Clinicians working in the McGill hospital network or,for that matter, any of the academic networks in the Province, will readily attest to the dramatic shortage in physician manpower that has increased enormously the burden on those who continue to work in the system. At the same time, while emer- Manpower Crisis gency procedures are provided and performed in an appropriate time frame, it is clear that those less ur- gent and elective have acquired long waiting lists of in- creasingly disgruntled patients. In certain instances, the shortages in specific specialties, such as anaesthesia, has a major impact on all other surgical and even medical spe- cialties, in a not surprising domino effect. Nor is this short- age confined to Quebec: the Provinces of Alberta and Saskatchewan have been recruiting physician manpower from South Africa while Newfoundland is reportedly seek- ing to "import" family physicians from Cuba. While the Canadian population remains steadfastly in favour of the Dean Abraham Fuks Canada Health Act and Medicare, which has obtained in the public imagination an iconic luster similar to that of the Con- stitution in the United States, nonetheless, a number of editorialists have begun to nip away at the margins with suggestions that the increasing visibility of a second tier of medical care in Canada will bring relief from the various ills that affect our ~ ...... (please...... see.... Manpower,...... pg. 5) -::::s Manpower Crisis 1 Achievements Residents and Fellows 19 ~. Letters to The Editor 2 Award to Dr.Martin Entin 20 =- Editorial 3 TSDAResident Research Award 20 DEPARTMENT OF SURGERY Upcoming Events 4 The Y2K Iceberg 21 The Kingmed Artificial 8 The Seigniory Club 24 NEWSLETTER MUHC Director of Nursing 8 New Canadian Arthritis Network 25 McGill UNIVERSITY Canada's New Blood Supply System 9 Professors 26 Surgical Research News 10 Obituaries 28 SPRING 1999 Better Times Ahead 12 Vision for the Future 29 Alan Turnbull Runs Marathon Marathon 13 Dr. Harvey Brown 29 Chairman's Message 14 Dr.R.C.-Hhiu 31 Dr.J.L. Meakins Announces New Appointments 15 Dr.Mostafa Elhilali 32 MUHC Breast Centre 16 Dr.Jonathan L.Meakins 34 Royal College Meetings New Format 16 Dr. Ron Lewis 35 Patient's Comments 17 Dr. Ron Zeit 37 Kudos 18 Dr.Lawrence Rosenberg 38 THE SQUARE.. ~ 2

Dear Editor: section (similar to McGill News - I think it Dear Editor: I have been following McGill's news and is called "Where are they now") so that we You are doing a wonderful job with the the Department of Surgery. I enjoy read- can keep up to date with the progress and Knot. I particularly enjoy the old? photos. ing the Square Knot. Just to update you, placement of our surgical alumni. A good idea. I stopped doing cardiac I have been appointed on January 1st, Andrew Hill, M.D. surgery last summer and was accepted 1999 as the new Ottawa, Ontario into the BFA program at the Nova Scotia Chief of Surgery at School of Art and Design as a freshman ? Letters Dhahran Health this fall. Quite a refreshing challenge in to The Editor Center (500 beds). Dear Editor: thought processes, thinking in terms of In addition, I am Thank you for keeping me informed negative space, parataxis, chiaroscuro and the regional Director of ATLSin the East- through the years about the RVH via the so forth. I'm writing to get Stan Skoryna's ern Province. I have a few of McGill's Square Knot. I must confess I have ne- address. He was a role model for me graduates working with me including: glected you lately, but you know how I feel when I worked as a veterinarian for him Drs. Alauddin, Maglouth, Zahrani, Rasim about the hospital and its staff. It set me at the Donner Building in 1958. I would and Bin Siddiq. on a course which I have always enjoyed. like to drop him a note. Sincerely, My profession took a turn back in the early David A. Murphy I will keep you updated of my news. My '80's as my sports hobbies became more Halifax, Nova Scotia special regard to the staff. dominant and now it is a major part of my Ed's Note: Sameh 8arayan, M.D., FRCSC practice. Yes I am still practising and do- Dr. Skoryna's address was sent to David. Dhahran, Eastern Saudi Arabia ing elective surgery one day a week at the Lakeshore General Hospital Center. I rele- gate myself to my preferred surgeries and Dear Editor: those that I am best at. Thanks to Dr. Teddy Coutsoftides for a I would like to compliment you on the re- very generous contribution to the McGill cent number of the Square Knot (Fall'98). I attend and participate in four sports clin- Surgical Alumni and Friends. Ted is in Or- It has a varied choice of presentations en- ics as well as my main office in the south ange County, California. • hanced by the photographs demanding west one complex in Pointe Claire. I am memory researches. The coverage of top- also the attending surgeon at John Abbott ...... ical subjects is particularly well done: no College in Ste Anne de Bellevue and run a one could remain oblivious of what is go- weekly clinic there for the various injuries ~ Addendum ing on around McGill and the RVH. at the intercollegiate sports teams which · are twelve in number. I attend games and · RE: HONORARY FELLOWSHIPS - Congratulations again on the sustained often travel with the teams. ROYAL COLLEGE OF SURGEONS quality of the Newsletter. · OF ENGLAND Martin A. Entin, M.D. My son Michael is in his third year at · In the last issue of The Square Knot RVH,Montreal Bishop's University and my older son Mark (Fall 1998), there is on page 6, an ar- is in the RCMP serving in Vancouver, Be. · ticle on those Montreal surgeons who My wife Patricia is busy as an interior dec- · have received an Honorary Fellowship Dear Editor: orator. As well as having fond memories · from the Royal College of Surgeons of Keep sending the news. I enjoy reading of the RVH, I am greatly indebted to their · England. Dr. Donald R.Webster is fea- the latest events from the Vic and surgi- transplant team for keeping me alive to · tured and others mentioned who have cal environment. I did leave the Vic in function and appreciate these later years. · received this prestigious high honor in 1974 and still doing orthopedic surgery in I received my new heart in 1988. · the past are Drs. Thomas Roddick, Ed- N.B. Thanks and regards, · ward Archibald, Gavin Miller, Wilder Dr. Alban Hache So much for some news. I promise to · Penfield, and F.J. Shepherd. Dieppe, New Brunswick keep in touch and keep you informed. Best regards, It has been brought to our attention AI Legare that a recent honoree is Dr. Lloyd D. Pointe Claire Dear Editor: Maclean .• I have a suggestion for the Square Knot. It EDM might be nice to have an alumnus update THE SQUARE :z.. ~ 3

bleeding from? Today,the first diagnostic measure would be oesophago-gastroscopy. What a difference!

Minimal access surgery by laparoscopy as first developed by MILLENNIUM - Important SdenUfic Advan,,, gynecologists has been a fabulous technical innovation very T.As we approach the year 2000, everyone is preparing lists of much due to the development of fiber optic flexible scopes. the top personalities, discoveries and media events in the past year, century or millennium. Recently, the Editors of Science OPEN HEART SURGERY magazine chose the following as the most Ever since the work of Doctors F. John lewis and C. Walton Editorial important scientific advances of the past Lillehei, these have become among the most frequently done year: the expanding universe; circadian operations not only for heart defects, but also for ischemic ;: rhythms; potassium channel structure; cancer treatment and heart disease. These operations became a reality because of i; prevention; combinatorial chemistry; genomics; neutrino mass; the invention of the pump-oxygenator by the late Doctor John biochips; quantum physics; and molecular mimicry. Gibbon of Philadelphia. Perhaps in this section we should add o3: :::I I» the arrival of synthetic (Dacron and Gore-Tex) vascular grafts \D :r- I» The section on cancer treatment and prevention dealt with the which have revolutionized the practice of Vascular Surgery. ~ creation of a number of new powerful drugs such as Heceptin, Tamoxiphen and Raloxifene. INTENSIVE CARE Dr.Lloyd D.Maclean established the first SICUin Canada. With The whole exercise makes us reflect on the tremendous the concentration of highly skilled care by a multi-disciplinary achievements that have occurred in the care of the Surgical team, patients with complicated shock, trauma, infections, Patient. Which do you think are the most significant - say dur- multi-organ failures cannot only be studied but treated with ing our professional careers,since the year 1960? It is perhaps beneficial outcomes in these Critical Care Units. best to confine our study to this period and to Surgery in Gen- eral. Otherwise, we have to consider that, in the past two mil- PROSPECTIVE TRIALS lenniums, the most important inventions have been the The management of patients is no longer done in an empiri- contraceptive pill, classical music, the atomic bomb, the Hindu- cal manner. The Ancient Greeks believed that we could un- Arabic number system, the internet, anesthesia and even hay. derstand the world rationally. But the scientific method requires that we ask questions of nature by experimentation. So, in no particular order, here are our nominations: We have learned that the best way is by prospective ~

TRANSPLANTATION Ever since the pioneering work of Sir Peter Medawar, solid organ transplantation has had a major impact on the care of patients with heart, lung, liver, kidney, pancreatic and more recently small intestine diseases. It is noteworthy that Doctors Josephus C. luke and Kenneth MacKinnon performed the first kidney transplant in identical twins in Canada at the RVH in October 1958. In October 1963, the first kidney transplantations from cadavers in Canada began at McGill.

LAPAROSCOPY AND ENDOSCOPY We remember doing an Upper GI X-ray se- ries in a patient with hematemesis. The study would show oesophageal varices, a gastric ulcer and a duodenal deformity (ul- "The doctor will see you now, Mrs. Perkins. Please try not to upset him." cer or varix?), but where was the patient - The New Yorker THE SQUARE z... ~ 4

~ randomized trials and by Outcome Analysis. Look at COMPUTERS all the information that we have acquired from the NSABP not Though invented in the 1940's, (Thomas Watson, Chairman of only for the management of carcinoma of the breast, but also IBM is reported to have said in 1943, "I think there is a world ongoing for cancer of the colon and rectum. market for maybe five computers"). Computers have become part of our lives since the 1960's. This new technology in the NEW DIAGNOSTIC TOOLS storage and monitoring of data has greatly facilitated the re- Such a resume would not be complete without considering covery of information to care for patients on the wards, in the the advent of ULTRASOUNDand CT-SCANS. The presence of a OR,and in the Critical Care Units. Do you remember when we CT scanner in a hospital is no longer a luxury, but a necessity. had to call the labs for results at the end of the day? The abominal abdomen is not so mysterious anymore. An elective exploratory laparotomy has become a thing of the There are more but these certainly are, in our opinion, the most past. Our radiology colleagues are kept busy full-time carrying important. Just imagine what improvements will be recorded out these tests both in the "working up" of patients and in in the Winter Issue of The Square Knot in the year 2099! • their "follow-up" .

...... Upcoming Events

April 14-75, 1999 May 25-26, 1999 Sept. 6, 1999 E.J. Tabah Visiting Professor, RVH General Surgery Royal College, Vascular Royal College Exams, Toronto Dr. Michael Baum, Written Exams University College of London Medical Sept. 23-27, 1999 School, England May 27,1999 Annual Meeting Royal College of Fraser Gurd Day Physicians & Surgeons of Canada & Cana- April 15-17, 1999 Dr. Alden Harken, dian Association of General Surgeons, Annual Meeting of American Surgical Professor and Chair, Thoracic Surgery, Montreal Association, San Diego, CA Case Western Reserve, Denver Oct. 12-15, 1999 April21, 1999 June 3-4, 1999 16th International Conference Urology Research Day Stikeman Visiting Professor International Society for Quality in Health Dr. Kevin McKenna, Dr. Davis Drinkwater, Care, Crown Towers Hotel, Melbourne, Visiting Professor, Professor and Chair, Australia Department of Physiology and Urology Cardiac & Thoracic Surgery Northwest University, Chicago Vanderbilt University, Nashville Dec. 4-7, 1999 8th International Meeting of Laparoen- ApriI28-30, 1999 June 14-18, 1999 doscopic Surgeons, SLS Annual Meeting, Annual McGill Orthopedic Visiting Professor Orthopedic Royal College Exams - Ottawa Endo Expo '99, Sheraton New York Hotel Dr. James F. Kellam, and Towers,New York Vice-Chairman, June 19-23, 1999 Department of Orthopedic Surgery, Plastics Royal College Exams - Montreal April 9-14, 2000 Carolinas Medical Centre, Charlotte, NC Accreditation of all Programs, McGill June 21-23, 1999 Royal College Canadian College April29, 1999 General Surgery Royal College Oral Exams of Family Practice - CMQ McGill General Surgery Joint Rounds Osler Amphitheatre, MGH July 17-20, 1999 Fourth Biennial Conference May 22-23,1999 International Association of Medical Urology Royal College Exams - Ottawa Science Educators "Advances in Medical Science Education, Learning Modes and Teaching Strategies'; Georgetown Univer- sity Conference Center, Washington, DC THE SQUARE ..z 5:l 5

~ health care system. This is altogether regrettable, McGill uniquely.) It should be immediately obvious that the as the one silver lining in the physician manpower cloud is size of the input pool is a simplistic analysis of the problem. the fact that it is due in large part to concrete and specific It is important to understand how many physicians are leav- government policies, both federal and trans-provincial - ing in any given year and thus to understand the net change therefore, what is imposed by governments is reversible but of the physician manpower workforce in the country. The will require a united political effort if we first moderating factor is to note that of all the people who Manpower are to succeed. enter medical school, only a proportion end up in practice. (continued from pg.ll The study by Eva Ryten and colleagues' demonstrated the It is important to understand, as I will at- following: Ofthe 1,780 men and women who entered med- tempt to describe below, that the factors that have led to the ical schools due to graduate as the Class of 1989, 1,722 re- current shortage in physician manpower will lead to an ac- ceived a medical degree. When the subset was examined in celerating deficit, with a major manpower crisis in Quebec pre- 1995-96, only 90% of the successful graduates were active dicted for the year 2006 by none other than the College des in practice or residency training in Canada. Thus, the actual medecins du Quebec. Their voice is echoed by the Royal Col- yield seven years after graduation was in the range of 85 to lege of Physicians and Surgeons of Canada, in extensive pre- 90%. The loss to non-medical careers is less than 1%, un- sentations by the Association of Canadian Medical Colleges (in derscoring what is now being supported from independent particular through the analytic work of Ms. Eva Ryten1.2), the data from Statistics Canada, viz., that there is an increasing analyses and presentations of Professor Mamoru Watanabe of emigration of physicians from Canada. the University of Calgary, as well as other observers. Recall, however, that the loss from the physician manpower WHAT THEN ARE THESE FACTORS? force is not of recently-graduated physicians so much as in- First a little history: In 1964, a Royal Commission on Health dividuals who cease to practice in a term from 35 to 50 years Services chaired by Justice E. M. Hall' recommended a dou- after graduation. In fact, the decline begins rather quickly bling of the number of places for the study of medicine in with a loss of 10%, i.e. 90 down to 80, in the first 20 years, Canada in order to cope with the country's burgeoning popu- with an increasing slope such that a further 10% loss is seen lation. To achieve this, four new faculties of medicine were es- in the following decade and a further 10% down, to 40% by tablished and the other twelve, including McGill, were funded the year 40 post-graduation. Eva Ryten has made the clearly for considerable expansion by the provincial governments. intelligent point that the manpower loss will be "tuned" to This expansion had the anticipated and hoped for result, such the size of the graduating class and other input sources 35 that Canadian medical schools produced 1,700 graduates in years in the past. Therefore, the current annual loss should 1976, almost doubling the graduating class size of the early approximately mirror the graduating class sizes of the '60's 1960s. Rather than being a source for satisfaction, this result and so forth. Therefore, the departure rate is certain to dou- led to a new series of concerns that Canada might be head- ble over the next two decades, reflecting the increasing out- ing for a physician surplus and the same Justice Hall who put of Canadian medical schools from 1966 to 1985 as noted chaired the Royal Commission recommended in 1980 that a above. Thus, as Ms. Ryten points out, in 1960 there were 871 new study be carried out. In 1984, provincial governments medical graduates but only 471 MDs thirty-five years earlier, carried out such a physician workforce study and recom- for a net gain of almost 400 physicians. By 1974, there were mended enrollment reductions, rather than a stabilization of 1,560 graduates with only an expected loss of just under 500 the output pool. This was the result, in part, of the Barer-Stod- for a net difference of 1,000. In 1997, this differential had dart Report' and all provincial governments accepted these shrunk, with 1,581 new medical graduates, roughly the same recommendations. It should be noted that the ACMCissued number as '74, now, however, balanced by an anticipated de- statements, both in 19855 and 19W,pleading for a more con- parture of 854. Thus, based on simple actuarial projections servative response to the perceived new threat. Nonetheless, of sizes of graduating classes and even ignoring the dis- the "visible hand" of provincial governments intervened, dra- counted yields, the pure class sizes alone predict with a high matically reducing the intake size of Canadian medical schools level of confidence a negative trend by the year 2009, with from a peak of over 1,800 in 1985 to an intake pool that will the number of departures exceeding the number of new graduate fewer than 1,500 physicians from the year 2001 practitioners. onwards. In fact, McGill, whose class size peaked in the mid- 80s at 160, has been, over the last three years, admitting ap- However, a number of factors will clearly accelerate this trend; proximately 110 or 111 students. (I hasten to add that these cuts were imposed on all Quebec medical schools and not THE SQUARE,.. z 5l 6 ~ IMMIGRANT POOLS member this is not yet the low point of the decline). If this The number of landed immigrants to Canada who noted med- is the input side, what is the output flow? The CMA Physi- icine as their intended occupation peaked at the same time as cian Master File shows approximately 1,000 retirements our class expansion was proceeding. Thus, approximately and deaths as being the current rate. If we add to this the 1,000 landed immigrants in 1974 when added to the 1,560 net emigration of approximately 500 physicians and the in- Canadian graduates, meant a net input of 2,650. Hand in hand creased need of 700 per annum to look after the increased with the draconian cuts in entry class size, there was a dra- population size,we seem to have an outflow of 2,250 physi- matic and almost uniform restriction on immigration of physi- cians per year. This is a very serious net negative balance. cians to Canada. This has had quite a substantial effect. Thus, between 1974 and 1994, the numbers dropped from 1,000 to f) More worrisome are the projections for the next decade. As approximately 500 and in 1997, the number of landed immi- noted previously, the loss rate will increase substantially grants claiming medicine as their intended occupation, was and as I noted previously, has been projected as exceeding 245. When added to the intake of new graduates of that year 1,500 by the year 2009. If we in fact maintain our current of 1,577, the net intake of 1,822 is more than 800 "units" of medical school production size at less than 1,500 effective output (noting only an retention rate even at seven medical manpower lower than in 1974, and this is all in the 85-90% face of a population increase. years) and the emigration noted above, then Canada will be producing, if current trends are not dramatically altered by active governmental intervention, no more than a half to POPULATION GROWTH two-thirds of the required physician output to maintain In order to maintain self-sufficiency in M.D. manpower pro- self-sufficiency. Just for comparison, Canada, with 31 mil- duction, Canada would have to provide additional physicians lion people, producing 1,500 doctors per year, should be to match the burgeoning population. The projected growth compared to the United Kingdom, whose population of 58 rate of some 371,000 individuals per year between '96 and '06 million has led the government to recommend an increase suggests a need for approximately 700 additional physicians of medical school intake to the U.K. to 5,000 per annum'. per annum to meet the increased population size. That number should give us pause.

EMIGRATION Statistics Canada has indicated that the net emigration rate of Several further points are worthy of note. First, the "incuba- Canadian physicians has increased from about 378 in '96 to tion period" for the production of a physician from the be- about 550 in '98. ginning of medical school to the development of an independent specialist, is approximately 10 years, and a fam- Mamoru Watanabe has discovered an additional trend sup- ily physician, approximately 7 years. Therefore, in order to porting the Stats Canada numbers, suggesting that physicians, have any impact on our production rate of physician man- within 20 years of graduation, are leaving the labour force at power in the year 2006-10, we must take action NOW! The increasing numbers. Thus, he raised a concern that the actual ACMe, together with the Royal College, the College des slopes of loss were inordinately conservative and the deficit medecins, and other organizations, gathered together in the would be even greater than conservative projections indicate. Canadian Medical Forum, have been attempting to bring this point to the attention of the provincial ministers of health as WOMEN IN MEDICINE well as the federal minister, Mr. Allan Rock. Thus far, Quebec Dr. Watanabe has also suggested that the increasing number has initiated a manpower study and has stabilized the class of women in the profession might in fact exacerbate these de- size, i.e. halted the cuts. There is no indication yet of when clining trends. He has noted, and I believe there are CMA task an increase in the class size will be implemented. I should force data to support this contention, that women provide point out that although an increase in class size would lead fewer total years of work in a career path, given the time to to increased funding for the Faculty of Medicine, it would bear and rear children. This is an additional trend not easily also necessitate the rapid expansion of infrastructure needed parsed into the equation, but providing a further downward to teach additional medical students. You are all aware of pressure on size of the pool. the need of clinician manpower for teaching, in particular in the new curriculum, and the high demand of bedside and There are two simple calculations to close this section of the operating room education. This point has been made to the review. Government but thus far, with no concrete responses. o The current entry size is approximately 1,500 physicians per year based on 1997 numbers from the graduating class (re- It is interesting to note that we pay increasing THE SQUARE z:... ~ 7

~ attention to teaching our students, both at McGill The reason it is important to act quickly is that, as all of you are and throughout Canadian medical schools, the appropriate at- aware but governments sometimes forget, the incubation pe- titudes, skills, values and behaviors appropriate to Canada's riod of a specialist from entry to medical school to entry into multicultural population. We are sensitive to the quality of the practice is in the order of 10 years and a family physician in the training and hence, the product. It is not clear that immigra- order of 7 years. Thus, in order to have an appropriate medical tion, other than in exceptional circumstances from academic manpower pool for the year 2009, we must act today .• centres elsewhere, will permit us to maintain and increase the need for recruitment of academic clinicians. Therefore, for medical schools in particular, the need to be self-sufficient, i.e. train our own specialists, is critical. REFERENCES o E. Ryten, A.D. Thurber, L. Buske. The class of 1989 and It is also important to note that McGill, together with other post-MD training. CMAJ 1998;158:723-8. medical schools, has used recruiting from outside Canada as @ E. Ryten. None is too many - it's time to discard this an important source of academic talent. This cutback noted bankrupt physician supply policy for Canada. ACMC above by Government has been not only in medical school Forum 1998; 31(3):8-17. numbers but, as mentioned previously, in the ability to recruit @) Royal Commission on Health Services. Vol. 1. Ottawa: foreign medical graduates. Unfortunately, our need to recruit Government of Canada; 1964. Cat no Zl-1961/3-1. p.529. chiefs of departments and outstanding clinical scientists with o M.L. Barer, G.L.Stoddart. Toward integrated medical re- training in France, Switzerland, the United Kingdom, Australia source policies for Canada. Prepared for the and elsewhere has been dramatically hampered by the dra- Federal/Provincial/Territorial Conference of Deputy Minis- conian if not Kafkaesque policies of the Government. It is all ters of Health. Ottawa; 1991. part and parcel of a misperception of the overabundance of o Association of Canadian Medical Colleges. Comments on medical manpower. As a result, the four medical schools in physician manpower in Canada. Ottawa: The Associa- Quebec are permitted currently to recruit amongst them, only tion; 1985. 8 foreign medical graduates per annum. This is clearly insuf- o Association of Canadian Medical Colleges. Should Cana- ficient to meet our needs and we continue to make represen- dian faculties of medicine reduce the number of tations to the Government that I believe will be successful in places for the study of medicine? ACMC Forum 1991; lifting these restrictions. 92;25(1,2):1- 31. fj Wanted: 20 per cent more docs in Britain (editorial). Lastly, as you know, the number of residents in our pro- The Medical Post 1998 Mar 24; p.24. grammes is linked directly to the number of graduates in the Quebec medical schools. Thus, the decreased number of med- ical students has led to a decreasing pool of residency num- ...... bers over the last number of years. It is only by receiving · permission from the Government of Quebec to recruit foreign · medical graduates as residents and trainees that we have · PHYSICIAN'S REVENUES been able to cope with the dramatic cutbacks. Thus, a change · PROVINCE OF QUEBEC to one policy will improve all policies. · 1992 1996 1997 · ($K) ($K) ($K) The silver lining in all these clouds is, I believe, that the poli- · Total Remuneration $1,962,847 $2,079,586 $2,072,173 cies are about to change but require a concerted show of force. · (all modalities) I believe we will see the following over the next two years: · Number of Physicians 14,072 14,700 14,291 · • GP's 7,131 7,346 7,063 o A recognition, both provincially and federally, of this dra- · • Specialists 6,941 7,354 7,228 matic pending shortage of physicians. · Average Remuneration @ A call by governments to substantially increase the class • GP's $111,503 $117,412 $121,324 sizes of medical schools. · • Specialists $168,235 $165,506 $168,121 @) A lifting of restrictions on academic recruitment of foreign · Source: Annual Statistics medical graduates · Regie de I'assurance maladie du Quebec o A loosening of restrictions to recruit foreign physicians to · work in the community. · · THE SQUARE ...z 5: 8

artide ~views the 35th anniversary of the first 1.Canadian made artificial kidney recently placed in a medical history museum in Kingston, Ontario, and used for many years at the Royal Victoria Hospital. The Kingmed In 1965, I was privileged to spend Artificial Kidney a year with Dr.Andrew Bruce in the Queens Department of Urology. The year before, at McGill's Royal Victoria Hospital, I had the Dr. U.Douglas Ackman opportunity to see the revolutionary Kolff artificial kidney. This washing machine sized 100 liter device was a new Dutch action. To our pleasant surprise it functioned without a hitch, invention for dialysing patients with renal failure. It used a and was run on a regular basis thereafter. Needless to say, cellophane dialysis membrane. It was very large and I noted clinical trials of the sort required today were not done. that it was not able to keep a constant diffusion gradient; to optimize the third space effect. It seemed more efficient to After several weeks, we decided to attempt to manufacture establish a smaller 10 liter perfusion bath with a constant the artificial kidney. A financial partner was found and level of solute, maintained by a simple overflow drip of per- Kingmed Limited was established. Machines were manufac- fusate. The level of gradient could easily be maintained or al- tured and sold in Canada and the USA,before passing into the tered by changing the turnover rate in the bath. During my hands of an American manufacturer. The machines were op- resident term, I discussed this idea with Dr. Peter Morrin, the erated for many years at the KGHand Royal Victoria Hospital. Chief of Nephrology at K.G.H . About the same time, I met Mr. Fred Siemonsen, through my position as National Medical Di- Dialysis was smoother on the patient's fluid shift and there rector of the Canadian Ski Patrol. He was managing a machine were fewer blood-brain barrier symptoms. In addition, a cost shop started by his father. We got onto the subject of build- saving feature was the re-use of previously disposable perfu- ing a prototype of this dialysis machine and he agreed to help sion coils which were washed with chlorhexidine, rinsed and produce it. After several months, this remarkable person had re-used many times. This was appreciated by the descendants fabricated what looked like a working model. of Scottish settlers, running the hospital. It is remarkable that one of these 1965 machines survives today, and is being pre- At exactly that time, I received a late evening call from Dr.Mor- served at the medical museum in Kinsgton. • rin to see if the machine could be made available on an emer- C. F. Doug/as Ackman, M.D., F.R.C.S. (C), F.A.C.S. gency basis. We drove a pickup truck to the machine shop and Clinical Associate Professor, McGill University washed down the newly fabricated artificial kidney. This was brought to the K.G.H.in the middle of the night and put into ......

Valerie Shannon Appointed MUHC Director of Nursing

The appointment of Valerie Shannon as the MUHC's first Di- Mrs. Shannon, and the recently appointed Director of Profes- rector of Nursing was unanimously approved at the Novem- sional Services, Dr. Denis Roy, as two outstanding senior clin- ber 27 meeting of the Board of Directors. ical leaders. He added that the membership of the MUHC's Central Administrative team was now complete. • In making the announcement, Executive Director Dr. Hugh EDM Scott expressed his delight at the appointment, referring to THE SQUARE ""z ~ 9

Red Cross. Each of them requires many people to donate their time or a unit or two of blood.

"Canadians must and will have access to safe and adequate September 23,1998, the Canadian Blood supplies of blood, blood products and their alternatives, when- OnServices (CBS)took control of Canada's blood system except in ever and wherever they need them'; says Cranston. Quebec where that role has been assigned to Hema-Quebec. Restoring public confidence in the safety and security of For more information on Canadian Blood Services,or to find out Canada's blood supply sys- how you can get involved, please call toll-free at 1-888-462- tem is the top priority for 4056, or visit the CBSWeb site at: www.cbstb-btscs.com. Canada's New CBS,says its new Chief Ex- Blood Supply System ecutive Officer (CEO) Ed's Note: This information was obtained from the Canadian Lynda Cranston. Mr. Ken- Council on Health Services Accreditation .• Officially in Place neth J. Fyke is Chair of the EOM Board. CBS is a national, non-profit organization that features six important elements designed to result in a safer and more accountable blood sup- ply system for Canadians.

The first important feature is the structure and composition of the CBS Board, which has been designed to reflect and bal- HEMA-QUlIE<:- ance key blood system stakeholder interests. The Board in- cludes consumer, medical, technical, scientific, public health, and business community representatives.

CBSis assuming responsibility for 15 blood and 2 plasma cen- tres, as well as thousands of local blood donor clinics from the

...... THE SQUARE ""z 3 10 News From The McGill Division are truly exciting times and everyone is encouraged to partic- ipate actively. of Surgical Reseach -By Lawrence Rosenberg, M.D., Ph.D. Within the Division, the pace of activity increases. A new Ex- ecutive Committee will come into being this month to deal with issues that transcend the graduate program and that concern all of us in the Department. We need to establish a strong presence within the new MUHC (virtual) Research In- stitute, and this will mean growing stronger and becoming ell another MRCoperating grant deadline better integrated within the Division. I encourage everyone has come and gone - good luck to all those hearty souls who with an interest in research in the Department to send me have ventured out once more into the barren wilderness of their comments, suggestions, worries, or anything else that Canadian research funding opportunities. you feel we need to be dealing with at this time. The land- scape is changing quickly and we must be prepared to stay at Closer to home, the creation of the MUHC will soon begin to least one step ahead of the maddening rush. affect the way research is organized and conducted. The new Associate Executive Director for Research (a.k.a. Scientific Di- These are truly interesting if not somewhat chaotic times, but rector of the merged research institutes), Dr. Emile the opportunities are there to be seized. I invite the surgical Skamene, is finalizing plans to orient research around de- research community to come together with one voice to make fined axes. Researchers (and their clinical collaborators) are certain that Research in Surgery will have a definitive and being asked to review the current draft version of the plan and prominent place at the table of the MUHC. to indicate in which axis(es) they would like to reside. The three axes that should be of interest to most of us in surgery One example of the exciting research being conducted in the are Molecular and Medical Oncology; Infection, Immunity, In- Division is described by Dr. Steffen. + jury and Repair; and Cell,Tissue and Organ Engineering. These ..••...... •....•...... •...... •...... •••...... •••...... ••••......

"Back" To The Future siderably in the past fifty years. The percentage of senior cit- ORTHOPAEDIC RESEARCH LABORATORY izens in the overall population is increasing. Accompanying DIVISION OF ORTHOPAEDIC SURGERY, MCGILL UNIVERSITY this observed shift in age demographics is a drastic increase The Orthopaedic Research Laboratory was founded in May in the prevalence of medical ailments related to degenerative 1993 within the Division of Orthopaedic Surgery, and has changes in the musculoskeletal system. The aged human grown steadily since then. Today it has sixteen full- body, due to wear and decreased physical activity time employees from a variety of academic disci- levels, is more susceptible to such ailments. However, plines (surgeons, molecular biologists, engineers, seniors seventy and even eighty years old still could etc.), forming a competitive interdisciplinary re- have an excellent quality of life. The problem is so search team. The laboratory also has a large stake alarming that UNESCOhas declared musculoskeletal in academic education, with six Master's degrees diseases to be the primary health care concern of the (two jointly with other engineering disciplines) and next decade. three PhD degrees supervised and completed in the last three years. Traditionally the group has a core Spinal diseases, prevalent also in middle age, are the competence in spinal research. However, many of most costly reason for workman's compensation pay- the basic science research topics are equally relevant for other ments, and the second most common diagnosis for sick leave orthopaedic subspecialties, and the laboratory plans to diver- in the Western World. The lifetime probability of an individ- sify its activities in the near future. Presently there exist three ual requiring medical help for back pain is eighty percent. The main research streams: (1) intervertebral disc degeneration total cost to society for primary medical treatment and sec-, and repair; (2) bone graft substitutes; and (3) minimally inva- ondary insurance payments for back pain is estimated in the sive surgical techniques. United States alone at sixty billion dollars annually.

In the industrialized world, life expectancy has increased con- Today,spine surgery has a re-operation rate estimated THE SQUARE ""z ~ 11

~ to be as much as fifty percent. The Orthopaedic Re- tures to be used as a transplant to functionally replace the de- search Laboratory has developed research activities to explore generated intervertebral disc are being studied. Such alternative treatment methods. Instead of the symptomatic causative treatment methods would likely not only be treatment methods (e.g., spinal fusion to stiffen the joint be- cheaper, but also provide a long-term solution to the problem. tween adjacent vertebrae, partial removal for a herniated disc) used today to alleviate back pain, innovative molecular biol- The Orthopaedic ResearchLaboratory is supported by the Med- ogy methods which stop or even reverse the degenerative ical ResearchCouncil of Canada,The Arthritis Foundation, the Or- changes observed in the aging intervertebral disc are being thopaedic Research and Education Foundation, the Canadian investigated. Also, in-vitro engineered tissue and organ cul- Arthritis Network (NCE-Program)and the AO International Foun- dation. Its academic and industrial collabo- rations include numer- ous institutions in North America and Eu- rope. The group pub- lishes and presents internationally .•

Thomas Steffen, M.D., Ph.D. Director, Orthopaedic Research Laborator

......

Were You There? 1971 GIFT FROM WOMEN'S AUXILIARY - RVH The LIFE ISLAND made by Mathews Inc. Alexandria Va., was a "room within a room" ventilated by special filters designed to produce a sterile air flow. It protected the infection prone leukemic, transplant or burn patient from the outside envi- ronment and allowed normal nursing function to be easily carried out without gowning and scrubbing required for old- fashioned isolation room care. It was made of clear plastic curtains with nursing sleeves on two sides for patient care. Food tray was autoclaved and placed by a sterile corridor on to the patient's bedside table. The Life Island was donated by the Women's Auxiliary of the Royal Victoria Hospital to the Transplant Service.•

TheLife Island THE SQUARE i:! !:l 12 Emergency Rooms and by improving Day Surgery, would di- minish the length of OR lists. o Increase the numbers of beds in Long Term Care Institutions by 600. t may be that difficulties in the provision of Heatth (are o Provide the wherewithal so as to decrease waiting times for Iin Quebec "bottomed out" in 1998. This austerity was the re- elective surgery. This will be done by hiring additional per- sult of health care costs being slashed by more than 2 billion sonnel and by adjusting hospital budgets so as to allow more operations to be done. dollars by former Health The government's Info Health hotline will be expanded. This Minister Jean Rochon. o is the one that has been a success in answering all kinds of Better Times Ahead? But he himself became a questions relating to Health, but in the future, it will also Health Care cut as a re- take distress calls from depressed or suicidal patients. sult of the Provincial Election on November 30th. Though elected in his county by a slim margin he was transferred to These measures were welcomed by the Quebec Federation of another portfolio. (Remember that 10 hospitals were closed in Specialists as well as by the Quebec Federation of General Prac- the Province since 1995, seven of them on the island of Mon- titioners. It is felt that these measures will correct overcrowded treal including the Lachine General, the Reddy Memorial and Emergency Rooms, decrease ORwait lists and improve the care the Queen Elizabeth.) of the elderly. The Quebec Hospital Association is also pleased with this infusion of funds into Quebec Hospitals with empha- When the National Assembly resumed its sessions in early sis on care of the patients rather than on fiscal matters, struc- March, the new Health Minister, Pauline Marois, announced that tures and established dogmas. But Madame Marie-Claire "the era of painful cuts in Quebec hospital funding is over." Daigneault-Boudreau, president of the QHA cautioned that there is a lot of work to do. By March 31st, the accumulated In his budget tabled in the National Assembly on March 9th, deficit for Quebec Hospitals was $650 million. Finance Minister Quebec Finance Minister Bernard Landry allocated substantial Landry has allocated $700 million to erase these shortfalls. amounts to Health Care - $1.7 billion. One billion dollars will be for patient care and services. This includes 300 million for Dr. Hugh Scott, Head of the MUHC, is delighted with the hospitals which have kept within their budget ("they per- news that a huge burden may be lifted. Since 1995, the RVH, formed well") and 700 million for salaries, home care and ser- MGH, MCH and MNH have accumulated a deficit of $75 mil- vices for the elderly, and the mentally and physically lion - a crippling 19% of their $400 million operating bud- handicapped. We do know that the $13 billion a year spent on gets. For 1998 alone, they were $29 million in the red. It is health care (30% of the provincial budget) will be augmented hoped that this $29 million deficit will be eliminated in 2 by some of the $1.4 billion windfall in equalization payments years. So it looks like the future is brighter .• from the Federal Government. In spending for Health Care, EDM Canada is ranked 7th (tied with the Czech Republic) at 9.6% REFERENCE of Gross Domestic Product. The USAis first at 14.2% and China, o The Economist: World in Figures, 1999. Uganda, Trinidad and Tobago have the lowest health spend- ing at 3.8 to 3.9%'.

At a press conference given in Montreal on March 5th, Minis- ter Marois announced the following policies; o The government will intervene in the planning of hospi- tals affiliated with Universities. She seems to support the McGill super hospital but not the one for Universite de Montreal. The latter proposal may be dropped in favour of maintaining the 3 present pavilions at Notre-Dame, Hotel- Dieu and St-Luc. @ It is intended that more nurses will be recruited. The Que- bec Federation of Nurses has 47,500 members but 5,000 have retired or left the profession. @) The government will "accelerate" the establishment of Am- bulatory Care Centers in Hospitals. This would decongest "Budget Cuts" THE SQUARE ~ S 13

first group of people to ever have run a marathon on all 7 con- tinents. Obviously, Antartica was the most difficult. They sailed from Ushvaia on Russian research vessels specially built for An- tartic waters. Last summer they ran the African race in the Alan D. M. Turnbull, Attending Surgeon at Kruger National Park and this year they race somewhere in D.the Memorial Sloan-Kettering Cancer Center in New York has South America. That will leave them their final race, the 7th kept in shape by running marathon races and skiing in Mont- continent, which is already scheduled for the break of dawn, Tremblant. Alan who graduated from the McGill Post-Gradu- January 1st 2000 on the north island of New Zealand. As the ate Training Program in General world turns, that is one of the earliest places where the sun Surgery in 1967 was one of 32,000 will rise that day, and the race will be the first major athletic Dr. Alan Turnbull runners in the New York City event in the new millennium, anywhere in the world .• Runs Marathon Marathon last November 1st. They fOM were cheered by 2 million specta- Marathon tors, serenaded by .40 bands, hy- drated at 24 water stations and tinctured at two dozen medical stations. While New York is one of the world's great- est marathons, it is not one of the most ex- otic. In 1997, Alan ran in the Medoc Marathon in Bordeaux, France. The course winds through 53 vineyards and features wine stops at every mile. While the aver- age marathon offers water and gatorade, the Medoc marathon tempts with Lafite- Rothschild, Pichon-Longueville, Latour and Mouton-Rothschild.

Last January, Alan ran in the Antartic Marathon. The course stopped at the vari- ous research stations from Chile, Ecuador, Russia, Poland, Argentina etc. ending at the Chinese Base where they were welcomed Dr.Alan Turnbull with friends at the half-way point the Antartic Marathon. He is wearing his with tea, rice and souvenirs. The snow and of Memorial Sloan Kettering CancerCentershirt over dual-layered running gear. ice were on the first third of the course, on a glacier. Since this was their summer the course was largely mud and slush and the temperature above o°c.

The purpose behind this was to become the THE SQUARE z... S 14 Chairman's Message changes to the operating rooms to do this work. - By Johanthan L. Meakins, M.D., D.Se., F.R.C.P.C., F.A.C.S. The Trauma Program is unexcelled. New recruits in Or- thopaedics and General Surgery have re-energized the entire The first annual general meeting at the MUHC took place on program despite our desperate shortage of a crucial human January 27, 1999. The following were Dr. Jonathan L. resource, the anaesthetists. Advances in technology have al- Meakins' remarks: lowed Ophthalmology to maintain and increase its volume of cataract surgery while becoming the centre for retinal surgery Ladies and Gentlemen, entirely in the same block of operating time. It is an honour and pleasure to participate in the First An- nual General Meeting of the MUHC. Key words are First and Somehow, we have maintained the number of OR minutes Annual as we are participating in the birth, growth and de- with a small decrease in total number of cases. velopment of an extremely impor- How have we managed? The management module com- The MUHC's First Annual tant process which bines a collaborative approach at every level specifically General Meeting will permit us to Surgery and Nursing for all surgical services: Surgery, Nurs- continue to deliver ing and Anaesthesia in the OR and all in the Intensive Care Takes Place the quality of care together with the intensive care specialists. All are required to our community as we are totally interdependent. We call this "Co-Gestion" that it has come to expect. You would think or partnered management. that I would be the last to want to move to the Glen Yards. My family has been at McGill Using this approach, involvement of all professionals, in de- hospitals almost continuously since 1904 and veloping preadmission clinics, day surgery, same day admis- since 1924 in positions of responsibility. I am sion, has permitted bed closures but no decrease in services at the tail end of my career. Why ask for the delivered. Indeed, we are doing per site, 15-20% more cases agony of implementing dramatic and radical than in 1990. Over 45% of surgery is now Day Surgery and change? So why do it? our target is 60%. However, I do not think we can do it in our present plants even with planned renovations. Today, a pa- It is the premise of the Surgical Department Dr.Jonathan L. Meakins tient goes to preadmission, then to x-ray, often to cardiology, that the creation of the MUHC and the move respirology, or endocrinology; back to preadmission all taking to the Glen Yards will allow us to provide days to weeks, not counting the hours they spend wandering MOREservices not less,and those in keeping with the clinical, about lost. The day of surgery the patient goes to admitting technological and pharmacological advances in our peer coun- office, ward and OR. Given our plant and considering the el- tries. Frankly, these institutions are accustomed to being in evators - hardly patient friendly - we cannot do better. the forefront of clinical advances and in many areas. Within our present buildings, we have reached a limit of where sur- The lifetime of a hospital is 20-25 years. The centre of a Sur- gical services can go. You should know that the life of an gical Service is the operating room - ours (RVH, MGH) were American hospital is 20-25 years when it is replaced as non- built in the 50's and are several cycles out of date. Indeed in functional and ill-suited to the continual changes in the de- one building, the floor plate was too small when built and if livery of surgical care. you can imagine the need for video equipment, TV screens, the surgeon, assistants, anaesthetists, technicians, nurses and Vis-a-vis integration, we have started to see the benefits of de- instruments; there is hardly room for the patient. The explo- veloping a critical mass of experts on a single site providing sion in new minimally invasive techniques has revolutionized leading edge clinical care. The MUHCTransplant Program is the care. These Star War activities will be centralized at the Mon- largest in the Province having in 1998 transplanted the most treal General but I can only visualize, perhaps, creating two livers, 43; kidneys, 48; pancreas, 9; and hearts, 13; and over a operating theatre rooms to include the everyday support tools third of all donors in the Province. We are second to Toronto as required whereas we need at least 10-12. Some specialties a multi-organ centre. The Vascular Group has the most modern will do most of their work through small incisions using TV, vascular lab and a critical mass of surgeons providing service scopes and x-rays to guide their tiny instruments. across the 3 adult hospitals. They have started doing non-in- vasive aortic surgery, but to be state of the art need dramatic The MUHC, as an entity, underwent an accredita- ~ THE SQUARE ..z S 15

~ tion visit by the CCHSA. To summarize, they were cializations demands grouping of patients. The volume must amazed at the high level of care delivery in what were con- be adequate to ensure the level of understanding of the par- sidered a dysfunctional layout of the buildings. Particular ticularities of complex patients for ALL staff. Specialized areas comment was made concerning staff dedication. The CCHSA of surgery become more complex, a critical mass of all will pro- wondered how we could provide so much support to families vide the best care. The more of any problem one sees the bet- and were seriously concerned about this aspect of total care, ter we do. Integration will give our community the quantity as the simple cases go to day surgery or short stay and the and quality of care it deserves and to which it is accustomed. acuity of inhospital patients becomes more intense, will our ability to look after patients and their families become in- Uncertainty is frightening, so is change, but for the surgical creasingly compromised? This trend is exacerbated by the in- services, if we do not change and adapt, mediocrity is likely flux of the complex cases from surrounding hospitals. and that is an untenable. We have been reacting for too long and as an institution with its community, we need to drive the Can our respective adult hospitals do everything. Not any- agenda, to maintain our level of caring and clinical excellence. more. Increased complexity of inhospital care and sub-spe- That is what integration and the Glen Yards are about. • ......

Were You There? Dr. J.L. Meakins announces Royal College Exam 1965 New Appointments

THE ROYAL COLLEGE OF PHYSICIANS Dr. M.E. Elhilali AND SURGEONS OF CANADA Vice-Chair, Department of Surgery McGill University and MUHC Fellowship written examination in GENERAL SURGERY

Dr. D. Evans PAPER NO.1 Monday, September 20, 1965,9:00 a.m. Director, Trauma Program

SUBJECT Dr. P. Guy The Principles and Practice of GENERALSURGERY Clinical Coordinator, Trauma Three Hour Paper Answer any four questions. All of equal value. Dr. G. Fried Director, Minimally Invasive Surgery Each question to be answered in separate book. Chair, Committee on Standards of Present and Future Video- o Discussnon-penetrating wounds of the chest under the fol- scopic Equipment Across Sites lowing headings: a) classification Dr. J. Hinchey b) clinical features Director, Surgical Scientist Program c) treatment f) Describe the aetiology, clinical features and treatment of Dr. Phil Gordon non-malignant diseases of the colon which may produce Chair, Promotions and Tenure Committee obstruction. @) Discuss reflux oesophagitis under the following headings: Dr. M. Tanzer a) altered physiology Member, Promotions and Tenure Committee b) clinical features c) treatment Dr. S. Chevalier <» Discussthe aetiology, diagnosis and management of post- Member, Promotions and Tenure Committee operative pulmonary complications. o A 75-year-old male presents with an ulcerating lesion on the left side of the tongue. Describe the management of such a case. THE SQUARE !:i !:I 16

Cancer Research Initiative to develop and utilize a new version of the PEM instrument which will help better assessment of deep seated breast lesions closer to the chest wall and also to assessthe status of regional lymph nodes. McGill Uni,,""y Breast Center is a comprehen- Tsive academic center where breast surgeons, radiologists, One of our goals is to continue to develop and evaluate the pathologists, geneticists and other health professionals work role of new technology in women with breast pathology in together in providing diagnosis, treatment and support for the hope that smaller and earlier cancers can be found and women with breast better treated. pathology. Research, MUHC Breast Centre teaching and patient care A proposal and impact analysis for a McGill Breast Center to are an integral part of the be located at the RVH site has been developed. Several meet- center. At the present, it is located at two sites, the Royal Vic- ings of involved individuals, the latest in February 1999 have toria Hospital (RVH) and the Montreal General Hospital (MGH). helped clarify and solve some of the logistics of the merger. 13,000 women were seen in 1998. Since October 1998, the In the meantime our two sites (MGH and RVH) are proceed- Breast Center has been designated one of five referral centers ing functionally as one, the McGill Breast Center. for the new provincial breast screening program. Once a mammographic abnormality has been identified in any of the Given the designation of the MUHC Breast Center as a referral provincial screening centers, patients are then referred here investigation center, there is a real need to ensure that all el- for further investigations. As our two sites (RVH and MGH) are ements are in place for successful operation. Functioning at electronically linked and with the Regie Regionale Coordinat- two sites has been possible. However, a single site operation ing Center for the Screening Program, transfer of patient in- seems more practical, more efficient and better for patients formation is done promptly. Furthermore decisions about and staff. The Departments of Surgery, Radiology and Admin- treatment is also made without unnecessary delay, thus de- istration are committed to a successful single site operation. creasing patient's anxiety. In addition to research into teach- None of this would be possible without our generous bene- ing modalities for professionals and patients, evaluation of factors such as the Cedars Cancer Institute and the Montreal new diagnostic and therapeutic modalities are an important Breast Cancer Foundation, the Girls for the Cure (Montreal part of the mission of the center .. The development and ini- Girl's Private High Schools) and the Annual Carl Andersen run. tial evaluation of the new Advanced Breast Biopsy Instrumen- tation (ABBI) was done at the MGH. Positron Emission In summary, the emphasis of our center has been on the de- Mammography (PEM), a new technology adapting the livery of comprehensive care to the patients. It is time now Positron Emission Tomography Technology to the assessment to be more efficient by providing a "one-stop approach" at a of breast lesions is being done at the RVH with the help of a single new location thereby substantially reducing the wait- prototype instrument. In collaboration with Dr. Chris Thomp- ing time from the discovery of a problem to the time of di- son from the Montreal Neurological Institute as principal in- agnosis and treatment. • vestigator, a new grant has been submitted to the Breast ......

Royal College The Royal College of the Board and Advisory Council ratified a decision to Physicians and Sur- hold a separate CAGSAnnual Meeting as of the year To Change The Format geons of Canada have 2000. The proposal was to meet as a single organi- of Its Meetings changed the format of zation initially, but to encourage affiliation with the Royal College An- other surgical societies with relevant interests in nual Meeting which CAGS.The time, site, and nature of the proposed au- will be effective by the year 2000. In summary, the Royal Col- tonomous meeting are still under discussion. •

lege Meeting will be directed toward a single theme which fOM will be in the field of education. The meetings will be held annually in Ottawa and continue to be held during the month of September. At the Annual CAGSMeeting in Toronto in 1998, THE SQUARE z... !a 17 Patient's THE COLLEGEOF PHYSICIANS AND SURGEONS the O.P.S.O.discussed the most frequent complaints and how of Ontario like our own College des Medecins du they investigate these. Comments Quebec is very sensitive to patients' complaints and professional misconduct. A seminar was Here is a list of the most frequent: held at the University of Ottawa in October 1998. Two speak- ers, Dr. Gary Johnson, anesthetist and John Carlisle, registrar of

PATIENTS' COMMENTS ABOUT CONSULTANT'S ATTITUDE, SENSITIVITY, PROFESSIONALISM

About Clinical Examination Complainant's Feelings About Interview After Consultation Rough - Shoved, Squeezed, Pushed Didn't Listen To Me Belittled Excessive Force - Rapid uncomfortable Wouldn't Let Me Finish movements Put Down Annoyed I Couldn't Remember Details Painful - Insensitive to Discomfort Humiliated Didn't Believe Me Abrupt, Brusque - Cursory, Superficial Embarrassed Berated My Views and Personal Life Mean Attitude to Exam Scorned Dismissed My Questions or Comments Used Unsterile Pin Mocked Used Mocking Questions and Sarcastic Took Phone Calls -Interrupted Exam Demeaned Tone Left Me Unattended - No Explanation Interrogated Asked Irrelevant Financial/Personal Questions Didn't Explain the Examination Disparaged Confused Me With Other Patient Did Exam With His Young Child Present Dismissed Deceitful About Relationship With Provided No Feed Back During Exam Deceived Insurance Company Wouldn't Answer Questions Abused

Degraded Judgemental Comments Personal Aspects Of Exam Berated by Consultant No One Else Present Accused Me of "Faking" Remained in Room While Complainant's Impression Felt I Was "Cheating" Dressing/Undressing of Consultant Said I was a "Malingerer" No Privacy Arrogant Commented I Was "Lazy" Made to Undress Unnecessarily Discourteous and Disrespectful Said I had a "Manufactured Gait" Not Told Why the Need to be Nearly Unprofessional and Undignified Naked Told Me to"Get a Life" Hurried, Brusque Told Me to "Go Eat Painkillers" Refused to Provide Gown Uncaring Felt Ogled Said I Had Created a "Retrograde Ind ifferent Disaster" Cool, Remote, Aloof Critical of Other Health Care Provider Rude Mean, Scornful Attitude Sarcastic and Cynical Sexist Culturally Insensitive Biased, Prejudiced Hurried and Disorganized Inconsiderate Deceitful THE SQUARE z:... ~ 18

equivalent to the MRC in that country. He the publication of the first edition by Phil then spent a week as a Visiting Professor Gordon and Santhat Nivatvongs, Pro- at the National Cheng-Gung University fessor of Surgery at the Mayo Clinic. The Medical College in Tainan,Taiwan. Dr.Chiu first edition was hailed as a classic and is Max Aebi is proud to has been invited as a member of the Ex- considered by many to be the leading D.announce that Or. J. Dennis Bobyn, Di- ternal Scientific Advisory Board of the Ot- source of colorectal surgery information rector of the Jo Miller Orthopaedic Re- tawa Heart Institute and participated in its worldwide. No other book in colon and search Laboratory, along with his research inauguration meeting on Feb. 11-12. He rectal surgery delivers this much infor- team has won for the has also been invited to serve as Editor-in- mation. It is published by the Quality KUDOS!! fourth time the Otto Chief for a new international journal enti- Medical Publishing Company, Inc. in St. -erg rg ",. Aufrance Award of the tled Cardiac and Vascular Regeneration: Louis, Missouri. Hip Society. This is one Angiogenesis and Myogenesis, Basic to of the important awards in orthopaedic Therapeutic. The first issue of the Journal Or. Karen M. Johnston of the Division surgery in North America and it is quite a is expected early in the year 2000. of Neurosurgery at the MGH has been unique situation that this research group awarded two grants from two sources as has won this award four times over the Or. Mostafa M. Elhilali has been elected independent funding for certain aspects last 10 to 12 years. Dr. Aebi emphasizes Secretary General of the Societe Interna- of research projects in her Neurosurgical that this demonstrates the acceptance of tiona Ie d'Urologie. Their central office will Sports Medicine Clinic at McGill. The first this work both in the orthopaedic as well be moved to Montreal at the RVH site un- is from the FRSQREPARfunding project as in the scientific world. The MUHC Divi- der Dr.Elhilali's supervision. This is the first and the second is from the SAAQ. This sion of Orthopaedics is very proud of the time the office has been moved from funding will be used for graduate student work of Dr. Bobyn and his colleagues as France in it's 90 year history. This is a great support and for further investigations in this puts them truly amongst the top lead- honour for Canada and the MUHC. the management of sports related head ers in arthroplasty research in the world. injuries. Her sports clinic has made a Two MUHC surgeons, Or. Loretta Mar- name for itself by making a significant In January of 1999, a Search Committee con, gynecologist and Or. William O. amount of progress in the field of sports chaired by Or. Martin Black, selected the Fisher, orthopedist were wed in a splen- related head injuries with particular at- new Head ofthe Division of GeneralSurgery did ceremony in Westmount last Septem- tention paid to diagnosis, investigation MUHCand McGill University to be Or. Nico- ber 12. The groom and best man were and the management of this epidemio- las V.Christou. The Square Knot congratu- clad in full Highland dress. logically important injury. lates Dr.Christou in this appointment. In the October 1, 1998 issue of The New Or. Jean-Martin Laberge was Visiting Or. Francesco Carli, Chief of the MUHC England Journal of Medicine, there appears Professor at Hartford's Children's Hospital Department of Anesthesia, is pleased to a landmark contribution in the treatment on November 24th, 1998. He gave Grand announce the appointment of Or. Anneli of a dreadful condition: osteogenesis im- Rounds on Fetal Surgery: Considering the Vainio, as Director of Chronic Pain Care at perfecta. It is entitled CyclicAdministration Fetus as a Patient, and Neonatal Rounds the McGill University Health Centre as of of Pamidronate in Children with Severe Os- on The Effects of Fetal Tracheal Occlusion January 1, 1999. Dr. Vainio joined the teogenesis Imperfecta. The authors are: on Lung Growth. McGill Department of Anesthesia in 1996 Francis H. Glorieux, MO, PhD; Nicholas having graduated from the School of J. Bishop, MO; Horacio Plotkin, MO; We are proud to announce that Or. Car- Medicine, University of Turku, Finland in Gilles Chabot, MO; Ginette Lanoue, roll Laurin has been made Emeritus Pro- 1973. She obtained a doctoral degree at RN; and Rose Travers, RT. fessor of Surgery at McGill. the University of Helsinki in 1990 with her thesis being on the management of It is noteworthy that Or. Philip H. Gor- Or. David T.W. Lin has generously en- pain due to cancer. Dr. Carli urges us to don has brought honor to McGill by his dowed a fellowship in the Research De- take advantage of this first class service. textbook entitled Principles and Practice partment of the Faculty of Medicine for a of Surgery for the Colon, Rectum, and student at the post-doctoral, Ph.D. or Or. Ray Chiu was invited to Taipei in No- Anus. The second edition was published Master's level conducting medical re- vember 1998 as a member of the Advi- in December and has become a standard search (The Dr.David IW. Lin Fellowship). sory Council for the National Heart reference text for general and colorectal Research Institute of Taiwan, which is surgeons. It has been seven years since At the end of March, Or. L.O. ~ THE SQUARE z... ~ 19

~ Maclean went to Naples in ciety. At the same meeting on November work done with Dr. Ray Chiu on The Use Italy to present a paper at the First Inter- 11th, he gave another paper entitled Day of Muscle as a Power Source for Implantable national Meeting to Treat Obesity by la- Surgery and Same Day Admission. Henry Cardiac Assist Device Design. He co-au- paroscopic Techniques. His main message then went to Tainan in Taiwan on No- thored two chapters with Dr. David S. was Do not use any Technique that doesn't vember 17th to address the staff of the Mulder on Video-Assisted ThoracicSurgery. work by Open Methods!. In May in Or- National Cheng Kung University with a These were recently published in a text- lando at the meeting of the Society for paper entitled Management of Breast book called "Minimal Access Thoracic Surgery of the Alimentary Tract, Dr. Cancer: Changing Paradigms. He was Vis- Surgery" by Chapman & Hall Publishers. Maclean will give another address on the iting Professor at this university from No- One chapter was co-authored with Dr. management of obesity. vember 16th to the 19th. On the way Chiu on Dynamic Cardiomyoplasty in the back, he stopped at the University of textbook called "Surgical Options in the Dr. Jonathan L. Meakins is accumulating British Columbia at St. Paul's Hospital and Treatment of Heart Failure" by Kluwer Aca- a lot of air miles. On November 11, he was gave the John K. MacFarlane Oncology demic Publishers, which is due out in the made an Honorary Member of the Span- lecture as a Royal College Visiting Profes- spring. Vinay is currently completing his ish Surgical Association. On November 13, sor entitled Changing Perspectives in Cardiac Surgery Fellowship at the Univer- he was appointed as Fellow Ad Eundem of Breast Cancer Management. sity of Ottawa Heart Institute and he hopes the Royal College of Physicians and Sur- to practice in Canada upon completion. geons of Glasgow. Between December 13 Dr. Judith L. Trudel has been appointed and 18, he was the invited speaker at the as Associate Editor of the Journal for Dis- Congratulations to Dr. loana Bratu for Philippine College of Surgeons and Philip- eases of the Colon and Rectum effective obtaining a fellowship from the Montreal pine Society of laparoscopic Surgeons. At January 1st, 1999. Starting in September Children's Hospital Research Institute. the end of the year, he was the Henry of 1999, she will also be an Associate Ex- This will allow her to spend a second year Swan Visiting Professor to the Department aminer for the American Board of Colon in the laboratory of Drs. Flageole and of Surgery of the University of Colorado and Rectal Surgery. Further, she has been laberge, working on the Antenatal Treat- and to the Denver Academy of Surgery. appointed as Chair for the Self-Assess- ment of Congenital Diaphragmatic Hernia. The Square Knot is proud to announce that ment Committee of the American Society She will be presenting a video entitled Ul- Dr.Meakins has been invited to deliver the of Colon and Rectal Surgeons for the term trasound-Guided Percutaneous Needle De- Gallie lecture at the meeting of the Royal 1998-2001. She has been a member of flation of Fetal Intra- Tracheal Balloon College of Physicians and Surgeons of that committee since 1993. This commit- Occlusion at the upcoming meeting of the Canada at its meeting in the year 2000. tee publishes CARSEP(Colon and Rectal American Pediatric Surgery Association. Self-Evaluation Program), the colorectal Dr. David S. Mulder was made Presi- equivalent of SESAp,every 4 years. Dr. Talat Chughtai has been accepted dent-Elect of the Central Surgical Associ- into the Cardiac Surgery Residency Train- ation at its meeting in St. louis, Missouri, Dr. Carol-Ann Vasilevsky has been ap- ing Program here at McGill, starting July March 4-6, 1999. pointed as Chair of the Colorectal Surgery 1st, 1999 for 3 years. He recently pre- Subcommittee of CAGS and as a CAGS sented a paper at the 2nd Biennial Inter- Dr. Bernard J.F. Perey of Dalhousie Uni- representative to the National Committee national Congress of Cardiovascular and versity organized last fall the reunion in on Colorectal Cancer Screening. Thoracic Surgery in Karachi, Pakistan en- Halifax and Digby of the McGill class of titled The Role of Cardiopulmonary Bypass Medicine 1956. There were 16 classmates in Trauma. Talat will be presenting a pa- along with spouses or girlfriends present. Achievements per at the upcoming 79th Annual Ameri- It was a real success. Residents can Association for Thoracic Surgery meeting in New Orleans entitled Long- Dr. Henry R. Shibata, as has become his and Fellows term Effects of Cricopharyngeal Myotomy custom, visited the Orient in November. for Muscular Disease of the Esophagus. He was invited to give two talks in Japan- ese in Hiroshima, the first of these on No- Congratulations to Dr. Stephen Korkola vember 10th was entitled Changing and his wife Emma on the birth of their Concepts in the Management of Breast February 10th, 1999, son Samuel Stephen born at the RVH on Cancer: 1998. This was given at the 60th oDr. Vinay Badhwar was granted the de- March 26, 1999, weighing 7 pounds, Annual Meeting of the Japan Surgical So- gree of Master of Science from McGill for 7 oucnces; baby brother for Benjamin .... THE SQUARE ..z 5: 20

In 1973, Dr. Entin was elected President of the American Soci- ety for the Surgery of the Hand and took part in the first ex- change of surgical information on Replantation during his visit to China. He invited the Chinese Replantation team to visit Adjudicatory Committee of the Board of Associ- McGill University and to present their work at the Congress in Tated Medical Services has recommended Dr. Martin Entin be Dallas, Texas in early 1974. awarded a William B. Spaulding certificate for 1998. In 1986, Dr.Entin was honoured for his contribution to Surgery Special Award This award was created of the Hand by the Third Congress of International Federation to recognize the contri- of Societies for Surgery of the Hand in Tokyo, Japan as a Pio- to Dr. Martin A. Entin butions made by Prac- neer in Hand Surgery. tising Physicians to the development to the History of Medicine in Canada. The award More recently, as Chairman of the RVH Centennial Volume Sub- is named in honour of Dr.Bill Spaulding, an avid Physician-His- committee, Dr. Entin worked closely with the author, Neville torian himself. Terry, achieving the publication of the New History of the RVH in time for the Centennial Celebration in 1993. Throughout his association with the hospital as Surgeon-in- Chief of Plastic Surgery, Dr.Entin had a sustained interest in de- In 1994, the Board of Directors of the Royal Victoria Hospital veloping the Surgery of the Hand, especially the correction of honoured Dr. Entin with the RVH Distinguished Service congenital deformities of upper limbs in children. He developed Award for his continuous dedication to patient care and a number of innovations through research which enabled more teaching of students .• efficient reconstruction of the malformed limbs and hands. EOM ......

ship of the Society ofThoracic Sur- geons. Winning this award two years in a row is a tribute to Dr. Chiu's strong research program, Vidor (hu, a 4th year Cardiac Surgery ~, and Victor Chu is to be congratu- D.ident, is the recipient of the TSDA (Thoracic Surgery Directors lated for his superb work, and Association) Resident Research Award for 1999. This is the bringing honor to the McGill Car- second consecutive year that a McGill diac Surgery Residency Program. TSDA Resident cardiac surgery resident wins this We are very proud of Victor's ac- award, Dr. Marc Pelletier receiving comp~ishment. • Dr. Victor Chu Research Award this award in 1998. Victor's research work which was presented at the So- ciety of Thoracic Surgeons Annual Meeting in San Antonio, Texas was judged as the best paper by a resident from those submitted by residents all over North America. His prize winning paper was entitled "Angio- genic Response to Transmyocardial Revasculariza- tion (TMR): Laser versus Mechanical Punctures~ This Dr. Victor Chu and his wife Jennifer work was carried out in Dr. Ray Chiu's laboratory dur- are the proud parents of a daughter ing Victor's academic year as a third year resident. The Emily Jia born on March 26, 1999. presentation of this award was first announced at the TSDA meeting held prior to the STS meeting; and the second presentation was before the member- THE SQUARE z... !:I 21

ganize the conference in just three months time.

HOW BIG IS IT? Dr. Harrison Fox, senior staff person with the US Congres- s Washington stood on the brink of im- sional Subcommittee on Government Management, Infor- Apeachment in December and President Clinton ordered missile mation and Technology, summed it up this way:"Members of strikes against Iraq, another event across town went unno- Congress and staff are just beginning to recognize that this ticed. It was one that could turn out to be even bigger than may be the third largest national emergency of this century, l the other two. behind World Wars I and 11': I The V2K Iceberg A two-day conference called Y2K Yet Fox, who prepares a Congressional report card on US Gov- Scenarios and Strategies: Coping ernment Y2K "mission critical" readiness (the last grade was a with Disruptions and Managing Long-term Consequences was "0" overall), maintains a sense of calm and humour, even while hosted by the Washington-area-based World Futures Society talking about his "Top 10 list of disasters waiting to happen" - (WFS). It was an event that still leaves me feeling shaken and from oil and gas shortages to worldwide recession. He uses a afraid - yet paradoxically with a growing sense of hope. big red Year 2000 tool box, complete with an 11 foot pole (to help national leaders touch this "untouchable" issue) and a NOT WHAT 1'0 EXPEaEO child's "Ernie cup'; to remind us that "We have to keep things I don't know what your image of a "futures conference" is, but simple and very understandable': Fox brought a refreshing can- this wasn't mine. There were representatives of several police dour and clarity to a complex and politically-explosive issue. departments, the US Air Force, National Guard, Department of Defence, and Federal Emergency Management and. Environ- THE SIZE OF THE PROBLEM mental Protection Agencies, former FBI and NASAstaffers, year Major presenters described the Y2K'berg as having four key levels. 2000 "remediation" consultants, city and county managers, participants from several Canadian health departments, and The tip of the iceberg is the well-known, two-dig it-date the Swedish Defense Research Institute. computer software problem. Affecting governments, indus- tries and institutions worldwide, it's generally accepted that It felt more like an emergency measures conference than one the problem is too big, the cost of fixing it too much (esti- dealing with a computer problem. In fact, that was one of the mated at $600 billion), and the time available too little for biggest insights from it all. key operations in all sectors to be fixed. US officials report that many federal programs - such as Medicare payments - Y2K is not just a computer problem. This computer "bug" is will have failures, and that cost estimates have grown by two more like a computer 'berg - the kind that sank the Titanic. to three times. Once thought to affect only the largest com- Far deeper than I'd previously imagined, it has the potential to panies, it's now also known that "the date problem" affects reach into every aspect of our lives. everyone with a computer.

Even editors of the World Future Society's own publication, The The next level, what's called "the OTHERYear 2000 problem" Futurist, missed the boat in estimating the size of the prob- by research scientist Dr. Mark Frautschi, is the issue of em- lem. In 1994, they rejected a proposed article by Y2K expert, bedded chips and systems. Computer chips regulate and Peter de Jager. "We ... felt that the 'Year 2000 problem' was a control a large part of our society. From the guidance of mis- minor technical glitch that would probably be fixed long be- siles to electric power and distribution systems, gas fore the year 2000. We were wrong'; says managing editor, pipelines, water supply and sewage treatment systems, to of- Cynthia G. Wagner. In May 1998, the magazine did a major fice security systems and home electronic equipment, these l about-face by telling readers about their mistake and printing chips are everywhere. I a detailed article on the subject. It's estimated that there are about 50 billion in use worldwide. "The magnitude of the problem is far greater than we Some of these are date sensitive and not-year 2000 compli- thought'; said Margaret Anderson, WFS member and former ant. That means these chips will begin failing around January principal of Booz-Allen, one of the US's largest consulting 1st, 2000 and for the first few years of the new century. The firms. That urgency led Anderson, a former Cobol computer question is, how many? No one knows. programmer herself, and others at the Futures Society to or- ... -aq S4lUOW 8 L Ol S L aJE' swawuJaAofi 1E')01PUE'alE'lS SE'M Jallddns JO[E'W auo S!4l asnE')aq liE' - spo06 aA!a)aJ JO d!4S l,uPlno) Aa4l asnmq ssau!snq JO lno luaM JO AIPE'JOdwal ;,Uo!paJ!p JOJ fiU!l!E'M aJ{' slaAallE') pasop sassau!snq JO SPUE'Sn04l JO spaJPun4 'Sdn JO am a4l UI -01 a4l PUE''wE'JfioJd IE'UO!l!'Uou aAE'4 IIllS aM "fiuOI os a~E'l PlnoM l! l4fin04l JaAaU I" "966 L a)u!s aW!l IInJ lSOWIE' sanss! "SaldwE'xa SE'sUMopln4s SJOlOW IE'Ja )llA uo fiU!~JOMuaaq s,aH "anss! a4l Ol papuodsaJ aAE'4 aldoad -ua9 PUE' (Sdn) a)!AJas la)JE'd pal!Un s,mA lSE'1palp uapJE'H AIMOIS M04 lE' paspdms S! 'pUE'IAJE'W 'AlUnO) AJawofilUoW ;,SU!E'4) Alddns mo JO am/!E'J a4l s!" 'UapJE'H laE'4)!W SAE'S)1E'4 JO Ja!4) lafipnq MOU s,04M Jal4filJaJlJ JawJoJ E''S!AE'Oua4dalS 6u!4mm E' Ol [Alaposj 6upq Ol AlPE'dE') a4l SE'4 lE'4l 6u!4l auo a4L "paJJa U!E'4)-Alddns a4l pailE') S,l! 'SWJal ssau!snq UI "Sla~JE'W JO asdE'IIO) a4l PUE' ampnJlSE'JJU! JO fiUlIdd!D a4l U! llnsaJ II!M )llA lE'4l saAaliaq a4S "papJOM ApE'ap s,04M "Sa)!AJaS PUE' spo06 Ja4l0uE' S! '(vL6L JO S!S!D A6Jaua a4l 6upnp) a)wo AfiJaU3 J!a4l JOJ Ja4l0 4)E'a uo puadap 4)!4M sassau!snq lE'np!A!p IE'Japa1 a4l PUE' A)ua6IJ lUawa6E'uE'W A)uafiJaW3 IE'Japa1 a4l -U! mo aJE' OOl oS "luapuadapJalU! A146!4 MOU aJE' sa!WOUo)a lE' 6u!UUE'ld A)ua6Jawa uo pa~JOM s,04M JossaJoJd 4)J{'asaJ PUE' Sla~JE'W ~)OlS mo 'palE'JlSUOWap S!S!D la~JE'W UE'!sIJ a4l E''UOPJ09 E'lnE'd ;,sla6 l! Jafi6!q a4l 'l! uo ~JOM aM aJOW a41 sIJ "saAli mo unJ Ol - Alddns JalE'M pUE' AlPppala 'SUOllE')!UnW "~U!4l aM UE'4l aJaAaS aJOW aq Ol 6u!ofi S,ll" ")llA uo ls!w!ssad -wO)alal ApE'lm!lJE'd - Sa)!AJaS 1E'!luassa JO qaM lSE'A'U!4l E'UO E' OllS!W!ldo UE'6u!aq WOJJ 6unMS AIIE'UOsJads,a4 SAE'S'PlalJ luapuadap A/!AE'a4awO)aq aAE'4 aM 'Alapos E'SIJ ;,ssaupapau a4l U! SlUE'llnsuo) dOl a4l JO auo 'UapJE'H "WalqoJd a4llnoqE' -UO)JalU!" Jno SE' paq!map SE'MfiJaqa)! a4l JO laAal pJ!4l a41 lSOW MOU~ 04M as04l fiuowE' 6U!MOJfi aq Ol swaas uJa)uo) IIWWI710 SSINISnS IHl

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~ hind the Federal government in their preparedness, Jonathan Spalter, a senior official of the US Information and over 50% of counties have still taken no action on Y2K. Agency, said "Unlike a natural disaster, we can prepare for and This is especially important since "much of the impact of the act on this one': "A Y2K solution requires not merely a tech- Y2K crisis will have to be dealt with at the local community nological response'; he said,"but a global diplomatic response" and regional level'; according to Kenneth Hunter, co-chair of plus creative social and economic action, such as the world- the conference. wide effort that successfully limited CFCuse in the mid-90s.

One former NASA engineer sees a more immediate problem. Progress was reported in many fields. Financial institutions "I'm here to learn how I can talk to my family about this. They seem to be the most advanced towards Y2K compliance. Sev- all think I'm crazy'; he said. It was a concern shared by many at eral local government officials described advances in their Y2K the conference. While research shows that general Y2K aware- prevention efforts and emergency preparedness. USFederal de- ness has grown, most conference participants believe that gov- partments such as Social Security, Environment, and Commerce ernment, industry and the public still do not grasp the potential have their critical systems nearly ready. Energy companies such size and importance of the problem. And since no one knows as Atlanta GasLight Company have well developed contingency for sure what will happen, it's a hard subject to talk about. plans. And Harden's Century Technology Services has compiled a database of over 1 million embedded chips, helping clients Many would rather not talk about it at all, to avoid creating identify those which may breakdown. panic. However, "it's important to give people good informa- tion'; said Dr. Douglass Carmichael, psychologist and president To prevent problems before they happen, three of five of Shakespeare and Tao Consulting. "And we can't just say 'it's Venezuelan petrochemical refineries are reported to be shut- going to be okay'. It might not be fixed': He suggested the ting down prior to the end of 1999 so they can check, upgrade best option is to give clear information on what's been found and phase back into production after Jan. 1, 2000. Some and what is likely to happen, what the repercussions could be, chemical plants are said to be doing or considering the same. and what we have to do to deal with it. The number of organizations and networks set up to commu- WHERE'S THE HOPE? nicate information and encourage action is also spiralling. The All this may sound extreme, even paranoid. It's an issue con- World Futures Society has created an excellent database of ference organizers struggled with in preparing the agenda: these resources on its website (www.wfs.org/y2kcfrrc.htm). how to cut through participants' awareness or denial of the problem without seeming like alarmists. ALMOST TOO MUCH TO TAKE Despite these signs of progress, the spectre of exploding "Creating panic serves no end'; says co-chair Robert Chartrand. pipelines, nuclear missiles going haywire, and the potential for "But companies and agencies need to treat this situation as a economic breakdown and environmental disasters seemed to complex emergency, starting now, and deal with it accordingly': far outweigh any sense of optimism and opportunity. Then something switched. The real work of the conference, said co-chair Hunter, was to create "tangible actions that participants can take now to suc- At the end of day one, several participants asked organizers cessfully cope with the crisis': Or as Jan Nickerson, a Massa- for a change: from more information on the problem, to ac- chusetts woman who's designed a card game to educate tion on solutions. people about Y2K, said "to build community not crises': Turning on a dime, the organizers switched the next afternoon Nickerson was not alone. Other participants felt this global into a brainstorming and action planning session led by par- crisis can also be a global opportunity. ticipants themselves. Group-designed topics included how to communicate Y2K simply; community planning and emer- John Peterson, a twice-decorated, former naval flight officer- gency preparedness; and identifying "national and global" turned-futurist, described it this way:"ln each stage of history, leaders. Participants identified 11 key actions such as: [we] must learn to adapt. Y2K is a learning event for humanity o Become a Y2K community facilitator/trainer yourself. Don't to get to the next stage. It's an opportunity and a test. It will wait to be appointed or for someone else to act, it may not require a whole new way of thinking and responding ... If you happen. sit around and wait for leaders, you're going to miss this one. f) Connect with responsible and reliable sources of information It's not a technical problem. It's about people': and assistance. ~ WOI

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The research themes include Genetics and Inflammation, Cel- lular and Molecular Biology of Joint Tissues,Bioengineering for Joint Reconstruction, Diagnostics and Therapeutics, and Methodologies and Outcomes. There are 16 participating cen- ESTABLISHMENT OF A NEW CANADIANAKTHRI· tres in an integrated clinical trials network. Registries for os- TIS NETWORK (CAN) - A NATIONAL CENTER OF EXCELLENCE teoarthritis, rheumatoid arthritis and joint replacement are This is a new National Center of Excellence (one of 14) being established. funded by the Social Sciences Humanities Research Council and the Medical CAN also represents a funding and working partnership with New Canadian Arthritis Research Council of Industry, both nationally and internationally, and with national Canada. Of 74 ap- institutions such as the Medical Research Council of Canada Network plications in 1998, and the Arthritis Society of Canada. Part of its mandate is a only 3 were funded. requirement to establish new companies and to create new The award is for $14.S million over an initial period of 4 jobs. It has been heralded by NSERCas the best proposal for years. The first term is 7 years that can be renewed for a fur- a National Center for Excellence ever received. It also repre- ther 7 years (total 14). sents a potential blueprint for the future of Health Care Re- search and Treatment in Canada. This is the first National Robin Poole, Ph.D., D.Se., Director of the Joint Diseases Lab- Health Care program of its kind in the world. oratory, Shriners Hospitals and a Professor in the Division of Surgical Research is the Associate Scientific Director for the Other members of the Network in the Division of Surgical Re- Network, and a member of the Board of Directors. He and search, Department of Surgery, include Drs. J.S. Mort, A.D. Dr. Tony (ruz, Ph.D. (Director, Mt. Sinai Hospital,. University Reeklies (Joint Diseases Laboratory, Shriners Hospitals), P.J. of Toronto) were primarily responsible for the creation of this Roughley (Genetics Unit, Shriners Hospitals for Children), and new network. John Sampalis, M.D.; from Orthopedics, Drs. Max Aebi, Mauro Alini, and Thomas Steffen. It represents a partnership between the very best scientists and clinicians (about 120 people) across Canada (16 universi- For further information about CAN you can contact Robin ties are involved), working together on arthritis to improve its Poole ([email protected]; Fax:514-849-9684; Tel.: 514- treatment at the level of research, the development of new 849-6208) or Tony Cruz ([email protected]; Fax: 416-586- drugs, prostheses (artificial tissues and joints), diagnostic aids, 8628; Tel.: 416-586-8537), or contact the web site of the clinical trials and patient care. Arthritis Society (www.arthritis.ca) .•

Were You There? - 1970

Lt. to Rt.: Drs. DJ. Kinnear, I.T. Beck and R.D. McKenna are congratulated by the President of the AGA (American Gastroenterology As- sociation), Dr. Charles F. Code of Rochester, and the President of the CAG(Canadian Gas- troenterology Association), Dr. Eric Nanson, Saskatoon on an excellent programme for the joint annual meetings .• THE SQUARE ""z ~ 26

Following lunch at the Children's, Dr.Tepas was given a tour of the Osler Library which was an obvious highlight of his visit and this was followed at 5:00 P.M.with the second Surgical Grand Rounds at the Montreal Children's Hospital when Dr.Tepas pre- FOURrH ANNUAL H. ROrKE ROBERTSON sented his topic Performance Improvement in Trauma Care. This T.VISITING PROFESSOR was an excellent talk on total quality management and how the Dr. Joseph J. Tepas, III, Professor and Chairman of the De- team at the University of Florida, Jacksonville, were able to im- partment of Surgery at the University of Florida Health Sci- prove this important aspect of surgical treatment. ~ ence Center in Jacksonville visited the MUHC on January Visiting Professors 21st, 1999. Dr. Tepas is well recognized both nationally and internationally for his contributions to the field of Pedi- atric Trauma and he has served as Chief, Division of Surgical Critical Care at his University since 1990. We were honored to have him visit McGill University as the Fourth H. Rocke Robert- son Visiting Professor in Trauma.

The program started with Surgical Grand Rounds at the Mon- treal Children's Hospital when Dr.Tepas gave an excellent lec- ture on Resuscitation of the Injured Child: Who, When, Ho~ and Where. An excellent attendance was present and this was Winners of Resident Prizes augmented by the pediatricians at the Children's who changed Lt. to Rt.:Drs.l. Panthanki, P. Chopra, G.Gupta, T. Chughtai their Grand Rounds from Wednesday to be present at our Grand Rounds on Thursday morning in order to hear Dr.Tepas. In addition, a large number from the MUHC attending staff were present as well as a large attendance from Hopital Ste- Justine who received a separate invitation.

Grand Rounds were followed by resident presentations from 9:00 - 1:00 P.M.and an excellent series of presentations were made by residents, both from the Children's and the adult components of the MUHC, and also from Hopital Ste-Justine and the CHEOin Ottawa. A total of 11 presentations were made and the panel of judges (Drs. Tepas, Owen and Shaw), Lt. to Rt.: Drs. B. Williams, D.Evans, Chopra,I. Panthanki, H. Flageole, after much deliberation, awarded the prizes as follows: P. Professor Tepas,S. Gupta, K.Shaw, T. Chughtai, M. Laberge.

GENERAL SURGERY First Prize - Drs. S. Gupta and Z. Panthanki from Plastic Surgery who presented a paper on Electrical Injury - A Surgical Tour de Force Second Prize - Dr. P. Chopra, Pediatric Surgery from CHEOwith a paper on Traumatic Evisceration Third Prize - Dr. T. Chughtai, General Surgery from MGH on the topic Adult Respiratory Distress Syndrome: Two Cases Treated by ECMO Lt. to Rt.: Drs. N. Christou, R. Brown, Professor Tepas,B. Williams, D. Owen, M. Laberge, K.Shaw, E. Monaghan THE SQUARE i:j !:I 27

~ To conclude the day, the Senior Pediatric Surgical GENERAL SURGERY DAY Residents from the Montreal Children's Hospital and Hopital FEBRUARY 2S, 1999 Ste-Justine along with the Pediatric General Surgeons enter- Dr. Michel Gagner, Chief of La- tained DrJepas at dinner at the Mount Stephen Club. paroscopic Surgery at the Mount Sinai Medical Center in New York, In summary, Dr. Tepas was an excellent Visiting Professor and on February 25th, was the Visiting maintained the standard of previous H. Rocke Robertson Vis- Professor in General Surgery and iting Professors, Drs. Maull, Gennarelli, and Gruss. + Videoendoscopic Surgery. This visit was sponsored by Sherwood H.B. Williams, M.D. Davis&Geck and the hosts were Dr. Nicolas V. Christou, Head of the .••...... ••..•...... ••...... ••...••.. Division of General Surgery at Dr.Michel Gagner McGill and Dr. Gerald M. Fried, Head of the Section of Videoendo- scopic Surgery at McGill.

Dr. Michel Gagner is a native of Montreal, Quebec. His under- VIAN SAYlALV VISITING PROFESSOR graduate education was at the Seminaire de Sherbrooke and he IN ONCOLOGY obtained his medical degree at the Universite de Sherbrooke in Dr. Gabriel Hortobagyi visited the MUHC in November of 1982. He completed his General Surgery training at McGill in 1998 as the guest of the Cedars Cancer Institute of the RVH. 1988 where he also earned a Ph.D.in Experimental Surgery with Dr. Hortobagyi is the Chief in the Department of Breast Med- a thesis entitled Human Lipolysis in Sepsis. ical Oncology Section and holds the Connally Chair in Breast Cancer at the University ofTexas, M.D. Anderson Cancer Center Dr. Gagner went to the Universite Paris-Sud for a year of post- in Houston, Texas. His lectures were as follows: graduate training, followed by a fellowship in hepato-pancre- atico-biliary surgery at the Lahey Clinic. In 1990, he was RVH - Pre-Operative Chemotherapy - The Developing Role appointed Assistant Professor of Surgery at the Universite de MGH - Breast Cancer Therapy - Truths and Questions Montreal and staff surgeon at the Hotel Dieu de Montreal. Strathcona Anatomy and Dentistry Building - The Advances in Oncology Lecture - Hypothesis Based In 1995, Dr. Gagner joined the staff of the Cleveland Clinic Development of Therapy for Breast Cancer Foundation as Head of the Section of Laparoscopic Surgery, Westin Mont-Royal Hotel Department of General Surgery. In 1998, he moved to New - Milestones in Breast Cancer Research and Management - York where he is Chief of the Division of Laparoscopic Surgery From the Past to the Future at the Mount Sinai Medical Center. On November 19th, after giving a conference at the Pavilion Notre-Dame of the CHUM, Dr. Hortobagyi addressed the staff Dr. Gagner has gained an international reputation in the field of the JGH with a lecture entitled Controversies in Breast Can- of laparoscopic surgery. He is recognized as an innovator in cer Management. laparoscopic techniques, both by direct manipulation of in- struments and robotic assistance. Currently, his attention is fo- Dr. Gabriel Hortobagyi is an excellent example of the true clini- cused on endoscopic endocrine surgery and laparoscopic cian/scientist and Cedars was very proud to welcome him. + surgery for morbid obesity.

....••...... •...... ••..•...... ••...... He gave Grand Rounds at the JGH. The title was Laparoscopic Endrocrine Surgery. ERIC FLANDERS VISITING PROFESSOR A delightful reception was held at the Mount Stephen Club for Dr. Ronald Feld, Professor of the University of Toronto and Se- General Surgery staff and residents. There was a good spirit nior Oncologist at the Princess Margaret Hospital, was this year's of comraderie and after dinner, excellent speeches were made Flanders Visiting Professor at the MGH. The title of his talk was by Drs. N. Christou, G. Fried, and M. Gagner who recalled Management of Lung Cancer: Progress into the Millennium. + the fond memories that he had of McGill. + EDM EKL WOI JO III? 'aww1?1601d fiu!u!I?J111!9JW a41 U! sluap!saM leJ!fims • 'HAM a41 1A) Ja!4J Ot awos JO 6U!U!1?111I?J!6msJPI?104111?1aUa6a41 OlU! le spa(oJd fiulPl!nq Auew 41lM paAloAul seM pall4JJe uelP lndu! alql?nll?AU! UI? apl?w 04M uoa61ns JPI?1041 pan!WWOJ -eue) fiulpeal e 'naJJaw 'JW '68 JO afie a411e AI1UaJaJ palO PUI?aA!pnpOld 'alql?!lal 'paJuapadxa A146!4 e SI?MUOSI!M W!r llIlIlIIW 7718dWlfJ 'lIW 'aWOJU! S!4 luawalddns 01 Ala6ms II?laua6 II?UO!l!PPI?uo Alal 'HNW a411e lSlfiolOlsA4dojpala-omau 01 pa6!1qo SI?MPUI?Ala6ms JI?!PlI?JU! pau!l?ll AIPl?wpd lOU SI?M UMOU~ lIaM e seM Jadser '10 'l6 JO afie a411e 4JleW ul palO a4 'lll?M PpoM 6U!MOIIOJapl?Jap a41 U! paU!I?Jl suoa6ms lsa4) TO lI1dSIf( ll118l11H 'lIO palll?J os a41 JOlUI?UWaJ 6upl?addl?s!p lSI?Ja41 41!M UOWWOJul

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Today each division in the department will speak to their own ith the exception of two retreats, the issues, their recruiting plans, their activities in research and McGill Department of Surgery has not had a meeting of any teaching, and what they see as critical to their future. There is sort and this seemed an excellent opportunity to do so. One a lot of activity in other divisions of which we are astonish- of our objectives is to craft a single clinical and academic de- ingly unaware. To manage this enterprise is going to be a very partment of the McGill hospital departments and coalesce complex and difficult tax, but if we can function cohesively with the departments across all McGill University hospitals. and collectively it is likely to be a success.

As we integrate into a single clinical and academic structure, our goal for the next five years is to prepare to move to the Dr. Harvey Brown new site, the Glen Yards. The clinical and academic implica- HEAD, DIVISION OF PLASTIC SURGERY tions are of enormous importance. Indeed, the clinical inte- gration at the MUHC has already extended to the point that The purpose of this Day - named after one of our most re- neither adult general hospital can provide a full range of ser- spected and revered McGill surgeons -this year- is to congre- vices independently of the other. In fact, we are in many re- gate and allow each surgical division director an opportunity spects already functioning as a single clinical entity. As I now to outline their vision for the next 5-7 years. As I become more travel between the two hospitals, I see many aspects in one mature, I find my VISION is frequently defined in terms like hospital that I would like transferred to the other and vice "myopia" or "presbyopia", but not yet hemianopsia" - at least versa; that there are systems and facilities in place that can be not to my face. The significance of choosing a time frame - to the benefit of both institutions. "next 5-7 years" should not escape us. The planned "theme park" or "boutique site" will now appear in 2004 or 2005 or We must recognize that the University ofToronto Department ?2006 - thus our vision for 5-7 years is very appropriate - what of Surgery is now the premier department of surgery in the will happen from Dec. 1998 to Dec. 2006. country. One of our major objectives is to change that. If we can group all the positive aspects of both the RVH and MGH, Lloyd and I arrived at McGill almost together in about 1963. I think we can achieve that. If we don't succeed, we will con- Dr.Maclean of course was slightly senior to me in rank (he was tinue to be second best in this country. surgeon-in-chief at RVH,and I was junior assistant resident at MGH) and age by approximately 10or 15years, I think. How- The Departmental Executive has reached consensus in some ever, he would be the first academician to acknowledge that elements of direction. The agenda is how to move to a new any look into the future - vision, we're calling it -requires an site. In essence, we are working for the future of those staff examination of the past. in their 30s and 40s and for our new recruits. Personally, I may never operate on this new site nor benefit from organizing the Patient care, research and teaching are the pillars on which clinical and academic services other than as a patient. Those McGill builds and advertises its excellence. Plastic Surgery at of us who are S5 and over will not see much of the benefit of this university stands out as one of the premier surgical spe- this work. However, our legacy to the institution will be a func- cialties from all of those standpoints. To my knowledge, Plas- tion of how well we carry out the task at hand. tic Surgery was the first surgical sub-specialty to be truly integrated on a university-wide basis. This occurred in July As I said in the message from the Chair in the Fall 1998 issue 1967,and I am proud to count myself as being among the first of the Square Knot: 6 graduates of the integrated program in 1969. Since then, 90 graduates of plastic surgery have been produced ~ .. 'lUap!SaJ 11?)!fiJns )IlSl?ld l PUI? 'lUapnlS 11?)!paw -aJJ sall!WaJ1Xa asa41 JO afil?JaAO) 'UO!ll?lndwl? U! pallnsaJ l 'luapnlS ')S'W I 'SlUapnlS 'O'4d l AJOll?JOql?1JnO U! fiU!~JOM aAI?4 PlnoM ofil? 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~ Across the MUH(, plastic surgery research is mod- minimally invasive cardiac surgery; as well as a number of new estly funded in the area of $200,000.00 and active search for surgical procedures which were developed in our own research funding is an ongoing process. laboratories. In pediatric cardiac surgery cases,two surgeons do nearly 150 open heart surgery, successfully accomplishing In the past five years, the Division has been extremely pro- most complex procedures in some of the youngest patients, ductive - with 23 peer reviewed articles published, 7 book thus establishing a reputation which has made the Montreal chapters, 1 book, 28 abstract posters, and 12 scholarly pre- Children's Hospital a national referral centre, receiving patients sentations delivered at peer reviewed meetings. from as far away as Western Canada and foreign countries.

With the introduction of the Clinical Investigator Program here In Cardiac Surgery, we have a fully approved residency pro- at McGill, we, in the Division of Plastic Surgery, feel that op- gram, and I am proud to say that at a recent internal review portunities exist for enriching both the Division and individ- we got not only full approval, but also a comment stating that ual candidates in a stimulus towards academic surgery. I there is "an impressive morale of residents in spite of very would modestly point out that the first successful recipient of heavy duties': the certificate as graduate of the Clinical Investigator Program at McGill will be Dr. Kayvan Khiabani - R4 in Plastic Surgery. In research, there were more than 50 papers, chapters and books published last year, as well as MRC grant and industrial Plastic Surgery is alive and well at McGill, and I fully believe it funding. The members of this Division are on the executives will continue alive and well in the MUHC. of provincial, national and international professional societies. We are also represented on a dozen or so national and inter- Now! Will somebody find us some anaesthetists! national journal editorial boards. Our residents "habitually" re- ceive prestigious research prizes.

Dr. R.C.-J. Chiu The challenge to Cardiac Surgery in general terms is, as for HEAD, DIVISION OF CARDIOTHORACIC SURGERY everyone else, the danger of being downsized in spite of long waiting lists because of the financial constraints. My other I was asked by the Chairman to talk about the vision for the major concern is that in our effort and obsession to deal with Division of Cardiothoracic Surgery. My predecessor and the this critical clinical environment, we may lose the ability to founding chairman of this Division, Dr. Dobell, perhaps would sustain and to nourish the academic and research involve- be too humble to say so but as far as I am concerned, our vi- ments by our staff, particularly since this Division has histori- sion should be to achieve world class excellence in service, cally depended heavily on surgical scientists for its academic teaching and research. We try to realize this with two major productivity, rather than on basic scientists. efforts; one by pooling our energy and resources, and two by encouraging an identity of excellence for each of our faculty GENERAL THORACIC SURGERY members. This Division in the MUHC consists of only 10 fac- This discipline has evolved. As many of you know, before 1960 ulty members, too few to create many Sections for the highly all "thoracic surgeons" were general thoracic surgeons. With the specialized areas within the Division. Therefore, we must ask development of Cardiac Surgery, it became part of Cardiotho- each faculty member to develop an area of unique expertise. racic Surgery. But lately, with the tremendous developments in We then try to sustain and support each member to achieve general thoracic surgery, it is again becoming an independent national and international recognition which in turn will bring branch of our discipline. The Royal College, reflecting this acclaim for our Division. change, has established a new separate thoracic surgery train- ing program. At McGill, a few senior surgeons are focusing their Briefly I will comment on a couple of issues: The development practice on Thoracic Surgery and together they operate on over and future of Cardiac Surgery and Thoracic Surgery at McGill; 700 major cases. But we are still evolving in this area. We need and some short-term organizational matters. to recruit new young faculty members and expand our clinical and research base in Thoracic Surgery, to which our sister hos- CARDIAC SURGERY pital JGH has been very helpful. We are also trying to establish About five of our staff of ten focus their efforts in adult car- a new thoracic surgical residency program at McGill. diac surgery, with others participating part-time, and to- gether they carry out more than 1,000 open heart surgical The other item I want to touch upon is the issue of cardiac procedures each year, ranging from heart transplantation to surgery integration in the MUHC. 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~ INTEGRATION for about a day. Stone management is mostly done on an out- Presently, the Division of Urology is fully integrated and has patient basis and endoscopic surgery will fit within the short been for many years. This is based on a McGill-wide prac- stay. All infertility casesare done as out-patients. The JGHwill tice plan involving all our full-time faculty who cover four remain as is. teaching hospitals. This has been in place in one form or an- other for over twelve years. It has allowed us to develop con- PATIENT CARE centrated areas of excellence in different hospitals because We have to continue our efforts to recruit attending staff in the economic impact does not pose a problem. There is no areas where we are vulnerable. For instance, we now have financial impact resulting from the transfer of patients from only one pediatric urologist left. In the department as a one hospital to another to allow the development of exper- whole, we have only one fully qualified andrologist and only tise and centres of excellence. Each hospital site developed one neurourologist. We have just one individual in endourol- its own strengths and deals with certain types of patients. ogy; she was sick in the last few months and we realized how We are quite sensitive to the perception that this would not vulnerable we are in that area. We have strong presence in all lower the value of the hospital nor the patient. The residents these four areas but we need to reinforce them by additional know what kind of patient and exposure to expect at a given recruitment. Presently, two residents are training for pediatrics site and are not going to complain that they don't see a cer- which should provide very good reinforcement. We have one tain pathology in this hospital or another. There is enough resident going next year to New York to train in andrology. For pathology to go around. endourology we are looking for the right individual and we are recruiting as well for a neurourologist. We are looking into At the MGH, we do most of our urologic oncology. At the RVH, the possibility of developing a male health centre to address we do most of our stone management, all our infertility pa- the needs of the aging male as far as erectile dysfunction, pro- tients and all our laser applications. At the JGH, we do neu- static disease and screening for prostate cancer. We are re- rourology, urinary incontinence and erectile dysfunction. organizing our out-patient services. General urology is done at all hospitals, but the expertise is mostly localized and focused at one or another of the sites. RESIDENT EDUCATION When we say urologic oncology is done at a the MGH, the re- Since June, Armen Aprikian is our new program director and he search component of urologic oncology is also based there. has injected new and exciting ideas into the teaching program. When we say infertility at the RVH, that's where the infertil- We had excellent applicants in the past and we continue to have ity research is based. At the JGH, that is where the erectile excellent applicants for the coming years. Our residents in the dysfunction and the urophysiology is based. last four years have always had a 100% pass rate at the Royal College and Quebec exams, and we have in this department Where would we like to be until we are on one site? We pro- enough excellent role models to motivate residents and that is pose the following. However, the plans are under study at the why we are successful in recruiting residents. We are looking moment and we don't know when, or if they will happen be- into the development of a resident scientist program to provide fore we move into one site. We would like to move all our in- a year or two of additional research exposure. patients from the RVH to the MGH and therefore have two services: one covering general urology and the other urologic BASIC RESEARCH oncology. In this manner, we would have at least one unit One of the objectives of today is to inform the department as where the nurses are familiar with urology patients. At the a whole of our activities. In infertility, we have Claude Gagnon moment, because of the small number of beds we cannot have who is a full professor and director of our research laborato- one nursing unit on either site. The nurses cover multiple ries. Teruko Taketo is a tenured associate professor and works other services and therefore are not specialized. Also group- on sex differentiation. Orest Blaschuk, also a tenured associ- ing the residents on fewer services will provide a better teach- ate professor, works on cell adhesion molecules. Simone ing experience. The residents will be able to see what is Chevalier, associate professor with tenure, works in cellular bi- significant in both services and have a much wider range of ology and biochemistry, particularly in the area of the surgical opportunity. Moreover, this would probably allow us prostate. Mario Chevrette who is working in molecular ge- to become much more efficient. At the RVH,we will concen- netics, a very new field, was very instrumental in raising sev- trate more on ambulatory care and short stay patients. Two eral grants this year. Pascal Vachon, who joined our or three beds will probably cover the needs of this short stay department in July and is based at the JGH, is working with unit. These will be very high turnover beds as patients with Serge Carrier on central pathways of erection. endoscopy and laser prostatectomies have to stay in hospital ... MaU e aAe4 a6Jaqel U!lJeW-Uear pue aloa6el~ aU~I~H 'ue!SSpalaw s!~Jes 4l!M auo aAe4 4Jea pue slueJ6 'spadse AJeUO!S!As3Hl THE SQUARE z... ~ 35 .. MRC grant looking at the issues of trachemalacia and lung malformation and diaphragm hernia. Dr. Ron Lewis HEAD, DIVISION OF VASCULAR SURGERY Industry is a major supporter of activities in the department, either through clinical trials or technology transfer. Major On July 1 1996 Vascular Surgery at McGill was integrated into players in the division are Drs. Rosenberg, Fried, Tchervenkov, a single Division that now comprises Christou and, to a lesser extent, David Fleiszer. In terms of pri- • Vascular Surgery MUHC vate funding, Dr. Fried has been far and away the most suc- • Vascular Surgery JGH cessful, developing the Burnstein Foundation for Laparoscopic Surgery which is now funded at $1.9 million and supports the The main reason for integration was to provide a CRITICAL development and future of videoscopic surgery. MASS of certified, academically inclined vascular Surgeons who could focus on and realize the development of Vascular SURGICAL SCIENTIST PROGRAM Surgery at McGill, unencumbered by competing cardiac and The Surgical Scientist Program has already cut its teeth. Res- thoracic surgery. We started as four surgeons at the RVH serv- idents in the program spend a minimum of two years in the ing the populations of the RVH, MGH and the prior QEH;and lab during which they get a Masters or Ph.D. They are ex- two surgeons at the JGH. For reasons not directly related to pected to produce or return to the standard clinical program the Division, we have had problems maintaining that critical that consists of 4.5 clinical years and six months of epidemi- mass; three surgeons have left: one for Ottawa, one for the US ology or similar type training. and one retired. One has been hired; we have struggled with the arduous process of hiring another willing and extremely NEW HIGHLIGHTS able surgeon for the last year; and we are looking to recruit Dr. Rosenberg has developed the molecule which has to do another young and talented surgeon in July of 2001. with the management of diabetes. Dr.Tchervenkov has an un- matched record in liver transplantation relating to the man- With integration underway, we envision 3 additional major agement of hepatitis-B patients; it has been published and is goals for the next few years: becoming increasingly accepted. • Accreditation of the Vascular Lab • Pursuit of five major academic areas of Vascular Surgery CLINICAL ACTIVITIES • Development of a high quality cost-efficient Clinical Program Operating time is limited in part because of budget, but pri- marily because of a shortage of anesthetists. We are not at Accreditation of the Vascular Lab is an urgent objective and is the moment in a position to change that. Nevertheless, clin- already in progress. A critical prerequisite was adequate com- ical productivity remains stable as it has in large part over the puterization, to permit development of a Vascular Registry. last four to five years. • The lab is the centre of physiology based modern Vascular surgery. The number of residents varies between 65 and 80 depending • More important it is the hub of clinical epidemiologic stud- on the year. They are scattered widely throughout the McGill ies of vascular disease. To date, studies have been retro- teaching hospitals as well as the four community hospitals. spective. A world class lab with an established vascular Registry makes possible prospective study of Vascular dis- Judith Trudel is director of the residency program and is in the ease, as well as the successesand failures of vascular surgi- process of getting a Masters in Education from the University of cal treatment Chicago. Paul Belliveau has taken part in the Dean's Teaching • Finally, an accredited lab is now a RCSdesignated prereq- Scholars Program, as will Sarkis Meterissian this year. This has uisite for our 2 year Vascular Fellowship Program. We have contributed to the quality of our teaching and the development two fellows at present. Next year, we will skip one year of of both the undergraduate and the postgraduate programs. recruitment to ensure that we provide enough facilities for vascular training of our general surgeons. We plan to con- This summary is retrospective and generally that is retrogres- tinue to cycle this recruitment to meet the needs of both sive. However, given that a new Division Head is in the offing Vascular Surgery and General Surgery it would not be appropriate to project plans. The 5 major academic pursuits of the Division will be:

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~ we can be creative and provide the mathematical dents. We will be studying how to evaluate the residents ob- imperatives that will drive that agenda. jectively so we know whether or not they have actually learned what they were supposed to learn. Secondly, we have divided our teaching of the principles of surgery into Dr. Ron Zeit 15 or 16 individual units - from 3 to 8 weeks in duration de- HEAD, DIVISION OF SURGICAL EDUCATION pending on the topic. We assign staff to head these teach- ing units, we have clear objectives for each unit, and have McGill now has a new Division of Surgical Education and the evaluations based on those objectives. This is a cyclical two- following is a brief outline of surgical education as it stands year program for all residents and all sub-specialties that and what we will strive for in the future. participate in it. We are in the early stages of developing a surgical skills training program. The first Core year would UNDERGRADUATE SURGERY emphasize basic surgical skills common to all sub-specialties. The Department of Surgery contributes to undergraduate This would be more sub-specialty specific in the second year. surgery in three areas: With regards to subspecialty training, we are hoping to create Firstly, the various divisions of surgery make numerous signif- a subspecialty committee to share ideas on how to train res- icant contributions to the Basics of Medicine (BOM) and Dr. idents and build off each other's strengths. Larry Conochie serves as a Unit Head for one of the systems- based learning periods. FACULTY DEVELOPMENT We have a very strong faculty development program at McGill. The students enter the hospital in their second year and are Our own Larry Conochie is an active member of this group and exposed to surgery during their Introduction to Clinical Sci- we hope he will help us in our quest to increase the skills of ences (ICM) period. ICM-A is equivalent to the old Introduc- our faculty members in teaching and evaluation. tion to Clinical Sciences and this program is run by Medicine in January of every year. Surgery seesthe students eight times RESEARCH IN SURGICAL EDUCATION over the course of a month to show them how to examine var- With regards to research in surgical education, we already have ious areas of the body from a surgical point of view. ICM-C is McGill people actively involved on the national and interna- a 10-week block during which we introduce the students to tional scene. We would like McGill to become a national leader the pathophysiology of surgery and how to make a diagnosis. in areas of skills development and evaluation in surgery. This is a new program, part of the new curriculum develop- ment done at McGill over the last four years. LOOKING TO THE FUTURE Education boils down to four steps and it is very important After they graduate from the ICM-C period, the students do that within each division we strive to adhere to these four Principles of Medicine (POM) in their third and fourth years. principles -- the education spiral. During this period, which used to be called clerkship, they come to the hospital for a two-month period: one month of Modern learning is through objectives. If you have no idea of general surgery and one month of sub-specialty training. what you are supposed to know at the end, there is no way to actually put forth a viable learning program. Secondly, one RESIDENCY TRAINING IN SURGERY must develop evaluation instruments. Thirdly, you figure out Our residency training programs at McGill are divided into two how to implement your program and, when the teaching pro- sections: the first two years of Core Surgery training and the gram is completed, you begin the evaluation process. This next three years of sub-specialty training. process includes evaluation of the learner, the teacher and the program. When you know if the objectives are met, that's Once the medical school graduates are accepted into a sur- when you modify the objectives and the spiral begins again. gical subspecialty, they enter McGill's Core Surgery program That's how education works and how we must structure all as- and we become managers of those residents during these pects of our surgical training. first two years of their training - their clinical rotations are decided by the program directors, not us. Currently, Core We have purchased and are beginning to use a new computer- Surgery at McGill, and certainly across the country, is going based evaluation system called Performance Enhancement through a transition period. With regards to clinical rota- Technology (PET). We now have an easy method of obtaining tions, we are developing attainable objectives for the resi- data quickly and efficiently, allowing us to evalu- ~ ,;JOU)/ cJJonbs dlJ1" jO anSS!lXaU a4l U! Jl:'addl:' II!M S)!pad04lJO jO UO!S!A!Oa4l uo !qa\f xew 'JO jO lJodaJ a41 :aJoN S,PI ......

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