lGH Department of Su,ge~ is alive and well and very active. Most ,ecently Tour departmental GFT offices and clinics have been redone, renovated and enlarged on the fifth floor of the 'A' Pavilion. New clinics and a full-time teaching office will certainly improve our teaching program. The very convenient physical space is ample and will sat- isfy our expansion needs for the next five years. Serious efforts What's New to acquire endownment funding has been initiated to provide necessary funding for more academic pursuits. at The JGH Our Division of (VT continues to be headed by Nate Sheiner. He continues a very active surgical practice and enjoys visiting his two granddaughters in the USA. Normand Miller is Program Director of Vascular Surgery at McGill and is very actively involved in the executive committee of the hospital. Bob Goodman, one of our cardiac surgeons, recently took a leave of absence. However, Yves Lan- glois continues a very ambitious surgical program as we recruit a new surgeon.

Tassos Dionisopoulos has been GFT since 1993 adding strength and depth to our Plastic Surgery Division which is guided by May- nard Shapiro. ~ (please see The JGH pg.4) Sir Mortimer B. Davis Jewish General Hospital ......

-::::I What's New at the Jewish General Hospital 1 H.RockeRobertson Visiting Professorship 12 DEPARTMENT OF SURGERY Letters to the Editor 2 M.D.Anderson Experience 14 '"-- ...... NEWSLETTER ca. Editorial 3 Surgical Epidemiology II) ...... 15 Jewish General Hosptial Surgical Staff 5 CAGS ...... 15 McGILL UNIVERSITY Kudos 6 Were YouThereThen? 16 ...... ••...... •..•.•...... ••.•••...... •...... •..•.• ...... • VOL. 6, NO.1, WINTER 1996 Canadian Network for International Surgery 7 McGill Anesthesia 17 Surgical Education in Developing Countries 8 International Visiting ResearchFellows 18 Sal Mount to Stay 8 RVHDivision of General Surgery Staff 18 Rotations at Barrie Memorial Hospital 8 A Decline in General Surgery Applicants 19 History of Plastic Surgery (cont'd) 9 Obituary ...... 20 Departure 9 McGill University Hospital Centre ...... 21 Welcome Aboard 9 OHIBData 21 ...... , .. The Surgical Education Corner 10 Upcoming Events 22 UI pue au!)!paw U! aAll)e aq 01 anU!lUO) °sul~eaw °lor °10 lie aM °Sly6noYlmo UI ale nOAleYl MOU~ Aq Uan!lM S! pleMl0J aY1 °S66L AJa6ms lie nOAlal 01 un} aq PlnoM 11ly6noYl aM UI ssa1601d pall!lUa la61e~ Aq paYS!lnd Ala61ns 1A) - al!wal An9. ~00q1xa1 e JO SJ01lpa aYl ale U!~WOIOS "S L l .6,d UO J

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t- o z 3HlfnDS"" lHl THE SQUARE ""z ~ 3

PRESENT WERE Dr. Brian Evans, representing Dr. L. Hurst, Chair, Plastic Surgery Dr. John P. Girvin, Chair, Neurosurgery Dr. E. D. Monaghan, Chair, General Surgery ORE CURRICUlUM SURGERY IN GENERAl Dr. Paul F. Odell, Chair, Otolaryngology CRecently some concern has been expressed and some Dr. Ernest W Ramsey, Chair, Urology questions are being asked about gradual changes which Dr. T. R. Todd, Chair, Thoracic Surgery have taken place in Core Curriculum for Surgery programs across Canada. Dr. James P. Waddell, Chair, Orthopedic Surgery Editorial Dr. Ken Harris, Coordinator, Core Surgery, UWO When the Core Curriculum was originally de- Mrs. J. Cassie, Head, Accreditation signed, the Royal College Committee on Specialties (COS) re- Mme. L. Papineau, Head, Exams ceived input in order to prepare the Objectives and Training Mrs. S. Waugh, Head, Credentials Section Requirements from all the Surgical Specialties. For example, Dr. R. D. Weisel of Cardiac Surgery was unable to attend. Dr. Paul F.Odell of Ottawa, Chairman of Otolaryngology sub- mitted those for E.N.T.; Dr. W. Rennie of Manitoba submitted A number of matters were clarified. It was emphasized those for Orthopedic Surgery; Dr. M. T. Richard submitted that Program Directors are still in charge of the rotations of those for Neurosurgery. The idea was that we structure a their trainees and it is the job of the Coordinator of Core Cur- common core of training of a generic type so that our "un- riculum working with the Specialty Programs to arrange the differentiated" Surgical Residents would develop the knowl- appropriate rotations. edge, skills and attitudes in Surgery in General so as to pass the Principles of Surgery Exam in two years. In discussion, there was a general sense that two years "Com- mon" core training are not required to attain the objectives A council resolution in April 1990 (#90-074) stipulated that of Core Surgery, and that many of the objectives can be at- Core Training Program Committees include the Program Di- tained in the course of training in the surgical specialty con- rectors of each Residency Program which is dependent on cerned. If training in the specialty concerned could start core training. This seemed to be a good idea at the time. sooner, it would add flexibility to the rotations 'possible in the later years of residency. These Specialties wish to add Gradually, however, it has evolved so that these very same rotations in their own discipline during the two years of Core Program Directors are requiring Core Surgical Residents to at- and that these be" double counted" to extend the length of tend rotations in their Specialties, so that all across Canada training in their own discipline. right now, the Core Curricular Programs have become differ- ent in many ways, since they have become "rotation based': The Committee agreed to the following definition of "Core Surgery": two years of training in an accredited surgery res- That therefore is the problem. idency to meet the Core Surgery objectives, with at least twelve months of clinical activity outside the specialty con- These matters have been discussed at the Royal College both cerned. However, this was not approved by the Royal Col- by the Accreditation Committee (Head - Ms. Jo Cassie) and lege Credentials Committee in late January. by the Credentials Committee (Head - Ms. Sheila Waugh). The Accreditation Committee stipulated that henceforth, it It was agreed that all the Surgical Specialty Committees will would accredit two types of Core Surgery - the "Common be invited to propose amendments to their residency re- Core" model and the "Core Surgery directly under the control quirements to reflect this current thinking. of the Surgical Specialty" model. The objectives for Core Surgery are to be reviewed by a small In order to resolve some of these issues, a meeting of the "ad-hoc" committee chaired by Dr. James Waddell. The cur- Chairs of the Royal College Specialty Committees in surgical rent objectives date from April 11, 1992. It will be necessary disciplines was held on January 12 at the Royal College. This to "harmonize" these objectives with the contents of the meeting was organized by Dr. J. P. DesGroseilliers and was Principles of Surgery Exam. chaired by Dr. Gilles Beauchamp, Chair of the Test Committee for Principles Of Surgery. Core Surgery is still a relatively recent concept and has been working quite well judging from the results of the ~ THE SQUARE ..z 2 4

~ P.O.S. exams. Though it needs some fine tuning, It is to be noted that the University of and McGill there is a danger of tampering too much and compro- were the first two medical schools in Canada to institute such mising its objectives. Core Curricula in their surgical postgraduate programs. •

PRINCIPLES OF SURGERY 1994 1995 Residents Total Number Percent Total Number Percent Training In No. Passed Passed No. Passed Passed

Cardiothoracic Surgery 2 0 0.0 2 1 50.0 General surgery 117 106 90.5 138 135 97.8 Neurosurgery 12 11 91.6 23 21 91.3 Orthopedic Surgery 57 48 84.2 73 67 91.7 Otolaryngology 24 22 91.6 30 28 93.3 Plastic Surgery 10 8 80.0 17 17 100.0 Urology 23 20 86.9 28 26 92.8 TOTAL 245 215 87.7 311 295 94.8 Results of the P.O.S. exam of the Royal College by Specialty AFTER the institution of Core Program in Surgery in General.

~ Tassos brings expertise in free flap reconstruction af- Barry has established an Anal Physiology Laboratory and is ter his fellowship training at Sloan Kettering in New York. very much involved in surgical teaching. Maynard is very much involved in the administrative func- tions of the department and the hospital. Harvey Sigman, recently appointed as Full Professor, is our The JGH Dave Elkin and Jack Cohen continue their Chief of General Surgery. He has a very full schedule being (continued from pg.l) varied and busy plastic surgical practices. the Assistant Dean of Medical Education and Student Af- fairs at McGill and carries on an active surgical practice as The Colorectal Unit is strong academically and now has well as being responsible for the teaching program in Gen- three surgeons in the group. Phil Gordon has profoundly eral Surgery. He also has important responsibilities in distinguished himself and most recently chaired the meet- national and international medical education societies. ing of the American College of Colorectal Surgeons, in Mon- Harvey has great energy and still has time to enjoy his treal, as its President. Phil has been a tower of strength in grandchildren who live in Montreal and enrich his life. AI our department being actively involved in all affairs. Carol- Spanier busily runs the ICU and is responsible for CTU 1. He Ann Vasilevsky continues in active practice after having had has been very involved in international critical care soci- her firstborn, a girl, one year ago. The division has been eties, writing and lecturing throughout the world. Ben strengthened by Barry Stein who returned to the JGH after Mitmaker and Jacob Garzon carry a heavy surgical load do- completion of a fellowship at the Lahey Clinic in Boston. ing a full range of general surgery while carrying ~ THE SQUARE ..z ~ 5 ~ a large responsibility for teaching. Jacob's grand- Henry Korman. They contribute to the department in a con- children are a joy and Ben's young family continues to ma- tinuing and ongoing fashion. ture. Roger Fenster, whose first child was recently married, and Issie Shanfield who was recently married, Dr. Robert Levine has retired from active surgical practice. He both continue in active surgical practice. Richard Mar- continues to be associated with the department and the hos- golese is the Chief of Oncology at the hospital and is in pital in his position as DPS at the Jewish Hospital of Hope. active surgical practice within our department. Richard participates in teaching while actively maintaining his In 1993, Martin Black was appointed Chief of Surgery. He high profile in oncology. Steve Karp has been awarded the is Chief of Head and Neck Oncology at McGill and has pur- Chercheur Boursier and substantial peer reviewed grants sued a vigorous recruitment campaign to augment the for his immuno-oncology program in surgery and the De- full-time academic staff of the department. He remains in partment of Oncology. Steve's expertise and distinguished active surgical oncologic practice at McGill. record enhances both departments. Many changes in the health care system are on the horizon. Our staff is rounded out with the participation of Drs. Harry The Department of Surgery at the JGH looks forward to be- Glick, Arthur Freedman, Bernard Rothstein, Jeff Rivilis and ing an active participant in fulfilling its university role. •

......

The JGH Department of Surgery

Seated, Left to Right: Center Row, Left to Right: TopRow, Left to Right: Missing from photo: Dr. David Elkin, Dr. Robert Levine, Dr. Harvey Sigman, Dr. Barry Stein, Dr. TassosDionisopoulos, Dr. Jacob Dr. Nathan Sheiner, Dr. Allen Spanier, Dr. Bernard Rothstein, Dr. Martin Black Dr. YvesLanglois, Dr. Harry Glick, Garzon, Dr. Isidore Shanfield, Dr. Philip Dr. Robert Goodman, Dr. Richard (Chief), Dr. Carol-Ann Vasilevsky; Dr. Jeffrey Rivilis, Dr. Arthur Freedman, Gordon, Dr. Maynard Shapiro, Margolese, Dr. Stephen Karp, Dr. Jack Cohen, Dr. Roger Fenster, Dr. Normand Miller; Dr. Henry Korman. Dr. Ben Mitmaker, Ms Judy Pollack (Admin. Assistant); THE SQUARE... =::z 6 the Royal College as a representative of vember 5 1995. The honorary presidents General Surgery on the Plastic Surgery of the gala evening were the husband and Examinations Board. wife team of Dr. Julius Metrakos and Dr. Kay Metrakos (uncle and aunt of Dr. Pe- Pnin. Brodt is the edi- Dr. Carroll Laurin has received the ter Metrakos). An amount of $40,000 Dtor of a new book entitled Cell Adhesion Order of Canada. was raised for the Liver Transplant Fund. and Invasion in Cancer Metastasis pub- The Masters of Ceremonies were Mr. lished by the Landes Co. (Austin) and Dr. Jonathan L. Meakins was invited to George Balcan, CJAD morning man, and Springer (Berlin). The be a speaker at the Hong Kong Surgical sportscaster Ted Blackman. Blackman KUDOS !! book provides up to Forum held at the end of January at who received a liver transplant asked his date reviews on cellu- Queen Mary Hospital at the University of wife, Lyane, to thank his surgeon, Dr. lar and molecular Hong Kong. This is a postgraduate meet- Tchervenkov. He quipped, "I am not really mechanisms in the process of cancer ing held twice a year and all presentations qualified to tell you about the doctor's metastasis and is geared to both clini- are given by invited guest speakers in- fine work since I was in a coma at the cians and basic scientists in oncology and cluding leading surgeons from overseas. time he was doing it': related disciplines. In addition to Dr. Jo's topics were as follows: Brodt, review chapters in this book were • Art and Medicine - Medicine in Art In November 1995, Dr. Marvin Wexler also contributed by Dr. Orest Blaschuk • Intraabdominal abscess:modem management addressed the 46th Annual McGill Re- from the Division of Urology and by Drs. • Biliary pancreatitis in the modern era fresher Course for Family Physicians on John S. Mort and Anneliese Recklies • Peritonitis- 7996 "Surgical Treatment of Breast Cancer - of the Joint Diseases Laboratory at the Past, Present and Future - A New Para- Shriners Hospital. Dr. John R. Moore has just celebrated his digm': He also gave a Workshop on 80th birthday in Gagetown, New Brunswick. "Problems in Breast Cancer Manage- Dr. Ray Chiu was an Invited Speaker at ment': This was his 20th consecutive the following International Conferences: Dr. Harry S. Morton in the Canadian year in addressing this gathering of Congestive Heart Failure: From Molecular Medical Association Journal, December 1 300-400 family physicians from Biology to the Clinic, in Venice, July 1st, 1995, published a paper At One Time, Op- throughout Canada. Marvin was the 1995; World Conference in Surgical Effi- erations Outside The Hospital Were Not Un- 1995 A.J. Grace Memorial Lecturer of ciency and Economy, in Kiel, Germany, common. Dr. Harry Morton, a 1932 the Southwestern Surgical As- September 15th, 1995; Symposium on General Surgery graduate of the Univer- sociation which met in London, Ontario Current Perspectives in Cardiovascular Dis- sity of London, is retired and lives in in November. The title of his address ease, in Saint John, New Brunswick, Octo- Lunenberg, Nova Scotia with his wife was "Will Bassini, McVay and Shouldice ber 14, 1995; Surgical Workshop on New Rachel. He used to be an Attending Sur- Rise From the Ashes". Also, after dinner, Approaches to Cardiomyopathy, in geon at the RVH. he was the Guest Speaker at the London Toronto, October 26, 1995; and Sympo- Hunt and Country Club, and showed a sium on Heart Failure and Transplanta- Dr. Anie Philip of the Division of Plastic video entitled "Living and Dying in tion, at UCLA,Los Angeles, November 11, Surgery at The Montreal General Hospital Ethiopia" based on travels there several 1995. He was a Visiting Professor at Jichi has won the Fraser, Monat and McPherson years ago. Previous McGiliians accorded Medical College in Japan on November Medical Research Award for 1995 to 1998. this honor have included Donald Web- 6th, 1995, and a Guest Lecturer at the ster 1956, l.D. Maclean 1973, Dave Japanese Society for Artificial Organs in Dr. Hani Shennib was nominated as Mulder 1992, and lMeakins 1994. As Osaka, Japan on November 9th, 1995. member of the Program Committee of the a Guest of the Detroit Academy of Society of Thoracic Surgeons. A new text Surgery in January 1996, he spoke on Dr. Nick Christou has been appointed edited by Dr. Shennib, Immunology of the "Laparoscopic Versus Open Inguinal an examiner in General Surgery by the Lung Allograft, has been released by Herniorrhaphy: A Methodical Evaluation Royal College. Springer-Verlad. Through Phase 7, 2 and 3 Controlled Clin- ical Trials" Recently he was the Visiting Dr. R.L. Cruess has been named to the Dr. Jean Tchervenkov was honoured at Professor - William Beaumont Hospital - Order of Canada. the Milos Restaurant on Park Avenue dur- Royal Oak, Michigan January 1996. ing the Royal Victoria Hospital Transplant ~ Dr. David M. Fleiszer has been named by First Annual Fundraising Dinner on No- (KUDOS continued on pg. 22) THE SQUAR,.E z !:l 7 Dr. A.P. Mclean Royal Victoria Hospital 687 Pine Avenue w., Room S7.30 Montreal, H3A 1A1 Tcaoadiao Network for International5u~"y (CN151 Fax: (514) 843-1503 was established and incorporated in August 1995. Its purpose is to promote the delivery of essential surgical care in develop- Dr. Antoine loutfi ing countries. Therefore, the CNISwill be a forum for those con- Royal Victoria Hospital cerned with surgical 687 Pine Avenue w., Room S10.22 The Canadian Network care and training in Montreal, Quebec H3A 1A1 the developing world. Fax: (514) 843-1503 for International Surgery It will also be a bank e-mail: [email protected] of technical and theo-

17" '< retical expertise, a means of raising funds and an organization I hope that the CNISwill become the medium bringing together :z:,...... ~ to support and implement specific projects. all those interested in working in developing countries .• s·o ~ It had its first meeting in Ottawa in November 1995 during o ~ the 2nd Canadian Conference for International Health. Its ~ first directors are Dr. R. Lett, Dr. P. McLean and Mrs. J. Van- ? Dum. They were elected for a one year term. Dr. Lett was chosen to be President.

During the Ottawa meeting, it was felt that the CNIS should establish links with the Canadian Society for International Health and should provide representation on its Executive Board for Obstetrics, Orthopedics and Anesthesia.

We are actively seeking members to join. The cost for indi- viduals is $50.00 CDN. Anyone interested should contact one of the following: Dr. A. Loutfi with Dr. Haile Legasse and the OR. Staff in Bale, Ethiopia. Dr. Ron lett 1669 Victoria St., #310 Prince George, V2L 2L5 Tel.:(604) 561-1280 Propranolol For further information or to refer Fax: (604) 561-1286 a patient please contact: e-mail: [email protected] for Small MGH- Abdominal Aortic Dr. J. Morin (514) 937-6011, ext. 4324 lise Morin, RN (514) 988-7007(pager) Aneurysm Trial Dr. A. Hill (514) 937-6011, ext. 4326

RVH- ENTRY CRITERIA Asymptomatic Infrarenal AAA Dr. O. Steinmetz (514) 842-1231, between 3.0 - 4.5 cm ext. 4981

EXCLUSION CRITERIA JGH- o Contraindications to Propranolol Dr. N. Miller (514) 340-8304 0) HR ::; 50 BPM b) Asthma Stephanie Goyette, RN c) Symptomatic CODP d) IDDM (514) 340-8232 (pager) o BETABLOCKERS o LIFEEXPECTANCY::;1 YR • "al!S leml e UI A)Uap!Sal 1!a4l JO lled se UO!lnl!lSU! S!4l -!weJ pue SlUa!led a4l JO spaau a4l aAldS Ol papaau aq II!M c:i :::E U! UO!lelOl 4lUOW P-£ A10lepuew e alaldwO) Ol alqe aq II!M a)!Alas ale) aA!le!lIed a4l JO W10J le4M puaWWO)al Ol P10J c Ala6ms lelaUa9 U! we1601d Al!SlaA!Un 1I!9)W a4l U! pallolua -lellS 4dasor "10 Aq paJle4) a)lOJ ~sel e JO UO!lnl!lSul a4l seM .cIV 171 IV sluap!saH "lel!dsOH le!l0waw a!lles a4l Ol Ala6ms lelaUa9 dals la4lmJ lofew V "SWalqOld 6uWels am aw04 a4l JO UO!l C o U! we1601d A)Uap!Sal a4l pualxa Ol UO!le)lIdde a4l paAold -elo!lawe a4l pue 'a)!Alas ale) aA!le!lIed a4l JO 6uWelS ue!) == -de se4 a6a1l0) leAoH a4l JO aaUlwwo) uO!lel!pamv a41 -!SA4d a4l ApelnJ!lled - swalqOld 6U!XaAasa4l JO uO!lnlosal ...c:i ..: 7V11dSOH 7VII:IOW1W 111:11:1V81H11V a4l JO Ma!A U! UOlleu6!sal S!4 Malp4l!M a4 'Slel!ds04 pale!IY CI >0- SNOl1V101:11AVH 01 WVI:I90l:ld AI:I191:1nS 7Vl:llN19 7719JW -Je a4l pue 1I!9)W 'luawulaA06 a4l Aq saAlle!l!U! JO laqwnu e m JO asnms "pa6ue4) aAe4 ...... sa)uelSWn)l!) 'AI!ddeH

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8 ::; z 3HvnOs"" lHl THE SQUARE ..z ....o 9 the MD Anderson Cancer Center in Houston, Texas studying gene therapy for lung cancer under the supervision of Dr.Jack Roth, will return to McGill University and The Montreal Gen- eral Hospital as an Assistant Professor in the Division of Car- ONT/NUATION OF THE HISTORY diovascular and Thoracic Surgery on July 1st, 1996. + COF PLASTIC SURGERY AT McGILL EDM In 1967, Drs. Drummond and Woolhouse worked to create a combined McGill Plastic Surgery Resident Training Program. • Dr. Robert Midgley, MGH ...... Dr. Robert D. Midgley and MCH trained, was appointed geographical DR. EMERSON BROOKS - full-time to the staff of the RVH. This appointment broke A farewell dinner party was held for Dr. Emerson Brooks and with tradition. The resulting amalgamation and integration his wife Mary on Jan. 25th, 1996 at the Mount Stephen Club of resident rotations was a first for any Division of Surgery which was organized by Dr. Ross Murphy's committee. Fifty- at McGill. Residents started rotating through the MGH, RVH five colleagues and friends attended and MCH in equal aliquots and the stimulating Wednesday Departure the occasion. Dr. Ross Murphy re- afternoon Plastic Surgery Rounds of case presentations, dis- counted Emerson's career as an ortho- cussions, arguments and bravado were held in equal rotation pedic surgeon at The Montreal General Hospital and his many through the three hospitals. In 1976, Dr. Midgley resigned contributions to the academic community of McGill University. his Associate Professorship at McGill and his staff positions Dr. Dennis Bobyn, Director of Orthopedic Research at the MGH, at the RVH, also Queen Elizabeth and Queen Mary's where detailed the growth of the Orthopedic Lab under Dr. Brooks' he was Director of Plastic Surgery. During his nine years on guidance which is recognized nationally and internationally staff at McGill, Dr. Midgley served as Examiner in Plastic == for hip arthroplasty research. Dr. Brooks' secretary, Diane Surgery for both the Quebec College and the Royal College. P Motherwell, who has worked for him since he came to the In 1988, he was elected President of the Canadian Society of MGH, talked about the excitement of working with such a dy- Plastic Surgeons. He may be remembered at McGill for his namic person and how sad his departure will be to the whole clinical teaching, acquiring RVH Ward-10E exclusively for McGill community. Dr. Max Aebi, Chairman of the Division of plastic surgery patients and collaborating with Drs. Daniel Orthopedic Surgery at McGill, presented Emerson with a and Terzis in the 1976 publication of the first recorded clin- plaque acknowledging his outstanding work as Program Di- ical microneurovascular free flap in the Western world. rector of the Orthopedic Residency Training Program. Dr. Rea Brown recounted the beginning of Dr. Brooks' era at McGill and For the past twenty years, Dr. Midgley has been doing Plastic, his commitment to building an outstanding group of ortho- Reconstructive and Hand Surgery in Charlottetown, P.E.I. He pedic surgeons, especially related to trauma. Drs. Michael is married to hematologist, Dr. Elizabeth Ross. + Tanzer, Dave Burke, Eric Lenczner, Larry Conochie and Ross EDM Murphy make up the team that Dr. Brooks put together to ...... comprise a vibrant Division of Orthopedic Surgery at the MGH. Dr.Bobyn then closed the evening by presenting Dr.Brooks with Welcome Aboard On July 11996, Dr. Peter Metrakos a personal laptop computer. A good time was had by all. + will join the McGill section in Organ Transplantation headed by Dr. Lawrence Rosenberg at the RVH. He will be involved in trans- plantation of the liver, pancreas and A fter a very warm day, kidney and he will join Drs. Jean a lady said to Yogi Berra, Tchervenkov and Jeff Barkun in this capacity. Dr. Metrakos is a graduate of the McGill Residency Training Program in Gen- you look pretty cool. eral Surgery finishing in June 1994. He obtained a McLaugh- He said to her "you don't lin Scholarship and went to train in transplantation at the look so hot yourself': University of Western Ontario and in Minnesota.

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lated committees, he was an active member of the Curriculum Committee at McGill. He started the residency program in Emergency Medicine at HAT.S NEW McGill in 1971 and was its director "Education by objectives is not possible unless examinations are until 1980. On the national stage, he constructed to measure attainment of those objectives ..." was Chairman of the Committee on Education and Chairman of the Post- The process of evaluation is vitally important in any education graduate Education Committee, both system. Remember, the evaluation of education must begin with of the Canadian Association of Gen- a clear and meaningful definition of its objectives. Once you tell eral Surgeons. He is or has been a the learners what you want them to know at the end of the Dr. E.D.Monaghan member or chairman of many other learning experience (i.e., their objectives) you must then evalu- education related committees and so- ate those objectives to see if they've been met. This sounds so cieties. He played and continues to simple but we frequently overlook this critical relationship be- playa key role in the development of tween the two. But why do we need to evaluate? Whom are we the Core Surgery training program in Canada. He also served as evaluating? Or what are we evaluating? Examiner in Surgery for the Royal College of Canada and as Chief Examiner of the Quebec College of Physicians and Surgeons. He The first thing to realize, is that an evaluation does not mean the was the Associate Dean for Postgraduate Education at McGillfrom final exam we give the student at the end of his or her learning 1986 to 1993. Currently, he is the Chairman of the Specialty Com- period. Rather, evaluation is a process by which we assess not only mittee in General Surgery of the Royal College. the performance of the students but the effectiveness of teachers and the quality of the program itself.We collect this data and make With a background so rich in Educational activities, it is no won- judgements in these three areas. For example, our evaluation data der why he is considered one of McGill's premier Surgical Educa- will tell us which students can be promoted (evaluation of the tors by both the staff and all trainees who have been fortunate learner), that we must organize faculty development workshops to enough to learn from him. On behalf of all of us who leamed improve our small group teaching (evaluation of the teacher) and Surgery from him, thanks for being one of our staff who truly that the time allotted to a surgery rotation may have to be ex- cares about his students. tended to accommodate ambulatory care teaching (evaluation of the program). As you remember from our discussion about the ed- BULLETIN BOARD ucation spiral, we make these judgements to modify our program Not much to add here this edition. Word has it Dr. Gerry Fried objectives and the process or cycle of education begins again - the and a few General Surgery residents are furiously preparing "spiral': In the next issue of the Knot, we'll look more closely at the a McGill Department of Surgery homepage for the Internet. various methods of evaluating the learner. This will allow people around the world to see what we're doing here at McGill at all levels of Surgical Training. This SURGICAL EDUCATOR PROFlLE- will be constantly updated to keep current with program E. D. Monaghan, CD., B.A., M.D., M.Sc., F.R.CS. (0, F.A.CS. "upgrades" if you will. I'm told this should be online in early spring if not sooner. I've had a sneak preview of their ef- Dr. Monaghan began his training at McGill University back in forts and it looks fantastic. 1958 after graduating from medical school and he started his surgical career at the Royal Victoria Hospital in 1965. Since that As always, your comments, criticisms and suggestions are always time, he has developed a local, national and international repu- welcome. If any of you have any good ideas with regards to learn- tation as one of Surgery's outstanding educators. He received Ed- ing methods, program ideas or anything else related to Surgical ucation training at the University of Illinois in Chicago shortly Education, we'd love to hear from you. Keep in touch! • after coming on staff at McGill and was soon awarded "The Until the next edition, here's how you can find us: Golden Apple'; the Meritorious Award for Teaching by McGill's graduating class of 1974. Locally,Dr.Monaghan became involved McGill Surgical Education as Program Director of the McGill Postgraduate Training Program [email protected] in General Surgery from 1979 to 1986 and he served as the Co- Undergraduate Coordinator ordinator of the Undergraduate Surgical Teaching program at [email protected] McGill from 1966 through 1985. Along with other education re- Core Surgery Coordinator U05JlaqOIJ ')0 ~J!M aJa~ UMO~5 alD 5laUUIM

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demiology was held. The purpose of the meeting was to bring together members of the Department who have background in Epidemiology or who have been involved in research within the domain of Clinical Surgical Epidemiology in order to dis- n the recent years, Su~ical Epidemiology has evolved as cuss common interests as well as perceived needs for the de- Ia well defined discipline that integrates Clinical Epidemiology velopment of research in this area. with surgical research. The development of this new discipline has been in various directions including health care services The participants identified the need for better interaction, col- evaluation, outcomes laboration and training. The possibility of pursuing infra-struc- Surgical Epidemiology research, and clinical ture support and the establishment of a formal group within trials. The McGill De- the Department was discussed. The participants also realized partment of Surgery was one of the pioneers in this area by that it will be essential to recruit others in the Department who conducting numerous clinical trials in cooperation with epi- have an interest in Surgical Epidemiology to partake in the demiologists and by initiating pure epidemiological research group's activities. In view of this, a second meeting will be held aimed at the study of surgical patients or health care services. in the near future. Any member of the Department who has an A number of surgeons in the Department have acquired grad- interest or background in Epidemiology is invited to attend this uate training in Epidemiology, while others have developed meeting. Those who are interested please call, write, e-mail, or strong interest in the field and are involved in research within fax a note to Dr.John Sampalis indicating your availability dur- this domain. As the number of such individuals is growing to ing February and March at the following coordinates: • a critical mass, the establishment of a forum to allow discus- sion, exchange of ideas and initiation of a stronger collabora- Dr.John Sampalis tion was considered appropriate. Telephone: (MGH) 937-6011 ext. 4715 or 4634 Telephone: (RVH) 842-1231 ext. 4851 or 4848 With this objective in mind, early this year a first meeting of Fax: 934-8293 or 845-8156 individuals in the Department with an interest in Surgical Epi- e-mail: [email protected]

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tain the maximum benefit for the scarce health care dollar. This in turn has increased the demand for ongoing outcome evaluation, the development of clinical practice guidelines and other mechanisms of quality assurance. Damatic changes are occurring in the delivery of Canadian Health Care. Technological advances, hospital re- For General Surgery, one of the most dramatic changes is the organization and shift in the delivery of service from an in-patient to an out- T CAGSPosition Statement cuts in funding patient basis. Patients undergoing surgery which previously 'I have all had a required prolonged hospital stays are now being treated as I on Ambulatory Care profound effect out-patients. Patients requiring in-patient treatment fre- " on the way health quently are admitted to hospital on the day of surgery. Tech- care in general and General Surgical services in particular are nological advances such as the advent of laparoscopic surgery delivered. One of the major determinants of these changes is have facilitated this shift to out-patient based surgery. There the reduction in funding which has resulted in a desire to ob- are economic and medical advantages which derive ~ JJUJJOdJJn 'SJWpuo JIO) OJloljS 'JO 'uolMoW flO] 'jJno uljO( 'JO :Jlj6m OJJjJ7 JiJqWDI{) ,!JDqJiJdiH iJl{l;O JO!JiJlU! iJl{l Jno 6u!AJl ,- ¥tJM0W

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The evolution of health care and scientific reasoning to- It is an honour to be part of this historic occasion as we cele- gether with the budgetary pressures imposed by western brate the 50th year of the Department of Anesthesia at McGill. governments have challenged the way we operate and make I would like to take this opportunity to cordially invite you to decisions. Whether these challenges are related to a world- join us at any of the following events, some of which form part wide economic and political instability, or a health care re- of our celebration activities: definition or our academic insecurity, we are compelled to reflect on one clear issue "00 we need an academic Depart- February 27-March 1 ment of Anesthesia 7': A critical analysis of academic anes- CAE Patient Simulator comes to McGill Anesthesia thesia in major countries indicates a great difficulty in Virtual Reality in Medical Education - Workshops and Lectures recruiting academic chairs, the sharp reduction in postgrad- April 13 uate trainees and decreased research funding. McGill Anesthesia Research Day May 27-30 It is my strong belief that academic anesthesia has a greater 38th McGill Annual Refresher Course, Montreal chance to survive this challenge here at McGill than in some June 14-18 other institutions. 1996 is the year we celebrate fifty years of Canadian Anaesthetists' Society Meeting, Montreal existence as an academic department. Wesley Bourne, the September 20 Founding Chairman, understood the needs of the specialty, McGill Anesthesia 50th Celebration and some of his thoughts expressed in his presidential address September 21-22 to the American Society of Anesthesiologists' meeting in New McGill Open House-McGill Anesthesia Display York in 1942 are well worth repeating: "...the more I contemplate this our institution, the more Also, two books will be published in 1996 - one covering the convinced I am that it is sound at heart, and that its strength History of the Department and the other a Biography of is the strength of youth. As time goes on, my successors will, Dr. Wesley Bourne .• I hope, be able to boast of glorious achievement; they will be able to vindicate that boast by citing a long list of eminent ...... men, great masters of experimental science, great artists in ~ Answer to question on page 2: 32 years! clinical procedure. They will, I hope, mention with high hon- -USA Today UOiiPW JiiJi!d 'ijJno7 iiU!OJUil 'UO!SS!JiiJiiW S!!fJ05 'noJs!J4) !fJ'N 'Ao!fUiiAJii4Jl uOii['un!fJ08 Jjii{ 'U04oouoW P] 'nOiiA!/Iii8/nOd :lqO!1I OlljiJ7'M0II JP08 Jii/XiiM U!AJOW 'iiU/!W iiU!Jii4JO) 'SU!!f0iiW u04JOUO['UOiiPOW pion 'oJoQ!45 iJUiiH :lq6!11 0miJ7 'Moil lUOJ:/

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The ratio of students first choice in gen- T.TO GENERAL SURGERY: DOES THIS AUTOMATICALLY MEAN J eral surgery to positions in general surgery has declined dra- A DECLINE IN INTEREST IN GENERAL SURGERY? matically from 1:157 students ranking general surgery first Since 1993, the applicant pool of graduating medical stu- to every available position in 1993 to .08:1 in 1995. dents applying to general A Decline in General surgery has been shrink- Another complicating factor in these ratios, is the significan- ing. In 1993, the first tincrease in the number of positions in general surgery. 1993 Surgery Applicants match that graduating was the last year the CaRMS offered a PGY-2 match for gen- students had to select eral surgery. Up to that time positions were filled at the PGY- their specialty direct from medical school, 276 (19.3%) of the 2 level and in 1993 some entry positions were reserved for graduates applied to general surgery. those 1992 graduates who had done a rotating internship. In 1994 all of the entry positions were put into the PGY-1 As can be seen in Table I, that number and proportion of ap- match increasing the number of entry positions in general plicants has been declining. This year in the 1996 match 194 surgery for graduating students. At the same time there was graduates (14.4%) applied to general surgery programs. a decline in the numbers of graduates choosing general surgery as their first choice for PGY-1 training consistent The application pat- with the decline in the terns of graduating number of graduates students has changed Table 1 applying initially to since the first match Match Total # of Grade # of Applicants to % of # Total # of Applicants to general surgery. Table Year in Match in 1993. Students are General Surgery of Applicants General Surgery III demonstrates that more focussed on 1993 1432 276 19.2 1203 this results in a higher particular disciplines 1994 1406 258 18.3 1473 proportion of these po- and although they 1995 1415 197 13.9 1158 sitions being filled by apply to fewer disci- 1996 1348 194 14.4 1429 students who did not plines, the numbers chose general surgery of applications per as their first choice. student remains the same. The results of this pattern is shown in Table I, where All of these data would suggest a declining interest in gen- the proportion of students applying to general surgery has de- eralsurgery as a career choice for graduate students in Cana- creased since 1993, but the number of applications to general dian medical schools. This however does not take into surgery has in fact increased. Students are realizing their account the changes in Royal College training requirements chance of a successful for some of the surgical match to their career specialties and subspe- choice is excellent, Table 2 cialties. Cardiothoracic (82% of graduates # of # of Grads % of Grads # of % of Ratio of surgery has become matched to first Match Grade Rankin~ Rankin~ Positions Positions Positions cardiac surgery and choice discipline) and Year in Genera Genera in General in General to Match Surgery Surgery Surgery Surgery Applicants thoracic surgery. they have responded 1993 1265 78 5.7 48 3.8 11.57 by applying to more Both of these programs 1994 1274 76 5.7 48 3.8 1 : 1.27 programs within their have changed to direct 1995 1284 52 3.9 64 4.8 1: 0.08 chosen discipline. entry specialties mean- ing the graduating stu- There are two other dents can enter these measures of student interest in general surgery as a career disciplines at PGY-1 level not requiring general surgery first. choice. 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o....z c z ~vnos lHl THE SQUARE ::""z 22 Dr. Lloyd D. MacLean was a Visiting Professor at The Indiana Upcoming University School of Medicine in February. On Friday, February 16th he spoke at The Columbia Club on Health- Events KU DOS care Delivery Systems and on February 17th he (continued from pg.6) was the 1996 John E. Jesseph Memorial Lec- March 13-17, 1996 turer. His talk after Surgical Grand Rounds, in SAGES the Myers Auditorium, was entitled Recent Advances in the Treat- (Society of American Gastro-intestinal Endoscopic Surgeons) ment of Obesity. Postgraduate Course: Problem Solving in Endoscopic Surgery Pennsylvania Convention Center, Philadelphia. Drs. Gitte Jensen and Sarkis Meterissian received an MRC N.B. "Video-Olympics" - March 17. operating grand for the study "Molecular Mechanisms of Lym- phocyte Trafficking." • March 21, 1996 EDM McGill Division of General Surgery Visiting Professorship. Dr. Jerry M. Shuck, Case Western Reserve University in Cleveland. Sponsored by Davis+Geck ...... March 28, 1996 Corrections The E.J. Tabah Visiting Professorship. Dr. Norman Wolmark. Dr.Wolmark is a McGill graduate of 1970. to the Fall '95 Issue May 1996 Dr. Fraser N. Gurd Day - Orthopaedic Surgery.

June 6-7, 1996 Stikeman Visiting Professorship Dr. Hillel Laks, Chairman, Division of Cardiothoracic Surgery, University of California in Los Angeles.

September 1998 Surgical Diseases of the Esophagus Montreal. Chairman: Dr. Andre Duranceau.

The caption under this photograph should have read: Mrs. Dorothy and Dr. Bruce Williams

• The caption under the photograph of the late Dr. Gurd ...... should have read: Dr. Fraser N. Gurd.

• On page 6, Dr. Hany Daoud was honoured by the Principal in recognition of his 15 years association with McGill. ~%nkWou - The Square Knot regrets these errors. here has been a generous response to our appeal for funds. Almost $9000. has been received by the TMcGill Surgery Alumni and Friends. We are most grateful. • Ed Monaghan and David Mulder