhelmingly are topics that demonstrate sound surgical principles. The students present a 10-minute case with relevant literature review, there is a period questions, of and then cases are uploaded to the T portal U of where all students will access have to these Powerpoint presentations as part an of e-learning library that is rapidly growing. The presentations are graded not and the atmosphere is relaxed and provides an opportunity to talk about principles surgery of in a very non- threatening and encouraging environment. Lunch with the Chief: rotating through surgery share a lunch hour with Rotstein.Dr. This is an opportunity to get to know the students at the Fitzgerald Academy and hears any concerns that they about the have curriculum specific of rotations. message The Learning initiatives: Learning RobertDr. Stewart’s leadership, our department augmented the regular UG University Toronto of curriculum with a number other of opportunities studentsfor with the view these of might bring the surgical experience closer to the learner, hopefully making less it intimidating and more fun. These include: Self-Study Report, External 2020 Review | Dr. Jeremy Hall Dr. and Dr. All members the of Division are active Department of Surgery, Faculty University of Medicine, of Toronto These events are typically dinner over with a guest various on speaker(s) subjects pertaining to physician/learner success in an academic setting. Heads particularly a particular when individual is problematic. The Division Heads identified have a point person responsible and UG for PG education in each their of Division. The Education Council also coordinates the Faculty Events. Development tasked with addressing the problem. These may include private meetings with individual teachers with recommendation improvement, for including attendance at workshops to improve the skill set individualsof with consistently TES. low The data is also discussed with the individual Division Effectiveness Scores are reviewedon a regular basis along with the briefings that areconducted lengthat arm’s the by Department Surgery of Education Coordinator. When problems are identifiedmoreof or one council the members are The Department Surgery of at St. Michael’s Hospital has an Education Council that meets regularly to monitor the quality education, of coordinate the teaching activates the of Department and to address anyissues should they arise. Teaching been added. Whelan Dr. has also coordinated the a multidisciplinary of development team to deal with major knee disruptions. Education Hall, Khoshbin, and Nauth been have specially trained in this area, including pelvic complex fracture reconstruction. With the recruitment Jeremy Hall Dr. of in July 2009, expertise in the area pelvic of and acetabular surgery has program is headed Daniel Dr. by Whelan and is integrated with thebroader University Toronto of CollegeeffortHospital. Women’s centred at Trauma: participants in the Trauma program, Drs. but patients with orthopaedic upper extremity issues, previously shared Michael Dr. by who McKee to Banner-moved University Medical Centre and the College Medicine of as the Chief Surgery of in The sports medicineJuly 2017. this of component Sports Medicine and Complex Upper ExtremitySurgery: Aaron Nauth assumed have care the of majority of

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19. Hospital Reports 19. Hospital Reports 223 Self-Study Report, External 2020 Review | Development Care Fracture in Chair Term Research Career Early Blair Professorship Canada Research Chair in in Research Chair Canada and Translation Knowledge Care I of – Tier Quality in Research Chair Canada Safety Surgical and Simulation Surgery in Chair Keenan in Research Chair Canada Safety Surgical and Simulation Research in Chair Keenan Leadership Career Early ProfessorshipRae Colorectalin Surgery Career Early ProfessorshipRae Tool Breast Cancerin Decision Dr. Aaron Nauth Dr. MohammadDr. Qadura Dr. SubodhDr. Verma Teodor Dr. Grantcharov Teodor Dr. Grantcharov OriDr. Rotstein de Sandra Dr. Montbrun Adena Dr. Scheer O/S V/S C/S G/S G/S G/S G/S G/S During the pastyears, 5 our Department has 9 Chairsheld and 3 Professorships. Subodh Dr. Verms holds1 Canada a Tier Research Chair. Chairs: 2014-2019 Endowed Term and houses a basic science research centre in the west called (now tower the Keenan Research Centre for Biomedical Research) and the eastdedicated tower to education and Knowledge Translation. The SimulationWaters Centre is located in the east St. Michael’stower. Hospital has also fostered the the of development Applied Health Research Centre This (AHRC). unit focuses various on aspects clinical of trials and health services research and represents a resource our for Department. The general atmosphere around research at the Institution has definitely aided in recruitmentthe of high clinician-scientists level to the Department. Research Chairs Professorships and Research chairs and professorships are essential to support a thriving academic mission. They provide critical support in the salary of way support and therefore time protection, the but discretionary monies provided are vital to fund nascent/ early research projects. They bring exceptional profile to the individual and Department. the Department of Surgery, Faculty University of Medicine, of Toronto This is program a new These lecture series is which one doing? How To Do Better? Do doing? To How Differences in Learners A Pre-Clerkship Educational Initiative Surgical Education. Dr. Jeremy Hall-Dr. are How We Dr. JoryDr. Simpson- Teaching & tricks Tips Top for MaraDr. Goldstein- Generational DanDr. Cojocaru- Stepping Out the of Shadow: Achieving Excellence in Undergraduate The Li Ka Shing Knowledge Institute (LKSKI) opened in the fall The two centre tower 2010. of quality sessions, and courses management. on Activity Research included participation our by faculty in teaching programs, leadership programs, development There been have a number other of activities in which surgeons been have supported with a goal of enhancing personal career These development. have • • • • May 6, 2019 • discuss the Important the of first impression and to present how yourself success for May 29, 2017 An evening with Larry Rosen from Harry Rosen and Darren Mason from Andrews to Faculty Development Evenings 2014-2019 the surgical journey from the perspectives of patients through interactive workshops. Previous patients volunteer their time to share their experiences and insights with third year medical students. The students learn about humanistic and patient-centered approaches into undergraduate surgical education. Patient as Teacher: Jorydeveloped Dr. by Simpson integrating surgery. is It hoped that these types experiences of seeingof real basic observations translate to clinical practice will stimulate the some of enthusiasts. UG is inaugurated Rotstein Dr. by and has been a very successful aimedendeavor at bringing ‘bench to bedside’ concepts to the undergraduate learners in Popular Science: Dr. Grantcharov Dr. is In the most recent Annual Report the of University Department, publications 337 attributedwere to our St. Michael’s Hospital Department Surgery, of compared to 326 inpublications 2009. and 173 in 2014 A number individuals of are appointed in the Department Surgery of as full time scientists without clinical activity. The Department has recruited 5 full time scientists to within work various research groups the past years. over 15 These include Andras Dr. Kapus, Katalin Dr. Szaszi, Gregory Dr. Fairn, Wolfgang Dr. Kuebler Schweizer. The research interestsand Tom Dr. theof firstfour fundamental scientists relate to infection/inflammation woundand healing. Their expertise in bioimaging brings important methodological skills to the Department and the Institution. All funding found hold from the Canadian Institute Health of Research as well as at least other one major granting agency. Dr. Schweizer is a cognitiveTom neuroscientist who is part the of Department Neurosurgery. of His expertise goes well with other Departmental members in the study brain of tumours, head injury, and effectsof on cerebellum. the alcohol Publications Simulation/Education: renowned his for innovation in assessment surgical of skills. With hiscolleagues, comprehensive a training and assessment curriculum skills for in basic and advanced laparoscopic surgery has been designed and implemented and several randomized trials assessing the impact these of curricula performance on in the operating room been have performed. Dr. Grantcharov is considered an international leader in the use simulation of as an adjuntto technical training in the operating room. has He now initiated hisstudies adapting the use “black of box technology” to the operating room where his group will study the genesis errors of during surgical care. Grantcharov’s Dr. Under supervision, Dr. Sandra de Montbrun completed PhD her and has already established herself as a leader inthe use of technical testing surgical of graduates as part the of certificationcolorectalof trainees under auspicesthe theof American Board Colorectal of Surgery. Non-Clinican Scientists Self-Study Report, External 2020 Review | Trauma/Critical Care In this area, research The Institution has traditionally Department of Surgery, Faculty University of Medicine, of Toronto the Hospital Children. Sick for Adena Dr. Scheer works in the area Breast of cancer decision tools. support our effort neuro-oncology,in Sunit Dr. Das was recruited as a clinical surgeon and has a robust basic research group in the biology of glioblastoma. facilitate To his research, his research group is located with like-minded researchers at the Labatt Brain Research Centre Tumour at the arrival Nancy Dr. of Baxter, institutional profile healthin services research in the areaof colorectal oncology and screening has expanded considerably,a conclusion supported Dr. by Baxter’s publication record and grant capture. To This activity spans several division including neurosurgery, cardiac surgery, and vascular surgery. Oncology: been in involved medical oncology clinical trials especially in the area breast of cancer. With for thefor prediction peripheral of arterial disease. On the clinical research side, activities focus on innovation (neurovascular/endovascular), health services research in access to vascular surgery and also large multicenter trials and registries. Vascular Diesease: Diesease: Vascular activity spans fundamental research, clinical trials and health services research. The fundamental sciences focuses endothelial on cell biology, vasospasm and the biomarkers of development offcompanies in doing so-J. deRezende works Dr. in trauma device anddevelopment is the of one Founders InventorrMD. of Karen Dr. Cross has developed an image anlysis device healing for wounds and is a Founder the of company MIMOSA. surgery infection, resuscitation, urologic surgery and fracture management, Health c. Services Research in trauma and acute care surgery, and spine surgery and d. Knowledge Translation including wound complex care and our of prevention osteoporosis. of Two surgeons focus surgical on innovation, both spinning research is performed acrossmultiple divisionwith a concentration in General and Orthopaedic Surgery. In trauma/critical care, methodologies include a. fundamental research in the areas infection, of inflammation and bone growth,b. clinical trials in The major areas research of and innovation are: Trauma/Critical Care:

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19. Hospital Reports 19. Hospital Reports 225 May-08 Jul-96 Oct-15 Jun-12 Jan-13 Sep-10 Jul-12 Jan-09 Sep-01 Jan-14 Jul-05 Jan-19 Jul-07 May-08 Oct-05 Jul-93 Nov-06 APPOINTED n/a n/a PROMOTED n/a n/a n/a n/a n/a n/a Jul-10 n/a Jul-07 n/a n/a n/a Jul-08 Jul-04 Jul-11 LAST Self-Study Report, External 2020 Review | Full Full TO Assistant Associate Full Associate Associate Associate Full Assistant Associate Assistant Associate Associate Full Full Full PROMOTED SurgicalOutcomes Group Inaugurated this in 2018, group meets every six month. The groupwas lead Nancy Dr. by Baxter andMohammed Dr. Al-Omran, both health services researchers, and was intended to bring together surgeons had who recently joined the Department and had aninterest in meeting like- minded individualsin the department. This group to date has spawned two projects using advanced analytics and artificial intelligence. One aimed at collecting and analyzing quality measure for vascular surgery care and a second aimed at using AI to evaluate cervical spine xrays fractures. for Other projects include using AI to analyze help and optimize usage elective of time. OR G/S C/S O/S VS GS N/S G/S G/S G/S G/S O/S U/S C/S N/S G/S O/S G/S DIVISION RESEARCHER CS CI CS RESEARCHER CT CS RESEARCHER CI CT CT CI CI CI DESIGNATION CT CT CI Department of Surgery, Faculty University of Medicine, of Toronto SCHWEIZER, Tom BAXTER, Nancy Timothy DANIELS, GRANTCHAROV, Teodor KUEBLER, Wolfgang LATTER, David DAS, Sunit FAIRN, Greg LAWLESS, Bernard AHMED, Najma Jory SIMPSON, Daniel WHELAN, *LEE, Jason Mark PETERSON, NAME Sarah WARD, Mark WHEATCROFT, REZENDE NETO, Joao 2014/2015 2014/2015 2014/2015 2014/2015 2014/2015 2014/2015 2014/2015 2014/2015 2017/2018 2016/2017 2015/2016 2015/2016 2018/2019 2018/2019 2017/2018 2017/2018 ACADEMIC YR. 2018/2019 the Canadian Foundation Innovation. for Faculty Promotions 2014-2019 Foundation, The Ontario Neurotrauma Foundation and the Canadian also have Cancer Society. We been the recipient infrastructure of grants from reviewed funding is also derived from the Heart and Stroke Foundation, The Kidney Foundation Canada,of Services the Physician’s Incorporated of healthof Research, the major federal funding agency Peer has in increased 2019. to 16 in from 2014 11 to $15.8 millionto $15.8 Importantly, in the 2018-2019. number members of our of Department holding at least research one grant from the Canadian Institutes As summative a report, data from the Department of Surgery University demonstrates of Toronto and increase in funding from million $6.7 in 2014-2015 Grant Funding 6. SUNNYBROOK HEALTH SCIENCES 19CENTRE

Photo: Courtesy of Sunnybrook

Avery Nathens, Surgeon-in-Chief, Sunnybrook Health Sciences Centre

Heads of Divisions trauma centre in Canada with over 2000 trauma Dr. G. Cohen, Cardiac Surgery activations per annum, the Odette Cancer Dr. A. Dueck, Vascular Surgery centre, the 6th largest cancer centre in North Dr. T. Mainprize, Neurosurgery America, the largest arthroplasty program in Dr. A. Yee, Orthopaedic Surgery Canada, and the largest and only American Burn Dr. J. Fialkov, Plastic and Reconstructive Surgery Association verified burn centre in Canada. Dr. R. Kodama, Urology Over 2014-19, the Ross Tilley Burn Centre Dr. S. Ashamalla, General Surgery and the Tory Trauma Program celebrated their 20th and 40th anniversaries, respectively. The Department of Surgery at Sunnybrook Health Sciences Centre is comprised of 72 full The Department has embarked on two initiatives time faculty across 7 divisions. The Department to improve the experience of staff and faculty. First, is home to the Tory Trauma Program, the largest recognizing the value of diverse perspectives, the

226 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 19. Hospital Reports 227 Self-Study Report, External 2020 Review | two additional nurse experts in wound care. John from Fildes the University (2019) Nevada of (Las Medicine of School Vegas) speaking Lessons on Learned from the One October Shootings. better serve patientsTo and to enhance the potential academic for contributions, a new Division Spine of Surgery was created in 2019 with Finkelstein Joel Dr. namedas the Division Head. This Division is comprised a total of 6 of surgeons from both neurosurgery and orthopedic surgery and has a mandate to provide care to patients with traumatic malignant or diseases of the spine, focus improving on the quality spine of care, and support academiccollaborations. The Department also created a Complex Wound Service to provide in higher 2019 care level across the organization. This service will serve the needs in-patients of with necrotizing soft tissue infections, decubiti, challenging or surgical wounds. The service is Shahrokhi led Dr. by and is comprised an of advanced practice nurse and undergraduate students with Lunch a new with the Professor seriesand brought the TEAM (Trauma Evaluation and Management® (TEAM®) to the Sunnybrook also campus. have developed We a program to embed military physicians and physician assistants intoclinical care within the trauma service.This initiative provides an opportunity these for providers to maintain their skills in preparation combat. for In recognition thisfor work, distinguished representatives from theCanadian Special Operations Forces Command (CANSOFCOM) presented a plaque to Sunnybrook as the preferred trauma training centre the for Canadian Special Operations Forces. In addition to hosting the annual Tile Lecturer in Trauma, the Department hosted several visiting professors including Karen Dr. Brasel, Oregon Health & Sciences University “Best (2016) Case, Case, Worst Helping Patients Understand Drs.Prognosis”, Anna Dare and (2016) Jim Turner “LancetCommission Global on Surgery”, and Dr. Department of Surgery, Faculty University of Medicine, of Toronto and Fuad led Dr. by Moussa, invested have we heavily into improving the experience of Education remainspriority a the for Department Award by the by OntarioAward Surgical Quality Improvement Network (Health Quality Ontario) contributionsfor since its inception in 2015. Meritorious Certificateplacing for in the top all of 10% hospitals in North America. have We also been awarded a CertificateAchievementof structure to offer maximal benefit to patients. The Department has been recognized twice for its quality surgical of care with an NSQIP ACS with reviewing surgical mortality and unplanned return to the using OR a consistent and validated improvement activities in the area surgical of site infections, occupancy, and flow are a focus. major Each the of surgical divisionshas been charged Surgical Quality Improvement Program has been recognized internally and fully incorporated into the Management OR structure. Performance College Surgeons of National Surgical Quality Improvement Program NSQIP) and (ACS the Trauma Quality Improvement Program. The The Department has a focus surgical on quality improvement and has expanded quality improvement activities through the American of Surgeryof holds now a total chairs. 13 of successful fundraising initiatives directed at supporting ourfaculty, with chairs 5 new named and professorship. one Sunnybrook’s Department Trials Services, Sunnybrook Research Institute and NirDr. Lipsman as the Director the of Harquail Centre neuromodulation. for There several were surgeon scientists and 5 surgeon-investigators. Department members assumed leadership roles in research including Karanicolas, Dr. Head, Clinical Over 2014-2019, the DepartmentOver 2014-2019, increased its academic profile through recruitmentthe of 4 on a Joy in Work initiative in a Joy on Work to improve the morale the of staff in perioperative services. potential. Snell Dr. will provide findings her and recommendations toward the 2019. end of In the operating room, also have we embarked lead (Dr. Laura Snell) to evaluate whether our environment provides an opportunity for each member to succeed and reach their full Department appointed an Equity and Diversity Dr. AndrewDr. Dueck is the Division Head and was re-appointed Ahmed Dr. in 2018. Kayssi (surgeon investigator) was recruited to the Division in 2017. The Division members are fortunate to been have named to a number Chairs of Professorships. or Dr. Vascular Surgery The Division Vascular of Surgery has staff 5 members, are whom 4 of surgically active; the fifth (Dr. Maggisano)continues withoutpatient clinics longer no but performs surgery takes or call. The division has a significantfocus on distal angioplasty limb for salvage and has embarked anon initiative referred to as “Project Saving Legs” to raise awareness and to innovate in the the of development most advanced therapies to amputation.prevent Giuseppe Dr. Papia advanced the Project Saving Legs TM campaign officially by trademarking the initiative and continues to receive considerable publicity and helpful dissemination through the media. The Division also has a major focus thoracoabdominal on aneurysms and through collaboration with cardiac surgery and the use open of surgery and hybrid techniques (EVAR/TEVAR) has excellent outcomes. Surgery as well as a Peters-Boyd Academy teaching award undergraduate for teaching at Sunnybrook. StephenDr. Fremes continuesto lead the Divisional activities in the research domain. He was reappointed as the Bernard GoldmanChair Cardiacof Surgery with in many 2016 research contributions related to coronary revascularization. the Department won He Surgery of Charles H. Surgeon-ScientistTator Mentoring for Award his remarkable track record mentoring graduate students his over career. His contributions have also been recognized through his appointment as a statistical editor the for Journal Thoracic of and Cardiovascular Surgery. Over 2016-17, Cohen andDr. his team remarkable were for two Canadian firsts in structuralheart disease – implantation the of Caisson percutaneous trans-septal mitral valve and the Edwards Pascal percutaneous mitral valve repair system. Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto Award for outstanding contributions to education within the Department University Toronto of of Surgical Skills Centre Distinguished Education Outstanding for Award Contributions. This award recognizes those individuals made have who exemplary, innovative contributions toteaching and learning in the Surgical Skills Centre the over past Moussa year. Dr. the E. Dr. won Bruce Tovee in Canada. also He received the Marvin Tile inAward recognition his of continued advocacy studentsfor and significantcontributions to both the University and Sunnybrook’s Department of Surgery. the University Cohen won Dr. Toronto of contributions. Christakis Dr. was named the Johnrecipient the Provan of 2015 Outstanding Surgical Educator Award. This honour is sponsored theby Canadian Association Surgical of Chairs and is awarded annually in recognition outstanding of contribution to undergraduate surgical education Director Undergraduate of Education 2017) (to and Fuad Dr. Moussa has remained the lead at Sunnybrook in undergraduate surgical education. Members also were recognized their for educational was recruitment no departures or 2014-2019. over Division members important held have leadership roles in surgical education. Cohen served Dr. as the residency program director Dr. to 2016, George Christakis as the University Departmental has strength in cardiac surgical clinical trials through the leadership Stephen Dr. Fremes. of Gideon Cohen servesDr. as the Division Head and was reappointed There his for second term in 2017. TAVI’s (Transcatheter Aortic Implantation)TAVI’s Valve per annum, the highest in the province. The team performed the first percutaneous transseptal mitral valve replacement in Canada worldwide) (3rd and continues to be the highest volume centre in the country. innovation, Beyond the Division The Division Cardiac of Surgery is comprised of four surgeons with a broad range expertise of and strong record innovation of in structural heart disease, the major focus the of Schulich Heart Program. Sunnybrook performs now 150 over Cardiac Surgery

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19. Hospital Reports 19. Hospital Reports 229 Self-Study Report, External 2020 Review | based interventions in major depression, obsessive- compulsive disorder and Alzehiemer’s disease. facilitateTo the delivery high-quality of neurovascular care stroke for and aneurysm patients, Sunnybrook established the Centre for Surgical team was also awarded the Frost & Sullivan ProductNew Innovation in Award the category image-guidedof surgical systems. His was work highlighted the by CBC and the Royal College and his team CNS Innovator received the 2018 of also award. Yang the Dr. the University won Year Department of Surgery’s George Armstrong-Peters Prize. This prize is awarded to a young investigator haswho shown outstanding productivity during his initial period as an independent investigator as evidenced research by publications in peer reviewed journals, grants held, and students trained. the Harquail familyOver 2017/18, gifted the Harquail Centre Neuromodulation for which for NirDr. Lipsman was named the Director. The Focused Ultrasound Foundation recognized Sunnybrook Health Sciences Centre as a Centre Excellence,of thanks to the pioneering of work physicist Kullervo Hynynen and clinical excellence and innovation through Nir the Dr. of work Lipsman. Sunnybrook’s team led the first FUS- Dr. Todd Mainprize Todd Dr. transitioned to the of role the Division which for was Head he in 2016 Drs.previously Nir Lipsman interim. Over 2017/18, andClement Hamani Dr. recruited were to the Division, setting the stage tremendous for program indevelopment the area functional of neurosurgery. The Division has made remarkable contributions to Toddtheneurosurgery.of field Mainprize Dr. and his team accomplished first, a world’s usingfocused ultrasound to deliver chemotherapy across the blood brain barrier. This landmark was event profiled in the Globe and Mail, CTV news and received considerable attention from the medical community. spinal VictorDr. navigation Yang’s technologywas recognized through an award at the annual meeting theof National American Spine Society best for innovation. was also Yang Dr. the recipient the of Sanford Larson the for best Award spine research paper at the AmericanAssociation Neurological of Surgeons Annual ScientificMeeting. His 7D

Department of Surgery, Faculty University of Medicine, of Toronto

Cancer, and Trauma programs. members in who addition to tremendous innovations in the area neuromodulation of make valuable contributions to the Stroke, Neurosurgery The Division Neurosurgery of has 8 faculty the best faculty teacher in the University Division of Vascular Surgery and Papia receiving Dr. a Peters- AcademyBoyd clerkship faculty teaching award. Undergraduate teaching has been a strength the of Division, with Dueck receiving Dr. an award for Sunnybrook Medical-Dental Staff Association as treasurer and more recently as their vice president. of theof Surgical Safety Checklist through his as role Faculty Lead Checklists for at the Canadian Patient Safety Institute. Papia has Dr. also served the on co-chaired the Department’s Committee Stress on and Burn Out. also He led a national initiative on the a consensus of development statement the on use appointed as Chair the of Education Committee thefor Canadian Society Vascular of Surgery and Members the of Division also have been very engaged in leadership activities. Papia was Dr. Early-Career Professorship his upon recruitment and Giuseppe Dr. Papia was named the John Ross and Patricia Quigley Chair in Limb Preservation. Family Chair in Vascular Surgery taking the over position from the inaugural chairholder, Robert Dr. Maggisano. Ahmed Dr. Kayssi received the Blair Andrew Dueck was appointed as theMaggisano award where the recipient is selected from nominations across the entire Faculty Medicine. of DavidDr. Stephen was selected to to an receive Trauma NorthAO America Advanced Clinical Education Program his for Award contributions to education through Foundation. the AO care. Cari Dr. Whyne, leads who a strong imaging and bioengineering group at Sunnybrook Research Institute was appointed as the inaugural Susanne and William Holland Chair in Musculoskeletal Research. Paul Dr. Marks was named the inaugural theholder of Susanne and William Holland Chair in Sports Medicine Research at Sunnybrook Health Sciences Centre and Finkelstein Joel Dr. was named the Feldberg Chair in Spinal Research. The members the of Division been have recognized theirfor strengths in education. David Dr. Wasserstein received the University Division of Orthopedic Surgery undergraduate teaching award; MarkkuDr. Nousianen has extended competency based surgical education to other specialties through his leadership. received the University Wadey Dr. of FacultyToronto Medicine of Excellence for Award in Graduate Post Education, and Development Innovation. This award recognizes longstanding her commitment towards enhancing educational opportunities trainees for and is a competitive Thomas R.Loudon honouring Award him his for outstanding service in the advancement athletics of related to his contributions to sports medicine. Dr. Gollish was appointed as the Provincial Clinical Lead Central for Intake and Assessment Centres to enhance(CIAC) the efficiency of orthopedic care across Ontario. Albert Dr. wasnamed Yee President the of Canadian Orthopaedic Research Society. Hans Dr. Kreder was appointed to the Canadian Orthopaedic Foundation Board of Directors. Jeff Dr. Gollish was appointed Chairthe theof Standards Committee the of Canadian Orthopaedic Association. John Dr. Murnaghan was recognized his for longstanding contributions to orthopaedic education in Canada, being awarded the Canadian Orthopaedic Association Presidential Merit. of Award Bheeshma Dr. Ravi was selected asthe Canadian Orthopedic Association North American Travelling Fellow. Division members been have fortunate to be named to several research chairs to advance orthopaedic Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto as did Drs. Yee and Dr. Wadey. Dr. Gollish Dr. as and did Wadey. Dr. Drs. Yee received Sunnybrook’s Leo Stevens’ Leadership JohnAward. Dr. Cameron the University’s won Many the of Division members recognized were for their accomplishments locally and nationally. Dr. Richard received Holtby Sunnybrook’s Marvin Tile award meritorious for service to the Department, (surgeon investigator, sports medicine), Sebastian (surgeon investigator,Tomescu arthroplasty), and Bheeshma Dr. Ravi (surgeon scientist, arthroplasty) all were recruited to the Division. Richard JohnDr. Dr. Cameron, and Holtby, Dr. Barry Malcolm retired from clinical practice. program with 2200 over hip and knee replacements per annum. Richard Dr. Jenkinson was appointed the Head Orthopedic of Trauma the for Tory Trauma Program. Drs. Patrick Henry (surgeon investigator, upperextremity), David Wasserstein Division Head and Program Chief, Holland Bone and Joint Program, taking from over Hans Dr. Kreder. Murnaghan Dr. assumed the Medical of role Director the of Holland Centre transitioning the role from Jeff Dr. Gollishoversaw who the development Canada’sof largest extremity lower arthroplasty (downtown). Areas(downtown). focus of include trauma, particularly that the of pelvis and acetabulum, upper extremity reconstruction, hip and knee arthroplasty, spine, and sports medicine. Albert Dr. assumed the Yee of role Over 2014-19, Orthopaedic Surgery The Division Orthopaedic of Surgery includes surgeons21 and scientist one across two sites: Bayview and the (uptown) Holland Centre Dixon Sunnybrook Surgical Award Teaching to recognize(2017) his impact trainees on in their and development as evolution surgeons. much of the of activitymuch in cerebrovascular care and serve as a nidus academic for activity to advance this important strategic direction Sunnybrook. for LeoDr. DaCosta was awarded the William Dr. Neurovascular Intervention (CNVI) in early 2019 andLeo Dr. Da Costa was appointed as its inaugural Medical Director. The CNVI will consolidate

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19. Hospital Reports 19. Hospital Reports 231 Self-Study Report, External 2020 Review | chairs the American Society Reconstructive for MicrosurgeryMicrosurgery Group Women's and was appointed as a Director the of American Board Plastic of Surgery. Laura Dr. Snell was appointed the inaugural lead Equity for and Diversity in Sunnybrook’s Department of Surgery. Members the of Division been have recognized for their leadership. Jeschke Dr. received Sunnybrook’s Leo Stevens’ Leadership and Award was also named the chair the of Translational Research Committee the for Department Surgery. of was He also appointed as chair the of Strategic Planning Committee the Society for Shock and the Elder Care Committee the of American Burn Association. was he appointed presidentIn 2019, the of Shock Society. was He also appointed to the executive committee the of Surgical Infection Society. Dr. Cartotto was re-appointed to the Burn Science Advisory Panel the of American Burn Association to oversee the funding burn of trials the by US Department Defense of and is the on executive committee the of American Burn Association. Dr. Paul Binhammer was appointed President, Canadian Society Surgery for the of Hand. Joan Dr. Lipa skin replacement and was awarded a large grant by Hydro to support stem cellToronto research. He also received the ListerPrize - the highest honour recognizing research inthe Department Surgery of and was reappointed as the Chair Burn of Research.

). Department of Surgery, Faculty University of Medicine, of Toronto calaverasurgicaldesign.com

Jeschke has the pioneered use 3-D of printing for to permanent rigid bonding and allows more for precise alignment. tape Bone has recently been patented and is undergoing clinical trials. Dr. flexibility and translucencyprovided by bone the tape facilitates the temporary stabilization and alignment adjustment of multiple fragments prior biomedical engineers at SRI has developed a stabilizationbone device (“bone tape”) use for in patients with craniofacial injuries. The initial and other centres. ( Fialkov, workingDr. in conjunction with approaches to implant design using advanced imaging technologies that since have been commercialized and are in use at Sunnybrook The Division has been productive from the research and development perspective. Antonyshyn Dr. and his team at SRI developed have innovative with a focus stem on cells and skin regeneration transitionedbut to another organization in 2018. Nik was recruited as a scientist at Sunnybrook Research Institute (Biological Sciences Platform) surgery and Alan Dr. Rogers was subsequently recruited to the burn centre as a surgeon investigator with a focus quality on and patient safety. Saied Dr. Binhammer Jeffrey to Dr. Fialkov. ManuelDr. Dibildox (burn surgery) to on the Mayo moved Clinic to undertake a training program in plastic entirely dedicated to care the of burn patient. Divisional leadership transitioned from Paul Dr. also includes the Ross Tilley Regional Burn Centre, Canada’s largest and only American Burn Association verifiedcentre with another 4 surgeons reconstruction). The plastic surgeons also heavily support the melanoma program. The Division and breast reconstruction. These three areas are well integrated into the trauma program (craniofacial, hand) and cancer program (breast The Division Plastic of and Reconstructive Surgery includes 5 active surgeons with areas of expertise including craniofacial, hand surgery, Surgery Plastic and Reconstructive Achievement Award andAchievement Award is the Chairman theof Urologic OncologyWorld Foundation, uCare (Societie International d’Urologie( to facilitiate clinical research in the developing world, and the International Consultation on Urologic was recruited to the Department but in 2016 subsequently to Houston to moved take the on the of role Director Advanced of Laparoscopic and Robotic Surgery at the Houston Methodist Institute Innovation,for Technology, and Education. The Division members received have numerous awards their for contributions to urologic care. KlotzDr. was Chair the recipient a Term of in Prostate Cancer Research in recognition his of major contributions and innovations in the field and was awarded Lifetime the Dean’s Achievement the by his for UniversityAward Toronto of contributions in the area prostate of cancer. He also received the Canadian Cancer Society’s O. Harold Warwick Prize his for significant advances in cancercontrol and was appointed as a member theof Order Canada of his for contributions to the treatment prostate of cancer, notably for leading the adoption active of surveillance as a standard aspect patient of care. has He received the Canadian Urologic Associations Lifetime he receivedhe a Meritorious Service Medal from the Governor General his for humanitarian work. Urology The Division Urology of has 6 faculty members, are whom 5 of active surgeons and another iswho scientist a with a leadership inrole the Institute Medical of Sciences within the School Graduateof Studiesat the University Toronto. of The Division is internationally recognized its for expertise in reconstructive urology with a focus bothon the urethra (Dr. Kodama) and bladder (Dr. Herschorn) with referrals from across Canada. KlotzDr. is renowned world his for research in active surveillance prostate for cancer. Kodama Ron Dr. served as theOver 2014-19, Division Head. There is an active search underway hisfor Raj successor. Dr. Satkunasivam Dr. ). This). Self-Study Report, External 2020 Review | touchsurgery.com/simulation/diep-flap Department of Surgery, Faculty University of Medicine, of Toronto Social Services. His was work featured CTV’s on investigative documentary series, In 2018, W-5. program with Ukrainian fellows. received the He Departmental Marvin Tile and Award the Ronald M. Distinction Zuker for Award in the Division Plasticof Surgery these for outreach activities as well as the Ochrymovych Helping Hands Canadian Ukrainian from Award Humanitarian craniofacial injuries following the war in 2014. has millionHe $1 received over from the federal government (Minister Foreign of Affairs) for this activity and has recently received $4 million in philanthropic support to a robust develop exchange Humanitarian surgery has also been a major focus certain of members the of Division. Dr. Antonyshyn has led several missions to Eastern Ukraine to provide surgical care and to increase the capacity surgeons of to provide care complex for in Graduate Post Education, and Development Innovation. Antonyshyn Dr. was the recipient theof Department Surgery of Undergraduate teaching award as well as the William K. Lindsay Faculty Research . Mentor Award Shahrokhi and Jeff Dr. Fialkov (2018) (2019) recognizedwere as the best surgical teacher across all surgical departments and received the Dr. William Dixon Sunnybrook Surgical Teaching whileAward Lipa received Dr. the University of FacultyToronto Medicine of Excellence for Award developed algorithms to address free flap failure, a major barrier to performing free flaps communityin hospitals. Binhammer Dr. is heavily involved with upper extremity curriculum development with Foundation the AO (International). Dr. developed a relationship with a technical partner (TouchSurgery) to produce an app to teach DIEP flaps ( is used in combination with our surgical simulation laboratory to provide a comprehensive training experience learners. for Further, they also have the Educating Sunnybrook Beyond local for Award educational initiatives related to burn care. Drs Lipa and Snell developed have unique simulation program to better prepare trainees in advance of their experience in the operating room. They have Division members engaged have in many educationalinitiatives, ranging from local outreach to capacity building overseas. Jeschke Dr. received

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19. Hospital Reports 19. Hospital Reports 233 Self-Study Report, External 2020 Review | in the Division, with several members named as chairholders term or either of endowed chairs, including Natalie Dr. Coburn (Hanna Chair in Surgical Frances Oncology), Dr. Wright (Temerty Chair in Breast Surgery) and Avery Nathens Dr. (De Souza Chair in Trauma Julie Dr. Research). injury prevention was recruited and has in 2014 since transitioned into in role a industry in 2019. The Division has introduced several innovative clinical programs including Adult a Young Colorectal Cancer Clinic, a rapid diagnostic assessment program early for diagnosis colorectal of cancer, a hepatic artery infusion program, and a radioactive seed localization program breast for cancer. The Division introduced transanal minimally invasive surgery to Canada and has subsequently developed a proctoring program, allowing the for dissemination across the country. The trauma program has developed a partnership with the Canadian Forces, embedded military physicians into clinical rotations so that they might maintain preparedeness for combat. The program has received recognition from the Canadian Special Operations Forces Command (CANSOFCOM) this for initiative. There has been a particularly strong research focus General Surgery The Division General of Surgery has active 18 staffmembers with5 areasfocus:of colorectal oncology, HPB oncology, breast cancer and melanoma, acute care surgery, and trauma. Natalie Dr. CoburnOver 2014-2019, transitioned the of Divisionout Head to role focus her on research activity and Shady Dr. Ashamalla assumed the Division of role Head. there been have severalSince 2014, recruits into the Division including Julie Dr. Hallet(surgeon- investigator, hepatobiliary health oncology, services research), Luis Dr. Da Luz (surgeon-investigator, trauma, health services research, clinical trials), and Barbara Dr. Haas (surgeon-scientist, trauma, health services Barto research). Dr. Nascimento (trauma) has assumeda leadership position in Brazil and Junaid Dr. Bhatti, a scientist with a focus on Department of Surgery, Faculty University of Medicine, of Toronto Ontario Excellence in Clinical award. Teaching from the University Division also He Urology. of received a Professional Association Residents of of Royal College Urology Examination Committee Chair. Robert Dr. Nam received the Jewett Award and the Postgraduate Surgical Award Teaching Division Urology of Faculty Postgraduate Teaching Kodama Ron Award. Dr. received the Michael Jewett Postgraduate Lecture award and served as the their teaching excellence. Herschorn Dr. received an Undergraduate Medical Excellence in Teaching fromAward the Faculty Medicine of as well as the contributions in prostate cancer research. The Division members been have recognized for the Ajmera Family Chair in Urologic Oncology and continues to make significant Continence Society Lifetime Achievement Award. RobertDr. Nam was re-appointed Association his for contributions related to his research the for treatment urinary of incontinence and overactive bladder and received the International from a patient and an unrestricted donation from Astellas Pharma Canada.has He also received a presidential citation from the American Urological those with urinary lower tract disorders. This Program was funded a donation by million $2 of Program in Functional a research Urology, initiative to better understand the epidemiology, gaps in care, and optimal care strategies among Dr. Sender HerschornDr. leveraged his expertise to launch the Research University Toronto of Richard Williams the by American Award Urological Association, the for highestimpact research in prostate cancer the last over decade. Diseases also He Oncology. for received the 19 Frances Wright in as role her fellowship director, Surgical Oncology brought the University of through a successfulToronto accreditation process a designatedof Hepatobiliary oncology fellowship through the Fellowship Council and the ACGME. receiving the Innovative Curriculum from Award Sunnybrook international her for course gastric on cancer and Shady Dr. Ashamalla received the Ivan Silver Innovation his for Award educational initiatives related to transanal total mesorectal excision. Ashamalla Dr. also led the creation the of Mike Richards and Doug Gilmour foundation to support continuing surgical education in minimally invasive colorectal cancer surgery at Sunnybrook. NathensDr. the held first Bleeding Controlcourse in Canada. The course, part the of Stop the Bleed Campaign (US Department Homeland of Security), teaches the to public respond how and act a to save life faced when with a bleeding Through emergency. a teach the teacher initiative, the course has now spread across Canada. Wright Dr. received the best mentor award in General Surgery Oncology and Nathens Dr. Mentorship the Bryce Taylor fromAward the Department in recognition for his mentorship junior for faculty in pursuing academic careers. Both Karanicolas Dr. and Dr. was named president the of Trauma Association Canadaof andNathens Dr. assumed the position Medicalof Director, Trauma Quality Programs at the American College Surgeons. of Education is at a strength within theDivision at all Brennemanlevels. Drs Tremblay, and Haas have all received Undergraduate Medical Excellence in AwardsTeaching from the Faculty Medicine of and Drs. Karanicolas, Tien, Wright, and have Fenech been the recipient the of Sunnybrook Department Surgeryof Undergraduate Awards. Teaching Dr. received theTremblay University Division of General Surgery’s Robert Mustard Mentorship inAward recognition mentorship her for post- of graduate trainees while Haas Dr. the Nicholas won Colapinto best for Award resident Teaching seminar. The faculty members inthe Division had have a strong record excellence of in continuing medical education, with Haas Dr. receiving theMarcus Burnstein Outstanding Presentation at the Award Annual Update in General Surgery; Coburn Dr. Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto was appointed the Clinical Lead Patient, Reported Outcomes and Symptom Management, all at Cancer Care Ontario. Lorraine Dr. Tremblay Fellowship to Germany and Calvin Dr. Law received the Rose award from the Sunnybrook Foundation his for efforts in securingphilanthropic support. Frances Dr. Wright was appointed the Clinical Lead, Quality and Knowledge Transfer as well as the Skin Cancer Lead and Coburn Dr. Regional President, Vice Cancer Services, Cancer Care Ontario. Brenneman Dr. was appointed the Program Director the of Residency Program in General Surgery. Karanicolas Dr. was the recipient theof American College Surgeons of Traveling as Medical Director Trauma of at Sunnybrook, taking from was who Tien, over Homer Dr. appointed Medical Director Ornge, of Ontario’s air ambulance Nathens agency. Dr. was re-appointed as Surgeon-in-Chief and Calvin Dr. Law was re- appointed Chief the of Odette Cancer Program and conduct related of pan-Canadian clinical trials. The Division members a strong have reputation local,for regional and international leadership in their respective areas. Nathens Dr. was appointed Scientific Director for ClinicalTrial Services at Sunnybrook Research Institute and Hallet Dr. was appointed to the editorial board the of Annals of Surgical Nascimento Dr. Oncology. was named the chair the of Canadian Research Outcomes Consortium Trauma Committee – a lead the for Reid GrahamReid Scholarship and had also received a Ministry Research of and Innovation Early Researcher his for Award improving on work outcomes after liver resection. Division members alsohave been recognized their for leadership with PaulDr. Karanicolas appointed as the Medical and Hallet received a Career Award Development from theSociety Surgery for the of Alimentary andTract Paul Dr. Karanicolas was therecipient theof the of Department Surgery’s of Rosco

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19. Hospital Reports 19. Hospital Reports 235 Self-Study Report, External 2020 Review | Network (CAPHC-CPDSN) in collaboration with Canadian Institute Health for Information (CIHI). I participate as an active member the of Pediataraic Surgical Chiefs Canada. of I also serve the Ministry Health of as the Pediatric Surgical Lead in Ontario 1 Access to Wait Care Initiative. Ontario and Canada in the mission to provide access to optimal participate care. We in the Canadian Association Paediatric of Health Centres-Canadian Paediatric Decision Support We participateWe in leadership roles across residents, fellows, graduate students aspiring to careers in delivery pediatric of attract care. We Fellows from around the and world fully trained clinicians regularly attend SickKids-sponsored Continuing Medical Education (CME) events. Having assumed this effective role I June, am 2018, pleased to confirm thatcontinued progress has been made the on initiatives and strategic goals as follows: 1. Department of Surgery, Faculty University of Medicine, of Toronto James Drake, Surgeon-in-Chief, The Hospital Sick for Children

their own right. Our teaching mission includes education and training medical for students, than the University Western of Ontario and UniversityQueen’s combined. Many the of clinical faculty members are world-renown scientists in Health Research (CIHR) Canadian (the “National Institutes Health of NIH or equivalent”) than the national funding rate and receives more funding 480 faculty engaged in all types basic, of clinical, and educational research. SickKids is consistently more successful at the Canadian Institute for the best in the world. SickKids has a world- renowned Research Institute (RI) with more than of Philadelphia.of SickKids treats the sickest and most children complex in Canada. Comparators, where available, place the quality care of among science SickKids center. is often compared with Great OrmondLondon’s Street Hospital, Boston Children’s Hospital, and the Children’s Hospital The Hospital Children Sick for (SickKids) is Canada’s largest pediatric academic health Photo: sickkids.ca

CHILDREN 7. THE HOSPITAL FOR SICK SICK THE FOR HOSPITAL 7. 19 identifying quality improvement targets improving patient care and outcomes decreasing institutionalhealthcare costs Disease Primers),Lancet, Cell, and Cancer Cell. In the most recent year(June 2018-May our surgeons2019), published 265 papers with a combined journal impact factor an 879.5, of average impact per factor publication. 3.7 of securing grants in an increasingly competitive funding environment. Our average success rate in the previous 2 CIHR fall project CollegeSurgeons of National (ACS) Surgical Quality Improvement Program (NSQIP) which is a data-driven, risk-adjusted, outcomes-based program to measure and improve the quality surgical of care with benefits of participation including: • • • been increasing published year. year We over in the highest impact journals, including New England Journal Medicine, of Nature, Lancet JournalOncology, the of American Medical Association (JAMA), Nature Materials, Nature Reviews (Clinical Drug Oncology, Discovery, The department continues to succeed in We continue to participateWe in the American The research productivity our of department has • 5. Publication Detail • Self-Study Report, External 2020 Review | by anby increase in Cardiovascular complex Surgery and Neurosurgery cases and up identical to FY17/18 FY18/19, and FY2015/16 from in 25% FY16/17 decline 2% of previous year over years identical to FY17/18 increasing case length); driven primarily Emergency Cases: all of 26% cases in Volumes: 12,167 cases for FY18/19, a cases FY18/19, for 12,167 Volumes: nearly Hours:OR 26,411, Average Case Length: year (8 trend of 2.17 time, surgical services block OR utilization and turnover statistics. • • • • Operational efficiency: OR start OR Activity:OR

2018. Additional2018. renovations in Cardiovascular Surgery and General Surgery are planned. adhere to all provincially mandated surgical safety checklist policies with ~99% compliance. Surgery and Neurosurgery completed were in b) to the process care of delivery continue. We resources focused were implementation Epic on and fine tuning thisyear, and will focusrenew operationalon efficiencies incoming the year to make the most available of time: OR a) to increase in complexity and length. Operating availabilityRoom is still a constraint. project OR Operating renovations (OR) in Room Plastic In the area clinical of care refinement aligned The mix surgicalof cases in the continues OR Department of Surgery, Faculty University of Medicine, of Toronto 4. 3. 2.

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19. Hospital Reports 19. Hospital Reports 237 Self-Study Report, External 2020 Review | Drivers Human of GBM. Terry Fox FrontiersNew Program Project Grant in Stemless-based of Development Prognostic Biomarkers and Therapeutic Targets. Terry ResearchFox Institute. $1,328,820 CAD rhabdoid brain tumours. Canadian Cancer Society Research Institute, Brain Canada/ Health Canada CAD Initiative. $1,214,047 glioblastoma.of CAD CIHR. $1,051,875 Functional Genomic Screen to Identify Advancing biology-based therapies for Stem cell related genesis and maintenance to deterime next steps both for Divisions. Plastic Surgery, Chris Forrest was reappointed a term for to up 5 years. I elected to not reapply reappointment. for A international search was conducted and DirksPeter was appointed Division Head. Marty elected Koyle to not reapply and an international search a new for Division headis currently underway Surgery, under Division Head Agostino Pierrro, and Othopedic Surgery, under interim Division Head Andrew Howard recently have concluded and Review Committees are reconvening » » » Following a third 5 year review of Following a third 5 year review in Neurousrgery, Following a firstyear 5 review Urology, in year five reviews for GeneralTwo and Thoracic Following the Departure Glen of VanArsdell, Division Head, Cardiovacular Surgery an In terms leadership, of year five reviewswere conducted a number for our of Departments. 1. 2. 3. . 4. Department of Surgery – Division Reviews Five Year Department of Surgery, Faculty University of Medicine, of Toronto Consortium. $1,500,000 CAD $1,500,000 Consortium. Dextrous and Implants. Tools Canadian Foundation Innovation. of $1,800,000 CAD glioblastoma.of Canadian Epigenetics, Environment and Health Research infants: Causes, prevention and treatment. National Institutes USD Health. of $1,545,799 Institutes Health. of $2,803,483 USD Glioblastoma.for The Brain Tumour Charity. $1,481,356 GBP Uganda: Predicting developmental outcomes and identifying patients at risk early for treatment failure National after ETV/CPC. Device Consortium. $3,500,000 USD Program: introducing innovative therapies to halt the disease progression and promote CAD CIHR.recovery. $3,637,274 Cancer Research. CAD $4,788,278 Device Innovation. Food and Drugs Administration Pediatric P50 FDA (FDA), SU2C Canada ‘Cancer Stem Cell CAD $11,791,833 Dream Team’. a Therapeutic Hurdle and Opportunity Ontarians.for Ontario Institute for Epigenetic and Molecular Networks. Epigenetic reorganization and differentiation Post-infectious hydrocephalus in African Rapid Prototyping Patient of SpecificModels, Chromatin Proteins as Drug targets Improving infant hydrocephalus outcomes in Necrotizing Enterocolitis Research National Capital Consortium Pediatric for Cellular and Genetic Heterogeneity as Targeting Brain Stem Cell Tumour » » » » » » » » CIHR, with externalgrant funding worth a total $54.3M. of Notable grants included: » competitions (compared with was 29.4% nationalwe 15.0% In fiscal rate). year 2018/19 236held researchgrants, including 28 from Liver TransplantationLiver at SickKids, joining Drs. Mark Cattral and Anand Ghanekar on the pediatric liver transplant surgery team. 2019-20 DavidDr. Barron will be joining SickKids in the capacity Head, of Cardiovascular Surgery David’soutstanding effectiveJuly 1, 2019. academic productivity, publication record, his focus on quality metrics and outcomes, clinical and surgical skills, and his leadership qualities will continue to bring the Division Cardiovascular of Surgery at SickKids to greater even achievements. Blayne Amir Sayed, MD is PhD, the newest Transplantmember Program, the of Toronto joining the Department University Toronto, of Surgeryof as an Assistant Professor. His primary appointment is in the Division General of Surgery at the Hospital Children Sick for in pediatric liver transplantation and hepatobiliary surgery, with an additional appointment in the University Health Network Multi-Organ Transplant Program and Division General of Surgery at Toronto General Hospital in adult liver transplantation. will Sayed Dr. be the Surgical Lead Pediatric for Dr. JustynaDr. Wolinska has joined the Division Generalof and Thoracic Surgery effective through 6, 2017 November and including year (2 contract). June 30,2019 GeorgeDr. Ibrahim joined the Division of NeurosurgeryHe has effectiveJuly 1, 2017. degreereceived a bachelor’s in biochemistry at Queens University followed his by medical curriculumschool in the UniversityCalgary. of 2017-18 JustynaDr. Wolinska joined General and Thoracic Surgery effective November through6, 2017 June 30, 2019. 2018-19 ArsdellGlen Van will be leaving his as role Head theof Division Cardiovascular of Surgery to take leadership a new on at role the UCLA Mattel Children’s Hospital effective September5, 2018. Self-Study Report, External 2020 Review | Plastic and Reconstructive Reconstructive and Plastic Surgery Urology Cardiovascular SurgeryCardiovascular and General Surgery Thoracic Neurosurgery Orthopaedic Surgery 2019/20 DIVISION HEADS Dr. Martin Koyle Martin Dr. Dr. Peter Dirks Peter Dr. Howard Andrew Dr. (Interim) Christopher ForrestDr. Dr. David Barron David Dr. Agostino Pierro Dr. Department of Surgery, Faculty University of Medicine, of Toronto Transplantation and Ischemia. His research interests are Heart Transplantation, Ischemia, Milrinone, Pacemaker, Cardiac Output. Dr. ChristophDr. Haller joined the Division of Cardiovascular studied He Surgery in 2017. Universityin the Tuebingen Hospital in the department of Cardiovascular and Thorasic Surgery in Germany. His research interest in 2015-16 recruitsNew include Augusto Dr. Zani (General andThoracic Surgery) and Dr. Doug Cochrane (Neurosurgery). 2016-17 Santos (Urology), and Kristen Davidge (Plastic and Reconstructive Surgery). A Welcome! search is underway member a new for the of Division of General and Thoracic Surgery. 2014-15 recruitsNew include Drs. Martin Gargan and Mark Camp (Orthopaedic Surgery), Frank Papanikilalou (part-time) and Joana Dos New Staff It isIt a privilege to present this brief summary surgicalof activities behalf on the of Department of Surgery at SickKids. international search was conducted and David Barron from Birmingham Children’s Hospital, UK was recruited as Division Head effectiveJuly 1, 2019.

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19. Hospital Reports 19. Hospital Reports 239 Self-Study Report, External 2020 Review | of Perioperativeof Services, Cardiosvascular surgeon to purrsue an exciting opportunity Children’s Hospitalat Texas inHouston. 2016-17 dataNo to report. 2017-18 Gertsle,Dr Ted General and Thoracic Surgery left SickKids to assumethe position Chief of Pediatric of Surgery at Memorial Sloan Kettering Cancer 2018. USA in City, May, Center in York New JustynaDr. Wolinska joined General and Thoracic Surgeryeffective November through6, 2017 June 30, 2019. MartinDr. Gargan, Head the of Division of Orthopedic Surgery will be leaving the Hospital Children Sick for in to take March, a new on 2017 post as the Clinical Director Surgery of at the Bristol Royal Hospital Children for in the United Kingdom. 2018-19 ChrisDr. Caldarone’s tendered his resignation as Surgeon-in-Chief and Chief Department of Surgery, Faculty University of Medicine, of Toronto Ormond Street, UK. Professor gave Roposch the inaugural Lecture Wedge in his On June honor. hung John Dr. Wedge his up 30, 2016, scalpel. Wedge wasWedge our Mercer Rang Lecturer and the on same the Division day, hosted Professor Andreas fromRoposch, Great a former fellow Wedge’s Dr. of International in looking outcomes at with DDH Drs. Kelley and Gargan. Dr. On June 2016, 24, 2015-16 continued JohnDr. Wedge his clinical practice this year and his ambassadorial SickKids for role Consultant Paediatric Orthopaedic Surgeon, Oxford University Hospitals NHS Trust, UK. Medical Affairs and accepted postthe of Senior Clinical Research Fellow in the Botnar Research Centre, University Oxford of and Honourary stepped down from the Surgeon-in- of role Chief, Chief Perioperative of Services, and VP of 2014-15 JamesDr. Wright, G. Orthopaedic Surgery focus the on surgical care children of with solidtumors, in close collaboration with Dr A. Pierro and the oncology team. Departures oncology and liver tumors. will He be working as a general Paediatric surgeon with a main Reto M.Reto Baertschiger MD is PhD, joining the Division General of and Thoracic Surgery with a special interest in Paediatric surgical 198. UNIVERSITY HEALTH NETWORK

Photo: Courtesy of Department of Medicine

Shaf Keshavjee, Surgeon-in-Chief, University Health Network

five strategic priorities of the surgical program Introduction at UHN are: to attract and retain the best talent, to foster a culture of education, research The Surgery and Critical Care Program at and innovation, to advance technology and University Health Network encompasses 135 infrastructure, to capture a strong market share surgeons and 8 surgical specialties (including and to lead in health care policy development. Divisions of Cardiac Surgery, General Surgery, Neurosurgery, Orthopedic Surgery, Plastic The Surgical Programs continue to make significant Surgery, Thoracic Surgery, Urology and Vascular progress in innovation and in achieving clinical Surgery) as well as the other surgical related excellence and academic productivity. Surgery at departments of Otolaryngology/Head & Neck UHN holds a national and international profile Surgery, Ophthalmology, Gynecologic Oncology, of clinical and academic excellence in the fields of Anesthesia and Critical Care and the sections of transplantation, surgical oncology, neurosurgery, Surgical Oncology and Transplant Surgery. cardiovascular surgery, musculoskeletal health and arthritis, and minimally invasive surgery to name a The programs are committed to the Sprott few – many of the surgeons, divisions and programs Surgery vision to be world leaders in surgery. The are leaders in Canada and in North America.

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Self-Study Report, External 2020 Review | to Associateto Professor. Associateto Professor. the Program Director the for University residencyDivision’s training program and received the inaugural Stacey and David Cynamon Professorship in surgical education andinnovation. CellLVAD-Stem trial evaluating myocardial recovery in patients being supported a by mechanical circulatory support device. to the Royal College Surgeons of Edinburgh. of Dr Markus Selzner was promoted Dr Timothy Jackson was promoted Karen MD Devon Preeti Dhar MD Jaime Escallon MD Steven GallingerMD Anand Ghanekar MD David Grant MD Paul Grieg MD Timothy Jackson MD Leong MDWey David McCready MD Ian McGilvray MD Carol Anne Moulton MD Catherine O'Brien MD Penner MD Todd Jesse Pasternak MD Fayes Quereshy MD Michael Reedijk MD ReichmanTrevor MD Lorne Rotstein MD Gonzalo Sapisochin MD Markus Selzner MD Eran Shlomovitz MD Dr Cusimano was formally appointed as spearheaded Yau the NIHDr Terrence sponsored Dr Tirone David received honorary fellowship Alan Okrainec MD (Division Head) Mark Cattral MD Tulin Cil MD Sami Chadi MD Recruitments/Promotions/Retirements: • • • • • • • • • • • • • • • • • • • • • • • • Major Accomplishments/ Appointments/Awards: • • • General Surgery • • • • Department of Surgery, Faculty University of Medicine, of Toronto

multidisciplinary aortic surgery group. Scientist, has he assumed the surgical leadership theof cardiac transplant program and his research interests thean of involve development ex-vivo cardiac perfusion system cardiac for transplant. as Surgeon-Scientist and joined the Dr Mitesh Badiwala was recruited as a Surgeon- Dr Jennifer Chung was recruited Anthony Ralph-Edwards MD Richard MD Weisel MD Yau Terrence Mitesh Badiwala MD Jennifer Chung MD Robert Cusimano J. MD Tirone David MD Chris Feindel MD Maral Ouzounian MD Vivek RaoVivek MD (Division Head) • • • Recruitments/Promotions/Retirements: • • • • • • • • Cardiac SurgeryCardiac • Year Summary Report: Year Surgery Divisional 5 see attached UHN Department Surgery of Publication5 year Trend Report) Department of been successful at extramural grant capture with exemplary researchproductivity. (Please local, national and international students. Research Activities: Surgeons at UHN have the undergraduate, postgraduate and fellowship levels. In both quality and quantity education of they provided have excellent experiences for Education: Surgeons at UHN been have accomplished and highly productive educators at Education and Research to Full Professor. appointed to the Division Neurosurgery. of Associateto Professor. in-Chief at Women’s Collegein-Chief Hospital. at Women’s Langer Surgeon Scientist Award. MentorshipTaylor Award. CIHR grant his for the on work notch signalling cascade inbreast cancer. Selzner performed the first kidney transplant using organ Ex-Vivo perfusion. Mills excellence for Award in teaching. to the Interim of role President Vice General Hospital.– Toronto the Operating of role Medical Room Western Hospital.Director at Toronto Shaf Keshavjee MD (Interim Division Head) Gelareh Zadeh MD (Deputy) Mark Bernstein MD Michael Fehlings MD Fred Gentili MD Mojgan Hodaie MD Suneil Kalia D Paul Kongkham MD Andrew Lozano MD Eric Massicotte MD Ivan Radovanovic MD Charles MD Tator Michael Tymianski MD Valiante Taufik MD Vitor PereiraDr. was recruited (JDMI) cross- GelarehDr. Zadeh was promoted Dr Mojgan Hodaie was promoted Dr David Urbach has been named Surgeon- Dr Quereshy Fayez receivedthe Dr Paul Greig received the Bryce MichaelDr. Reedijk receiving a The transplant team lead Dr by Markus Dr Ian McGilvraywas awarded the Frank Dr Quereshy Fayez was appointed Dr Timothy Jackson was appointed to

• • • • • • • • • • • • • • Recruitments/Promotions/Retirements: • • • • • • • • • • • Neurosurgery Self-Study Report, External 2020 Review |

the Medical Director the of Toronto OperationWestern Room. and also received the Frank Mills for Award Excellence in a Faculty by Teaching Member. Ontario Association General of Surgeons. Ontario Association General of Surgeons. Rising Star at the Award International Liver Transplant Society Annual Meeting. Mustard Mentorship from Award the Division of General Surgery, University of Toronto, study Vascularized regenerative biomaterials medicalfor devices and cell therapy. grant project to her for titled Colorectal cancer stem cell plasticity: therapeutic A novel target. Teaching by a Faculty by Teaching Member is & she also received the Early Researcher Award (ERAs) from the Ontario Ministry of Economic and Development Innovation. Joseph and Wolf LebovicJoseph and Wolf Chair in HPB Surgery. thefor Ontario Surgical Quality Collaborative. Frank Mills Excellence for Award in Research Society Grant his for project: Phenotypic and Transcriptional Characterization Tumor-Initiatingof Cells in Primary Carcinoma. Hepatocellular Human for Innovationfor (CFI) grant to establish a Centre Islet for Research and Therapeutics. Scientist has who an interest in endocrine surgery. interest in acute care surgery and critical care. both retired in 2019. to Associateto Professor. Dr Quereshy Fayez was appointed as Dr Alice is the President new Wei the of Timothy Jackson is the Secretary the of Dr Quereshy Fayez was awarded the Robert Catherine O’Brien received a CIHR Foundations Dr Gonzalo Sapisochin was awarded the Dr Mark Cattral received a CIHR grant to Dr Steven Gallinger was honoured with The Dr Timothy Jackson became the Provincial Lead Dr Catherine O’Brien was awarded The Anand Ghanekar was awarded the Cancer Dr Mark Cattral received a Canada Foundation Dr Preeti Dhar was recruited haswho an Drs. Paul Greig & David Grant Dr Anand Ghanekar was promoted Dr Jesse Pasternak was recruited as Surgeon- Department of Surgery, Faculty University of Medicine, of Toronto • • • • • • • • • • • Major Accomplishments/ Appointments/Awards: • • • • •

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Self-Study Report, External 2020 Review | management patients of with back pain low while at the same time saving under money the leadership Dr of Raj Rampersaud. The has decided now MOHLTC to roll the out ISAEC model across the province as their strategy the for management back pain. low of American British Canadian (ABC) travelling Thisfellow. is the most prestigious Orthopaedic travelling fellowship in the mid- for world career academic Orthopaedic surgeons. (ISAEC) project successfully showed improvement in access and outcomes the for honorary doctoratedegree from the UniversitySeville, of Spain. Canada's Sports Hall Fame of in the Builder category his for in exceptional 2017 sports on work concussions and spinal cord injury treatment and research. Chair, Neurosurgery, Department of Surgery, University of Toronto. Stephen Lewis MD Nizar Mahomed MD MarshallWayne MD Darrell Ogilvie-Harris MD Raj Rampersaud MD Khalid MD Syed Michael Zyweil MD Dr Ogilvie-Harris was promoted to Full Professor Dr Rajiv Gandhi was selected to be the 2015 Inter professional Spine Assessment Centre Dr. AndresDr. Lozano was awarded an CharlesDr. was inducted Tator into Dr Andres Lozano Professor and Christian Veillette MD (Division Head) Jaskarndip Chahal MD MD Davey Rod Rajiv Gandhi MD Johnny Lau MD Timothy Leroux MD

• • • • • • • Recruitments/Promotions/Retirements: • Major Accomplishments/ Appointments/Awards: • • • • University Division Chairs at UHN: • Orthopedic Surgery • • • • • • Department of Surgery, Faculty University of Medicine, of Toronto

Innovation (CFI) the for “CenteR for Advancing Neurotechnological Innovation to Application (CRANIA)”. of theof Division Surgical of Oncology at UHN & Director the of Krembil Neuroscience Program at UHN. grant from the Canada Foundation for obtained regulatory approval to begin the global, multi-center ESCAPE-NA-1 trial. Officer ofthe Order of Canada. Member the of Order Canada of inaugural Harold & Esther Halpern Chair in Neurosurgical Stroke Research and received a grant from HSFC, Began enrollment in the Phase 3 FRONTIER stroke trial, and neuromodulation related epilepsy grants for closed loop control seizures– of CIHR one and the other CHRP (CIHR-NSERC partnered), and was promoted to a scientist position at the Krembil Research Institute. Innovations Grant from the Canadian Cancer Society Research Institute his for studyingwork methylation DNA and hydroxy-methylation in human gliomas. co-investigators awarded were a 3 year, $6.6M CDN grant from Brain Canada thefor project: the FRONTIER trial. the Crean Hotson Chairin Skull Base Surgery. the Alan Hudson Award. Teaching USD grant from$5.74M NINDS the for project: “developing the next generation PSD95 inhibitor”. Michael Tymianski and Wilkins Chair in Brain Research Tumor and elected as the Secretary-Treasurer of the Society Neuro-oncology. of Dr. Section, AANS,Award, Tumor and Dr Taufik ValianteDr Taufik received a $6.5 million Dr. GelarehDr. Zadeh was appointed as Head Dr. CharlesDr. was elevated Tator to MichaelDr. Tymianski was made a Dr. MichaelDr. Tymianski became the Dr Andres Lozano received the Order Canada of Valiante Taufik Dr. received two Dr. PaulDr. Kongkham was awarded 2-year a Dr Fred Gentili became the inaugural recipient of Zadeh received the Young InvestigatorZadeh received the Young Michael Tymianskiwas awarded a 4 year, Dr. GelarehDr. Zadeh was appointed as the • • • • • • • • • • • Appointments/Awards: • Major Accomplishments/

development of an of development international reputation attracting observers from all the world, over a complementary research program in the lab with both basic and translational aspects, and important collaborations with pulmonary medicine and interventional radiology. Investigator with a special interest in pulmonary thromboendarterectomy and mesothelioma. scientist with a special interest in lung transplantation and esophageal surgery. theof Surgical Pulmonary Hypertension over the last decade. has He built many aspects of this program, including recruitment surgical of fellows to train specifically for thisprocedure, of a National a of Quality Improvement Program in mastectomy Post Breast Reconstruction to Optimize the Patient-Cantered Experience. Armstrong Peters Prize 2017, – 2016 for Department of Surgery, University of Toronto. Reconstructive Surgeons staged and created a esophagusnew a young for acid attack survivor from Bangladesh. The UHN HelpsFund was established through an initiative at the Division Plasticof Surgerypatients for from middle to low income developing countries to travel to UHN to life-altering receive microsurgical complex reconstruction that is technologically advanced. Marc de Perrot MD Shaf Keshavjee MD AndrewPierre MD Kazuhiro Yasufuku MD Jonathan MD Yeung Dr Laura Donahoe was recruited as Surgeon- Dr Jonathan was recruited Yeung as surgeon- Dr Marc Perrot De has led the development Toni Zhong was awardedToni with the George A UHN team Thoracic of and Head & Neck Waddell MD (DivisionTom Head) Gail Darling MD Laura Donahoe MD Marcelo Cypel MD

• • • • • Recruitments/Promotions/Retirements: • • Major Accomplishments/ Appointments/Awards: • • • Thoracic Surgery • • • • Self-Study Report, External 2020 Review | .

The Journal of Hand Surgery was awarded with the CIHR Investigator New andAward the CIHR Foundation Scheme Program Grant – 2020 2015 the for Development Plastic Surgery Professor the by American Society Surgery for the of Hand. Foundation (CBCF) grant funding – 2018, 2015 Program has been appointed as the Editor in Chief of as an Associate Professor. as a Surgeon-Scientist. Director Surgery, Altum Health. This is the most prestigious Orthopaedic travelling fellowship inmid- the for world career academic orthopaedic surgeons. Clinical Lead – Rapid Assessment Clinics (RAC) - Low HQO. Back Pain Pathway, He alsoHe received the Whitecloud for Award Best Clinical Paper: International Meeting Advancedon Spinal (IMAST). Techniques British Canadian (ABC) travelling fellowship. Berris Academy at theAward University of Individual for Toronto Teaching Performance. Dr Steve McCabe was appointed a Visiting Zhong received CanadianDr Toni Breast Cancer Dr Brent Graham the of TWH – Hand Dr. Toni Zhong was promoted Toni Dr. Dr Heather Baltzer was recruited Brent Graham MD Siba Haykal MD Steven McCabe MD SchroederHerb MD Von Zhong MDToni Stefan MD Hofer (Division Head) Jamil Ahmad MD MD Anastakis Dimitri Heather Baltzer MD BrayPeter MD Dr Rajiv Gandhi was appointed Medical Dr Raj Rampersaud was appointed Provincial Dr Rajiv Gandhi completed American the 2015 Dr Steve Lewis was awarded the Wightman

Department of Surgery, Faculty University of Medicine, of Toronto • • Major Accomplishments/ Appointments/Awards: • Recruitments/Promotions/Retirements: • • • • • • • • • • • • • Plastic Surgery • • •

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19. Hospital Reports 19. Hospital Reports 245 Self-Study Report, External 2020 Review | Dr Tom Waddell Professor and Dr Chair, Tom incontinence and reconstructive surgery. He was also appointed to Assistant Professor. at the UHN in 2015. November 2011-19 Division of Thoracic Surgery, Department of Surgery, University of Toronto Investigator. His interests health, include men’s operating grant to support his oncology research. wasHe awarded renewal a hisof Canada Research Chair in Lung Transplantation innovation and translation laboratory of research, launching a ground-breaking clinical trial to inactivate or remove Hepatitis C virus prior to transplantation usingEx Lung Vivo Perfusion. 5 year research 5 years award over 1M for from CIHR project a for with potential to radically transform the treatment very of early stage lung cancer, transbronchial nanotechnology- mediated Photodynamic Therapy. Lifetime2018 Achievement Award, Transplantation of Society Canadian as the President Vice the of American Association for Thoracic Surgery Dr Tony FinelliDr Tony became Division Chief Dr Michael Robinette retired in 2018. Antonio Finelli MD (Division Head) Dean Elternman MD Neil Fleshner MD Hamilton Rob MD Magdy Hassouna MD Michael Jewett MD Girish Kulkarni MD Jason Lee MD Sidney Radomski MD Nathan Perlis MD Alexandre Zlotta MD Dr Dean Elterman was recruited as a Surgeon- Dr Marcelo Cypel continues his track record of Dr Kazuhiro Yasufuku has received an prestigious Dr Shaf Keshavjee has received the Dr Keshavjee was recently appointed • • • Urology • • • • • • • • • • • Recruitments/Promotions/Retirements: • • • • • University Division Chairs at UHN: Department of Surgery, Faculty University of Medicine, of Toronto his clinical trial “Lung Transplantation using Hepatitis C Positive Donors to Hepatitis C negative Recipients” and a CCSRI basic science national-level recognition of excellence in continuing medical education. lecture the on Future Transplantation of at the American College Surgeons of Annual Meeting. for thefor International Association the for Study Lung of Cancer, recognizing his growing reputation in this field. Distinguished CHEST Educator – a Award Cooper from Award the Canadian Society of Transplantation and appointed as Treasurer for the American Association Thoracic of Surgery. member the of Mesothelioma Force Task Interventional Pulmonology Meeting in Florence and the Faculty University Toronto of Medicine,of Ivan Silver Innovation Award at The Faculty Annual Medicine’s of 14th Education Achievement Celebration. Queen’s and RyersonUniversities. Officer ofthe Order of Canada. Gustav Killian Centenary Medal at the Congress World 19th Bronchology of and advising only not surgery on all but aspects lungof cancer care, including screening, radiation, and systemic treatments. with honorary degrees from both scientist in the early phase his of career and also was awarded Graham a Roscoe Reid Scholarship to fund help that research. important within role Cancer Care Ontario as the Clinical Liaison Lead lung for cancer, Surgery Tovee Award, alsoSurgery recognizing Tovee many years commitment of to teaching surgery. of Peters Prize his for success as a surgeon- Individual from Award Teaching the Wightman- Berris Academy. Dr Marcelo Cypel received a CIHR grant for Dr Shaf Keshavjee gave the John H Gibbon Jr Dr Kazuhiro Yasufuku received the Dr Shaf Keshavjee was awarded the Dr Joel Dr Marc Perrot De was appointed a Dr Shaf Keshavjee was appointed as an Dr Kazuhiro Yasufuku was awarded the Dr Shaf Keshavjee was recognized Dr Gail Darling was appointed to a very Dr Andrew Pierre the Department won of Dr Cypel the George won Armstrong Dr Kazuhiro Yasufuku an won • • • • • • • • • • • •

Chair CCN Vascular Dr Working Group), Lindsay (Royal College Speciality Chair), Dr Oreopoulos (became the Director of Postgraduate Surgery Education Director in addition to his responsibilities as Vascular Surgery ProgramDirector), Dr Roche- and planning program a ‘One of two site model’ the for delivery cardiac of and vascular surgery care in Northwestern Ontario, as announced Minister by Hoskins in July 2015. MunkCardiac reach to Centre’s re- establish local vascular care and support the a of development local Cardiac surgical service. In the interim the UHN Munk Peter Cardiac Center will be the site cases EVAR for performed TBHSC by surgeon(s). jointA new program in open thoraco-abdominal aneurysm repair has been created in conjunction with the Cardiac Surgery Division at UHN. TermAward Contributions for Long Wolff to Continuing Education from the University Division of Toronto of CEPD. significantleadership positions Dr Forbes (University Chair, Associate Editor Journal Vascularof Surgery, President CSVS, of Scientist, is who working mechanisms aorticof aneurysm wall expansion. as Surgeon-Scientist. Drs. Rubin and Lindsay led the have development This joint CV program will extend the Peter DouglasDr. received the Colin Wooster The Division's members continue to have Thomas Forbes MD (Division Head) John Byrne MD JohnstonWayne MD Kathryn MD Howe Thomas Lindsay MD George Oreopoulos MD Graham Roche-Nagle MD Barry Rubin MD Douglas MD Wooster Dr John Byrne was recruited as a Surgeon- Dr Kathryn was recruited Howe • • • • Vascular SurgeryVascular • • • • • • • • • Recruitments/Promotions/Retirements: • • Major Accomplishments/ Appointments/Awards: Self-Study Report, External 2020 Review |

Division Department Urology, of of Surgery, University of Toronto million Biobank for related research. most robotic uro-oncologic surgeries in Ontario with having now completed more than procedures 1400 related to kidney, testis (RPLND), bladder and prostate cancer. biomarkers, aiming to achieve personalized medicine in Over 380,000 Urology. bio specimens been have stored to date from 16,500 patients.over Over the last year, we receivedhave grant funds totalling $1.7 over reviewed grants from CIHR, OICR, CPCRF, and Canadian Cancer Society Research institute, Prostate Cancer Canada Research Foundation, Prostate Cancer Research Foundation and NIH. facilitate the discovery and validation novel of Canadian Uro-Oncology Group and was re-appointed as the Chair Love at PMH. research in prostate cancer with many major peer- the Langer Prize at Gallie Day. in a “CrossfireDebate” at the American Urological Association; particular sessions that are attended more than by 1000 registrants. Dr Neil Fleshner Professor & Chair, The division urology of has performed the The BioBank GU was foundedin 2008 to Dr Neil Fleshner continues as Chair the of Dr Neil Fleshner continued his clinical and basic Dr. GirishDr. Kulkarni was awarded FinelliDr Tony was invited to participate Department of Surgery, Faculty University of Medicine, of Toronto University Division Chairs at UHN: • • • • • • • Major Accomplishments/ Appointments/Awards:

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19. Hospital Reports 19. Hospital Reports 247 Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

Graduate Award. Teaching Vascular Surgery, Department of Surgery, University of Toronto pan Canadian Quality Improvement regional group those for using the SVS Vascular Quality Initiative (VQI) platform. University Vascular Post division’s with its partners at St. Michael's and Sunnybrook to fund international fellows advancedfor clinical training as well as the support the of University Divisional Citywide rounds and K Wayne Johnston lecturer at the annualresearch day. MSH Academic Medical Organization). clinical trials (BEST CLI), stem cell therapy for CLI, as well as intervention trials with industry. Nagle (Chair the of RadiationSafety Committee), Dr Rubin ( Program Head, MunkPeter Cardiac Center, Chair UHN of Dr Thomas Forbes Professor & Chair, Dr Graham Roche-Nagle established the Dr Kathryn received the Howe The Division continues in to work conjunction The Division has continued in involvement major We willWe continue to to and work develop maintain the appropriate environment to enable leadership in academic productivity and surgical innovation. understanding the of business aspects delivery of surgicalof services timely – delivery care of and volume targets with performance measures in place. of theof department are focused academic on productivity and also in clinical excellence with an in the country. Our department is academically productive and the dedication to patient care, teaching and research is exemplary. The members In summary, the have largest we and most academically productive department surgery of Summary University Division Chairs at UHN: • • • • • 199. WOMEN’S COLLEGE HOSPITAL

Photo: Courtesy of Department of Medicine

David Urbach, Surgeon-in-Chief, Women's College Hospital

Division Heads: Division of Plastic Surgery Orthopedic Surgery: Dr. John Theodoropoulos Dr. John Semple Plastic Surgery: Dr. John Semple Dr. Mitchell Brown

Core Staff Surgeons: Division Division of Urology of General Surgery Dr. Ethan Grober Dr. David Urbach Dr. Yonah Krakowsky Dr. Karen Devon “Healthcare revolutionized for a healthier and more Division of Orthopedics equitable world” is Women’s College Hospital’s Dr. John Theodoropoulos strategic vision, and the driving force behind our Dr. Jas Chahal surgical programs and our focus on Ambulatory Dr. Tim Dwyer Care. We are a recognized leader in women’s Dr. Lucas Murnaghan health, health equity, ambulatory innovation, and Dr. Daniel Whelan health system solutions. Women’s is the hospital

248 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 19. Hospital Reports 249 2018-19 Recruitment of Dr. Si- Dr. of Recruitment Hyeong Park, Orthopedic Surgeon – Foot and Ankle specialist Joan Lesmond Quality Excellence Award 2018 & 2019 hospital First teaching Canada an provide to in academic Transition- SurgeryRelated Program Self-Study Report, External 2020 Review | 2017-18 11 Core Surgeons, over 11 60 associate staff International Search for Recruitment SurgeonFoot & Ankle Dr. of Recruitment Krakowsky, Yonah Urologist Director and of RelatedWCH Transition Surgery Program Joint Total Outpatient ProgramReplacement Department Surgery- of Surgical Services awarded the Unit Joan Lesmond Quality Excellence Award 2018 & 2019

L-shaped 420,000 square foot, 9-story infrastructure with a capacity to serve 340,000 patients per year. Surgical Services was redesigned with state- 10 of-the-art Operating Rooms in conjunction with various specialized clinics, education and research facilities fashioned to further enhance the patient strategic focus, and working to ensure health system sustainabilityand accessibility all for enter who our doors. Our surgical department is currently home core surgeonsto 11 60 and associate over staff. Our core groupis comprised surgeons of whose primary College Hospital, base is and Women’s are all cross-appointed hospitals. at other GTA Their clinical interests include minimally invasive surgery, endocrine and thyroid surgery, medical education and ethics, sports medicine, pediatric orthopedics, breast surgical and oncology breast reconstruction, aesthetic surgery, urological dysfunction, sexual health, and transition related surgery.

2016-17 Deep expertise & Soft Tissue extremity Surgical innovations Transition Transition Related Dr. David Urbach Urbach David Dr. new Surgeon-appointed in-Chief New Department Surgeryof strategy developed: 1. strategic alignment Health 2. systems solutions 3. New Program developments: 1. programtrauma 2. Surgery Program Same3. Day Arthroplasty Pre of Amalgamation Anaesthesia of Unit Recovery Department of Surgery, Faculty University of Medicine, of Toronto 2015-16 with various teaching various teaching with awards Honor of Dr. John John Honor Dr. of years of forSemple 10 service as Surgeon- the in-Chief Educational Highlights Core honored surgeons

2014-15

new statenew the of art facility was open to the public. College Hospital standsWomen’s firm itsin new Phase I as the upcoming our of development new facility was under construction, the and 2015, by hospital redevelopment plan was completed and our 2014-2015 The DepartmentIn 2014, Surgery of was housed in Honora Legacy of 40 of years Service of – Dr. Lavina Lickley development: development: Otolaryngology, Hand Program Soft Tissue Trauma hemorrhoid, hernia and and hemorrhoid, hernia surgery bladder gall New program Collaboration with the the Collaboration with alleviate to LHIN Toronto pressure points e.g. including the Canadian Canadian the including Institute for Health Research over and 64 publications 8 core surgeons, over 18 researchactive grants Milestones through continuing innovation in our areas of external stakeholders. As a Department, strive we to remain in alignment with the hospital’s vision Over the last 5 years, the Department Surgery of has adapted to respond to the needs our of community members, patients, and internal and Central LHIN and a member the of Council Academicof Hospitals Ontario of (CAHO). fully affiliatedwith Toronto the University as of the designated ambulatory for hub surgery, training and research, in partnership with theToronto designed to keep patients hospital. of are out We

2016 Lois H Ross Resident Advocate Award, Nominee Dept Surgery, of Urology, Faculty Medicine, of PARO Resident & Advocacy Well-being • our current surgical areas focus. of Semple’s Dr. leadership roles extended the beyond walls of our department to include his Chair in Surgical Research the of Canadian Breast Cancer Foundation (Ontario Chair, Vice chapter); Board Governors, of Ontario College Art of and Design University; and as an internationally known clinician and scientist hisfor contributions health. to women’s Through the continued partnerships with neighboring hospitals and governingbodies, the Province Ontario of through its ConstructionPost Operating Funding (PCOP) helped to facilitate the establishment programs new of and tackle the system pressures existing of underserved areas. Through their continued contributions theirof clinical, educational and research endeavors our core surgeons recognized were theirfor many achievements: Dr Ethan Grober: The department the honored legacy Lavina Dr. of Lickley 40 her for years dedicated of service. Her academic and clinical accomplishments deeply were College Hospitalrooted in culture the Women’s dating was she when the of one co- back to 1977, founders the of Henrietta Banting Breast Centre, addresseswhich breast health, breast-related diseases and breast reconstruction. Lickley Dr. was the ChiefSurgery of and to from in 1998 1991; 1989 becameshe the firstwoman surgeon in Canada to become a Full Professorat the University Toronto. of 2015-2016 JohnDr. Semple completed his term as Chief of Surgery. During his 10-year tenure, Semple’s Dr. dedication shaped the department through a period transitionof and redevelopment that only not lead to the recruitment our of surgeons key to date, but his leadership contributed to the advancements of Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto Womens College - Tim Dwyer and James Rutka James and Dwyer - Tim College Womens knee,shoulder, hip and ankle. His research focus was based the on assessment surgical of andcompetence assessment in competence of the performance technical of procedures. process with the recruitment Tim Dr. of Dwyer, Orthopedic Sports Medicine and Arthroscopy surgeon. With a cross appointment at Mount Sinai Hospital, Dwyer’s Dr. clinical practice included open and arthroscopic surgery the of identified and reviewedkeypressure points within the health system, and in the Fall the implementation anof Otolaryngology, Hand Program, and the Soft Tissue Trauma Program established. were As continued we to expand, so did our recruitment Rounds. Through the Allergan Breast Fellowship Program, the Division Plastic of Surgery continued to train and mentor fellows locally and from abroad. Through our partnership Central with the Toronto Local Health Integration Network (LHIN) we fellows. Within the Division General of Surgery, Dr. Karen and Tulin Cil Devon Dr. developed a new ambulatory general surgery rotation, with weekly guided reflectivepractice. Devon established Dr. the Endocrine Surgery Journal Department Club, of Surgery Book Club and the Ethics Quality Care of a continuous theme marked the by undergraduate students rotated who through our various divisions and the and University the Sports Toronto of MedicineProgram (UTOSM) established a teaching curriculum and research program residents for and care experience.During this period, our 8 core surgeons active research 18 over held grants and 64 publications.over The rank excellence of was

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19. Hospital Reports 19. Hospital Reports 251 Self-Study Report, External 2020 Review | Deep Expertise and Strategic Alignment, Health System Solutions, and Surgical Innovation. and transition-related surgery underway. were approach.All surgeries are ambulatory, at WCH with 97% our of over patients discharged home the same and the day, remaining staying 3% in the Acute Ambulatory Care Unit (AACU) less for than hours. 18 The goal was to a model develop careof that supported the patients’ entire journey throughout surgical services with the vision that patients would be at the centre care. of Nursing staff and support staffwould beable to respond to the area the of greatest patient need and bottlenecks that occurred to due staffor spaceconstraints, would be reduced and eliminated or in some cases. This remodel improved efficiency, reduced downtime and offered a rapid flexible and response to surges in patient care needs and volumes, with all nursing staff having the knowledge judgement and to care patients for in all the phases care. of Recruitment remained a priority, and the search a of General Surgeon centralized to new a develop intake program hernia for and gall bladder surgery and an Urologist to a program develop in sexual medicine 2016-2017 DavidDr. Urbach was appointed the Surgeon- new in-Chief and Medical Director Perioperative of Services, succeeding John Dr. Semple. As he stepped into his our role, new department continued to grow core surgeons with 11 and 60 associateover continueTo staff.on paththe advancement,of the Department a Strategic held Planning Retreat to outline strategy. a new The three majorthemes included: development of 1. 2. 3. In the Spring Surgical 2016, of Services amalgamated the Anesthesia Post CareUnit and (PACU) Phase 2 Recovery areainto a single Peri-Anesthesia new ThisUnit (PAU). merger recognized the need to deliver post-operative care in and a new innovative Department of Surgery, Faculty University of Medicine, of Toronto

Emeritus, Depart Surgery, of University of Toronto 2015 Dr Lavina Lickley: • Awarded Professor Toronto, Toronto, Ontario, Toronto, CanadaToronto, TravellingDJO Fellowship, American Orthopaedic Society Sports for Medicine Plastic and Reconstructive Surgery. 2016. Orthopaedics, Surgery, University of recognition years 10 of service of as the Chief Surgeryof College Hospital, at Women's 2016 Reconstructive Surgery - University of Toronto. Recognizing contributions to the Division of "Mentorship by the Award" Women's College Hospital Research Institute, 2016 Plastic and Reconstructive Surgery, 2016 extraordinary contribution to the betterment theof specialty Plastic of Surgery, 2016 Reconstructive Surgery - University of Toronto. Recognizing contributions to the Division of Award - PresentedAward in recognition of outstanding contributions to plastic surgery resident education, 2016 Plasticof Surgeons. In recognition of Wightman-Berris Academy Wightman-Berris Academy Post Award. Graduate Teaching Wightman-Berris Academy Graduate Post Teaching Award Dept Surgery, of Urology, Faculty Medicine, of 2016 Apr - 2016 May 2016 ESSKA May 2016 Apr - 2016 - AOSSM 2016 2016 Jun - present Associate2016 Professor, University of Toronto - GallieUniversity Toronto of in Day: Award Chairman's Medal - Division Plastic of and Dr. JohnDr. Semple was awarded the President's Medal - Canadian Society Chairman's Medal - Division Plastic of and Arnis Freiberg Faculty Excellence Teaching • Dr Danny Whelan • • • Dr John Semple: • • • Dr. MitchellDr. Brown: • • Program - the firstitsof kind in Canada. With a major focus pre-operative on & post-operative and anesthesia state-of-the-art management, surgical techniques, virtual care applications, and cross-disciplinary collaboration, this program aims to reduce the dependence in-patient on beds Gynecology, the nurses from surgical services and gynecology recognized were with the Excellence in Collaborative Leadership leading for Award a full professional education day staff. for Sessions included hands-onmethods to engage staff and featured several guest speakers. Cancer Care Ontario College withpresented a certificate Women’s for Meeting Cancer for Target Surgery Times Wait – Time from Referral to Consult (Wait 1). an held internationalWe search an for Orthopedic Foot and Ankle Surgeon to a new develop centralized intake program and foot for ankle procedures, with an aimed start date August of 2019. Krakowsky, Yonah Urologist, Dr. welcomed We wouldwho a program develop in sexual medicine and surgery and serve as Medical Director the for Transition-Related WCH new Surgery program. Our program expansion was in full swing. launchedIn we May completely a new 2018, Outpatient Joint Replacement Surgery Total 2017-2018 College Hospital’s participationWomen’s in the Accreditation Canada process during December with the collaborative2017 effortsof all areas, affordedour organization with being accredited with Exemplary Standing, the highest rank from Accreditation Canada. This honorary status reinforced our commitment to patient- focused care and in that same year,our Surgical Services was awarded Team The Excellence in Collaborative Innovation their for Award joint efforts with Acute the Ambulatory CareUnit (AACU). Karen Dr. led a multi-disciplinary Devon team in developing an innovative model of care outpatient for thyroid surgery, creating a standardized ambulatory approach care of WCH for thyroidectomy patients that ensured safe, high- quality care. This initiative enabled a reduction in average length stay of and increased of level patient and staff satisfaction. In partnership with Self-Study Report, External 2020 Review | initiated a was an author three on was elected as a Fellow of was appointed Director of developed a course in Ethics and Professionalism the for 1 FoundationsYear course. Dr. KarenDr. Devon program in Surgical Ethics at withWCH, an inaugural speaker in Humanism in Surgery, and received three grants Department of Surgery, Faculty University of Medicine, of Toronto secondary breast augmentation, and a co-author a paperon published in JAMA. completed He his 10- year term as Program Director the for Division Plastic of and Reconstructive Surgery. and Medical Services Innovation Fund), and published peer reviewed 10 papers. MitchDr. Brown publications including an invited CME paper on Dr. DavidDr. Urbach the Canadian Academy Health of Sciences TimDr. Dwyer (UHN Arthritis Program, ConMED Linvatec College HospitalGrant, Academic Women’s the Canadian Urological Association Guidelines theon Management Disease; Peyronie’s of Leading the implementation “bottom” of urological transgender College surgery Hospital. at Women’s Educational and promotional accomplishments were seen throughout ourspecialized services as follows: EthanDr. Grober Undergraduate Medical Education in the Division of Urology Co-authored at the University Toronto; of the establishment programs new of in sexual medicine and health, transition related surgery wall(chest and genital surgery) and same day hip and knee arthroplasty surgery in were process. The Soft TissueExtremity Trauma Program was created to provide rapid access to the OR repairfor soft of tissue injuries in the LHIN and

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19. Hospital Reports 19. Hospital Reports 253 Self-Study Report, External 2020 Review | was appointed to the Board currently multiple held distinguished published 4 peer reviewed journal was the recipient the of Bernard Infections Surveillance Technology(ASSIST). This is an International working group based Washington of out University, Seattle funded by the Centre Disease for Control. was He awarded the Senior Scholar in the Graduate Faculty at OCAD University in the programs: Design for Karen Devon Directors,of Cancer Care Ontario. She was a panelist Bioethics on Health for in a Digital Age, and Co-Director a Surgical of Ethics Course at the University Toronto. of publishedShe 4 peer reviewed articles and presented at the Surgical Forum the of American College Surgeons of in San Diego. Tim Dwyer articles and is a collaborator a CHIR on grant on the study and Development of feasibility testing anof intervention to manage risk knee OA factors after anterior cruciate ligament injury. Semple John appointments including the Chair the of Surgical Breast Cancer Research, Canadian Cancer Society. wasHe appointed an Adjunct Professor at OCAD University, and also appointed to the Board of Directors the for Assessment of Surgical Site John Semple and Mitchell Brown John Semple and Mitchell Jas Chalal Langer Surgeon Scientist Award. This prestigious honour is awarded to an outstanding graduate theof Surgeon Scientist Program in the Department Surgery of shows who the greatest promise a career for in academic surgery. Department of Surgery, Faculty University of Medicine, of Toronto served as President the of Canadian was promoted to Full Professor Atlanta, Georgia andwas Visiting Professor at Dalhousie University in Halifax, Scotia. Nova 7 medical conferences including a live surgical presentation at the Southeastern Society of Plastic Surgery and Reconstructive Surgeons in Department of Surgery, University of Toronto. authoredHe chapter a in Plastic Surgery: 4th Breast.Edition presented He V.5, 25 lectures at Mitch Brown for Award and was the recipient the of Tovee Excellence in Graduate Post Education in the was an peer-reviewed author 21 on publications. David Urbach Association General of and Surgeons in 2017-18, Accomplishments by our core group included the following: “top” masculinizing“top” and feminizing chest surgery, with a plan to start performing “bottom” surgeries including vaginoplasty in the subsequent year. for Addictionfor & Mental Health (CAMH) and the numerous health practitioners and community efforts.member’s focus The at this time wason result partnerships of with Sherbourne Health Centre, Rainbow Health Ontario and the Centre The Transition-Related Surgery Program focuses providingon secure and prompt access to transition related surgeries. This program’s is evolution a biopsy to diagnosis decreased more than by 50% with the introduction the of ADP new model. through to treatment with rapid diagnostic wait times (less than and 48 hours), more timely access to treatmentand supportive care. The time from Diagnostic This Pathway (ADP). model strives to provide a seamless journey care of from diagnosis Departments of Surgery, Pathology and Laboratory Medicine, Nursing and the Joint Department of Medical Imaging, developed an we Accelerated In June 2018 anIn exciting June 2018 model new care of was created with women for findingsconcerning for breast cancer. Through a collaboration the of wait times, and keep patients hospital of out allowing recovery in the comfort their of homes. for commonfor major surgical procedures, improve We continue to pressWe forward with our initiatives using a multidisciplinary approach as we collectively work towards revolutionizing our commitment to healthcare equity through world class research, innovation and education. unit, in but the comfort their of own home. onlyNot are to proud be the we first in Canada to establish the first academicTransition-Related Surgery Program, this but collaboration would been have not possible without the expertise and strategic alignment clinical of staff,community and governmental partnerships. Ontario has the highest trans population in Canada, and being able to offer this service has allowed those living in Ontario access to quality care without having to travel province of out aboard. or This has aided in reducing the province of need out for coverage and allows follow care up where patients live. In June College Hospital the welcomed Women’s 2019, of renownedworld Marci Dr. Bowers to mentor help our surgeons in performing transition-related genital surgery. A pelvic and gynecologic surgeon with more than 29 years experience, Bowers Dr. alongsideworked our staff as partof an advanced international training and mentorship opportunity. care projects. The first wasMedication for Reconciliation. This distinction recognizes teams their for achievement in quality excellence that supports the vision, mission andvalues of ThisWCH. initiative was to ensure unintended medication discrepancies do occur. not This program was an inter-disciplinary collaborative effort, withpharmacy techniciansconducting Best Possible Medication Records, and pharmacists performing Medication Reconciliation at discharge. A second quality awardto the went Ambulatory Joint Replacement Program. Total This multidisciplinary effortprovided outpatient total joint replacement surgery program, which engaged patients and their families to ensure a safe and efficient discharge from hospitalhome. The to patients followed were post-operatively using a virtual care app and video conferencing with the use a tablet of to monitor progress 3 days for after surgerynurses by and surgeons. This collective mandate was to provide the same standard care of and safety that patients in receive an inpatient Self-Study Report, External 2020 Review | published 3 peer-reviewed Deep expertise and strategic alignment Health System Solutions Surgical innovations. Department of Surgery, Faculty University of Medicine, of Toronto Surgical Services was awarded the Joan Lesmond Quality Excellence two for Award health Through an international search process, we Si-Hyeong Dr. Parkwelcome will who be joining the Department Orthopedics of with a cross appointment at Mount Sinai Hospital hisfor expertise in and foot ankle surgery. strategic planning themes development: of 1. 2. 3. 2018-2019 This year has been an excellent example implemented have we how of our three in collaboration started the Transition Related Surgery organized Rounds he at WCH, the “Surgeon andSociety” and at the spoke Event East GeneralToronto Hospital Grand Rounds. Yonah Krakowsky Yonah articles and holds 3 grants including the International Society the for Study Women’s of Sexual Health. is He the undergraduate education coordinator Urology for and Assistant Program Director the for Urology Residency Program and Health and Interdisciplinary Masters in Art, Media and Design.attended He invited 13 visits and holds 3 grants including a CIHR patient- orientated research (SPOR) collaboration grant.

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CONCLUSION

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 255 20CONCLUSION

Mari and James Rutka, Casa Loma 2017

It has been an honour and a privilege to serve as an increasing percentage of women recruits, and the RS McLaughlin Chair of the Department of we offer outstanding educational programs for Surgery at the University these past 5 years. We have medical students, residents, and fellows alike. made great strides in our progress across all pillars of our strategic plan. While I am very proud of the New areas of interest in the Department of fact that our research and philanthropic funding Surgery these past 10 years have included an have doubled since I was appointed as Chair by emphasis on quality and best practices, global Dean Catharine Whiteside in 2011, I take equal surgery, and equity, diversity and inclusion. pride in knowing that we continue to publish in the highest impact journals in our specialties, we It was my goal to work assiduously with my promote our faculty to higher ranks along a defined colleagues in the Department in all spheres to and consistent upward trajectory, we have recruited improve our ranking in surgery using external the best and brightest new faculty members with ranking systems and metrics. That is why I am

256 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 20. Conclusion 257 Self-Study Report, External 2020 Review | US NewsUS Department of Surgery, Faculty University of Medicine, of Toronto of rankings of departments of surgery of so many years made have serving my in the capacity as Chair both extremely rewarding and seamless. these years past 10 during tenure my as Chair the of Department Surgery. of good Her grace and willingness to be in involved many formal and social events over Finally, I should like to acknowledge and thank my wife, Mari, support, love, her for and understanding and Stacey Krumholtz (Medical Illustration). Without them and the entire administrative office staff, we would be not in the enviable position that are. we (Communications Coordination), and Web Joanna Giddens (Strategic Plan Implementation Coordinator), and administrative assistant to the Chair, Sylvia Perry. hires New in our officeswho beenhave instrumental in our success include Stephanie Neilson I was indeed fortunate to outstanding have assistance in the Department Surgery of offices inthe Stewart Building led business by manager Nancy Condo, wise counsel thesepast many years, I would not beenhave able to accomplish what I did. Special thanks are given to Ori Rotstein, my Associate Chair, without whose sage advice and Chairs Surgery, of the Program Directors, and the Hospital Surgeons-in-Chief and Division Heads. have beenhave possible without the support very my of capable and effective Executive and SeniorAdvisory Committees, Education my Directors, the University of andof advocates the for Department Surgery. of nothing or the of above None in this report would of Medicineof with closely worked I have whom these years,past 10 Dean Catharine Whiteside and Dean They both have been stalwart Young. Trevor supporters Special thanks are given to the two Deans the of Faculty but inbut the samebreath I am optimistic that will we continue to rise in the rankings world given the historic tradition that rests at the University Toronto. of in 2020.I acknowledge that has it taken decades of hard and work attention to the academic mission predecessors my by to reach this position, coveted and World Report World and around the world, the University Department of Toronto Surgeryof ranked in the fourth position world-wide absolutely delighted that in the most recent Self-Study Report, External 2020 Review | Department of Surgery, Faculty University of Medicine, of Toronto

258

20. Conclusion APPENDICES

Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 259

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and/or and/or al contribution is depleted contribution al once a certain the

the duration of the SSTP. In In SSTP. the of duration the The funding from the Department of S of Department the from funding The

erage rose to 15/ to rose av the erage after which 2011, until The SSTP attracts the residents the attracts SSTP The

yr 9 average urgery. 1) including oughout r supervisor Department , 201 , a portion of of portion a provide sources external and supervisors e

the as a measure of of measure a as , Figure offset the cost of cost the to offset funds more no Thus, the SSTP must be financially sustainable and thriving as as thriving and sustainable financially be must SSTP the Thus,

( PhD students. students. PhD

rise January ), the first year of funding is provided by the by provided is funding of year first the ), hat is hat on average of 10/ of average on to

University ofToronto maintained th maintained . T

and 110 and Self-Study Report, External 2020 Review the SSTP.The gap between available funding and The Department of Surgery |

epartment. epartment.

This poses a dilemma for the Department because the residents are already already are the residents because aDepartment poses dilemma for the This continues the D . Neurosurgery

entered The deficit for 17/18 was resolved by a one a by resolved was 17/18 for deficit The

n on and

Cardiac, General Surgery and Neurosurgery residents enter the SSTP th next at eir enter the SSTP residents and Neurosurgery General Surgery Cardiac,

enrolled of the Surgical Scientist Training Program Training Scientist of Surgical the accepted is provided by the Department of S of Department the by provided is

se sources, however, is not confirmed until well into the academic year in year academic the into well until confirmed not is however, sources, se

496,000. is the responsibility of the resident the of responsibility the is

This level of funding is of This level funding been been s $ re enrolled after which there are there which after enrolled re funding. ac Surgery ac Report of The Task Force for Financial Sustainability Financial for Force Task The of Report wa

the SSTP comes from many sources many from comes SSTP the

Cardi 0/yr$849 Plastic and Reconstructive Surgery, Urology and Vascular Surgery r Surgery Vascular and Urology Surgery, Reconstructive and Plastic (

, s residents residents 22 17/18, For . 2) , produces high impact research, and serves as a training ground fo ground training a as serves and research, impact high produces ,

PGY of PGY level and benefits vary according to mixture of PGY levels, the the of levels, to mixture PGY according and benefits vary

410 residents with 300 MSc MSc 300 with residents 410 trained has funding, the the remainder funding, rogram for 17/18 for rogram an unsustainable financial burde financial an unsustainable salary

INTRODUCTION Department the establishing to vital been has (SSTP) Program Training Scientist Surgeon The began SSTP The world. the in Departments Surgery academic leading the of one as Toronto of University and

research residents surgical of number an essential component of the Department. the of component essential an BACKGROUND Orthopaedic current current approximately PGY level of funding. funding. of level PGY Funding th many e from of Funding subspecialties already have residents The revenue for revenue The enrolled but all sources of revenue are not confirmed. Whil confirmed. not are revenue of all sources but enrolled the does not increase with the number of residents of number the with increase does not P CURRENT SITUATION was SSTP the entering residents of number The number of residents a residents of number (Figure

Department of Surgery, Faculty University of Medicine, of Toronto

Report of The Task Force for Financial Sustainability of the Surgical Scientist Training Program Training Scientist Surgical the of Sustainability Financial for Force Task The of Report APPENDIX AAPPENDIX

260

Appendices Appendices 261

. )

-term . to the Gallie Gallie the to

. Self-Study Report, External 2020 Review | t be divisive among among divisive t be (Appendix 1 and long

Appendix - mid

the SSTP and any reduction might might reduction any and SSTP the

and/or hospitals and/or , Chair, Division of Vascular of Vascular Division Chair, , in

: What follows is a summary of the the of summary a is What follows

orce interviewed individuals listed in the the in listed individuals interviewed orce

F orce are provided in are provided orce . F for that year and and that beyond for year s with a reserve for contingencies for reserve a with s

ask ubstantially reducing the number of enrollees in in enrollees of number the reducing ubstantially i ). T ask applying from them deter might

. The The the mix of PhD and MSc residents is 50% (currently (currently 50% is residents MSc and PhD of mix the year basyear 3.

and any recommendations should no should recommendations any and -by-

. scope of this document. year ppendix a

. to provide recommendations to achieve achieve to recommendations provide to

al program program al

. nd the nd the

received by SSTP trainees SSTP by received .

SSTP is a major attraction of the Gallie program for potential residents residents potential for program Gallie the of attraction major a is SSTP

orce e F accepted most applicants. S applicants. most accepted

ask

dvancement

. 750K $750K to approximately rise will A

Department of Surgery, Faculty University of Medicine, of Toronto enter in 18/19 and assumingand 18/19 in enter that were held were that ivisional contributions ivisional ivisions are relatively new to enrolling residents residents enrolling to new relatively are ivisions D will will ough rough orce are listed in the A the in listed are orce and PhD students PhD and

F to the SSTP through a selection process process a selection through SSTP the to c remaina Department

ask everal T must

access : possible) (directly (avenues to: pursue) (avenues .

s s s d :

. The terms of reference for the T the for reference of terms The for the funding SSTP. orce recommendations were governed by the following principles following the by governed were recommendations orce 4 a task force led by Dr. Tom Forbes Tom by Dr. led force task a based of on recommendations the F

Given 16 residents SSTP raised several concerns. concerns. several raised SSTP Reduce salary of enrollees of salary Reduce MS of mix Alter . year first for funding MOHLTC provide that Divisions of number Increase

Reduce number of enrollees of number Reduce years and/or amount (in contributions supervisor Increase D University Increase (Department or Faculty of Medicine) Medicine) of Faculty or (Department University from support Increase Increase funding th funding Increase Increase number of external awards external of Increase number Division viable on viable financially be must SSTP The The quality of the SSTP must be preserved or enhanced or preserved be must SSTP the of quality The . maximized be should SSTP the entering residents of number The The SSTP to a large extent The large SSTP a has to

expense .

e ask • the and impede program. Also, s Also, program. T 2. 3. 3. 4. 1. 1. 2. 3. 1. 2. 1. 2. 3. 4. ivisions Increase revenue Increase Increase revenue Increase Reduc : considered were program sustainable a for options Several The members of the the of members The Appendix The impressions/discussion general DELIBERATIONS/INTERVIEWS beyo is discussions all of rendition fulsome A sustainable sustainable D

TASKFORCE struck Rutka Dr. 2018, January a T In Surgery 66% are PhD students), the deficit the students), PhD are 66%

It is do . would would

both both nefit both proposed proposed time time

reflect training schemes. schemes. training supervisors’ supervisors’

. ny process that restricted restricted that ny process

d raise issue other The .

. surgeon graduate students. students. graduate -surgeon

. supervisor and the and supervisor the

, Also for residents who perform perform who residents for Also candidate any philanthropic funds should be should funds philanthropic any ies salar their reducing substantially limit of the number of residents entering the the entering residents of number the of limit reflects the reality of the of reality the reflects Hospitals support support Hospitals the at Institutes Research the external external the for responsibility he

. the Thus, any solution should solution any Thus, ‘unfair’. as

However, sharply increasing supervisor contribution contribution supervisor increasing sharply However, at the current the at current CIP and PGME the addition, In

provide financial predictability financial provide aculty are less likely to have external grant support grant external have to likely less are aculty

their academic success. academic their

F Also, t Also,

this ede ivision, ivision, would

. ivisions do and other do not receive MOHLTC funding was was funding MOHLTC receive not do other and do ivisions among Divisions among levels, it was also felt that felt also was it -levels, D Self-Study Report, External 2020 Review | suggesting that $35K is a reasonable lower limit lower a reasonable is $35K that suggesting

declining budget. declining Thisleadership. Division the should with consultation in be done

. ivisional quotas raised concerns of diminishing the Departmental role in the the in role Departmental the diminishing of concerns raised quotas ivisional that receive funding that this see funding that receive D clear port graduate student salaries student graduate port contribution was that Junior that Junior was contribution sincentive to joining the SSTP. the joining to sincentive ivisions ivisions sup made made he issue of he their respective PGY respective their perhaps an ability to enter the job market upon graduation. However, a However, graduation. upon market job the enter to ability an perhaps . Those D supervisors’

, and ivisions that do not receive the funding see see funding the receive not do that ivisions D re with that evolution. On theevolution. that other with re hand upper an , setting that had a minimal impact on acceptance acceptance on impact minimal a had that a a has of Medicine Faculty he Both supervisors and residents in the SSTP need to apply for more external awards external more for apply to need SSTP the in residents and supervisors Both How to address the issue that some The shift towards more PhDs than MScs within the SSTP reflects expectations for successful Surgeon Surgeon successful for expectations reflects SSTP the within MScs than PhDs more towards shift The T external or grants through responsibility supervisors’ the is it community, scientific the Throughout Entrance to the SSTP should be primarily based on merit of the of merit on based primarily be should SSTP the to Entrance reduce sharply to unfair somewhat being Beyond SSTP. the joining by training their prolong Residents Supervisors must be accountable for funding of residents’ salaries. salaries. of residents’ funding for accountable be must Supervisors While encouraged to seek philanthropic support for the SSTP, the Divisions benefit from the brand of the the of brand the from benefit Divisions the SSTP, the for support philanthropic seek to encouraged While

• •

• Scientists imp might degree ideal the choosing from trainees • Department one supporting by precedent create to hesitant are and locally research • to awards fellowship non hiring to shifting supervisors of likelihood the increase may rates CIHR beyond below provided rates funding CIHR concerning a at paid are which salaries student graduate MSc/PhD University reflect do not amounts these that recognized lower rate. interfe di significant a as serve remuneration. of levels PGY from reduction allow not controversial research project. T research project. divisiveness causing possibly and SSTP SSTP their income from • • positions. • research supervised by faculty outside of their D of outside faculty by supervised research Those Those contribution must must be contribution Department the and Division/Supervisor the ideally ideally Thus, SSTP. the of prestige the and Surgery of Department •

Department of Surgery, Faculty University of Medicine, of Toronto

262

Appendices Appendices 263

. 4 a a

- ve made made There ations ations

The The

special

, or outside outside or , should come come should 18/19 funding funding 18/19

epartmental need s

all parties ha

ivision

en . D throughout all years throughout Self-Study Report, External 2020 Review

| SSTP This distinction will will distinction This th

. . es for funding are are funding es for the ctive ctive to the Division and Vice and Division the to

$3-5K) anticipated 20 anticipated

. /yr. /yr. ’s andupervisor D of the program whose applic whose program the of Opportuniti

s, they will potentially meritorious or PhD students, respectively. students, PhD or

. c level salary, then she/he should be be should she/he then -level salary, first year year first

PGY SSTP trainees

$1M t to address to offset Departmental Departmental offset as to manner so in some agencies/yr. otal remuneration (e.g. remuneration otal total ivisional AEF ivisional over

award award should aggressively pursue funding for the SSTP. SSTP. the for funding pursue aggressively should

, and documentation of financial support for the proposed proposed the for support financial of documentation and , and formalized in a signed contract signed a in formalized and om all parties (i.e. Resident, Supervisor, Division and and Division Supervisor, Resident, (i.e. all parties from access to D

external external

program LTC funding for the for funding LTC residents should offset both the both S offset should residents

. are encouraged to train SSTP residents. As they typically will not not will typically they As residents. SSTP train to encouraged are H

degree Divisions should be split split be should Divisions of sources (e.g. grants, endowed funds, philanthropy, AEFs etc), but must must but etc), AEFs philanthropy, funds, endowed grants, (e.g. of sources pools and/or pools the In order to make the accounting possible, salaries for salaries possible, to accounting make the In order whose applications are are applications whose funding full with should be confirmed be should

graduate graduate Department of Surgery, Faculty University of Medicine, of Toronto raising effort with a target of target a with effort raising reach a total number of less than 20 than less of number total a reach

ensure that sufficient support exists from the Supervisor, Division and the the and Division Supervisor, the from exists support sufficient that ensure

. provide documentation of sufficient funds to support SSTP residents SSTP support to funds sufficient of documentation provide

Divisions without MO without Divisions

. . Surgery of Department the in Office Research the by ratified and contract signed a in of sufficient funds to complete the higher degree. higher the complete to funds sufficient of

must trainee receives funding in excess of her/his her/his of excess in funding receives trainee Division an urgent fund in the Department of Surgery Surgery of Department the in

time as possible funding. external for apply to

. respectively ratio, 2:1 suggested a in access to clinical income Department of Surgery’s advancement efforts advancement of Surgery’s Department -in should be should Supervisors Supervisors Financial obligations for SSTP residents who are supervised outside of their respe of outside supervised are who residents SSTP for obligations Financial Funding may be from a variety variety a from be may Funding be confirmed The Any external fellowship awards to SSTP to awards fellowship external Any costs The transfer of SSTP residents from a MSc degree to a PhD degree should only be allowed if the residents’ residents’ the if allowed be only should degree PhD a to degree MSc a from residents SSTP of transfer The of Surgery Department the and (PAC) Committee Advisory Program the by meritorious deemed is project guarantee a is there if and Committee, Research Department) the Department of Surgery, of Department the slots should be be should slots training the of remainder The SSTP. the into accepted be should Research of Chair to chosen competitively Prospective SSTP residents SSTP Prospective in trainees SSTP are acceptable should . entry to prior Surgery of Department Scientists the or Institute, Research Hospital the Surgery, of Department the by provided be may as considerations University by raised funds Philanthropic funds non-philanthropic from philanthropic distinguish clearly that centers cost from Surgery. of Department the in Office Research the by made be s and expenses. expenses. and s contribution permitted to keep a portion of this amount as part of the t the of as part amount this of a portion keep to permitted SSTP SSTP If an have have available through the Research Office in the Department of Surgery of Department the in Office Research the through available f study of years much as provide to training their in possible as early as identified be should SSTP for candidates Potential lead SSTP trainees should apply to more than to than apply more 3 should SSTP trainees residents and supervisors should have a signed contract indicating their mutual responsibilities including including responsibilities mutual their indicating contract a signed have should supervisors and residents the completion of timely Continue limitation of Departmental support to 2 or 4 years for MS for years 4 or 2 to support of Departmental limitation Continue Residents who enter the SSTP are not universally completing their degrees their completing universally not are SSTP the enter who Residents

•

6. 7. 13. 12. 5. 8. 9. 10. 11. 4. 2. 3. 1. Given that everyone in the Department of Surgery Surgery of Department the in everyone that Given SSTP. the of stability funding address will solution single No . Chiefs) in Surgeons and Divisions, University supervisors, (residents, SSTP the form benefits stake in ensuring the SSTP is financially valuable financially is SSTP the ensuring in stake

RECOMMENDATIONS SUMMARY

5 . the n i

; This This may . -index exemplary funding funding contribution the s and PhDs s the c be lobbied to approve to approve be lobbied

contribution -wide -widefaculty In addition, this report may report this addition, In

of their SSTP trainees SSTP their of ntal strategic priorities strategic ntal the amount of amount the

the mixture of MS of mixture the

case,

in academic practice, practice, SSTP graduates academic in

supervising graduate students, H students, graduate supervising Also,

. Chair Divisional remuneration remuneration n this

i ; and/or a a Department and/or Research Committee should determine determine should Committee Research

upport. upport. number of number for the for ensuring financial viability. viability. financial ensuring

examples of high impact publications and/or and/or publications impact high of examples . be raised

entire Department to inform all faculty inform of to Department entire number who are , and responsibility of the of responsibility upervisor’s contribution and/or number of residents residents of number and/or contribution upervisor’s S a deficit may remain may deficit a e , possible, future possible, a for groundwork the lay Department However, strategic priority setting (whether it be by scientific focus, focus, scientific by be it (whether setting priority strategic However, , th

may need to need may to . n contributio ongoing

the Self-Study Report, External 2020 Review | ions ions an

position

to consider aligning SSTP funding with Departme with funding SSTP aligning consider to

evaluated

- Plastic and Reconstructive Surgery, Surgery, Reconstructive and Plastic Surgery, Generaly Surgery, Vascular Urology,

supported research programs, programs, research -supported . . country the across .

he widespread approach to approach widespread the indicate funding shortfall should be the be should shortfall funding to r should be re be should r ea the grant support. support. grant sufficient received have to likely less are who SSTP is in a surplus a in is SSTP

activities with grant with be applied be

the Department of Surgery Surgery of Department the efforts, those of In support eport should be circulated to the to circulated be should Report Taskforce

Department may wish d Surgeons, through the Specialty Sections, may Sections, Specialty the through Surgeons, and Physicians of College Royal ivision, and/or type of degree i.e. MSc/PhD) would require an entirely different process and does run run does and process different entirely an require would MSc/PhD) i.e. degree of type and/or ivision, need to need Even if all recommendations are enacted are recommendations all if Even Divisional/Supervisors’ contribut Divisional/Supervisors’ Failure of supervisors to provide Failure of supervisors this case, case, this could be influenced by funding levels. funding by influenced be could D within divisiveness creating of risk may impact either which areas to support and/or level of s of level and/or support to areas which either impact may faculty junior more favor to need may support Departmental and/or enrollees of SSTP selection The members The This This and shortfall and efforts -raising inassist any fund of SSTP graduates at 1 and 5 years in practice in years 5 and 1 at graduates of SSTP research The one of in year research and Orthopaedics Once enrolled/y number SSTP SSTP the such of as graduates the of of success measures gap. gap.

2. 1. 2. 1. 16. 14. 15.

RISKS TO THE PLAN THE TO RISKS OTHER ISSUES OTHER

Department of Surgery, Faculty University of Medicine, of Toronto

264

Appendices Appendices 265

6 Self-Study Report, External 2020 Review |

8 2017/1 – /10 Department of Surgery, Faculty University of Medicine, of Toronto Surgeon Scientist Training Program Funding 2009 Funding Program Training Scientist Surgeon

Figure 1

-2018 2002 Enrollment Enrollment Self-Study Report, External 2020 Review | -2018 1983 from received Degrees 2018: Survey Graduate SSTP SSTP Surgeon Scientist Training Program Program Training Scientist Surgeon

. 3.

Figure Figure 2 Department of Surgery, Faculty University of Medicine, of Toronto

266

Appendices Appendices 267

8 of

he $6000 $6000 x The The 000 000

. ,

and an and ,

additional additional )

. Any $658 =

428 428 the collective collective the additional cost cost additional /yr $15,000 Self-Study Report, External 2020 Review 13, |

and benefits. T benefits. and $ -

terms of reference of reference terms The The =

. 60 enrollees the /below this number that this number /below Tuition is is Tuition . 000/49 5K/resident/yr , al costs al difference between between difference the of is rising. rising. is

of PGY salary of matching matching

% 50% by

(going 48 to from (going $500 $500 of range value a

Department in the SSTPin the

contribution of contribution

. with total total

mandates the application to this program and and program this to application the mandates s PhDs for the SSTP residents SSTP the for For every resident above resident every For

tuition ward offset offset D). f the of external all years for tuition award. 20 enrollees 20 a h of 11 = 49 supervisors. $658 supervisors. 49 = -11

/P c with number of number cost MOHLTC funded first year. Thus additional cost of 7 of cost additional Thus year. first funded -MOHLTC process providing one year one providing process ivision. the

The Department Department The based on Divisional . D

competitive competitive

10 additional residents, respectively residents, additional for per 1-10 -20K year $2 000; cover cover ,

The PGME provides approximately

and/or and/or :

competitive $300 –

Department of Surgery, Faculty University of Medicine, of Toronto (i.e. 50/50 mix of MS of mix 50/50 (i.e.

000 000 , for additional residents, additional residents, for

supervisor by the the Department by SSTP residentSSTP

, d help help to discipline/research SSTP difference in PGY salary and benefits in PGY salary difference program . $30K/year the 68K/yr the . 18/19 $ and/or the

resident provide 20

000 = $958 = 000

, for for

cost estimate may be low because the the because low be may estimate cost

$496 assume

supervisor supervisor , costs are costs , Division, ,

funds are available to SSTP to available are funds Fellowship/Scholarship Departmental

. 000 + 000 +

additional additional 2018/19 $462

Appendix 1 Appendix SSTP THE FOR FUNDING program Scholarship Clinician/Graduate

years in years 3 of average funding each year. year. each funding a is Program Investigator Clinician The external funding and the PGY salary including benefits and and benefits including salary PGY the and funding external supervisor estimate may be high because of external awards. external of because high be may estimate This This additional costs additional Assuming remainder of supervisors equally bore cost, 60 cost, bore equally of supervisors remainder Assuming = Department makes up up makes Department by scale sliding a in cost raise/lower would Based non on in 2017/18 were residents mix 18 of , 7 remaining Endowed Endowed cost beyond cost beyond CALCULATION OF ADDITIONAL COSTS For responsibility of the of responsibility the endowed fund with fund endowed the residents in Cardiac Surgery, Neurosurgery, and General General and Neurosurgery, Surgery, Cardiac in residents for benefits and salary year first provides MOHLTC The Surgery s are Award Educational Medical Postgraduate

9 Self-Study Report, External 2020 Review |

2 Appendix Department of Surgery, Faculty University of Medicine, of Toronto

268

Appendices Appendices 269

10 Self-Study Report, External 2020 Review |

Department of Surgery, Faculty University of Medicine, of Toronto

11 Self-Study Report, External 2020 Review |

hair)

Gallinger

Anne Moulton-Anne n Carol James Wright (C Wright James Chris Ahuja Steve Whyne Cari

3 Appendix MEMBERS FORCE TASK SSTP Department of Surgery, Faculty University of Medicine, of Toronto

270

Appendices Appendices 271

Self-Study Report, External 2020 Review |

)

Surgery

, Faculty of Medicine, UofT of Medicine, , Faculty

Associate Dean, CIP Department of Surgery, Faculty University of Medicine, of Toronto Executive (former (former

, Chair, Division of Cardiac Surgery Cardiac of Division Chair, , , Vice Chair Research, Department of Surgery of Department Research, Chair Vice , l l , Chair, Division of Orthopaedics of Division Chair, , , Chair, Division of Neurosurgery of Division , Chair, , Chair, Division of General Surgery of General Division Chair, , , Chair, Division of Thoracic Surgery Thoracic of Division Chair, , , Chair, Division of Plastic and Reconstructive and Plastic of Division Chair, , , Business Manager, Department of Surgery of Department Manager, , Business , Chair, Division of Urology of Division Chair, , , Senior Development Officer, Department of Surgery/Faculty of Medicine of Surgery/Faculty of Department Officer, Development Senior , Vascular Surgery of Vascular Division Chair, , ano , Research Program Manager, Department of Surgery Department Manager, Program , Research z , Chair Department of Surgery Department Chair , eco i Rosenblum

an Neil Fleshner Chris Forrest Ferguson Peter Carol Swallow Carol Tom Waddell Tom Forbes Gr David Glen Vane Arsd Andres Lo Val Cabral Surgery Surgery of Department Michael Fehlings Research Committee Research Surgery of Department Norm Jim Rutka Nancy Condo

14. 12. 13. 15. 16. 9. 10. 11. 8. 3. 4. 5. 6. 7. 1. 2.

Appendix 4 Appendix INTERVIEWED GROUPS AND INDIVIDUALS OF LIST

Hospital Surgeon-in-Chief representative) (or incumbent will receive appointment (for Surgeon-Investigator or Surgeon-Scientist) Surgeon-Investigator(for or Surgeon- Scientist appointments) appointments with major teaching appointments) unit other for appointment descriptions (e.g. surgeon-ethicist,surgeon-global health, quality improvement & patient safety) which incumbent may be cross-appointed unless the search is the for Hospital Division Head in which case the Hospital Surgeon-in- Chief will serve in the as role Committee Chair) division (ideally from same specialty) the Hospital’s Division Nursing) (eg. of Surgery representative) (or undergraduate, postgraduate, resident fellow) or Representative the of Research Institute where Vice-Chair Research of representative) (or Vice-Chair Education of representative) (or (for Representative from appropriate academic Representative from SGS Department in Hospital Division Head (Committee Chair, Additional representative(s) from the hospital At least non-physician one working with University Division Chair representative) (or Chair the of University Department Student representative (may include Representative of senior hospital management

9) In addition, the search committee include: MAY 1) 2) 3) 4) The Search Committee itself must reflectbroad a diversityof backgrounds including race/ethnicity and gender. 1) 2) 3) 4) 5) 6) 7) 8) Self-Study Report, External 2020 Review |

Department of Surgery, Faculty University of Medicine, of Toronto primary appointment of the position. As per the Department Surgery of Search Committee Composition Guidelines, membership should include: research institute appropriate or academic unit, administration and student Committee body. membership must the by be Chair approved theof University Department Surgery of and the Hospital Surgeon-in-Chief the for Committee Composition The composition the of Search Committee must be broad and include representation from all stakeholders including hospital, university, the University’s Statement Institutional of Purpose, the University’s academic plan as from approved time to time, and, as appropriate, Departmental and Divisional academic priorities and special needs. on theon broad and best long-term interests of the University and that every decision will be considered relative to this framework. Furthermore, all proceedings must adhere to the appropriate FacultyUniversity Toronto of Medicine of policies. Committee members should keep firmly in view enhancing strengths in fields whichfor we are already distinguished while striking in out new intellectual directions currently not well represented. The primary focus the of search committee is Faculty searches arecrucial a activity and provide a chance to attract the broadest talent pool in the identificationof futurecolleagues. Each search also provides a strategic opportunity to reshape the faculty, offering the twin possibilitiesof Department of Surgery Best Practices for Conducting Full Time Academic Faculty Searches Faculty Academic Time Full Conducting for Practices Best Surgery of Department Search Committee Principles APPENDIX BAPPENDIX

272

Appendices Appendices 273 Self-Study Report, External 2020 Review | for a givenfor opinion, and to provide that to the rest theof committee presenting when view. one’s process, committee members will be expected to focus consistently and continuously on favourable and unfavourable views a candidate. of any basis as listed in the Ontario Human Rights Code. These include: Race, ancestry, place origin,of ethnic colour, origin, citizenship, creed, sex, sexual orientation, age, record offences,of marital status, family status, and same-sex partnership status. Furthermore, diversity candidates of should be encouraged and applications from welcome visible minority group members, women, Aboriginal persons, persons with disabilities, members of sexual minority groups, and others may who contribute to further diversificationideas.of comments and on assessments of individuals, taking care to provide objective evaluation and/or clarificationof individuals’ strengths and areas for further growth exploration. or focus A member’s should be to identify the factual basis evidence or criteria and reviewing candidate files. Members are who actively not participating attendingor may from be removed the committee atthe discretion the of Chair. to the University community. The Chair should provide updates to Committee Members and other stakeholders Hospital (eg. Universityor Departments) the on progress theof committee at periodic intervals to ensure established timelines are being met. they personal a have bias against or for the suitability candidates. of Although this may not preclude a committee member having input during meetings, will it to help ensure frank and open discussion throughout the committee’s deliberations, and also to late help prevent disclosures that are prejudicial to a fair process since personal bias can create both unreasonably In assessing candidates throughout the search All discussions discrimination must avoid on Members are expected to offerconstructive The Chair isthe only the of committee voice Committee members must declare whether 7) 5) 6) 3) 4) : - Department of Surgery, Faculty University of Medicine, of Toronto Review candidates, of ranking of The initial meeting the of Search (and subsequent meetings(and asneeded)

must remain committed to their obligations to participate actively in the process by providing input into job description/selection to attend every meeting in person by or teleconference. Input from each committee member is valued and is important to the functioning the of entire committee. Furthermore each committee member the completion the of search and selection of the successful candidate. In the case serious of breach confidentiality, of committee the may be dissolved and committee a new appointed. completely confidential. Further discussion outside committee meetings may only take place between committee members. Emails regarding confidentialcommittee discussions should be discouraged. This confidentiality extends beyond Committee members are expected to commit All discussions within the committee must be 2) rules. The following criteria must be adhered to: 1) The Chair is responsible effective for functioningof committeemeetings and establishing for the ground Committee Ground Rules discussion all of candidates, selection successful of candidate and rank-order list of candidates. Meeting 3 Interviews with debriefing after each candidate. The final interviewmeeting should include top candidates. interview of Development question list and assigning to committee members. Meeting 2: candidates, and a short of development list theof committee members regarding the potential list candidates; of Establish (5) a reasonable timeline the for subsequent meetings. (3) Establish(3) ranking criteria appendix (see Solicit initial (4) example); 1 for inputfrom committee ground Review rules (2) below); (see descriptionthe job/position as prepared the by Chair to present to the committee below); (see Meeting 1: Committee Establish should be used (1) to: Formulation of Search Plan surgeon-investigator, surgeon-teacher, etc.) academic rank academic classification job (surgeon-scientist, area clinical of expertise area research of expertise teaching commitment administrative commitment background/experience sought personal qualities sought

not a passivenot process. Search Committees should think creatively and proactively work to recruit candidates; Simply placing ads will produce not the applicant pool desired. At the time the of inaugural committee meeting, the Chair should solicit initial input from committee members regarding potential advertisement and should include local, national international e-mail dissemination, journals, posting national on and international organization websites and other web-based platforms. The position description should specify, as is appropriate: ------Generation of List of Candidates Review and of Candidate List Generation the of candidate list should be an active Job/Position Description A broad position specificationmust be developed from wide consultation and identifies institutional divisional/departmentalor needs the for next several years, as well as the relevant qualities successful candidates require in that context. It should be expressed in languagethat is as concrete and specific as possible so thatprovidesit a clear pointreference of againstwhich to measure candidates. The description job should avoid characterizing any search as a “replacement” a departedfor retired or faculty member as the search is an opportunity growth for and Thedevelopment. committee should decide a priori what is “required” and what is “preferred” in terms potential of candidates qualifications. Language used in the description job must be inclusive and open to all potential candidates. As part theof initial discussion regarding description, job a plan must be developed regarding widespread Self-Study Report, External 2020 Review | The Chair administrative or designate select circumstances, Search Committee recommendations may be advisory to the Chair. must keep document summaries all of discussions at all committee meetings. should be made based consensus. on In the position; the field is deemed unsatisfactory theby committee; and a determination is made that the Chair shouldapproach the committee member to reconsider and enter the process. should be discouraged, as these candidates will almost always raise concerns about fairness and process.due Exceptions may be made in those instances where a committee member was seen as a candidate early in the process did but seek not identified as a candidate, member the should resign from the committee as soon as possible in order to not compromise the process. Declarations candidacy of committee by members after the process is well advanced candidates. Committee members are asked to refrain from informal reference-checking, unless they are specifically assigned the task theby Chair the of Search Committee. Committee may take into account factors such as the importance consultation of with key stakeholders, sources for informationregarding past administrative, teaching and scholarly accomplishments, statements from short-listed candidates themselves and interviews with and diligence due should be planned and executed systematically at the appropriate time in the search process. In developing an approach appropriate to the search, the the skills, relevant experiences and other key attributes in the agreed position specification. Ideally decisions the of committee In instances where a committee member is Thorough and rigorous reference-checking Department of Surgery, Faculty University of Medicine, of Toronto 11) 10) 9) 8)

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Appendices Appendices 275 Self-Study Report, External 2020 Review | Chair must make every effort to ensure that this consensus can be reached, in but general Search Committee recommendations are advisory to the Chair. If there is significant discrepancy in opinion amongst members the of committee then the committee may request the Chair to obtain additional information including references, or to invite candidates a second back interview. for If the committee decides that candidates no meet the criteria then the process will revert back to the process identifying of potential candidates from the longer list that was established, beyond. or The Chair must inform the successful and unsuccessful candidates as soon as possible after the final decisionof committee. the interview should be between 30 minutes to an hour minuteswith 10-15 dedicated to the candidate presentation and the remaining time dedicated to questions. Each committee member should have the opportunity to ask his/her designated question. At the end the candidate should be afforded the opportunity to ask any questions the of committee. Finally the candidate should be given an idea as to the timeline the of decision process final for selection. Potential candidates must be updated regularly the by Chair as to the progress the of interviews, especially if there are changes to the schedule that may delay the final decision. Selection of Candidate After all interviews been have completed, the committeemust review the candidates and to decide the on successful candidate and an alternative as needed. This decision must be made in light theof description job and search criteria. The Department of Surgery, Faculty University of Medicine, of Toronto to the department’s climate or Divisional priorities Quality reference of letters Ability to make a positive contribution Ability to be a conscientious department citizen Confirmed interpersonal skills and attitudes Scholarly impact Research productivity Demonstrated teaching ability Commitment to collaboration with colleagues Alignment with Departmental their academic plan and their suitability the for position as well as answering questions. Each The interview must allow sufficient for time the candidatesto make a presentation describing future publications collaborations, or personal traits suitable the for position, academic/career plans. teaching experience, teaching interests, publication record, current and future research interests, current funding and potential future funding, ideas for The committee must a list develop questions of to be asked and responsibility each for question. Questions might relate Research to: experience, Effective Interview Process who were unsuccessfully shortlisted. be reviewed the by committee members and a short list between of 3 – 5 candidates should be considered. The Chair must inform individuals be mutually agreed all by upon committee members. See Appendix example 1 for of ranking criteria list. The applications should - Weighting the of individual components must ------established criteria which may include: - - The committee should then review the candidates’ application in light pre- of committee meeting, a finallong listof candidates should be finalized. The listmust be thorough and should contain representation from minority groups. reviewing conference proceedings, use networks, of and ensuringcandidates considered from come diverse backgrounds. At the time the of second various committee members the task contacting of nominators potential of candidates, reviewing editorial boards journals of to identify rising stars, candidates.The Chair should then designate to POOR FAIR NEUTRAL GOOD Self-Study Report, External 2020 Review | EXCELLENT & Divisional priorities Quality of reference letters and attitudes or to Commitment demonstrated collaboration Departmental with Alignment teaching ability of) (evidence for Potential scholarly impact skills interpersonal Confirmed CRITERION of) (evidence for Potential research productivity or demonstrated Potential Department of Surgery, Faculty University of Medicine, of Toronto Appendix – Sample B1 Ranking Criteria

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Appendices Appendices 277 2017 2017 2017 2017 2017 2017 2016 2016 2016 2015 2015 2015 2015 2019 2019 2019 2019 2019 2018 2018 2018 2018 YEAR Self-Study Report, External 2020 Review | CATEGORY Teaching – Sustained – Sustained Teaching Excellence Sustained Teaching performance – small performance – small group Dev’t & Use of Innovations Educational Course/Prog Dev’t & Coordination Performance, Teaching & AdvocacyMentorship & Development Innovation & Development Innovation & Development Innovation Performance, Teaching & AdvocacyMentorship Performance, Teaching & AdvocacyMentorship & Development Innovation Excellence in Community-Based Undergraduate Teaching Linking Undergraduate Research to Teaching – Teaching Individual Clerkship Foundations Individual Teaching

Department of Surgery, Faculty University of Medicine, of Toronto AWARD Excellence in Postgraduate Education in Medical Excellence Postgraduate Education in Medical Excellence Community-Based Teaching in Excellence Community-Based Teaching in Excellence Year the of Mentor -Regional College Royal Award Excellence in Postgraduate Education in Medical Excellence Postgraduate Education in Medical Excellence Postgraduate Education in Medical Excellence Postgraduate Education in Medical Excellence Postgraduate Education in Medical Excellence Excellence in Undergraduate Teaching in Life Life in Teaching Undergraduate in Excellence Sciences Awards Aikins Awards Aikins Awards Aikins Awards Aikins David Fear Fellowship Fellowship Fear David David Fear Fellowship 2017 Innovation Silver Ivan David Fear Fellowship 2017 Innovation Silver Ivan Innovation Silver Ivan Life in Teaching Undergraduate in Excellence Sciences LAST NAME Ahmed Grantcharov Di Pasquale Wanzel Fehlings Ferguson Lipa Wadey de Montbrun Kulkarni Agur Quereshy Roche- Nagle Simpson Ballyk de Montbrun Jackson Ashamalla Devon Farhat Yasufuku Morshead

FIRST NAME Michael Dennis Kyle Abhaya Najma Teodor Joan Veronica Sandra Barbara (Dee) Barbara Peter Fayez Graham Jory Kazuhiro Cindi Ann Sandra Timothy Shady Karen Walid

APPENDIX CAPPENDIX 2015-2019 Surgery of Department the in Winners Award 2017 2017 2017 2017 2017 2017 2017 2016 2016 2016 2016 2016 2016 2016 2016 2016 2016 2016 2015 2015 2015 2015 2015 2015 2015 2015 2015 2019 2019 2019 2019 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 YEAR CATEGORY Postgraduate Teaching Undergraduate Teaching Undergraduate Teaching Undergraduate Teaching Undergraduate Teaching Undergraduate Teaching Postgraduate Teaching Postgraduate Teaching Postgraduate Teaching Postgraduate Teaching Self-Study Report, External 2020 Review | AWARD Order of Canada Order of Canada Order of Canada Order of Canada Order of Canada Order of Canada Order of Canada Order of Canada Fame of Hall Medical Canadian Services Medical College/Associated Royal Award Wilson R. Donald D. R. Wilson Award Wilson R. D. Award Wilson R. D. George Armstrong-Peters Prize George Armstrong-Peters Prize George Armstrong-Peters Prize George Armstrong-Peters Prize George Armstrong-Peters Prize Arbor Awards Arbor Awards Arbor Awards Tovee Awards Tovee Awards Tovee Awards Tovee Awards Tovee Awards Tovee Awards Tovee Award Wilson R. D. Award Wilson R. D. Award Wilson R. D. Award Wilson R. D. Canadian Academy of Health Sciences- fellow Sciences- Health of Academy Canadian fellow Sciences- Health of Academy Canadian 2015 Award Provan John and Equity Health for Award Robert Sheppard Social Justice Society Canada of Royal the of fellowship Awards Tovee Awards Tovee Awards Tovee Awards Tovee Canadian Academy of Health Sciences- fellow Sciences- Health of Academy Canadian fellow Sciences- Health of Academy Canadian fellow Sciences- Health of Academy Canadian LAST NAME Rutka Daar Johnston Lozano Tator Tymianski Taylor Waddell Langer Ahmed Isaac Yan de Montbrun O'Brien Yang Zhong Cypel Ballyk McKneally Langer Pierre Kulkarni Brown Stewart Azzie Tien Richardson Perlus Murphy Greenberg Weizel Klotz Christakis Dare Dirks Simpson Moussa Hall Di Pasquale Jeschke Davis Urbach FIRST NAME Bernard Najma Andres Charles Michael Bryce James Martin Bernard James Abdallah K. Wayne Catherine Victor Toni Marcelo (Dee) Barbara Matthew J. K. Hanmu Sandra Robert Goeges Homer Berger Ryan Jeremy Dennis Andrew Abhaya Mitchell Anna Peter Jory Fuad Karen David Richard Laurence George Marc Department of Surgery, Faculty University of Medicine, of Toronto

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Appendices Appendices 279 2017 2017 2017 2017 2016 2016 2016 2015 2015 2015 2015 2019 2019 2019 2019 2019 2018 2018 2018 2018 YEAR Self-Study Report, External 2020 Review | CATEGORY Department of Surgery, Faculty University of Medicine, of Toronto AWARD and Investigator Award Surgeon Resident Outstanding Fazel S. Shafie and Investigator Award Surgeon Resident Outstanding Fazel S. Shafie and Investigator Award Bryce Mentorship Award Taylor Bryce Mentorship Award Taylor Bryce Mentorship Award Taylor Award Achievement Lifetime Lavina Lickley Surgical Skills Centre DH Gales Outstanding Outstanding Gales DH Centre Skills Surgical Educator Award Outstanding Gales DH Centre Skills Surgical Educator Award Outstanding Gales DH Centre Skills Surgical Educator Award Surgeon Resident Outstanding Fazel S. Shafie and Investigator Award Surgeon Resident Outstanding Fazel S. Shafie Charles Tator Surgeon Scientist Mentoring Mentoring Scientist Surgeon Tator Charles Award Mentoring Scientist Surgeon Tator Charles Award Mentoring Scientist Surgeon Tator Charles Award Outstanding Gales DH Centre Skills Surgical Educator Award Charles Tator Surgeon Scientist Mentoring Mentoring Scientist Surgeon Tator Charles Award Shafie S. Fazel Outstanding Resident Surgeon Resident Outstanding Fazel S. Shafie and Investigator Award Surgical Skills Centre DH Gales Outstanding Outstanding Gales DH Centre Skills Surgical Educator Award Charles Tator Surgeon Scientist Mentoring Mentoring Scientist Surgeon Tator Charles Award Royal College/Associated Medical Services Medical College/Associated Royal Award Wilson R. Donald LAST NAME Mansouri Lipsman Nathens Baxter Greig McLeod Kulkarni Cohen de Montbrun Wallis Witiw Swallow Al-Omran Grantcharov Wheatcroft Drake Wilson Hall Fremes Ferguson FIRST NAME Nancy Paul Robin Nir Avery Christopher A. Sandra C Mark Abhaya Gideon Mohammad Teodor James Carol J. Jeremy Stephen Stephen Peter

Department of Surgery, Faculty of Medicine 149 College Street, 5th Floor Toronto, Ontario, Canada M5T 1P5 T +1-416-9782623 | F +1-416-978-3928 [email protected] | www.surgery.utoronto.ca