SurgicalMarch 2013 the royaL A ustraNewslasian College of Surgeons

More than $1.2 million worth of scholarships inside!

The College of Surgeons of Medical images Australia and New Zealand Ensure there is patient consent 2013 c ntents Workshops & Activities 10 Cuba collaboration Professional development supports life-long learning. College From the Global Burden activities are tailored to the needs of surgeons and enable you to of Surgical Disease acquire new skills and knowledge while providing an opportunity for 24 16 Drawn to a homeland reflection about how to apply them in today’s dynamic world. NSW Fellow Raffi Qasabian in Armenia Keeping Trainees on practitioners as to the level of impairment suffered NSW by patients and assist with their decision as to the 18 ASC 2013 9 April, Sydney Track (KToT) suitability of a patient’s return to work. While the Keeping Trainees on Track (KToT) More on the program 9 April, Sydney guidelines are extensive, they sometimes do not This 3 hour workshop focuses on how to manage account for unusual or difficult cases that arise NZ 20 Scholarship from time to time. This 3 hour evening seminar trainees by setting clear goals, giving effective 6 May, Auckland – ASC feedback and discussing expected levels of compliments the accredited AMA Guideline Keeping Trainees on Track (KToT) opportunities for 2014 performance. You can also find out more about training courses. The program uses presentations, College support for encouraging self-directed learning at the start of case studies and panel discussions to provide 6 May, Auckland – ASC term meeting. surgeons involved in the management of medico- Supervisors and Trainers for SET research legal cases with a forum to reflect upon their (SAT SET) 24 Teaching the teachers Supervisors and Trainers difficult cases, the problems they encountered, and 6 May, Auckland – ASC the steps they applied to satisfactorily resolve the Non-Technical Skills for Surgeons The PD course in two regular pages for SET (SAT SET) (NOTSS) issues faced. Please note: Fellows will still need to attend very different locations 2 PD Workshops 16 April, Melbourne AMA training to be accredited to use AMA guidelines. 6 Relationships & Advocacy This course assists supervisors and trainers to QLD 36 28 Regional News 8 Surgical Snips effectively fulfil the responsibilities of their very Writing Medicolegal Reports 29 May, Brisbane important roles. You can learn to use workplace AMA Impairment Guidelines 5th ASERNIP-S on simulation 13 Dr BB Gloved 15 July, Sydney Edition: Difficult Cases assessment tools such as the Mini Clinical based training 14 Poison’d Chalice This 3 hour evening workshop helps you to gain Examination (Mini CEX) and Directly Observed VIC 15 Case Note Review Procedural Skills (DOPS) that have been introduced greater insight into the issues relating to providing 30 Successful Scholar 19 March, Melbourne as part of SET. You can also explore strategies expert opinion and translates the understanding Keeping Trainees on Track (KToT) Professor Marcus to help you to support trainees at the mid-term into the preparation of high quality reports. It also explores the lawyer/expert relationship and the meeting. It is an excellent opportunity to gain 11-13 April, Melbourne Stoodley and research role of an advocate. You can learn how to produce insight into legal issues. This workshop is also Surgical Teachers Course from the JMC Fellowship available as an eLearning activity by logging into objective, well-structured and comprehensive 16 April, Melbourne the RACS website. reports that communicate effectively to the reader. This ability is one of the most important roles of an Supervisors and Trainers for SET 32 Flexible Training (SAT SET) expert adviser. Experience from a Non-Technical Skills for 19 April, Melbourne job-share Surgeons (NOTSS) Finance for Surgeons Non-Technical Skills for Surgeons (NOTSS) 19 April, Melbourne 19 July, Melbourne 36 From the archives This workshop focuses on the non-technical skills This whole day course establishes a basic Sailing surgeons which underpin safer operative surgery. It explores Contact the 30 understanding of how to assess a company’s a behaviour rating system developed by the Royal performance using a range of analytical methods Professional

SurgicalMARCH 2013 THE ROYAL AUSTRALASIANNews COLLEGE OF SURGEONS College of Surgeons of Edinburgh which can help and financial and non-financial indicators. It Development Correspondence to Surgical News should be sent to: you improve performance in the operating theatre reviews the three key parts of a financial statement; Department on [email protected] More than $1.2 million in relation to situational awareness, communication, worth of scholarships balance sheet, income (profit and loss) and cash inside! +61 3 9249 1106, Letters to the Editor should be sent to: [email protected] decision making and leadership/teamwork. Each flow. Participants learn how these statements are Or The Editor, Surgical News, Royal Australasian College of Surgeons, of these categories is broken down into behavioural used to monitor financial performance. by email markers that can be used to assess your own PDactivities@ College of Surgeons Gardens. 250-290 Spring Street, East Melbourne, Victoria 3002 performance as well as your colleagues. surgeons.org or visit T: +61 3 9249 1200 F: +61 9249 1219 W: www.surgeons.org Polishing Presentation Skills ISSN1443-9603 (Print) ISSN 1443-9565 (Online) www.surgeons.org

The College of Surgeons of Medical images 12 September, Adelaide Australia and AMA Impairment Guidelines - select Fellows Surgical News Editor: David Hillis / © 2013 Royal Australasian College of Surgeons / All copyright is reserved. New Zealand Ensure there is patient consent The full-day curriculum demonstrates a step-by- 5th Edition: Difficult Cases The editor reserves the rights to change material submitted / The College privacy policy and disclaimer apply – www.surgeons.org step approach to planning a presentation and tips then click on 29 May, Brisbane The College and the publisher are not responsible for errors or consequences from reliance on information in this publication. Statements represent on the cover: for delivering your message effectively in a range of Professional the views of the author and not necessarily the College. Information is not intended to be advice or relied on in any particular circumstance. Medico-Legal The American Medical Association (AMA) settings, from information and teaching sessions in Development. Advertisements and products advertised are not endorsed by the College. The advertiser takes all responsibility for representations and claims. Know your limits on Impairment Guidelines inform medico-legal hospitals, to conferences and meetings. Published for the Royal Australasian College of Surgeons by RL Media Pty Ltd. ACN 081 735 891, ABN 44081 735 891of 129 Bouverie St, Carlton. Vic 3053. patient images. P27

Surgical News March 2013 / Page 3 Australia & Waitangi Day Honours compounded by financial imposts, comes at a President’s substantial cost. Perspective However, the dilemma is not to change yet again, but make work what we have. In his letter to the Secretary of State for Health (page 5), the Inquiry Chairman highlighted: “The extent of the failure of the systems shown in this report suggests that a fundamental change is needed. This does not require a root and branch reorganisation Clinical Leadership – the system has had many of those – but New Zealand New Year Honours it requires changes which can largely be do not recall the county of Staffordshire well, despite my implemented within the system…” Dame Companion of the NZ Order of five years training in United Kingdom. Famous for its Merit (DNZM) Ipotteries, it is a midlands county with the green rolling We make same mistakes hills that England does so well, combined with a dedicated Making work what we have – not throwing Dame Judith Potter (Expert Community industrial base. ‘the baby out with the bath-water’ is always Advisor on NZ National Board) Like much of England, it has suffered in the post- the challenge. The dilemma for Australia and Thatcher era without the benefits of the buzz of the New Zealand is that our Governments and Officer of the NZ Order of Merit (ONZM) ‘financial hub’ of London. That is my recollection and Departments of Health have this lemming-like Associate Professor Ian David Campbell although I was aware of the ‘Stafford Hospital crisis’, I was attachment to follow the United Kingdom’s still not expecting the devastating report from the ‘Francis approach and policies some three to five years Inquiry’ that has just been released. later. Perhaps our ‘leaders’ can short-circuit the It is a sobering read, for many reasons. I have a lingering process and read section 1.123 of the report (page fondness of the NHS; I completed my surgical training in its 67) in the section of ‘common values: putting hospitals. It was an important part of the formation of my the patient first’: surgical career. It provided free healthcare to a population “The overarching value and principle of the of over 50 million. For all its faults, I had always felt that the NHS Constitution should be that patients are NHS had its ‘heart in the right place’. put first, and everything done by the NHS However, reading the lengthy report with its 290 and everyone associated with it should be recommendations, it makes you wonder whether those informed by this ethos” thoughts were justified. Maybe that is what compelled the What a novel thought slipped into my mind, Australia Day Honours then Secretary of State for Health, the Rt Hon Alan Johnson as I read this. Over the two months of this year, Member of the Order of Australia (AM) MP to say to the House of Commons: experience data, with a focus on systems, not outcomes’ and the health related press has been ‘captured’ by “I apologise on behalf of the government and the NHS ‘staff treated patients and those close to them with what funding cuts, bed closures, government brawling – Associate Professor Andrew Donald for the pain and anguish caused to so many patients and appeared to be callous indifference’ (Page 13 of report). and the ‘blame game’. It would be nice for our Cochrane their families by the appalling standards of care at Stafford You would think that a health system, that has had ‘leaders’ to focus on this simple heading – Hospital, and for the failures highlighted in the report.” inquiries with the impact of ‘Bristol’ and ‘Shipman’, putting the patient first. – Dr Brian Leslie Cornish to the extent that these are now internationally and I suspect that the risk of a similar report in – Dr Mark Francis Ellis UK report has analogies here instantaneously recognised, would have focused the minds Australia and New Zealand is compounded by Perhaps more sobering is the conclusions are potentially of clinicians and management, as well as the organisational the multiplicity of stakeholders all trying to play applicable here in Australia and also New Zealand. scrutiny of regulators. It was not to be and indeed it is the a role in healthcare, and all trying to ensure they Medal of the Order of Australia (OAM) I need to highlight some of these for you in an abbreviated ongoing world of organisational reviews and changes that remain relevant and influential. The conflict form, ‘lack of basic care across a number of wards and have compounded, not simplified, these concerns. between the Federal and State Governments – Dr Malcolm Baxter departments’, ‘culture was not conducive to providing The report has major sections on ‘negative culture’, over funding and the ‘blame game’ recently – Dr Geoffrey Vernon Mutton good care for patients or providing a supportive working ‘professional disengagement’, ‘poor governance’, ‘lack of focus witnessed in Victoria is one aspect of this. environment’, ‘a high priority was placed on the achievement on standards of service’, ‘inadequate risk assessment of staff Welcome to 2013. Advocacy with a focus on – Dr John Cracroft Rice of targets’, ‘the consultant body largely dissociated itself from reduction’, ‘nursing standards and performance’, ‘wrong the quality of care provided for patients will management’, ‘there was low morale amongst staff’, ‘there priorities’. It laments the disconnect between the NHS and remain a core component of our activities over – Associate Professor Michael John was a lack of openness and an acceptance of poor standards’. the community, general practitioners, trusts, authorities, the ensuing 12 months Weidmann What particularly took my eye were two further regulators and professional bodies. It highlights that the Mike Hollands comments, ‘Statistics and reports were preferred to patient chaotic reorganisations of the NHS over the past 10 years President

Page 4 / Surgical News March 2013 Surgical News March 2013 / Page 5 Relationships & Advocacy

saw many Category 2 patients have their waiting time for elective surgery doubled. If ever proof was needed that the so-called blame game has survived recent reforms to health system funding, this is it. As we go to print, the Federal Government has just 2013 Training in Professional announced it will reinstate the withdrawn funding Skills (TIPS) courses for this year, but uncertainty remains around funding over the next four years. The TIPS course is a new program delivered The Victorian Regional Chair, Robert Stunden, is by RACS that offers Trainees and International to be congratulated for the measured and informed manner in which he represented the College during Medical Graduates (IMGs) the opportunity to: Issues that affect you • understand the importance of professional skills this dispute. He has been quoted several times Vote and stake your claim at length in the Melbourne Age and is now a first in surgical practice point of contact for journalists covering the issue. • recognise what constitutes professional skills At all times he refrained from taking sides in the dispute, calling instead for the politicians to get • develop skills relating to professional together and solve the dispute in the interests of competencies by practicing in a safe environment. patient care. Of course, Victoria is not alone. Across all jurisdictions, we are being asked to do more with Seven of the nine defined surgical competencies are less. The severity of the situation is felt first and related to professional skills. As is the case for technical foremost by those waiting for non-urgent elective skills, competence in professional skills requires surgery, but those working in public hospitals deliberate and repeated practice for expertise to develop are inevitably subject to heightened stress and – TIPS provides the setting and structure for that practice. frustration levels. Learn techniques for working with patients and colleagues Goodbye and good luck that can be applied to clinical practice. Participants have I have had the privilege of being a member of the opportunity to practice communication skills and Council for a number of years. During that time teamwork in real-life scenarios and receive feedback and I have had the honour of associating with many guidance from experienced instructors. remarkable members of our profession – of observing first hand the dedication, the sacrifice, the The TIPS course is recommended for all SET2+ ustralians have embarked upon becoming an important issue, already Ten current councillors are submitting simple desire to do the best that they can. Trainees and IMGs. Places are available on the what is effectively the longest exceeding 9.5 per cent of GDP in themselves for re-election. Make no mistake, being a member of Council following courses in 2013: election campaign in the nation’s Australia. The new College Council will take A for the maximum allowed time of nine years 22-23 March, Melbourne history (but still eclipsed by the 10 month The healthcare industry has now office on Thursday, May 9. equates to a donation of more than one year of 15-16 August, Sydney long New Zealand election campaign in become the largest employer in Australia If you have not received ballot papers one’s professional life. There is little reward for this 2 011 ). – one in nine employed people works in by now, please notify Margaret Rode at 28-29 May, Brisbane contribution other than perhaps the knowledge 23-24 September, Melbourne Of course, I am not talking about the healthcare. Can we point to productivity the College (margaret.rode@surgeons. that an effort has been made to make a difference 25-26 July, Adelaide forthcoming College Council elections increases to justify this increased org). The deadline for the return of ballot and to support what we believe is a worthwhile and 22-23 November, Auckland – the College’s democratic process is expenditure? papers is Thursday, April 4. necessary institution. fortunately a more streamlined affair. So with difficult times on the horizon Unfortunately a significant number February Council saw the retirement of two Nevertheless, the Council election is an for healthcare it will be important to of ballot papers each year arrive after surgeons – Spencer Beasley and Bruce Twaddle. I Fees important process. The Council largely have a strong and supported Council. the deadline and are therefore invalid, so have had the pleasure of associating closely with Australia determines the direction of our College. Taking the time to assess the candidates please post your completed ballot paper both of them. Both were immensely intelligent Trainees: $1,320 (inc GST) Non-Trainees: $2,735 (inc GST) For surgeons the College is our peak and casting a vote is one way of to the College sooner rather than later. Councillors, possessed of inordinate common professional body and, with increasing demonstrating support. The manifestation of the strains being sense. Neither shirked an issue or a task. I know New Zealand: strain on health care systems, there are Together with the ballot papers sent to placed on our hospital systems right them to be individuals of the highest integrity. They Trainees: $1,795 (inc GST) Non-Trainees: $3,710 (inc GST) predictably going to be stresses on our each surgeon is a CV booklet in which across both our countries are particularly will be missed. professionalism. the candidates outline why they wish to apparent in my state of Victoria. The

Not the least of these is the dilemma be a member of Council and the issues situation was cruelly exacerbated by Registration on the waiting list is free and of how to marry our social responsibility they seek to pursue. Please cast your vote the recent withdrawal of a considerable can be completed either via the online TIPS to help achieve healthcare cost reduction wisely. amount of federal funding, some of it registration form (www.surgeons.org), with our professional responsibility to Nominations have now closed. I can taking effect retrospectively. The situation emailing [email protected] or by calling Oana do the best we can for our individual report that there are 13 candidates for 10 was toxic, with both levels of government Michael Grigg Cochrane on +61 (0)3 9276 7419. Confirmation will then be sent to eligible applicants. patients. And healthcare costs are positions as general elected councillors. blaming the other for a situation that Vice President

Page 6 / Surgical News March 2013 Surgical News March 2013 / Page 7 Surgical Snips Surgical Snips

Continued health cover for ex-personnel Diggers returning from service in war ravaged countries will have to prove their conditions were the result of trauma in the field. This can cause secondary trauma, retired Colonel Susan Neuhaus has said. She said recent veterans should have access to the Department of Veteran’s Affairs ‘Gold Card’ which allows all of their medical costs to be covered by the government. “You decrease all of the secondary trauma that goes with people who are sick and trying to put in claims years after the event, Federal backflip who have this enormous burden,” she said. The Australian, February 12. The crisis in Victorian Healthcare has received a last minute reprieve after e-Health lagging the Federal Government announced The national e-health system rolled out that it would reverse the decision to late last year has been compared to cut hospital budgets. the Federal Government’s failed roof However, the government has pointed insulation system, recording dismal Separation success out that the money will go directly to uptake numbers. Dr Mukesh Haikerwal The Tasmanian Regional Chairman of the College Brian Kirkby has hospital administrators and not state has admitted there have been applauded health analyst Martyn Goddard’s call for the separation accounts. problems, with the system crashing as he of elective and emergency surgery. Within the letters section of the The reprieve will only count for attempted to promote the program for Launceston Examiner, Kirkby said that the urgent need for greater health the financial year. Federal Health the National E-Health Transition Authority. funding should not preclude the implementation of proven efficiencies. Minister Tanya Plibersek blasted the “The potential is great but all the “In 2011, the College wrote to all health ministers in Australia and New “incompetent” State Government, snags around the country need to be Zealand, enclosing a comprehensive report that demonstrates beyond saying: “For two years Premier Baillieu’s addressed,” Dr Haikerwal said. any doubt that the separation of elective and emergency surgical blatant disregard for the welfare The Coalition’s eHealth spokesman streams leads to greater efficiency and, most importantly, better patient of Victorian patients has seen … Andrew Southcott has called the failed outcomes.” standards of care decline.” system “Pink batts on steroids”. Launceston Examiner, February 7. Herald Sun, February 21. Sun Herald, February 17.

Provincial Surgeons of Australia The Alfred 49th Annual Scientific Conference General Surgery Meeting 2013

Friday 1 - Saturday 2 November 2013

Grand Hyatt Melbourne, 123 Collins Street, Melbourne Provisional Program now available! Evidence Based Vascular Surgery and Request a copy by emailing [email protected] Organisation of Vascular Surgery Services Australian and New Zealand Head & Neck Cancer Society 15th Annual Scientific Meeting Thursday 29 August to Saturday 31 August 2013 The Sebel Albert Park, Melbourne Save the Date!

Further information: E: [email protected] ‘Practical Updates T: +61 3 9249 1139 for General Surgeons’ ANZSVS 2013 Conference 12-15 October 2013 Hotel Grand Chancellor, Hobart, Tasmania 25 - 27 July 2013 For more information visit www.anzhncs.org Hilton Queenstown PROVISIONAL PROGRAM NOW AVAILABLE. To download visit: Contact T: +61 3 9249 1273 E: [email protected] New Zealand www.surgeons.org/member-services/college-resources/conferences

Page 8 / Surgical News March 2013 Surgical News March 2013 / Page 9 International Development

“Since 1963, Cuba has conducted collaborative programs in 108 countries involving more than 120,000 Cuban health workers within ‘medical brigades’.”

“This is implemented through an international Mr Monzon said the medical education mission of two years for every Cuban doctor and the component of Cuba’s international aid programs was design of a financial system in which Cuba shares the supported by the Latin American Medical School most important burden,” he told the conference. (ELAM) which provides six years of free educational “Since 1963, Cuba has conducted collaborative scholarships to students from developing countries. programs in 108 countries involving more than 120,000 Cuban health workers within ‘medical brigades’ that How it began rotate every two years. He said ELAM was founded in 1999 with the entry Collaboration with “At present, Cuban brigades are working in 66 of 1,933 students from 18 countries, but that it now countries, involving around 39,000 health workers, hosted 18,891 students from 90 countries. 17,000 of whom are specialists, many of them working “ELAM offers a Bachelor program consisting in an Health workers from Cuba are assisting in Cuban oral- in very difficult environments in (complex) places in emergency situations around the world maxillo-facial introductory year of Spanish language training for surgeon Dr Latin America, the Caribbean, Africa, North Africa, foreign students followed by first and second years of Ivan removing the Middle East, Asia and the Pacific. pre-clinical training, third to fifth years of studies in uba’s post-revolution focus on delivering free, Mr Monzon was a guest speaker at the International an arrow “We have also begun cooperation with Kiribati, different medical universities and the sixth year as an accessible health care by providing widespread, Medical Development Symposium held in September embedded in Tuvalu, Vanuatu, Nauru, Solomon Islands, Fiji, Palau internship to train in hospitals and neighbourhood the parotid subsidised medical training has resulted not last year at the College Headquarters in Melbourne. and Tonga.” C Cuba gland. clinics under specialist supervision,” he said. only in dramatic improvements in all national health He was invited to speak by Symposium organiser Assisted by Mr Monzon said Cuba was particularly pleased to “Almost all doctors then go on to complete an indices, but also the world’s highest ratio of doctors to and the Chair of the College’s International Committee Australian have provided medical aid and education to Timor 18-month specialisation in Integrated General population, according to the Cuban Ambassador to Professor David Watters who felt it important that surgeon and Leste following its Independence. Medicine or ‘family doctor’ training. Australia, Mr Pedro Monzon. Fellows understood the Cuban health and international Timorese He said the co-operation began in 2004 and “This is completed at hospitals and scrub-nurse. Mr Monzon said that with 11.8 per cent of GDP aid systems, given how often Australasian and Cuban involved approximately 350 Cuban doctors working neighbourhood clinics (in a system that) could be assigned to health, Cuba now had first world health surgical teams now meet in Pacific Island countries and in-country. considered the largest medical school in the world standards that included an infant mortality rate of 4.5 Timor Leste. “Cuban doctors now represented 80 per cent of the with 32 campuses across Cuba. per 1000 live births, an average life expectancy of 79 Addressing the theme of the Global Burden of Surgical workforce at the National Hospital, 100 per cent of “In conclusion we could safely say that by far Cuba years and the eradication of common tropical diseases Disease, Mr Monzon explained to the conference the the workforce at the five district hospitals and 100 per has the biggest health cooperation program in the world with free vaccination programs. central focus placed on international medical aid by cent of the workforce at the remote clinics,” he told the and that Cuba, with its relatively small population, He said that Cuba now had around 79,000 doctors for Cuba that now sees Cuban surgeons and medical teams Symposium. territory and GNP has saved more lives in the a population of 11.3 million – a ratio of one doctor per working in areas of need around the world. “Also 1000 scholarships have been given to study developing countries than all the G-8 countries together. 143 inhabitants – working in 267 hospitals and more He said Cuban International Collaboration programs medicine in Cuba, and in 2013 the country will have “And all these efforts have been done despite than 400 neighbourhood clinics across the country. were based on the delivery of Cuban doctors to improve around 1000 graduated doctors, a few of whom 54 years of economic, commercial and financial Australia, in contrast, has an approximate ratio of one health outcomes where needed along with the provision finished their studies in Timor Leste in a school blockade that includes everything from food to practicing physician per 330 people. of free medical scholarships in Cuba. founded by Cuba.” medicine.” u

Page 10 / Surgical News March 2013 Surgical News March 2013 / Page 11 International Development Surgeon health

both being essential for neurological and “In conclusion we could safely say muscular function. Magnesium [sulphate] is now recognised to reduce the likelihood that by far Cuba has the biggest health of cardiac arrhythmias, pregnancy cooperation program in the world...” induced convulsions, and probably reduces the likelihood of cerebral vasculature to spasm. However, given how dim and distant our biochemistry, we overlook that it is an essential co-enzyme for efficient glucose handling, and together with B vitamins helps activate enzymes for digestion, absorption and the utilisation of proteins, fat and carbohydrate. Magnesium may not be a wonder drug, but it is a missing element that plays a role in many Hidden benefits common conditions. Missing an essential element? The bibliography of peer reviewed evidence in high impact journals is impressive. There is a link between Cuban magnesium deficiency, hyperinsulinaemia doctors in a field hospital and the laying down of body fat, performing ne of my favourite patients Magnesium advocates also warn of particularly abdominal adipose tissue. My surgery on a attended the other day – a an association between fluorination of comment at the start about ‘approaching victim of the normally convivial, middle-aged water and deficiency, which is the result of type 2 diabetes’ alluded to the years of earthquake O surgeon, Ms Ng Magna, with the usual insoluble magnesium fluoride deposits in hyperinsulinaemia during middle-age, the which killed 90,000 health issues of many busy professionals bone and cartilage. generation of adipose deposits, visible to people at the same stage of life. I advised Ms Ng Magna to try many of us each morning as our struggle Embracing a slight tendency magnesium supplements promising her with weight gain despite reasonable to be overweight, hypertension, no ill effects other than the tendency of discipline in diet, and worry about the Last year’s International Medical Development “At the same time, however, there is always the challenge hyperlipidaemia, and approaching some magnesium salts to cause diarrhoea. eventual onset of diabetes in later life. Symposium was the third held by the College, but the first for doctors returning from Cuba who have been trained in type 2 diabetes, my patient could have Ms Ng Magna was not sleeping well Magnesium is critical to cholesterol to be jointly convened and badged with the Australian a different medical language and different medical system been in better shape, but was at least because she was suffering from night balance, dampening down the HMG-CoA Society of Anaesthetists, the Alliance for Surgery and who may need time to adjust and in some cases more making time for exercise and taking some cramps. She blamed too busy a practice reductase involved in its synthesis. It is Anaesthesia Presence, the Harvard-based Humanitarian training in order to provide the best possible care in their holidays. She was tired, not sleeping well, combined with the demands of and used in reactions by enzymes that lower Surgery Initiative and the International Society of Surgery. home environments.” and not quite the usual bouncy self. worries about teenage children causing LDL (bad), raise HDL (good) and convert Specialists and leaders in global surgery and anaesthesia The consultation was timed to discuss too many topics of disturbance. But I Omega 3’s and 6’s to prostaglandins. attended from North America, Europe, Asia and the Pacific Wide recognition the latest results. I had done all the usual can tell you once her night cramps were The magnesium deficiency could who delivered addresses on topics such as the measuring The Project Director of the College’s Australia-Timor Leste annual review tests, but also had included relieved by magnesium supplements, be contributing to Ms Ng Magna’s of unmet surgical need, the safety of surgery in low and Program of Assistance for Secondary Services (ATLASS II), magnesium and red cell magnesium she started to sleep better and her hyperlipidaemia. The evidence suggests middle income countries, essential surgical care and the Mr Glenn Guest, applauded Cuba’s medical aid program levels, something I’ve been checking more hypertension improved. LDL is lowered 10-18 per cent and HDL role of organisations in training, support, advocacy to Timor Leste both in the provision of surgeons and and more in recent years. raised by 4-11 per cent. and research. medical training for local students. Though the serum magnesium The results Magnesium may be all Ms Ng Magna will Professor Watters said the address by the Cuban “This year will see the return of 600 medical graduates was in the lower range of normal The improvement in her hypertension need. Time will tell. But it’s safe and without Ambassador was particularly helpful in allowing coming back to Timor Leste from training in Cuba and (0.72mmol/l), the red cell magnesium was the result of magnesium being a terrible side-effects. She started on 150mg Australasian surgeons to understand the role and training these numbers will result in a dramatic increase in the local was low at 1.5mmol/l (normal range natural calcium channel blocker. Both elemental magnesium (there are various of Cuban surgeons working across the Pacific and within medical workforce that will shape the country well into the 1.70-2.90mmol/l). As only 1 per cent of the minerals are important in smooth muscle salts and preparations) and, once certain Timor Leste future,” Mr Guest said. body’s magnesium is in the blood, with 40 function and must be in balance. she was not suffering from its laxative effect, “Asking the Ambassador to speak at the Symposium was “The challenge now is to integrate those newly per cent in the cells, it is a better reflection Each is a co-enzyme of many of the increased in stages to 400mg. about increasing cooperation, collaboration and respect graduated doctors who have been trained in a different of magnesium status to work on the red body’s reactions (think back to your When I next saw her she was smiling, between Australasian and Cuban surgeons,” he said. language, different medical system and different culture cell magnesium. days of biochemistry), some important she was sleeping well, her night cramps “Australasian surgical teams often work very closely with back into the Timor Leste health system. Many diets are deficient in magnesium, for glucose homeostasis. A number had gone, her blood pressure had Cuban surgeons across the spectrum of our international “Now, Cuba and the College in collaboration with the particularly where ready-made meals, of patients respond to magnesium dropped, mood bright and she felt aid program and the more we understand each other the Ministry of Health are all working to select the best and refined and junk food or snacks comprise alone in regard to their tendency to be generally better. Her teenagers hadn’t better that cooperation can be. brightest of those graduates to receive specialist training a significant part of the diet. There’s less hypertensive. stopped worrying her but then when does “The Cuban international medical aid program is very so as to provide the best possible secondary and tertiary magnesium in today’s food, particularly In the medical mind, magnesium has that happen? Maybe they should take large and there are some very fine surgeons doing very fine health care to the people of Timor Leste.” as, unless organic, it is normally grown in not gained the clinical limelight that magnesium too? But that’s another story. work which must be acknowledged. With Karen Murphy magnesium deficient soil. its brother mineral calcium has, despite Dr BB G-Loved

Page 12 / Surgical News March 2013 Surgical News March 2013 / Page 13 Surgical Services Audits of Surgical Mortality

Case study Delayed Diagnosis of Perforated Ischaemic Intestine People would read the words of before, but that is not to say that Hamlet, “Or to take arms against a sea they are ineffective. Follow the link to join this discussion on the College website of troubles, And by opposing, end them” The best one, of course, http://www.surgeons.org/my-page/racs-knowledge/blogs/all-blogs/anzasm (Act 3, Scene 1), and say – not me. would be to provide certainty -case-note-reviews/2013/anzasm-case-note-review-mar-2013/ Of course, my group is not only – it would appeal to surgeons surgeons, but also junior staff, nursing the most. But in the healthcare Case Summary Assessor’s Comment: staff and yes, even administrative staff. environment of today and n elderly patient was admitted to a Clearly this patient’s prognosis was poor The trigger for our current crisis of indeed tomorrow, uncertainty is major metropolitan hospital with from the outset (elderly demented patient morale is the relentless budgetary inevitable. It is one of the reasons Aa short history of being unwell with other comorbidities and ischaemic gut/ pressure – the need for cost savings in why change, reorganisations with abdominal distension and vomiting. gross peritonitis). However, a number of the face of increasing demand for our are so attractive to healthcare The patient had significant comorbidities management issues arise. services. managers. The mere process of including dementia and was unable to From reading of the case notes, the gravity Morale in hospitals is possibly different change provides the possibility give a history. The patient had recently of the patient’s condition and significant from other organisations. For example, I of achievement in and of itself – been treated in the same hospital under a overnight deterioration was not appreciated suspect that if I were one of the employees at least for a time. different unit for small bowel obstruction by the junior staff. When consultant review in a private company that was losing The second tactic is to which was successfully managed took place the following day, immediate money, our morale would be low because celebrate achievements and conservatively. surgery was scheduled. we recognised that the company could go successes. Too often we focus The patient was noted by the registrar to Elderly patients with ischaemic gut may belly-up and we would lose our jobs. on our failures and deficiencies. have abdominal distension with right sided appear deceptively well; however, a high For doctors and nurses, there is not The third tactic is to identify an tenderness and guarding. Abdominal X-ray index of suspicion is needed. Localised the same employment focus, not the enemy – real or imagined does showed multiple fluid levels. The registrar tenderness and guarding in a patient with same threat of unemployment. So why not matter (so long as it is not diagnosed recurrent adhesional small bowel small bowel obstruction should ring an is morale affected in hospitals? The the Director of Surgery). obstruction and admitted the patient for alarm bell. A CT scan might well have answer is not so simple. For hospitals, the usual target idiopathic ventricular tachycardia (IVT) and helped in diagnosis. The delayed diagnosis With respect to hospitals, I have is administration – “they are nasogastric suction. The following day the of ischaemic gut is a recurring theme Poison’d chalice come to recognise two things. growing at an exponential rate, patient was reviewed by the consultant of the in mortality reviews and needs to be Firstly, hospitals are either getting consuming our funding”; “they original treating unit, who assessed the patient emphasised to junior surgical staff. “From this day to the ending of the world; But we better, bigger, improving or they are don’t care about patients, just as being moribund due to an acute abdomen. Clearly this patient was going to have a declining. Treading water, as it were, in the bottom line”; “they are the At operation there were extensive prolonged postoperative ileus, and parenteral in it shall be remembered; We few, we happy a short period of time, is decline. source of our frustrations”. Alas, adhesions with a perforated ischaemic nutrition should have been commenced much few, we band of brothers; For he to-day that Secondly, public hospitals in it is not a solution for me. Sure terminal ileum and gross peritonitis. A earlier rather than at a week postoperatively particular are staffed by ambitious, they may be inept at times, bowel resection without anastomosis was after repeated requests by the surgeon. sheds his blood with me; Shall be my brother” high achieving individuals who are frustrating, but by and large they performed, leaving the abdomen open, and It appears that a serious error occurred Henry V (Act 4, Scene 3) working in that environment with are well meaning people, more the patient was managed in ICU. in ICU when nursing staff, requested to at least a little sense of altruism. at risk of unemployment than Several days later at a second laparotomy, remove skin staples, also cut the sheath t is my usual practice to do a ward I see it as one of my leadership The altruism may be directed clinical staff. Their “growth” the small bowel was anastomosed. The suture which led to abdominal dehiscence round before theatre. The hospital responsibilities to maintain and enhance at creating a bigger, better service or is not of their own making, patient then underwent a third laparotomy and the need for another operation. Iatmosphere is subdued. You do not morale. If the ‘morale meter’ is in the educating Trainees or whatever. but more a manifestation of shortly thereafter so that the abdomen There may have been miscommunication need to be clairvoyant to realise that all is positive, efficiency and achievement are Failing to allow and even celebrate such society’s demand for increased could be closed. The treating surgeon between medical and nursing teams here, not well. Even, the theatre start is delayed. enhanced. Alas the opposite also altruism is seen as a slap in the face, felt accountability. expressed serious concern about the and in a busy ICU communications need to It is clear to me that morale is low. holds true. as frustration and manifests as a fall in So what will I do in the face of patient’s nutritional state and requested be clear and well documented. Alexander Leighton was an American I particularly like Leighton’s morale. Threats and challenges are not falling morale? The two things parenteral nutrition. As noted previously in these reviews, sociologist and psychiatrist. In 1949 he analysis since it identifies morale as a problem but frustration, for whatever that I plan to do are provide as Several days later, due to concerns about in this case enormous hospital resources defined morale as the capacity of a group a characteristic of a group not an reason, is the major impediment to high much information and education wound infection, ICU staff were asked were expended on an elderly patient who of people to pull together persistently individual. In my experience a fall in morale in the hospital setting. that I can and promote as to remove skin staples. It appeared that clearly had a poor prognosis from the first and consistently in pursuit of a morale is just as likely to be triggered by Frustration wears down the individual much understanding of the the sheath suture also was cut, leading to operative procedure. Given the subsequent common purpose. perception as reality. prepared to see the glass half full and environment that I can. And abdominal dehiscence. The patient was cascade of postoperative problems, As a surgical director in a busy Alas, of recent times, it is reality that eventually the glass appears half empty provide a forum for discussion returned to theatre for the fourth time to consultation with family and withdrawal hospital, I am very aware of morale – is having a detrimental effect on morale. and declining morale is a malignant and communication and resuture the abdomen. of active treatment at a much earlier stage nebulous and abstract it might be, but And although abstract, morale can be process – it spreads insidiously and continue to encourage advocacy Subsequent progress was poor with might have been appropriate. there can be no denying its ‘realness’. measured – directly by absentee and sick sometimes rapidly. on behalf of our patients. And progressive development of multiorgan Henry V’s speech before the Battle of leave rates, by resignations, by the number So as a clinical leader, what tactics do secondly, to focus our efficiency failure. Consultation with the family Agincourt is a lesson in morale building of applicants for positions etc. and I have at my disposal to rebuild morale? drive upon removing any source resulted in a decision to withdraw active – against overwhelming odds, the indirectly by efficiency, even late theatre Well I don’t know of any new ones – I of frustration, however small. treatment and the patient died nearly a Guy Maddern English prevailed. starts and “extra curricula” participation. have seen and experienced them all Professor U.R. Kidding month after admission. Chair, ANZASM

Page 14 / Surgical News March 2013 Surgical News March 2013 / Page 15 Fellows abroad

Dr Raffi Qasabian, Gurgen Balasanyan (Cardiothoracic surgeon), Salpi Mkhitaryan Performing the country’s first thoracic endovascular aneurysm repair (cardiologist), Karen Zohrapyan (paediatric interventional cardiologist) Mount Ararat – ancient symbol of Armenia for the Armenians Artyom Avetisyan a trainee at NMMC with Dr Raffi Qasabian

How developed is vascular surgery as a What is the Armenian health system like? specialty in Armenia? While we are used to Medicare and the expectation that Drawn to a homeland I had a vision of waltzing in and teaching the vascular our medical treatment needs will be met, in Armenia only The grandson of Armenian refugees and a first-generation Australian, surgeons of the country the newest techniques in vascular the paediatric population’s medical care is subsidised by the surgery. It became clear very quickly, however, that there government, so people have to pay for their own medical Vascular Surgeon Dr Raffi Qasabian long felt drawn to the land of his ancestors was no real vascular surgical service to speak of in the treatment. While I do not receive any money for the work I country. perform there, patients still have to pay for their hospital stay fter an initial visit to Armenia in 2004 which he described Armenia so I did in 2009. On that occasion, I set up While there were vascular surgeons, there was no real and for any grafts or other equipment that I’d require for the as a life-changing experience, Dr Qasabian now tries to get meetings with a couple of vascular surgeons at different vascular surgical faculty, no real co-ordinated training, and operation. The average monthly wage in Armenia is $200, so Athere twice a year to help teach and train local surgeons in hospitals, but it was not hugely successful given that I was there was very little experience with even basic vascular you can imagine that any medical treatment is going to be the virtually nonexistent specialty of vascular surgery. an unknown entity. services, especially arterial. unaffordable for most of the population. I had to negotiate In between, he conducts internet consultations with cardiac It then became clear to me that I needed to have some Many of the current surgeons had trained in the old with the hospital administrators to minimise the cost to the surgeons, raises money for equipment and is in the process of backing for the sake of credibility and support. I therefore Soviet system, one which was foreign to me and not in patients as much as possible. seeking financial support to bring an Armenian surgeon to approached Medtronic, a large US based multinational keeping with the standards of the system in which I had Australia for specialist training. company, and asked whether they would support me with an been trained in the West. I decided that I would need to Are you planning to bring an Armenian doctor A consultant vascular surgeon at the Royal Prince Alfred educational grant so that I could start teaching surgeons there come to Armenia at least twice a year, every six months, to to Australia for training and if so why? Hospital with a private practice in Sydney and an outreach service the newest techniques in vascular surgery. We set up a meeting. establish some form of serious “service” and also to provide I realised very early on that by going to Armenia twice a year to Tamworth, Mr Qasabian tells Surgical News about Armenia As it happened, another staff member at Medtronic, an a follow-up and surveillance service. for two to three weeks at a time, I am not going to make any and his efforts to help raise surgical skills in a struggling country. Armenian by the name of Linette Shahinian heard about my real, long-lasting, significant difference. I feel it is necessary to proposal and came along to the meeting also. It was through What does that surgical service involve? train some young, local Armenian surgeons in the West with What made you decide to go to Armenia the first time her help that Operation Armenia was born. One of the cardiac surgeons there began acting as a go- the hope that on their return they can continue the work that I and what were your impressions? between for me. He would be sent the vascular cases by the have started by forging a vascular faculty or school. The first time I visited Armenia was in 2004 while I was a How did you go about providing surgical cardiologists, and would then discuss the history with me via During my last visit I was approached by a young vascular vascular surgical Trainee. It had newly emerged from the Soviet training and assistance? the internet and send me copies of any pertinent imaging. surgeon who wants to continue his training, preferably somewhere Union collapse as an independent republic, trying to find its own Linette had many influential contacts in Armenia, who were I would then make a decision about the need for in the West, and I am trying hard to make that happen. voice, its own feet, in a very hostile neighbourhood. able to put us into contact with some of the top surgeons in surgery, what type of surgery, with a view to operating The republic of Armenia is a tiny, landlocked, mountainous the country. I visited several hospitals, including the hospital on the patient (or just seeing the patient in consultation). Why are you so passionate about helping the people country, less than half the size of Tasmania, in the South Caucasus attached to the medical school and I was also introduced to the And so, patients started being referred to me by the local of your cultural homeland? region of Eurasia. It is bordered to the west by Turkey, the north by Dean of the Medical School. cardiologists. I suppose I feel I live a life of great privilege and I am very Georgia, the south by Iran and the east by Azerbaijan. I was invited to speak at a State Hospital called Nork I started operating on patients-performing open lucky to have been born in this amazing country and luckier It has a population of just over 3 million and when I first went Marash Medical Centre (NMMC), a paediatric and adult infrarenal abdominal aortic aneurysm repairs, bypasses still to have received a high standard of education. In a way it was still suffering the effects of a major earthquake in 1988 cardiology and cardiothoracic surgical hospital which for peripheral vascular disease, carotid endarterectomies I wanted to give something back and being of Armenian and had recently been to war with Azerbaijan. It was a very poor not only has the country’s best cardiac intensive care unit, (I gifted a carotid endarterectomy set to the hospital as they descent, with my family being uprooted the way they were, place. Nevertheless it was a pivotal, life-changing experience cardiac operating theatres and anaesthetic support, but also did not have the necessary equipment) and a host of other it seemed natural to “return” to complete a cycle that started for me as I sought to trace my roots and it was then that I first has an excellent group of interventional cardiologists and a vascular operations. back i n 1915. dreamt of one day coming to Armenia to work as a surgeon. radiology suite. On my last visit in January this year, I operated on a Armenia is a struggling little country with many large After I delivered that talk to the staff and Trainees of man with a ruptured aneurysm. I later found out there was hurdles before it, yet there are many people like me from all When did you next return and how did you go about the hospital, I was invited to use the hospital facilities to no-one else in the country at that time who could have or over the world contributing in many different fields and I providing assistance? commence vascular surgical services. This was the moment I would have performed this operation. The patient survived would like to think that in some way, I too will make a small On completing my training and establishing myself as a clinician had been waiting all those years for. Suddenly I could realise and was so grateful that he promised me he would offer a difference to Armenia. in Sydney, I had an ongoing nagging sensation to return to my dream of operating in Armenia. sacrificial lamb to thank God for his good fortune! With Karen Murphy

Page 16 / Surgical News March 2013 Surgical News March 2013 / Page 17 Annual Scientific Congress 2013 Curmudgeon’s Corner

Online registration and program updates: asc.surgeons.org Sky City Conference Centre, Auckland, 6 – 10 May, 2013

In Memoriam Our condolences to the family, friends and colleagues of the following Fellows whose death has been notified over the past month:

uckland, winner of the latest College. Two prominent figures will be indicated that the themes are an exciting George Jerzy most liveable city in the world honoured with Honorary Fellowships. shift in focus. Schweitzer, Acompetition, has a lot to offer The meeting will focus on Coronary South African Fellow visitors and is a gateway to one of the Artery Surgery, Minimally invasive President’s Lecture Sydney Nade, most popular tourist destinations in the Thoracic Surgery, and Aortic Valve This year the President’s Lecture will NSW Fellow world. It is not too soon to get the dates be delivered by Sir Ray Avery, founding replacement. The visitors include into your diary, and to decide how many member of the University of Auckland Professor Freidrich Wilhelm Mohr from What day is it? James Broadfoot, of the family members will be travelling School of Medicine, scientist, inventor Leipzig, Professor David Taggart from NSW Fellow to Auckland with you. and entrepreneur. Sir Ray developed low Oxford and Professor Robert McKenna Too many days to remember cost intra-ocular lens manufacturing for Los Angeles. The Annual Scientific Congress There will be a Masterclass on Mitral technologies which he gifted to the Fred here is one thing that really and fairies. Not at my door they We would like to notify readers in Auckland promises to be truly Valve Repair and a keynote lecture on Hollows Foundation. annoys me and that is don’t. that it is not the practice of outstanding, and some evidence of this Trans-catheter therapies for surgeons. The title of his lecture will be unwanted named days. You Last year I scared them witless Surgical News to publish obituar- comes from the following: “Improvements in Global Healthcare The international visitors and local T may well ask what do you mean by opening the door dressed ies. When provided they are • The 32 international visitors on faculty, through disruptive Science and contributors bring a wealth of experience by that – I mean Secretaries’ Day, in a sheet with the skull from published along with the names to learn from the world’s best. Technology.” and a strong evidence based approach. Valentine’s Day, Halloween etc. It is anatomy studies sticking out the of deceased Fellows under In • The 4 plenary programs covering not that we curmudgeons don’t like top where my head was carefully Memoriam on the College web- highly relevant issues related to Trauma Surgery General Surgery efficient secretaries – we do but covered. Boy, did they scream site www.surgeons.org go to the sustainable surgery. The Trauma program is convened by Patrick Alley will convene the General after all we pay them – what more and run. They won’t be back in • The 23 scientific programs are James Hamill. The trauma surgery Surgery program which will feature do they expect? 2013. Fellows page and educationally outstanding. program of the 2013 Annual Scientific outstanding national and international It is all this marketing stuff that And as for Valentine’s Day – click on In Memoriam. • There will be 28 master classes Congress aims to address issues facing all speakers. Masterclasses covering tries to get us to buy things such as what a waste of time and money. covering a wide range of topics, across ‘Preserving your Sanity’ and ‘When to Say } surgeons dealing with trauma including flowers and perfume, usually unwanted, It is just retailers trying to sell red roses all specialties Management of Burns for non-burns No’ are issues relevant to all surgeons in for secretaries on this special day. When and silk things and chocolates. In any Informing the College • The record number of over 400 surgeons, Transport and resuscitation, their daily practice when managing life is the day, you may ask? The official (US) event, no self-respecting curmudgeon If you wish to notify the College abstracts submitted thus far. Complex upper abdominal trauma and work balance and end of life issues. day is Friday of the last full week in April would be seen dead in the ladies’ intimate of the death of a Fellow, please There is a renewed plan to involve the management issues associated with There are combined sessions so that makes it April 26 in 2013, unless apparel section. contact the Manager in your surgical Trainees by providing a dedicated mass casualties. with Surgical Oncology and Upper you live in Brisbane where it is on Friday If you look at all the named days, there Regional Office. They are educational program. The Masterclasses on Penetrating gastrointestinal surgery discussing May 3, 2013. are more in some months than there are Injuries, Paediatric Trauma, and Distance, gastrointestinal neuroendocrine tumours, Don’t ask me why, but as we all days in the month. On April 1, 2013 we ACT: [email protected] Convocation and Delay and the Deteriorating Patient are of and Bariatric Surgery covering the know things are always a bit different have Easter Monday, April Fools’ Day NSW: [email protected] Welcome Reception – particular significance, being relevant to complications of Bariatric surgery. A in Queensland. I should also add that (that is one worth keeping) and César NZ: [email protected] keynote lecture by Professor David Watters Monday, May 6 many surgical specialties. the politically correct term is now Chávez Day – I bet you don’t know that QLD: [email protected] regarding preparation for regional and Attendance at the Convocation and the ‘Administrative Assistant’s Day’. one. Unfortunately I don’t have time to SA: [email protected] Cardiac & Thoracic Surgery remote practice will be of interest to many. Look at Halloween. This was a minor tell you who the good César was as today Welcome Reception is included at no TAS: [email protected] additional cost when you register for the Section Convenor, Indran Ramanathan Professor John Windsor non-official religious day, but has been my secretary has quit in a huff and my VIC: [email protected] meeting. Eighteen senior members of has invited an outstanding faculty – Congress Convener hijacked by the retailers and pesky little good lady says I can sleep in the shed the profession will be acknowledged for of presenters to the cardiothoracic Professor Andrew Hill kids who want sweets when they knock on which I can’t do as some little blighters WA: Angela.D’[email protected] their contributions to surgery and to the program in Auckland. Indran has – Scientific Convener your door dressed as goblins and ghosts burnt it down last night. NT: [email protected]

Page 18 / Surgical News March 2013 Surgical News March 2013 / Page 19 Scholarships 2014

Travel and research scholarship opportunities for 2014 The Board of Surgical Research Scholarships and Fellowships Research Scholarships and Paul Mackay Bolton Scholarship - Foundation for Surgery Funded Fellowships - Bequest, Donation for Cancer Research Research invites Fellows, This scholarship was established by Harry Bolton in and Sponsor Funded Trainees and other Surgeon Scientist Scholarship memory of his late son, Paul. Professor Paul Bolton was a distinguished surgeon, teacher and researcher Open to Fellows and SET Trainees enrolled in or intending to enrol in a PhD. Gross value John Mitchell Crouch eligible applicants to who died from colorectal cancer in 1978, aged 39. It is $70,000 comprising $60,000 stipend plus $10,000 departmental maintenance. Tenure is Fellowship designed to support applicants who wish to take time for up to 3.5 years. The John Mitchell Crouch apply for the following away from clinical positions to undertake a full time Fellowship of $150,000 is awarded research project under the supervision of an experienced Scholarships, Fellowships Foundation for Surgery New Zealand Research Scholarship to an individual, who in the investigator in the prevention, causes, effects, treatment Open to Fellows and SET Trainees enrolled in, or intending to enrol in, a higher degree. opinion of the Council, is making and Grants for 2014. and/or care of cancer. Preference may be given to Applicants must be a New Zealand citizen currently residing in New Zealand. Gross value an outstanding contribution to applicants who are enrolled in or intend to enrol in $60,000, comprising $55,000 stipend plus $5,000 departmental maintenance with a 12 the advancement of surgery, or to a higher degree. Gross value $60,000, comprising month tenure. fundamental scientific research in this area. $55,000 stipend plus $5,000 departmental maintenance The Fellowship commemorates the memory of John Please note: Foundation for Surgery John Loewenthal Research Scholarship with a 12 month tenure. > the availability of the advertised Mitchell Crouch, a Fellow of the College who died in Foundation for Surgery Research Scholarship 1977 at the age of 36. The Council of the Royal Australa- Sir Roy McCaughey Surgical Research Scholarship scholarships and fellowships is Foundation for Surgery Catherine Marie Enright Kelly Scholarship subject to funding. sian College of Surgeons invites applications or nomina- This fellowship was established as a result of a bequest Foundation for Surgery Reg Worcester Research Scholarship tions for the above Fellowship. to the College from the late Sir Roy McCaughey. Open > successful applicants will be Foundation for Surgery ANZ Journal of Surgery Research Scholarship required to procure 25% of the to Fellows and SET Trainees enrolled in or intending Open to Fellows and SET Trainees enrolled in, or intending to enrol in, a higher Applicants must meet the following criteria: value of the scholarship from to enrol in a PhD. The research must be conducted degree. Gross value $60,000, comprising $55,000 stipend plus $5,000 departmental > The applicant must be working actively in his/her field. their research department for in NSW. Gross value $60,000, comprising $55,000 maintenance with a 12 month tenure. > The award must be used to assist continuation of this applicable research scholarships stipend plus $5,000 departmental maintenance. Tenure work. is for up to 3.5 years. and fellowships (see website for Foundation for Surgery Peter King Research Scholarship > The applicant must be a Fellow of the Royal details). Open to Fellows and SET Trainees enrolled in, or intending to enrol in, a higher degree Australasian College of Surgeons who is a resident of > these advertised opportunities Research Scholarship in Military Surgery *TBC with the topic relevant to the practice of surgery outside of metropolitan areas. Gross value Australia or New Zealand. are to be used as an initial guide Open to Fellows and SET Trainees with an interest in $60,000, comprising $55,000 stipend plus $5,000 departmental maintenance with a 12 > Applicants must have obtained their College Fellowship only. Please consult the College Combat Casualty Care Resuscitation Research. This month tenure. or comparable overseas qualification within the past 15 website from 1 March 2013 for scholarship is to be undertaken in Maryland, USA and years (1998 or later) detailed information, including offers a stipend of $US40,000 with a 12 month tenure. Foundation for Surgery Research Scholarship in Surgical Ethics > The successful applicant is expected to attend the relevant application forms, *Please note that this scholarship is still to be confirmed Open to Fellows, SET Trainees and members of the public with a special interest in convocation ceremony at the 2014 Annual Scientific award conditions and important – please contact [email protected] for more ethical issues of modern surgery. Lay applicants must be sponsored by a Fellow of the Congress (ASC) of the College for a formal presentation. general information. information. College. Applicants must be enrolled in or intending to enrol in a higher degree with a The Fellowship recipient must be prepared to make > applications for scholarships topic relevant to ethical problems confronting surgery. Gross value $60,000, comprising a 20-25 minute oral presentation at the ASC on their and fellowships below must be Foundation for Surgery Richard Jepson $55,000 stipend plus $5,000 departmental maintenance with a 12 month tenure. research work including the contribution arising from received by midnight CST 29 Research Scholarship the award. April 2013 Open to Fellows and SET Trainees enrolled in, or intending Foundation for Surgery Louis Waller Medico-Legal Scholarship > The successful applicant is to produce a report in > Where applications are open to to enrol in, a higher degree. The gross value will be $60,000, Open to Fellows, SET Trainees and Law Graduates. Applicants must be undertaking, or the format required at the end of their Fellowship for all SET Trainees, then applicants comprising $55,000 stipend plus $5,000 departmental intending to undertake, doctoral research on the topic of medico-legal risks and the law inclusion in the John Mitchell Crouch book, which is maintenance, with a tenure for up to 3.5 years. to surgical training are also u in this area. Lay applicants must be sponsored by a Fellow of the College. Gross value published approximately every five years. eligible to apply in anticipation $60,000 per annum, comprising $55,000 stipend plus $5,000 departmental maintenance. There is no formal application form. A new application of their acceptance into the Tenure is for up to 3.5 years. must be made for each year of application. Applications SET Program. They must be For further information, please contact the must include the following: accepted into the SET Program Scholarship Program Coordinator, Mrs Sue Pleass, Fellowship in Surgical Education > A brief statement about current research work and by 1 August in the year prior Royal Australasian College of Surgeons, The Royal Australasian College of Surgeons and the Southeastern Ontario Academic future plans. to the commencement of the Medical Organization, Queen’s University, Kingston, Ontario, Canada, are offering a joint > Detailed curriculum vitae, including a list of 199 Ward Street, North Adelaide SA 5006. scholarship in order to take up Fellowship to fund Fellows and SET Trainees wishing to undertake a Masters in Surgical publications. Included must be a list of what they Tel: +61 8 8219 0900; the award. Education at the Faculty of Health Sciences, Queen’s University, Canada. The successful consider to be their five most important publications as Fax: +61 8 8219 0999; > the values of these scholarships applicant will only pursue the educational activities involved in the Masters program. well as the five most important national or international are all in $AUD, unless otherwise Email: [email protected] . The Fellowship is for a period of up to two years subject to satisfactory performance. It is lectures they have been invited to deliver. stated. Applications close midnight CST Monday 29 April 2013. valued at AU$70,000 stipend per annum with the Queen’s University providing funding > Important publications must also state impact factors for tuition. and the impact range for their sub-speciality.

Page 20 / Surgical News March 2013 Surgical News March 2013 / Page 21 Scholarships 2013

Scholarships 2014 More than $1.5 million on offer! More than $1.2 million on offer!

Travel Scholarships, Fellowships and Grants – Bequest and Donation Funded Murray and Unity Pheils Travel Fellowship The Murray and Unity Pheils Travel Fellowship was established Raelene Boyle Scholarship followingTravel a generous Scholarships, donation made by the Fellowships late Professor Murray John Buckingham Travelling Scholarship $20,000); a period of four weeks (valued at $10,000); a Pheils. Theand Murray Grants and Unity – PheilsBequest Travel Fellowship and Donation has a This scholarship has been established to encourage period of two weeks (valued at $5,000); a period of one Proudly sponsored by The international exchange of information concerning week (valued at $2,500); or a combination of these. Sporting Chance Cancer value of Funded$10,000 and is awarded to a Trainee or recent Fellow of the College to assist him/her to travel overseas to obtain surgical science, practice and education, as well as to Foundation further training and experience in the field of colorectal surgery. establish professional and academic collaborations and The Fellowship grant is intended to contribute The Raelene Boyle Scholarship, sponsored by the Murray and Unity Pheils Travel Scholarship friendships amongst Trainees. It is open to current SET substantially to: Similarly,The overseas Murray graduates and Unity wishing Pheils toTravel obtain Scholarship further training was SportingRaelene Chance Boyle Cancer Scholarship Foundation, is offered Trainees to enable them to attend the annual American > Return airfare to city (cities) of choice; and experienceestablished in a followingspecialist acolorectal generous unit donation in Australia made by or the late for the value of $60,000 comprising $55,000 in College of Surgeons (ACS) Clinical Congress being > Daily living allowance (travel, meals, Proudly sponsored by The New ZealandProfessor are alsoMurray eligible Pheils. to Itapply. has aApplicants value of $10,000 must not and have is stipend and $5,000 in departmental maintenance, held in Washington DC, USA, in October 2013. This accommodation, ongoing practice costs) Sporting Chance Cancer commencedawarded their to travels a SET prior Trainee to theor recent closing Fellow date forof theapplications. College to with a 12 month tenure. scholarship is valued at $3,000. No additional amounts are payable for travel or The Fellowshipassist him/her is open to for travel 12 months. overseas to obtain further training and FoundationThe scholarship is expected to draw interest from accommodation for family, locum costs, insurance, or The Sporting Chance Cancer Foundation experience in the field of colorectal surgery. Similarly, overseas Fellows or SET Trainees of the College working Stuart Morson Scholarship in Neurosurgery Margorie Hooper Travel Scholarship any other unspecified costs. withinestablished either thea university Raelene Boyleor hospital Research research unit, The Stuartgraduates Morson wishing Scholarship to obtain in Neurosurgery further training has andbeen experience The Margorie Hooper Travel Scholarship has been Scholarship in 1997 in honour of Raelene in a specialist colorectal unit in Australia or New Zealand are involved in cancer research that is expected to make established following a generous donation by Mrs Elisabeth Morson made possible through a bequest from the late The Fellow must spend a major part of each week Boyle, an Australian national treasure and also eligible to apply. Applicants must not have commenced a notable impact. Preference will be given to research in memory of her late husband. The Scholarship is designed to Margorie Hooper of South Australia. The Scholarship at the appropriate institution and give a guarantee to champion athlete. their travels prior to the closing date for applications. The projects with a focus on prostate cancer. assist young neurosurgeons within five years of obtaining their is for SET Trainees or Fellows of the Royal Australasian continue in practice in his local area on completion of Applicants must be working within either Scholarship is for up to 12 months. Applications for the Scholarship are open to Fellowship of the College (2007 or later) or neurosurgical Trainees College of Surgeons who reside in South Australia. the Fellowship. There is no application form. A letter a university or hospital research unit and Fellows and SET Trainees enrolled in, or intending to spend time overseas furthering their neurosurgical studies by The Scholarship is designed to enable the recipient of application should be forwarded to the Scholarship involved in cancer research that is expected to enrol in, a higher degree. Applicants to surgical undertakingHugh research Johnston or further Travel training. Grant The Scholarship is also to undertake postgraduate studies outside the State Program Coordinator, including the following details: to make a notable impact. Preference will The Hugh Johnston Travel Grant arose from a bequest of training are also eligible to apply for a scholarship in open to exceptional young surgeons who are registered to practice of South Australia, either elsewhere in Australia or > The intended Fellowship duration; be given to research projects with a focus on the late Eugenie Johnston in memory of her late husband, anticipation of their acceptance into the SET Program. neurosurgery in Australia or New Zealand but are not Fellows of the overseas. It is also available for surgeons to travel > An outline of the experience or skills you aim to gain prostate cancer. Hugh Johnston. This Grant for $10,000 is designed to assist They must be accepted into the SET Program by College. From time to time, the Scholarship may also be applied to overseas to learn a new surgical skill for the benefit of through the Fellowship and how this will benefit This Scholarship is open to Fellows and needy and deserving Fellows and Trainees of the College 1 August in the year prior to the commencement of assist overseas surgeons to spend time in Australia or New Zealand the surgical community of South Australia. Preference your current practice/hospital; SET Trainees enrolled in or intending to to gain specialist training overseas. Applicants must not the scholarship in order to take up the award. to further their training and/or research in neurosurgery. Overseas will be given to the latter. This scholarship is for 12 > The locations to be visited in order to achieve your enrol in a higher degree. SET applicants are have commenced their travels prior to the closing date for The successful applicant will be required to applicants cannot have commenced travel prior to applying for the months. The stipend is $65,000 and there is provision aim; also eligible to apply in anticipation of their applications. procure 25% of the value of the scholarship from scholarship. The value of the Scholarship is $30,000 and is intended for accommodation and travel expenses upon > A written confirmation from the institution/s where acceptance in the SET Program. his/her research department. to assist the recipient to meet the costs of undertaking further application. you are to gain your skill or experience. training andHugh / or Johnston research workANZ in ACS neurosurgery. Travelling This Fellowship scholarship is > A brief outline of the costs associated with acquiring The Hugh Johnston ANZ Chapter American College for six months, with minimum program duration of three months. Morgan Travelling Fellowship the skills and experience. of Surgeons Travelling Fellowship has been established The Morgan Travelling Scholarship was established to Hugh Johnston ANZ ACS Travelling Fellowship > wo written supporting references. to support an Australian or New Zealand Fellow of the fund a Fellow of the College to travel overseas to gain The HughCollege Johnston to attend ANZ Chapterthe annual American American College College of Surgeons of Surgeons CONROD-RACS Trauma Fellowship clinical experience or to conduct research for a period Ian and Ruth Gough Surgical Education CONROD-RACS Trauma Travelling(ACS) Fellowship Clinical has Congress been established in October to support2013, which an Australian is to be of approximately one year. To be eligible, the surgeon Scholarship Rehabilitation Medicine or New Zealandheld in WashingtonFellow of the DC, College USA. to Itattend forms the part annual of a bi-lateral American Scholarship must have gained his/her Fellowship in the past five The Ian and Ruth Gough Surgical Education A grant from the Motor Accident Insurance College ofexchange Surgeons with (ACS) the Congress ACS and inis Octoberopen to Fellows2013, which who is have to be A grant from the Motor Accident Insurance years (2008 or later). The scholarship is open to a Fellow Scholarship, valued at $10,000, was established by Ian Commission matched by Foundation for Surgery held in Washingtongained their DC, College USA. Fellowship It forms part in ofthe a pastbi-lateral 10 years exchange (2003 Commission matched by Foundation for from any specialty. The scholarship must be the only and Ruth Gough to encourage surgeons to become funds has enabled the College to offer annual with the ACSor later). and Applicantsis open to Fellows are expected who have to have gained a major their interest College Surgery funds has enabled the College to College funding secured by the Fellow but the candidate expert surgical educators. Applicants must be Fellows research funding for research into trauma to the Fellowshipand in accomplishment the past 10 years in(2002 basic or or later). clinical Applicants sciences are related expected to offer annual research funding for research is permitted to obtain alternative external funding or Trainees of the College, with permanent residency amount of $50,000. to have asurgery major interest and would and accomplishmentpreferably hold an in academicbasic or clinical appointment into trauma to the amount of $50,000. concurrent with the Morgan Travelling Scholarship. The of Australia or New Zealand. Tenure is for one year. The 12 month Fellowship is open to Fellows and sciences relatedin Australia to surgery or New and Zealand. would preferably The applicant hold an must academic spend a This 12 month Scholarship is open duration of the scholarship is 12 months. The value of Please read the important general information and SET Trainees. Proposed research may be in any appointmentminimum in Australia of three or weeksNew Zealand. in the United The applicant States of mustAmerica. spend to Fellows and SET Trainees. Proposed the scholarship is $10,000. Applicants must not have the scholarship conditions prior to submitting your of the following areas: epidemiology, prevention, a minimumWhile of three there, weeks they must:in the United States of America. While research may be in any of the following commenced travels prior to closing date for applications. application. protection,areas: epidemiology, rehabilitation prevention, or immediate protection, or definitive there, they> must:Attend and participate in the American College of Surgeons management in trauma. A single Fellowship of up to > Attend and participate in the American College of Surgeons rehabilitation or immediate or definitive Annual Clinical Congress in 2013 James Ramsay Fellowship for Provincial Surgeons $50,000 will normally be awarded but more than Annual Clinical Congress management in trauma. A single Scholarship > Participate in the formal convocation ceremony of that The James Ramsay Fellowship was established For further information, please contact the one Fellowship may be made to a total of $50,000 > Participate in the formal convocation ceremony of that congress of up to $50,000 will normally be awarded congress through a bequest following donations made in 1986 in any one year. The Fellowship may be used for > Visit at least two medical centres in North America before Scholarship Program Coordinator, Mrs Sue Pleass, but more than one Scholarship may be > Visit at least two medical centres in North America before and 1993 by Mr James Ramsay, AO, and subsequently either or both salaries and expenses. It is not a or after the Annual Clinical Congress to lecture and to share Royal Australasian College of Surgeons, made to a total of $50,000 in any one or after the Annual Clinical Congress to lecture and through the generosity of Mrs Diana Ramsay, AO. This requirement of this Fellowship that the research be clinical and scientific expertise with the local surgeons. 199 Ward Street, North Adelaide SA 5006. year. The Scholarship may be used for to share clinical and scientific expertise with the local Fellowship is only available to provincial surgeons in conducted in Queensland but it must be shown that Applicants must not have commenced their travels prior to either or both salaries and expenses. It surgeons. Australia or New Zealand and is designed to enable Tel: +61 8 8219 0900; the potential benefits flowing from the research will the closing date for applications. This Fellowship is valued at is not a requirement that the research be Applicants must not have commenced their travels prior to Fellows of the College to spend time developing their Fax: +61 8 8219 0999; assist the people of Queensland. AU$8,000. conducted in Queensland but it must be the closing date for applications. This Fellowship is valued at existing skills or acquiring new skills away from their Email: [email protected] . shown that the potential benefits flowing AU$8,000. provincial practice. Applications close midnight CST Monday 29 April 2013. PAGEfrom 38 the / Surgicalresearch News will March assist 2012 the people of More information about the ACS can be found at These Fellowships are open for travel in 2013 or 2014 Queensland. www.facs.org and can be taken for a period of eight weeks (value

Page 22 / Surgical News March 2013 Surgical News March 2013 / Page 23 Professional Development Registrations are now open for the *NEW* Surgical Teachers Course Melbourne 11-13 April, 2013 Adelaide 29-31 August, 2013 Clockwise: Faculty and participants of the 2012 Dili course; Joao Pedro, Perth 24-26 October, 2013 participating in the course; Eric Vreede with medical student. To register please email While Timor Leste and Australia share many of the same [email protected] chi challenges in the delivery of surgical education, there are a ng also many differences in the context of education. e The Timorese postgraduate diploma courses commenced T in July 2012 with five streams: surgery, obstetrics and gynaecology, paediatrics, anaesthesia and internal medicine. The courses will be taught by a faculty of young, recently graduated Timorese specialists. Dr Joao Pedro Xavier, a recently graduated East Timorese general surgeon has been appointed the director of the new diploma courses and will be assisted by international specialists spending time in Dili. Dr Joao Pedro’s eclectic teaching staff come from diverse backgrounds including Australia, Cuba, China, Nepal and the Philippines and have training in diverse medical systems which all have their own paradigm of health and teaching. Not only is the teaching faculty diverse, the Trainees whom they teach also have similarly diverse backgrounds as even though they call themselves East Timorese, they the teachers may have been trained in Indonesia, Fiji or Cuba for their basic medical degree. Taking teaching to the extreme In what was a great challenge for the College, we promised to deliver the Surgical Teachers Course to this diverse faculty and make it culturally specific and relevant ersatility, flexibility and adaptability are all skills for Timor Leste. Coincidentally, and in contrast to this, the associated with good teachers. Last year the College updated Surgical Teachers Course was delivered on the Vtook these principles to the extremes! In October same two days in Hobart to Australian surgeons. 2012, the College’s Surgical Teachers Course was delivered Alan Scott, Don Moss and Glenn Guest (the Dili faculty) simultaneously in two of the most diverse environments took on the challenge of making the course culturally imaginable; Hobart, Tasmania and Dili, Timor Leste. specific and relevant to Timor Leste and were assisted by The southernmost and the northernmost courses ever run Jenepher Martin and Stephen Tobin. differed not only in geography, but also in the diversity of Jenepher Martin led the original development of the environments of climate, culture and language. College’s Surgical Teachers course and was a member of the However, even though these courses were worlds apart, foundation faculty for the new Surgical Teachers Course in they both emphasised the same underpinning principle: the Hobart, demonstrating her own versatility, flexibility and To make this course relevant to Timor Leste, there were many which provided a framework for teaching, feedback and skills imperative to teach is implicit in the work of surgeons, and adaptability as a good educator. adaptations made to the original Surgical Teachers Course. For training. In Dili, as a result the fledgling teaching, faculty now feel teaching is a skill that needs to be learnt, just like the technical At the same time as the Dili faculty were off to Timor instance one of the key teaching methods in the course is referred much better prepared to tackle the responsibility of delivering aspects of surgery. Leste to deliver the course, David Birks, Trish Davidson, to as the ‘snowball’ principle. However ‘snowball’ is not a term Timor Leste’s first Diploma courses. For many years in Australia and New Zealand, surgeons Meron Pitcher and Jenepher Martin were heading down that readily translates to a country that is continually bathed in The real success of this course can only be measured over years were expected to teach, but had never been trained or given south to Hobart to launch the new Surgical Teachers Course. tropical sunshine and hasn’t seen snow since the last Ice Age! and decades as the attendees use their new found skills to teach any guidance in the skills of teaching. Most surgeons picked In delivering these courses, both groups of faculty Similarly, the sporting analogies involving golf and Aussie and influence the next generation of students and Trainees under up teaching skills in an ad hoc manner from their own crossed a relatively narrow body of water off mainland Rules football seemed unlikely to strike a chord in a nation their guidance. personal experience of being a student. Australia to arrive at their destination and both had course where no golf courses exist and the round ball form of football is But, in a very encouraging and early sign, Dr Joao called a It is now recognised that for surgeons to be effective dinners featuring seafood; however, this is where the dominant. In Hobart no such difficulties were encountered and meeting of all Trainees the week following the course and by all teachers, education about the principles of adult learning similarity ended. there was even a possibility that the snowball analogy could be accounts applied every principle of teaching and feedback that is needed. The College’s Surgical Teachers course was As one group enjoyed fresh seafood under the stars demonstrated for real! had been delivered during the course. developed in recognition of this need and has run successfully on the beach washed down with Tiger beer slapping Fortunately, despite cultural and language barriers, the course It would be hard to find a better example of how a course throughout Australia and New Zealand since 1999. away malaria and dengue mozzies, the other indulged in provided appropriate examples across all medical specialties to such as this can influence behaviour. With the Diploma training Recently, the ATLASS program (The College delicious food with the heater substituting for the warm highlight the principles of education which do cross the cultural program in the formative stages, this seems to have been delivered Humanitarian Aid Program to Timor Leste funded by tropical breeze. divide of two diverse countries as Timor Leste and Australia. timely and effectively and will hopefully have an influence for AusAID, the Australian Government’s overseas aid program) In Dili, the course was delivered in English (albeit Finally, the question should be asked: are we making a many years to come. achieved a substantial milestone by helping set up the first sometimes with a Scottish accent thanks to Alan Scott) difference in surgical teacher education? These strikingly Footnote: Many thanks to all the members of the faculty, the in-country medical training program under the auspices of to an enthusiastic audience, but the discussions often different venues underline the problem of evaluating what effects participants and the College’s Dili staff who organised things so the University of Timor Leste. Consequently the opportunity included a generous smattering of Tetun, Bahasa, Spanish the Surgical Teachers Course has on one’s teaching practice. well. Special thanks to Eliza Muir for her behind the scenes work arose to support these diploma courses with a faculty and Portuguese. Despite this tower of Babel, the course was Both courses received overwhelming positive feedback. In with this course while on her student elective! development initiative. well received. Tasmania, the course was noted as a good learning opportunity Glenn Guest and Jenepher A. Martin

Page 24 / Surgical News March 2013 Surgical News March 2013 / Page 25 International Development Medico-Legal

Photographs, X-rays, medical images and privacy

Ensure there is patient consent when documenting your work

n our current digital era, we have a colleague included during a increase. It is important to be aware of the increasing access to instant, easy PowerPoint presentation at an ramifications and consequences of using Irecording of images through mobile educational conference, used x-rays of this imagery – and mobile apps such as phones, as well as other digital media. the first surgeon without his consent. the recently released PicSafe aim to guide The medical field is no exception. It is The surgeon giving the presentation medical practitioners in the safe usage therefore important to recognise that was the treating surgeon. and storage of such files. there is no general right for medical Property of medical imagery is It is also crucial to remember to gain practitioners to use patient photographs, different to that of normal documents – the patient’s consent before the images x-rays or other visual images, whether for the right of ownership of these images are used. The patient’s consent should education, research or otherwise. is also accompanied by a duty of be recorded, and what the images will Baby Quentin’s Story Current privacy legislation introduces confidence. Taking or recording an image be used or potentially used for should be a set of 10 National Privacy Principles, does not necessarily mean ownership of discussed with the patient. An excerpt from the recent College publication, My Timor Heart which establish the minimum standards the image either – in the public sector It is also acceptable under privacy for handling of personal information. these photographs may become both the legislation for a medical practitioner Clinicians may be liable for fines of up to property and responsibility to have a Privacy f all the patients who have made the time to call in on him while she “On a trip to Oecussi in March 2011, $100,000 if they store or distribute clinical of the hospital. Statement or privacy been helped by the College’s was in Adelaide to pass on her personal we saw seven patients over the age of photos incorrectly. These obligations are consent document OTimor Leste program, few are thanks. 35 with cleft palates and lips. Two were A medical practitioner can only use not necessarily new. (either signed by or as famous as the adorable baby Quentin. The College’s Plastic and Reconstructive grandfathers. Neither had been to school.” or disclose health information for the Doctors have always had given to the patient) The little girl’s mother gave birth at an Surgery program has been operating in Dr Moore said there had been purpose for which it was collected, an obligation to maintain which indicates that Australian-funded birthing centre north Timor Leste since Dr Moore made his improvements since the early days, when unless the individual’s consent has been confidentiality in relation images may be used of Dili in December 2008, just an hour first trip in early 2000. He took over from he used to buy pigs trotters from the obtained – and not doing so may have to patients and patient for research, training before a planned visit from Australian Dr John Hargrave, the legendary Plastic markets to train nurses and community serious consequences. (Recent research information. A breach of and education Governor-General Quentin Bryce. and Reconstructive surgeon who had health workers how to insert sutures. undertaken at a Melbourne hospital* privacy or confidentiality purposes – and She was born with a cleft lip. When been making visits to West Timor and He paid tribute to Dr Joao Pedro Xavier, found that only a quarter of doctors can also lead to a allowing the patient Ms Bryce arrived to tour the facility, she East Timor since 1990. whom he first met as a medical student in surveyed had obtained appropriate complaint of professional to ‘opt out’ from this picked the newborn up and cradled her, Some things have changed in that time. 2000, and who is now a qualified surgeon. patient permission to obtain clinical misconduct, and potential by indicating that forming an immediate bond with parents There appear to be less people presenting “Dr Joao Pedro is symbolic of the steps images.) disciplinary proceedings such permission is not Virginia Ingrazia and Vencisolao Pereira, with traumatic injuries caused by violence forward. Also to have a Timorese surgeon Use of clinical images for other before medical boards given. who decided to name their precious baby and civil unrest. Now, most of the work of now doing excellent cleft and burn purposes, such as education, without and authorities. Practitioners after Australia’s Governor-General. the program involves repairing cleft lips surgery – Dr Joao Ximenes – is what we consent from a patient not only works Photographs and operating in hospital In March 2009, when baby Quentin was and palates in babies and children. have worked towards, and will continue to against a sense of confidentiality for other medical imagery environments should only a few months old, Dr Mark Moore, In adults, it’s repairing scarring and support,” he said. the patient, but may also have severe can be used for many check their hospital’s a Plastic and Reconstructive surgeon disfigurement, and Dr Moore sees All proceeds legal ramifications. Several recent cases useful purposes, and Privacy Statement or based in Adelaide, operated on her and hundreds of patients suffering from from the illustrate this: are included in patient Cover consent document to repaired her cleft lip. “Baby Quentin was dreadful burns, which have healed in purchase of • An investigation has been carried out records as an addition Story determine the extent of seen by the Governor-General on her first ways that have fused their limbs, faces, My Timor Heart in Western Australia in relation to to clinical care – and consent encompassed overseas visit to Timor Leste,” Dr Moore or fingers and toes. There are also some go directly to breach of patient confidentiality, after may be displayed within these documents. the College’s said. “She was keen on arranging for the adults who have struggled for years with Foundation for a newspaper published a photograph, to colleagues, Trainees and others for (*Research conducted by Dr David lip repair and her staff became aware of cleft lips or palates. Surgery to fund obtained from a hospital’s internal treatment purposes. Hunter-Smith in the Department of our team visiting and I was contacted by “Clefts are twice as common in Asian the Timor Leste website, of a patient being treated at However, any use beyond the treatment Surgery at Peninsula Health found that the Embassy and AusAID who arranged populations as they are in Caucasian program. An that hospital. of the patient runs the risk of a breach only a quarter of doctors surveyed had for her to attend our next clinic.” populations,” Dr Moore said. “In order form can • A chief resident of general surgery of privacy. A breach of privacy or obtained appropriate patient consent to be found on Baby Quentin is now a healthy, Australia, cleft palates and lips are page 46. at a US hospital faces disciplinary confidentiality can lead to a complaint of take clinical images.) beautiful four-year-old, and met up with repaired when children are very young, proceedings after taking photos of professional misconduct, and potential With Isla Tobin her namesake again when the Governor- but in Timor Leste, with no specialists To order a copy please contact a patient’s tattoo, using his mobile disciplinary proceedings before medical General returned to Timor Leste for available locally, many people go [email protected] or phone. boards and authorities. independence celebrations last year. Dr into adulthood without any surgical call +61 3 9249 1230. • An apocryphal story tells the tale As technology improves into the Michael Gorton, Moore said Ms Bryce had also generously intervention. of a surgeon who objected when future, clinical photography will also College Solicitor

Page 26 / Surgical News March 2013 Surgical News March 2013 / Page 27 Regional News Professional Development

performed better (higher global assessment score and/or shorter time Surgical simulation-based training to complete task) than participants Communicate well Skills transfer to the clinical setting who did not have this training. Improve your career and personal life Only one of the 20 studies did not produce any evidence to support nthony Dilley is a paediatric sur- personality types demonstrate distress wenty-three recent research this conclusion. In addition, for the geon who became a certified trainer and how this can worsen or be relieved. studies have strengthened the laparoscopic procedures, simulator- in Process Communication Model The Part Two PCM course revises the Tevidence that surgical skills trained groups generally made A (PCM) last year. He goes through what Part One course and concentrates on acquired through simulation-based fewer errors than control groups in PCM is and how this model has benefited how the model can be used for those training can transfer to the clinical setting. subsequent patient-based assessment. In 2012, the Australian Safety and Efficacy him both professionally and personally. He showing signs of distress. The exercises has found this model invaluable and thinks are interactive and a lot of fun. A PCM Register of New Interventional Procedures Simulation-based training versus his surgical training would have been easier provider course is available for those who – Surgical (ASERNIP-S) looked at patient-based training had he participated in it then. would be interested in teaching. research published since the 2006 For colonoscopy (one study) and systematic review (ASERNIP-S report no. camera navigation (one study), 61) to determine whether surgical skills participants who had trained exclusively What is Process The professional and gained through simulation-based training on a simulator performed at an Communication Model? personal benefits improve the performance of surgical equivalent standard on the in-surgery The Process Communication Model is large- PCM has had most benefit for me in Trainees in clinical settings. assessment procedure to those who had ly the result of lessons learnt from a lifetime providing a new way of perceiving how The following information is a brief received patient-based training only. of observation, data collection and synthesis those close to me, family and friends, prefer summary of the full systematic review performed by Taibi Kahler. It started from a to communicate with me. Being time poor update (ASERNIP-S report no. 80) which Clinical & research simple observation and unfolded as the next like most surgeons, it has been valuable to is available at recommendations question was posed and answered. understand how to make the use of time www.surgeons.org/asernip-s. ASERNIP-S recommends that Kahler observed that there are six spent with loved ones more fulfilling. further research be conducted into personality types, each associated with a I am forever grateful my wife agreed to Main messages the transfer of skills acquired through communication style, that occur in all of us do the Part One course with me! PCM ASERNIP-S looked at the evidence simulation-based training to the to a greater or lesser extent. Our base type is has also provided me with some new available since 2006 on whether skills patient setting, to strengthen the that which is fixed in infancy, and the order insights as to how to make encounters acquired through surgical simulation- evidence base. Areas still requiring of strength of the other five types appears between colleagues, clinicians and based training can transfer to the used to introduce novices to operating Board of Surgery which has required the further study include: locked in by age seven. With practice we administrators alike, less distressing and operating room and noted that: room behaviour and communication Fundamentals of Laparoscopic Surgery • the nature and duration of train- can strengthen our communication skills in more productive. • No solid conclusions could be drawn (using virtual world or simulated (FLS) certification since 2009. ing required to deliver the greatest these other five types. On occasion, my encounters with from the evidence due to differences operating room) i.e. non-technical An artificial surgical scenario may be transfer effect; PCM is a model that allows us to identify patients and their families have more in simulation-based methods and the skills. set up with: • the stage of training at which in others their preferred communication quickly steered to stable ground. While variable quality of studies included. • Further well-designed studies could • physical simulators Trainees receive maximum skill style, and should we wish to optimise I have found the model invaluable at • The evidence was rated as average explore the way that simulation-based • human cadavers transfer benefits from different our interactions we can then choose to my stage of life, I feel I would have had although the trend was to higher technical skills environments might be • animals forms of simulation; communicate with that person in the way an easier time during my training had I quality studies e.g. used to train and assess non-technical • virtual reality simulators with • the effect of different levels of that is most suitable. participated in PCM then. • twenty of the included studies were skills, such as decision-making. computer-generated tools and tissues mentoring during the training By identifying the communication I think I would have been better at randomised controlled trials (highest • hybrid simulators combining physical period on transfer rates; style, it is possible to anticipate the meeting the needs of myself, family and quality); What is surgical simulation- and virtual reality simulators. • changes in staff productivity as a manner in which an individual will the hospital than I actually did during • more studies required participants to based training? result of simulation-based training demonstrate that they are stressed, that period of my life. I know most allowing us to respond appropriately surgeons would come away from the pass (at a predetermined competency level) Traditionally, surgical Trainees gain What is the evidence? (Sturm et al 2007). utilising the model. course with plenty to reflect on! in simulation-based training prior to practical experience by watching Studies comprised a range of The model is derived from data assessment in the operating room. experienced surgeons perform operations laparoscopic, endoscopic and several generated through the analysis of tens of • More studies used standardised on patients and providing assistance. other surgical procedures. In most studies thousands questionnaires. With practice, assessment based on objective However, the opportunities to train in simulation-based training programs were Anthony Dilley Guy Maddern similar information can be gleaned by the validated global rating scales for this way are limited. Thus it is beneficial an ‘add-on’ to traditional surgical training. NSW Fellow patient-based operative performance. Only two included studies directly Chair, ANZASM PCM practitioner through a few minutes that surgical Trainees are required to Want to see what PCM • Simulation-based training was being comparing simulation-based training to of conversation and observation. practise their skills in artificial surgical can do for you? used in more specialties for surgical Further information environments before entering the patient-based training. Call or email the Professional Professor Guy Maddern How the model is learnt Trainees to gain basic technical operating room. Development Department on ASERNIP-S Surgical Director skills. This increased the variety of While simulation-based training Simulation-based training added The Part One PCM course provides [email protected] or 199 Ward Street equipment, training methods and programs were initially used as ‘add-ons’ on to normal surgical (patient-based) the participant with an understanding 03 9249 1106. North Adelaide, SA 5006 assessment methods used in studies to traditional surgical training, simulation training. of the model and an understanding The two PCM courses scheduled for Thursday 18 to and made comparison between studies For 15 different surgical procedures, AUSTRALIA of what the data generated from their Saturday 20 April in Melbourne and Thursday 13 to is increasingly being incorporated P: 61-8-8219 0900 Saturday 15 June in Sydney are fully booked. An more difficult. into curricula or even mandated by participants who received simulation-based pre-course questionnaire actually means. additional course has been scheduled for Friday F: 61-8-8219 0999 2 to Sunday 4 August in Melbourne. • Simulation-based training was being registration bodies, such as the American training prior to patient-based assessments It introduces the ways that different

Page 28 / Surgical News March 2013 Surgical News March 2013 / Page 29 Successful Scholar

Far left: Professor Stoodley at work; Left: With his extended team.

origin of the fluid that forms the cyst and the mechanism behind cyst formation have remained obscure,” he said. “It has been assumed that the fluid is cerebrospinal fluid (CSF), but that has not been proven. “Building on the techniques developed in the AVM project, we developed techniques for studying CSF movement which will allow quantitative assessment of fluid flow in the subarachnoid space and the spinal cord. “The technique will also enable Professor Stoodley said the central certain molecules and then applied these quantification of fluid flow out of the goal of AVM research was to prevent techniques to the rodent model of AVM. spinal cord, allowing us for the first time rupture by either removing the AVM or “This technology had not previously to study the balance between CSF flow interrupting blood flow, but that many been applied to study endothelial into and out of the cord. were surgically inaccessible while other molecular changes after radiation, but “Our goal is to understand how treatments such as injecting glue into we were able to demonstrate that this syringomyelia forms so that we could blood vessels or using radiation to block technique does provide quantitative perhaps prevent it, but this research could profile them off were not always effective. information about molecular changes.” also be useful in other areas of medical research such as in the treatment of Highlights Instead, he and his neurosurgery Professor Stoodley said that the research team have been working to research, funded via the JMC Fellowship hydrocephalus, Alzheimer’s disease or any Professor Marcus design a new invivo molecular imaging stipend, had proved so promising that his conditions that require the delivery of drug Stoodley technique which could identify AVM team had been awarded a $670,000 three- therapy into the central nervous system.” 2012 John Mitchell Crouch proteins that could be manipulated year NHMRC grant to continue the work. Professor Stoodley, who divides his time Fellowship – RACS to encourage clotting to seal off the He said that the team had now evenly between his research and clinical commitments, described receiving the JMC 2012 Eccles Lectureship in vulnerable blood vessels. identified highly prospective molecules Fellowship as a great honour and said Neuroscience - Neurosurgical “Our overall goal in this project is to for pro-thrombotic therapy and that the while the acknowledgement of professional Society of Australasia and develop a new treatment for high grade technology and methods used could have colleagues and peers was rewarding in itself, Growing knowledge Australian Neuroscience Society brain AVMs that are untreatable using a significant impact on other areas of current methods,” Professor Stoodley said. medical research. the Fellowship held such prestige it also Viertel Clinical Professor Marcus Stoodley was awarded the 2000 “In the first step, stereotactic “It could be useful in the treatment of helped attract wider support. Investigatorship – Sylvia and radiosurgery is used to stimulate particular brain tumours, for example, “Receiving this Fellowship has made it John Mitchell Crouch Fellowship in 2012 Charles Viertel Charitable molecular changes on the surface of because sometimes it is very difficult easier when communicating with funding Foundation endothelial cells in the AVM vessels. to design effective delivery systems for bodies because they know I have the he premier research award of the He said AVMs occurred when arteries 1997 Stuart Morson Fellowship “The second step is to target those chemotherapy to the brain, but if we support of the College,” he said. College, the John Mitchell Crouch in the brain connect directly to nearby – RACS molecules with antibodies attached to could treat tumours by blocking the “Sometimes it is difficult to get TFellowship, was last year awarded veins without the normal capillaries 1995 Medical Postgraduate molecules that stimulate intravascular blood supply to them that would be across the importance of some research to New South Wales neurosurgeon between them. He said that while they Research Scholarship – National thrombosis such as tissue factor. amazing,” he said. projects, particularly as a surgeon with Professor Marcus Stoodley for his usually formed before birth, symptoms Health and Medical Research “If proteins in an AVM were unique we “And now that we have received the a busy clinical practice because we ground-breaking research to develop may occur at any age with catastrophic Council could target them directly, but the cells NHMRC funding we can accelerate this obviously don’t have the same time new treatments for brain arteriovenous haemorrhages occurring most frequently are fairly normal so the idea is to use work.” as pure scientists to devote to writing malformations (AVMs) and advance in children and young adults. radiation to stimulate protein expression Professor Stoodley said his team of papers and addressing conferences which understanding of the pathophysiology of Syringomyelia is damage to the spinal “Yet even though the rupture of an that makes the AVM cells different to ten research scientists and PhD students can sometimes make the difference in syringomyelia. cord caused by a fluid-filled cyst that AVM can affect people suddenly and normal cells. Identifying exactly which were now using the technique to also winning funding. First awarded in 1979, the Fellowship is forms in the cord due to either congenital catastrophically – causing either instant proteins change after radiation and by help advance their understanding of “But I absolutely believe in the given annually to a surgeon who, in the abnormalities, spinal cord trauma or death or severe disablement – there is how much they change is quite difficult. syringomyelia given that the cause of it, importance of surgeons as scientists opinion of the College Council, is making tumours. nowhere near the same advocacy or “However, last year we worked to and the movement of fluids within the because we know the clinical problems, an outstanding contribution to surgical Professor Stoodley said that while the funding for research as there is for MS. develop an invivo molecular imaging spinal cord, remained a mystery. we know the conditions and diseases that advancements and research. conditions were comparatively rare, both “Similarly, syringomyelia can have technique to allow us to study aspects of He said the team, using the invivo mo- are the most difficult to treat. Professor Stoodley is Professor of had catastrophic effects. devastating consequences such as causing radiation-induced endothelial molecular lecular imaging technique, could now im- “Only a surgeon, for example, Neurosurgery at Macquarie University, “AVMs affect between one in 1000 and a patient who has already suffered a changes. age the entire spine with molecular tracers would understand the catastrophic conducts his research through the one in 10,000, which is about as common severe spinal injury to lose even more “First we used endothelial tissue showing not only the movement of fluid, consequences of AVMs and syringomyelia university’s Australian School of Advanced as Multiple Sclerosis (MS) and just like mobility and function and is believed to cultures treated with radiation to but also measuring the quantity of fluid. and then be in a position to drive research Medicine and has a clinical practice at the MS, the condition mostly affects young affect about one-quarter of all spinal cord show that we could image live cells “Syringomyelia is one of the most enig- and attract support.” Macquarie University Hospital. people,” he said. injury patients.” with fluorescent-labelled antibodies to matic neurological conditions because the With Karen Murphyy

Page 30 / Surgical News March 2013 Surgical News March 2013 / Page 31 Flexible Training

he College should follow Britain’s “It was decided by the Board to rotate not really a part-time arrangement. lead and establish a dedicated con- me to Liverpool Hospital to undertake “Often I would be asked to work on Ttact position, design a standardised Head and Neck Surgery training or change hours which posed major application process, transparent guidelines where I shared the position with Dr problems in trying to organise last minute and pathways, and allow for anonymous Gowrinanthanan Panchacharavel.” child-care arrangements. Valuable experience applications if the goal of flexible training Now a PhD student researching the “Still, despite this I believe it is much With some genuine support this Trainee made her part-time position work is to be realised, according to Post-Gradu- molecular genetics of rectal cancer at the better to have part-time training as an ate Fellow in Colon and Rectal Surgery Dr Garvan Institute of Medical Research option rather than see dedicated surgical Penelope De Lacavalerie. and The Kinghorn Cancer Centre, Dr Trainees leave the profession, but much Dr De Lacavalerie, who passed her De Lacavalerie received her medical work still needs to be done to make it General Surgery Fellowship exam in 2012, degree in her home country of Venezuela better.” is currently a Research Fellow in Colorectal and did her Basic Surgical Training in Dr De Lacavalerie said that another Surgery at Bankstown Hospital as part of London before moving to NSW with her central challenge confronting Trainees her training through the Colorectal Surgical Australian husband and entering the SET who wish to take up part-time training Society of Australia and New Zealand. training program. was that there was no clear pathway She undertook the last year of her General or dedicated officer at the College to Surgery training over two years in a job- Make it easy work with to ensure that everyone’s share position at Bankstown-Lidcombe and She said that despite the support she had expectations were met. Liverpool Hospitals in Sydney. received which allowed her to undertake She said in the absence of clear Dr De Lacavalerie said she pursued the part-time training, there were still guidelines as to how such positions option of flexible training following the significant barriers and a stigma attached should work, both Trainees and birth of her first child, Emilio, and her to flexible training which dissuaded some supervisors were being asked to make up return to work after maternity leave. Trainees from pursuing the option. the arrangements as they went along. “When I applied he was only ten “During those two years and even now, “In the UK, you apply through the months old, but within two months of I received many calls from other Trainees Postgraduate Deanery in charge of the returning to full-time training I realised whom I had never met asking me how I region; you have clear provisions that that my expectations of myself as both a went about finding a job-share training posi- must be met and the process is very first-time mother and full-time Trainee tion because they did not know, given that it transparent because it is a right not a were not working,” she said. is still so uncommon in Australia,” she said. favour,” she said. “I wanted to be part of his life, not just “All of them wanted to know how “In Australia you have to be quite see him occasionally, so I applied and was it was working out because one of the assertive, you have to do the legwork to very lucky to have very good, supportive central issues seems to be the myths that find a position, you have to design your mentors. still exist from both the perspective of own business plan or working model “I wrote to the NSW Chairman of Trainees and supervisors. and you have to find and win your own General Surgery at the time and fully “Trainees fear that they will only support which can be a difficult and explained my reasons for requesting flex- be given the boring easy work and draining experience. ible training and was very lucky to gain discouraged from taking on more “I also think that like the UK, the the support of the SET Supervisor and complex surgeries because they are not application process should be anonymous other surgeons at Bankstown-Lidcombe around all the time. Some supervisors and because many Trainees are frightened that Hospital. In the letter I included details employers seem to think that Trainees they will be stigmatised just by making of the South Australian experience with working part-time are less committed, less the request and that they will be viewed part-time training which is the only capable or less professional. differently if they seek flexible training. stand-alone, part-time training position “Yet these are all myths. “I think it is because part-time training available in Australia to my knowledge “I worked 100 per cent every day, and just doesn’t fit the framework of surgery “I was informed by the Board that the because of the support I received I was as it has developed over hundreds of only way forward to make it work was to able to conduct more surgeries, not less, years, but this needs to change if the find another Trainee to do a job-sharing and at a high level. I had the highest profession is to retain capable and arrangement. Following this, the College number of major surgeries as primary dedicated Trainees. put out an email to all Trainees in NSW operator in all my training during the “I have now received medical training and after an interview process a fellow part-time training year at Bankstown- on three continents and I honestly can say Trainee was selected to share the position. Lidcombe Hospital which puts paid to that the quality of training in Australia is “Unfortunately, after four months that myth. of the highest standard. However, it still of starting the post she decided not to “At Liverpool Hospital it became more has some way to go in terms of making continue with surgical training so I ended challenging to maintain a reasonable flexible training an acceptable, accessible up with a de facto stand alone part-time work-life balance. That hospital has the option and not a special request.” position which was kindly supported largest Trauma Centre in NSW, very With Karen Murphy by my mentors and Senior Registrar busy Head and Neck and Emergency Next month, Surgical News will talk to at the time. On completion of the first Departments and the usual staffing Dr Panchacharavel about his experience year, another email went out to Trainees shortages. While there I still ended up as a part-time Trainee. offering the job sharing position. working 50 to 60 hours per week which is

Page 32 / Surgical News March 2013 Surgical News March 2013 / Page 33 Fellows abroad

(vic asm) Professor Paul Finan, Anil Koshy, and Professor Peter Sagar. Inset: Anil Koshy, with the surgical secretaries, Mary(sitting), Fiona (middle) and Allyson. 55th Victorian Annual with the gastroenterologists and MDTS. I was “Surgical Practice and Training - confronting also involved in research with Professor Sagar Surgeons Meeting during this period. and tackling the regional issues” While I was there, I had the opportunity to attend the European Colorectal Congress meetings in Vienna, ACPGBI meeting in Dublin, FRIDAY 18 - SUNDAY 20 OCTOBER 2013 and the Frontier’s colorectal meeting at St Novotel Forest Resort, Creswick / Friday 18 October Mark’s, London. Welcome Dinner and Show - Sovereign Hill I had the opportunity to meet a number of (Families are encouraged to attend) doyens of colorectal surgery including spending a week with Professor Neil Mortensen at Saturday 19 October; Oxford Hospital and then a week at St Mark’s Meeting Dinner - Novotel Forest Resort, Creswick Hospital, London. I’m extremely grateful to my wife Ann, who is herself a successful and busy GP in the Maitland CALL FOR ABSTRACTS area. Her preparedness to give all this up for one year, and relocate herself and family to support me in my own surgical pursuits made it all Please indicate that your abstract is for VIC ASM 2013 and which possible. Submissionsarea you wish your topic to Arebe submitted Now under. AllOpen successful abstracts will be printed in the Final Program & online. Experience for all We have two children, Sarah and Alex, who are Submissions must include: nine and seven years-of-age and very affectionate. Our biggest fears were for Sarah and Alex, and – A title how they would assimilate, and whether their – An abstract of 250 words or less education would suffer from the move. – A short presenter bio (50 words) to facilitate the Chairperson’s Rest assured, kids make friends quicker than introduction adults and seeing their immediate fascination – Authors (Presenter in CAPS and UNDERLINED, i.e. J.L.M with the UK and ability to adapt, as well as their Peterson, A.K.MATTHEWS, A. Thomas, N. Bravo) A year abroad accelerated maturation from this move has made it clear to me that travel is a great educational – Address and Contact Details experience for children. – Conflict of Interest Declaration What I have gained from a single year of being The experience from another country is invaluable an overseas Fellow is hard to put into words. My Email abstract submissions by Friday 16 August to: family and I have gained a lot in terms of settling [email protected] in a new country and meeting different people, did my internship, residency, basic visas and addressing family and this has been very confidence boosting. and advanced surgical training issues such as schooling for The hospitality shown and the genuine PRIZES Iat Royal Prince Alfred Hospital children and so on. acceptance by my surgical colleagues at Leeds There are prizes for the following categories: (RPAH), Sydney. I then did a year of However, this move was an At the other end of the continuum, was humbling, and I am motivated to be involved 2013 DR Leslie Prize – Best clinical registrar paper colorectal research and completed my extremely rewarding experience for I have always been fascinated with in training of a similar sort while a colorectal 2013 RC Bennett Prize – Best laboratory based research paper presented Masters of Surgery (Sydney University). the whole family. We were able to take minimally invasive laparoscopic and surgeon in Newcastle. I feel inspired from my DCAS Scholarship – Best presentation appropriate to academic surgery. I then completed advanced colorectal the opportunity to explore England robotic colorectal surgery. I was uniquely Leeds’ experience to utilise this in the best way Medical Student Prize – Best presentation by a Medical Student fellowship training with Colorectal and Europe with the children and the privileged to work at a public NHS possible and provide a quality colorectal surgical Audio visual instructions will be sent to all successful authors. Surgical Society of Australia & New cultural exposure was of immense hospital where not only did they perform service to the people of Newcastle. Please note that single case reports will not be accepted for Zealand (CSSANZ), spending a year at benefit to our kids, who adapted quicker I am currently awaiting a surgical consultant the most invasive and radical surgery for presentation or poster both Fremantle and RPAH. than anyone could imagine. colorectal pelvic cancer recurrence, but it post in the public hospital system. In order to gain overseas experience The John Goligher Unit in Leeds was also the one NHS hospital in the UK I was extremely honoured to be invited to take in complex pelvic and laparoscopic was a major eye-opener into the NHS. in which robotic colorectal cancer surgery over Dr Paul Anseline’s Practice in Newcastle. MEETING ORGANISER colorectal surgery, I did a year of Having spent most of my training years was being pioneered. In the not too distant future, I would like to be Denice Spence, Victorian Regional Manager fellowship at John Goligher Unit Leeds, at RPAH, reputedly the largest pelvic During my time in Leeds I was involved in academics and the training of junior Royal Australasian College of Surgeons United Kingdom with Professor P.M.Sagar exenteration centre in Australia-New on the on-call roster, and I enjoyed members of the surgical profession. College of Surgeons Gardens and Professor P.J.Finan. Zealand, I was particularly keen on going I strongly recommend doing an overseas my time training surgical registrars 250 - 290 Spring Street, East Melbourne VIC 3002 Australia Moving overseas can be a very to Leeds to learn advanced complex and Fellows in the unit, taking them fellowship year to gain a life-altering experience. T: +61 3 9249 1254 F: +61 3 9249 1256 stressful experience since it involves surgery including pelvic exenterations through laparotomies and laparoscopic You will not be disappointed. extensive organisation with relocation, for colorectal cancer recurrence from procedures. I regularly attended the Anil Koshy E: [email protected] getting medical council recognition, Peter Sager. outpatient clinics, conjoint IBD clinics NSW Fellow

Page 34 / Surgical News March 2013 Surgical News March 2013 / Page 35 Yacht Squ adron (RS Y S) ADA C o u rtes y of the R o From the Archives

Sir Alexander MacCormick on board al Sy dne y

Sailing surgeons are part of our history

n 1876 four young men, Robert Scot Skirving, Alexander MacCormick, Thomas Anderson Stuart and Arthur IConan Doyle were studying medicine at the University of Edinburgh. Skirving made notes about his fellow s students. He observed that Anderson Stuart, who later founded the Sydney Medical School, was a bright boy with n a hook nose that earned him the nickname of ‘coracoid’ from the Latin corax (crow), but he found MacCormick and o Conan Doyle rather dull. Ironically, these stolid students were not what they seemed – e Conan Doyle’s literary success is well known and MacCormick became a highly respected surgeon. In another twist of fate, the g cultured Robert Skirving who admired Robert Louis Stevenson r and the rather gruff Alexander MacCormick, a man with ‘no Officers of the RSYS 1895-1896, Alexander MacCormick is in poetry in his soul’, were to become close friends who shared a the middle row, second from the right. Courtesy of the RSYS. u passion for the sea. Following a visit to Australia during his brief career in the mark as a surgeon. Working at the Prince Alfred Hospital S merchant navy, Skirving immigrated to Australia in 1883 and from 1885, MacCormick was an advocate of Lister’s antiseptic MacCormick arrived the same year. Under Anderson Stuart’s methods and was present at the Sydney Hospital in 1896 patronage, MacCormick became a demonstrator in Anatomy when X-Rays were first used to remove a bullet from a g and Physiology at the Sydney Medical School and Skirving patient’s thigh. was appointed as the Superintendent of the (Royal) Prince Skirving says that MacCormick was “one of the best n Alfred Hospital. exponents of safe surgery” and notes that his knowledge of i When Skirving and MacCormick arrived in Sydney, anatomy was a factor in his surgical success. He was also a l sailing was already a popular sport. According to the Sydney man of “inexhaustible energy”, starting at the hospital at 6.30 i Gazette, the ‘first Australian Regatta’ had been held on Sydney in the morning, lecturing at the university in the afternoon a Harbour in 1827. It consisted of three races organised by and returning to the hospital to operate until 8 or 9 at night. the officers of the HMS Success (Captain Stirling) and HMS Despite this busy schedule, MacCormick did manage to S Rainbow (Captain Rous) and two of the races had an alluring pursue his other love, sailing. prize of 50 Spanish dollars. In 1893, MacCormick joined the Royal Sydney Yacht By the 1880s, stimulated by reports of the fashionable Squadron and purchased the yacht, Thelma from JH Hoare. regattas at Cowes and the formation of the Royal Sydney Yacht Typical of her class, Thelma had a large sail area and a lengthy Squadron in 1862, sailing regattas were an established feature gaff extending to the head of the mainsail. She was very of Sydney society. fast and consistently won races in the 1890s, including the Skirving and MacCormick began their sailing careers on Gascoigne and Carleton Cup. Sydney Harbour in Chinese canoes. They also sailed with In 1897 MacCormick was appointed Commodore of the Frederick Milford, the first lecturer in surgery at the Sydney Royal Sydney Yacht Squadron and at the opening of the Medical School and Honorary Surgeon at St Vincent’s and season, the Sydney Morning Herald commented that “the the Prince Alfred Hospital. Skirving was slightly injured manoeuvres organised by Dr MacCormick had enabled the when sailing with them in 1889 and Milford distressed by the spectators to realise in some measure the fascination of incident, subsequently helped him to secure the position of the pastime…” Honorary Surgeon at St Vincent’s Hospital. It is interesting to note that the pastime was even more ‘fascinating’ in the 1880s when racing yachts had to avoid Two of a kind random shots from gunnery practice at St George’s Head. By this time Skirving was also an Honorary Physician MacCormick relinquished his position as Commodore at the Prince Alfred Hospital and he says of the dual of the squadron in 1900 and both he and Skirving served appointments: as surgeons in the South African War. MacCormick was “I was neither one thing or the other. I therefore rose to mentioned in dispatches in 1901 and Skirving wrote a eminence in neither. I became a surgeon of sorts with a pamphlet on ‘Our Army in South Africa’ (1901). Skirving also medical mind, and a physician with a very surgical mind. On completed his only novel, Love and Longitude in 1901 and in the whole I think it made me a better all-round doctor.” the years leading up to World War I, still managed to find time “Ironically, these stolid students were not what they seemed” MacCormick on the other hand was clearly making his to study navigation and sail. u

Page 36 / Surgical News March 2013 Surgical News March 2013 / Page 37 From the Archives

Thelma ANZSVS “the thunder on a western beach, Australian and New Zealand Society for Vascular Surgery and the windy hills and white crested lochs of the Hebrides” ANZSVS Sam Mellick Travel Fellowship

The Australian and New Zealand Society for Vascular Surgery recently awarded the inaugural Sam Mellick Travel Fellowship at the ANZSVS Meeting held in Melbourne 20 – 23 October, 2012. This award, supported by industry sponsorship, was awarded to Dr Simon Quinn from St Vincent’s Hospital, Melbourne. The award honours and recognises the contribution to Australian and New Zealand Vascular Surgery by Professor Sam Mellick CBE, FRACS, FRCS, FACS. Dr Quinn will use the Fellowship funds to present at the 2013 European Society for Vascular Surgery annual meeting in Budapest, where he will present data relating to outcomes from fenestrated and branched aortic endografts from St Vincent’s Hospital Melbourne, and to visit Nuremberg, Germany to gain further experience in the planning and techniques of deployment of such endografts for the management of thoracoabdominal aortic aneurysms.

The ANZSVS will award the next recipient of the Sam Mellick Travel Fellowship at the ANZSVS Meeting being held in Hobart 12 – 15 October, 2013. P hoto : eter G awthrop RPS Position Vacant. An exciting opportunity exists for an Upper Radiology/Pathology GI/Bariatric surgeon to join a large bariatric and Correlation Series general laparoscopic group in the south-eastern suburbs of Melbourne.

The Practice was started in The successful applicant will Gastrointestinal Oncology – 20th April, 2013 1984 and currently consists have advanced laparoscopic skills of three surgeons working as and excellent training in upper GI Not surprisingly and despite his increasingly successful Robert Skirving’s later years continued on a quieter course. Thoracic Oncology – 25th May, 2013 partners. The Practice workload surgery. Bariatric experience will be practice, MacCormick continued his love affair with yachts. He A Foundation Fellow of the College, he worked at St Vincent’s is approximately 50% bariatrics helpful, but not essential as we will sold Thelma in 1906 to Charles Lloyd Jones and commissioned hospital until 1923 and published extensively in journals such as (LapBand, sleeve gastrectomy and train and mentor an appropriate gastric bypass) and 50% general applicant. Specialist Australian Monson and Sinclair of Longnose Point to build the cutter the Medical Journal of Australia. and advanced laparoscopic recognition by AHPRA is essential. Morna, ‘an elegant fast yacht named after his youngest daughter’. In 1931 he wrote an authoritative book called Wire Splicing for $330 per session (Incl. GST) surgery. The successful applicant will In 1913, he again became Commodore of the Royal Sydney Yachtsmen which used X-Ray photographs to show the interior Early Bird Special Available! The main rooms of the Practice walk into a fully functioning in Boronia are very large with a practice and have immediate Yacht Squadron, a position he retained until after he returned of ropes. Skirving who sailed until he was in his eighties and full complement of staff including access to patients referred to the from his war service with the Australian Army Medical Corps. In insisted on the Hebridean practice of dyeing his sails red, was a 2 nurses, dietitian, a marketing Practice. It is envisaged that the 1920 he left the Yacht Squadron to become first Commodore of distinctive sight on Sydney Harbour. manager, research nurse as well successful applicant will work for as general office staff and a a short period as an associate the newly formed Royal Prince Edward Yacht Squadron. According to Douglas Miller, MacCormick viewed Skirving’s Stamford Grand North Ryde Business Manager. The main office and if mutually agreed, will join When the College was formed in 1926, MacCormick was a later nautical activities with some amusement saying that: Cnr Epping & Herring Roads is well-equipped and includes the the partnership. A public hospital Founder and its first Vice-President. However, he resigned in 1933 “…the boat with the deep red sails always had the engine in North Ryde NSW latest impedance oesophageal appointment in the south-eastern manometry and 24-hour pH suburbs will be seen as an without having attended a Council meeting and was not very action and never ventured past the Sow and Pigs.” (The ‘Sow and equipment (Manoscan). advantage but is not essential. involved in the College. It seems that as a sailing surgeon nearing Pigs’ was the opening of the Heads on the city side.) Ancillary rooms are located at Initial enquiries should be the end of his professional life, he had ‘other fish to fry’. Although very different, Alexander MacCormick and Robert Mitcham, Mornington, Mulgrave addressed to Mrs Julie Gould Registration & Enquiries: and Berwick although not all (Business Manager) on In 1926, he supervised Fyffe’s construction of the yacht, Skirving were linked by their heritage, profession and the sea. Web: www.arer.org.au surgeons attend all locations. (03) 9760 2777 Ada on the Clyde in Scotland. When the yacht was finished, Skirving dreamed of “the thunder on a western beach, and the Email: [email protected] MacCormick, who was then 71, set off for Australia with a windy hills and white crested lochs of the Hebrides” and as Phone: 02 8705 8329 skeleton crew of five. He sailed through the Panama Canal and Herbert Moran says, MacCormick “now rests in Jersey tied up returned to his mooring in Rose Bay four months later. His like a noble old hulk in quiet waters unperturbed awaiting the Designed to assist registrars and medical professionals to develop a better understanding surgical practice also remained a dominant feature of his life slow reluctant hand of the breaker”. of the clinical aspects of, and the correlation between, Radiology and Pathology. until in 1931 at the age of 75, he retired to Jersey. With Elizabeth Milford, College Archivist

Page 38 / Surgical News March 2013 Surgical News March 2013 / Page 39 advertisement All Books now Welcome to the Surgeons’ Bookclub 25% discount

25% 25% 25% 25% 25% Discount Discount Discount Discount Discount

To Order RACS Members can now access the 25% discount* by following the instructions: Log on to the RACS website Go to College Resources then Practice Perfect: 42 Rules for From 0 to Financial Freedom: Practical Handbook of Advanced Pediatric Cardiac Surgery, 4th How to Assess Doctors and Member benefits – then Wiley- Getting Better at Getting Better How To Do It Today! Interventional Cardiology: Tips Edition Health Professionals Blackwell Doug Lemov, Erica Woolway, Katie Steve McKnight and Tricks, 4th Edition Constantine Mavroudis (Editor), Mike Davis, Judy McKimm, Kirsty Yezzi, Dan Heath (Foreword by) 9781118597415 | Pbk | 102 pages Thach Nguyen, Dayi Hu, Shao Liang Carl Backer (Editor), Richid F. Idriss Forrest Follow the steps on the website 9781118216583 | Hbk | 288 pages November 2012 Chen, Moo-Hyun Kim, Shigeru Saito, (Illustrator) 9781444330564 | Pbk | 160 pages to ensure your 25% discount* August 2012 AU$12.95 | AU$9.71 Cindy Grines, C. Michael Gibson, 9781405196529 | Hbk | 958 pages March 2013 on all Wiley-Blackwell books AU$32.95 | AU$24.71 Member Price Steven R. Bailey AU$285.00 | AU$213.75 AU$47.95 | AU$35.96 Postage is charged on all orders: Member Price hat does financial freedom mean 9780470670477 | Pbk | 712 pages Member Price Member Price AU$7.50 within Australia and n this book, the authors engage the Wto you? Not having to work? December 2012 ediatric cardiac surgery is a dynamic, ewest How To title from BMJ AU$25.00 to New Zealand dream of better, both in fields and Being able to afford life’s luxuries fast-moving field. Busy practitioners, Books. This important book I AU$120.00 | AU$90.00 P N *Excluded from discount are endeavors where participants know without worrying about the cost? Member Price like you, need clear and comprehensive offers an introduction to the theory School (Jacaranda) titles. they should practice and also in those Financial security? Perhaps supporting ritten and edited by today’s guidance you can rely on to ensure optimal and the varying types of assessment where many do not yet recognize the the needy or disadvantaged? Well, if Wmost-recognised inteventional patient care. for health care professionals. The book transformative power of practice. The you believe and follow the conventional cardiology thought leaders, this popular For over 25 years Pediatric Cardiac includes information on such topics as clear set of rules presented in Practice approach to investing then forget it! guide focuses on key procedures and Surgery has been the gold-standard Where have work based assessments To read more Perfect will make us better in virtually You need a different approach, and in techniques. Each strategic or tactical reference for pediatric and adult congenital come from?; Why do we have different every performance of life. this book expert property investor Steve move is graded by complexity level heart surgeons, pediatric and congenital parts to the same exam like MCQs and about • Discover new ways to think about McKnight reveals how to start from and described in a simple, step-by-step cardiologists, intensivists, anesthesiologists, OSCEs?; How do colleges decide who these titles practice. Learn how to design scratch in today’s property market. approach that includes guidance on how residents and nurses. has passed or not?; Why can people successful practice. Apply practice Inside you’ll discover: to overcome practical difficulties and Now, in this thoroughly revised fourth pick their own assessors for their please go to across a wide range of realms, both • Steve’s exciting new two-part system navigate particularly challenging clinical edition, you again get trusted, complete MSF?; The role of formative assessment personal and professional for retiring richer, and sooner scenarios and complications. coverage of the field with timely new Portfolios and their value. The book www.wiley.com • Which properties make the best • The authors include specific • “Tips and tricks” gathered from the features and expert reviews of critical avoids jargon, is clear and succinct, and activities to jump-start practice growth and income investments personal experience of over fifty topics including heart transplantation, gives the pros and cons of the different Not all books promoted in Surgical • Doug Lemov is the best-selling • What strategies are best for you, and international experts emerging modalities for diagnosing assessment processes. News will appear on the RACS/ author of Teach Like a Champion why • Clear, practical, step-by-step guidance congenital heart and tracheal defects, the Wiley Landing Page. A hands-on resource to practice, the • How to buy more properties without on the latest procedures and surgical technique of Fontan conversion rules within will help to create positive working harder in your job techniques, performing challenging with arrhythmia surgery, the medical You can still order these, as with outliers and world-changing reservoirs • And much, much more interventions, and managing challenges of managing adult CHD any other book, by finding it within of talent. complications patients, and more. wiley.com, after loggin in.

Page 40 / Surgical News March 2013 Surgical News March 2013 / Page 41 College Awards

Congratulations on your achievements Awards presented at last year’s Annual Scientific Congress

award Winner award winner to Australia in 1999, he established an of 2011 winner a Masters of Surgery in 1966 (UQ), he of Timor Leste, years that included business gained the FRACS in 1967 and then turmoil and unrest, but despite the academic neurosurgery unit at the embarked on a long and distinguished challenges, David Scott maintained a University of New South Wales and excellence career as a general, vascular and steady hand and provided consistent Prince of Wales Hospital. In 2008, award transplant surgeon at the Prince Henry leadership. Professor Stoodley was appointed the Hospital (1971-1991), Fairfield Hospital Not only have many patients inaugural chair of Neurosurgery at the Rooms With Style (1971-1996), and Monash Medical received care they might never Australian School of Advanced Medicine offers 3 core Centre (1991-2003). He was also a have had, but there have also been (ASAM) at Macquarie University. services exclusively Professor Stoodley was awarded a strong contributor to the College and significant advances in the training for Surgeons its committees, including becoming of local staff, including a general PhD in 1997 for his research on the Executive Director for Surgical Affairs surgeon, an ophthalmologist and an pathophysiology of syringomyelia. >Medical Fitouts and, for a brief period, the acting Chief anaesthetist. Other Trainees are in the During his neurovascular fellowship >Practice Executive Officer. training scheme and today the Timor training at the University of Chicago, Professor Stoodley developed an interest Management Early in his career Professor Scott Leste program is recognised as a Consulting developed an interest in contributing to model for other assistance programs. Professor Marcus in endothelial and arteriovenous Professor David Scott surgery outside Australia. He developed David Scott has been a member of Stoodley malformation (AVM) molecular biology. >Recruitment FRACS strong associations with Malaysia, Hong the International Committee since A further interest of Professor Stoodley 2012 John Mitchell is the monitoring of surgical outcomes International medal Kong and Singapore where he visited to 1997, convening the first International Crouch Fellow teach and examine on many occasions. Medical Aid Symposium held at the using information technology. Marcus Call today These links also resulted in training College in 2006 and he chaired the developed prototype software for this to find out how opportunities for surgeons from South International Project Management he John Mitchell Crouch purpose and was awarded patents in the USA to cover the coding and analytical we can tailor our he RACS International Medal East Asia to train in Australia under his Committee from 2002 to 2007. David Fellowship is the premier research services to suit is awarded to Fellows who have guidance. He also represented the College has been a mentor and guiding force award of the Royal Australasian aspects of this work. T Professor Stoodley has published your practice. made lasting contributions of an on the Asian Surgical Association (1997- for other junior surgeons who have College of Surgeons. It is separate from T over 100 papers and book chapters. He exceptional nature over a long period of 2007), including being its Vice President. also gone on to contribute to the Foundation Grants and independently time in the delivery or development of In 2001, Professor Scott travelled to international work in this College. funded. The Fellowship commemorates has supervised four students who have 1300 073 239 surgery for underprivileged communities newly independent East Timor to perform It is fitting that the International an outstanding younger Fellow of completed their Doctor of Philosophy and he has six PhD students currently [email protected] overseas. a needs analysis with regard to specialist Medal is presented to David Scott at the College who died in 1977 on the www.roomswithstyle.com.au David Scott has made a significant services. This resulted in an Australian this convocation, being held during threshold of a highly promising career. under his supervision. This is in addition contribution to surgery both in Australia government funded, RACS-managed the 2012 RACS ASC in Malaysia, the John Mitchell Crouch was a young to supervising three Masters students, and Internationally. program of surgical and anaesthetic place of his initial contributions to surgeon who showed astute clinical, three Honours students, and nine After attaining his medical degree specialist service, for which he became International Surgery. organisational and research abilities and undergraduate research projects. Professor Stoodley served as the Suite for Lease through the University of Queensland director for the next decade. These were Citation kindly provided by this award is made to an individual who, neurosurgery representative on the RACS in 1962 and higher studies resulting in formative years for the young nation Professor David Watters FRACS in the opinion of Council, is making Potts Point, Sydney Board of Surgical Research from 2006 to an outstanding contribution to the A brand new advancement of surgery. 2011. He is a board member of the Brain Foundation and is on the editorial board ground floor suite of Professor Stoodley is a committed approximately 95m2 surgeon-scientist. of Pædiatric Neurosurgery. of unfitted space in For Lease Marcus Stoodley graduated from the Professor Stoodley worked as a Surgical News University of Queensland with a Bachelor volunteer neurosurgeon in Kathmandu, a bustling residential Nepal as part of a program that led to district. Conveniently AMA HOUSE, ST LEONARDS, SYDNEY welcomes letters from readers. of Medical Science with distinction in 1986 and MB BS (Hons) in 1987. His the development of an independent close to major hospitals 3 x Specialist consulting rooms available neurosurgical clinical training was in Perth neurosurgical service there. He and nursing homes. Modern spacious medical suites with a large and Adelaide and he was the first Australian participates in the CSIRO ‘Scientists Please write to The Editor, Surgical News, patient waiting room neurosurgeon to complete an intercalated in Schools’ program, regularly visiting 1300 073 239 Royal Australasian College of Surgeons, a regional primary school to engage Ample parking adjacent to rooms doctorate during his clinical training. [email protected] 250-290 Spring St, East Melbourne. Vic 3002 He undertook neurovascular students in an appreciation of science. Citation kindly provided by www.roomswithstyle.com.au Contact (02) 9438 2271 or 0411 430 509 (ah) or email: [email protected] fellowships at the University of Chicago and Stanford University. On his return Mr Joseph Lizzio FRACS

Page 42 / Surgical News March 2013 Surgical News March 2013 / Page 43 Regional Awards

Congratulations on your achievements

Awards presented at the NSW End of Year Dinner, held on 14 December, 2012 He has been an invited speaker and visiting Alan and his wife Pat have been for many they performed the little miracles that defined Professor in every Australian State, NZ, USA, years the ambassadors of Rural Surgery both surgery in country NSW in those times. Canada, Portugal, Spain, Brazil, Italy, Monte at home and across the many lands they have Slowly but surely, Alan instigated the went on to become Head of Department Carlo, Greece, the Netherlands, England, travelled. They, initially, as a young couple protocols to his practice and then the hospital Graham R. Nunn Reginald Lord Scotland, Israel, Singapore, Fiji, China, Japan, enjoyed the travel to distant shores, and despite that would be used to establish breast cancer t is with great pleasure that I introduce at both these institutions. In 1992 he was rofessor Reginald Lord AM, MD, FRCS, Vietnam, Indonesia and India. the arrival of Chris then Tom and finally Amy, treatment, bowel cancer surgery and trauma Graham Nunn to the NSW State also appointed to the Prince of Wales FRACS, has shown all the qualities of He has trained 1-3 Fellows per year from their times of camping, walking, biking and treatment. These practices have been refined Committee. Hospital as a cardiothoracic surgeon. In leadership in the academic and clinical I P Asia and Australia in vascular and transplant sailing all over the world have not slowed. over the years, but the basis to current Graham Nunn has had a great influence 1997 he retired from Westmead Hospital aspects of surgery throughout his career to be surgery. Many hold chairs in surgery in Alan had his surgical training-wheels on practice is easily seen in Alan’s work. not only on my own career, but that of many to concentrate on paediatric cardiac a worthy recipient of the NSW Merit Award of Australia and overseas including Professors in many of the hospitals of the British Isles, Alan was one of the doctors who watched other currently practising cardiothoracic surgery and subsequently was appointed the RACS. Effeney, Lusby, Jones, Lynch, Gotley, and the where he worked with many fine surgeons of over the establishment of a private sector surgeons, both adult and especially paediat- Consultant Emeritus. Professor Lord graduated in Medicine from late Alex Chao from Singapore. the time. He was very proud of the academic in the area, and was heavily involved in the ric surgeons . Not one to seek the limelight, Graham remained at the Children’s the University of Sydney in 1960. He trained at He has been president of the Australian achievements in his studies into vascular establishing audit. There was the arrival outside of the cardiothoracic community Gra- Hospital at Westmead and the Prince of Wales St Vincent’s Hospital, Sydney 1960-1965 and St Chapter and Vice President of the disease. He also worked with the legendary Mr of other specialists and the largest change ham’s achievements are perhaps little known. hospital until 2008 when Queensland Health Thomas’ Hospital, London with vascular leaders Les Ernest Hughes. This excellent grounding of all, the arrival of specialist anaesthetists. I first met Graham in the latter stages restructured its paediatric cardiac surgical Drs Kinmonth, Cockett, and Browse 1966-1967. International Society of Cardiovascular in establishment of logic to investigation has This transition was not the simplest in of my advanced training. I was one of the services and he was approached to lead this He trained at UCSF 1967-1969 with Dr Jack Wylie Surgery, and Chairman of the Section of held him in good stead. this GP driven town; however, with Alan’s fortunate few Trainees who were allocated service. Graham was appointed Director of the pioneer of the operation of endarterectomy Vascular Surgery and Military Surgery RACS. Alan and I both are grateful to the involvement many of the difficult moments a rotation to the Cardiac Unit at the RAHC Paediatric and Congenital Cardiac Surgery and completed his training in vascular and renal In 1985 he was invited to serve as Colonel of pioneering spirit of Dr Irwin Hanan, who were smoothed over and possible combatants at Camperdown prior to its relocation to the Queensland. He retired from this position in transplantation surgery in San Francisco. the Royal Australian Army Corps. He led a St established the first General surgical practice became tennis partners or sailing buddies. Westmead site. The most striking feature was March of last year. He returned to Australia and St Vincent’s Vincent’s team to Vietnam 1971-1972. in Nowra. He worked as a General practitioner Alan has one major failure; he likes the absolute attention to detail in all aspects of Graham has both a national and Hospital to join the Professorial Unit with Prizes and Honours are numerous and to establish himself, and then used his skills adventure, but he sometimes gets lost or an operation from the prepping and draping international reputation in the paediatric Professor Doug Tracy. Subsequently he became include Member of the Order of Australia 2004. learned in New Zealand and the United injured. To have Alan as the doctor for the to the application of the dressing at the end of cardiac surgical community, having developed Associate Professor 1972-1985 and Professor His scientific contributions include Kingdom to further the practice of surgery. canoeing trip for his son’s school class was in the procedure. This applied no matter whether a single patch closure technique for the repair of Surgery and Chairman of the Department dynamic studies of flow in the thoracic Alan also wishes to recognise the role played theory an excellent choice, but that is theory the procedure was a relatively simple ASD of atrioventricular canal defects. He is visiting 1985-2004. He established the Rural School duct, haemodynamics of the vascular steal by Drs Pat and Bill Ryan in helping him for you. Alan being involved, as always, set out closure or a complex intracardiac structural professor at the Mafraq Hospital in Abu of Medicine in 2004 at Wagga. In 2004 the phenomenon in the cerebral circulation, the establish a specialist surgical practice in in the canoe only to see the paddle stick in an repair. To this day I strive to achieve an atrial Dhabi in the United Arab Emirates. UNSW conferred Emeritus Professor Status. mechanism of TIAs via alternate pathways and Nowra in 1978. underwater rock and his shoulder continue closure suture line that even attempts to Graham was an examiner for the RACS The same year he became the first Professor defining the syndrome of carotid paraganglioma. Alan had an interest in almost all aspects on its merry way to dislocation. There at the resemble a Graham Nunn closure! from 1994 until 2002. In 2006 his contribution of Surgery at the University of Western Sydney Together with Dr Yuri Bobryshev, Professor of surgery. He was truly a General Surgeon. head waters of the Shoalhaven, he thankfully Graham is not native to NSW. He grew to cardiothoracic surgery was recognised and helped establish the Medical School. He Lord postulated and then identified A dab hand at Breast Disease, Biliary disease, had an eperb alert device and was eventually up in the wilds of Kangaroo Island in South by the RACS with the Award and Medal for was Director of Surgery at Campbelltown and dendritic cells in the artery wall and defined their role in inflammatory components of and hernia repair, Alan would not be daunted airlifted out of the canyon, following his self Australia prior to attending the University Excellence in Surgery. Camden Hospitals. atherogenesis. by the occasional fracture and hand injury. administration of IVI pethidine – the other of Adelaide. His university transcript would His contributions were recognised by His skills in establishing and maintaining Professor Lord has encouraged students Children were very much part of his operative responsible adult had fainted at the sight of the make the majority of students blush with the Commonwealth with awarding of the standards in surgery have been used in and graduates to be actively involved in the repertoire, and I still remember the intensity needle. shame. His lowest grade appears to have been Member of the Order of Australia in 2004. metropolitan and rural areas throughout learning process. He is recognised as a leading of concentration over the tiny sick babies with Alan has retired from active surgical a credit on a single occasion. Throughout his Graham has been an avid supporter of Australia by health authorities where codes academic researcher, teacher and outstanding pyloric stenosis. practice and we are hoping that he will undergraduate years Graham was awarded no the Operation Open Heart Project of the of practice and outcomes had been a concern. vascular surgeon with the equanimity that It must be remembered that this young continue in a teaching role in the Shoalhaven. less than seven prizes. Sydney Adventist Hospital. This project brings Professor Lord has always been a problem cardiac surgical services to developing nations encourages calmness, care, skill and an endless upstart had arrived in a town where there His retirement dinner from the hospital was On graduation he went on to the solver for the community and an advocate for where no such services exist. He has been thirst for knowledge. He is the complete was one part time surgeon plying his trade, in Kigali in South Africa, the only people Royal Adelaide Hospital and trained in our profession. on at least 20 such trips. This has led to the Professor of Surgery and deserves recognition and the stories go of GP surgeons removing there were his family. Alan is, an intensely cardiothoracic surgery under the tutelage of Professor Lord is author of over 250 development of a fledgling cardiac surgical by our College. gallbladders with the hospital gardener private man and proud of his Queensland Ian Ross and Darcy Sutherland. On gaining publications, mostly related to vascular disease unit in Port Moresby. The PNG Government including the text book ‘Surgery of Occlusive Citation provided by Anthony Graham attending to the ether mask. heritage (especially at time of the State his FRACS in 1979 he undertook further has recognised this contribution by awarding Cerebrovascular Disease’ of which he is the Alan was involved in an almost of Origin).The people of Country NSW, training in both adult and paediatric surgery The Order of Logohu. sole author. imperceptible change to specialisation especially the Shoalhaven, have benefited in London and Boston as well as research Alan Kline Graham Nunn’s personal attributes are too He is a pioneer of extracranial arterial and amongst the regions’ doctors and hospitals. from his love of surgery, simplicity and his work. He worked with Professor Magdi t is my honour to present to you Mr Alan numerous to even attempt to describe. thoracoabdominal aortic reconstructions. Alan’s best man at his wedding had been Col genuine respect of patients, most of whom Yacoub, Marcus Deleval, and Aldo Castaneda. Kline. Alan has been a friend, colleague Ladies and gentlemen, Fellows, this Merit He has been a member of the editorial Shepherd, and the Shepherds have spread their now count themselves as his friend. Returning to Australia, Graham was and mentor for over 20 years. He is, even Award by the NSW State Committee is but advisory boards of the Journal of I influence throughout the practice of surgery Mr Chairman, I present Mr Alan Kline, appointed to Westmead Hospital and the in retirement, the Senior Surgeon of the a token of appreciation for the contribution Cardiovascular Surgery, Annals of Vascular in many ways throughout NSW and Australia. for the presentation of the State Committee Royal Alexandra Hospital for Children as Shoalhaven Hospital District in Nowra, on the Graham Nunn has made to surgery in NSW. Surgery, Phlebology and ANZ Journal of Col was Alan’s anaesthetist, a lovable larrikin Merit Award. a cardiothoracic surgeon. He subsequently beautiful south coast of NSW. Citation provided by Robert Costa Phlebology. of a GP and part-time anaesthetist. Together Citation provided by Martin Jones

Page 44 / Surgical News March 2013 Surgical News March 2013 / Page 45 The Royal Australasian College of Surgeons Member Advantage Benefit Program Royal Australasian College of Surgeons 2014 Rowan Nicks Take advantage of great savings on a wide range of benefits! Australian & New Zealand Exchange Fellowship

The Rowan Nicks Australian and New Zealand RACS Fellows and Trainees enjoy exclusive savings on Exchange Fellowship is intended to promote accommodation, leisure experiences, airline lounge memberships, VALUE ADDED BENEFITS international surgical interchange at the levels package tours, insurance services and more. of practice and research, raise and maintain the þ Save on travel related expenses profile of surgery in Australia and New Zealand These services are free to use at any time and can be accessed by þ Save on insurance services and increase interaction between Australian and phone or via the Member Advantage website. New Zealand surgical communities. þ Save on financial and wealth services The Fellowship provides funding to assist a New For further information, visit: þ Save on shopping, leisure experiences and gifts Zealander to work in an Australian unit, or an www.memberadvantage.com.au/racs Australian to work in a New Zealand unit, judged My Timor Heart by the College to be of national excellence for a period of up to one year. Written by Ellen Whinnett and Ellen Smith Accommodation Magazine Subscriptions Travel Insurance Package Tours Using striking photographs and volunteers’ stories My Timor Heart Applicants must have gained Fellowship of illustrates the profound positive impact of the College’s Timor Leste the RACS within the previous ten years on the program. Written by Ellen Whinnett, a Walkley award winning journalist and the Head of News at the Herald Sun newspaper. All proceeds from the closing date for applications. sales of My Timor Heart go directly to Foundation for Surgery to fund the Selection Criteria Timor Leste Program.. The Committee will Order Form – consider the potential of the applicant to become a surgical leader and ability to provide a particular Name: ...... service that may be deficient in their chosen Address: ...... surgical discipline. Telephone: ...... – assess the applicants in the areas of surgical ability, International Money Transfers Car Buying Service Lifestyle Experiences Gourmet Hampers Email: ...... ethical integrity, scholarship and leadership. Please find enclosed my payment for: $...... The Fellowship is not available for the purpose of $60 AUD + P&H ($10 AUD in Australia for first copy then AUD $5 for extending a candidate’s current position in Australia each additional copy) (incl. GST) or New Zealand. *Please contact us for Postage & Handling costs outside Australia. Value: Up to $75,000 pro-rata, depending on the Cheque: Money Order: funding situation of the candidate and provided Credit Card: sufficient funds are available, plus one return Card Type: Mastercard / Visa / American Express economy airfare between Australia and New Zealand. Card No: Tenure: 3 - 12 months

Expiry Date: ...... Online Wine Sellers Car Rental Airline Lounge Memberships Home and Car Insurance Signature: ...... Further Information Application forms and instructions will be Please send this form to: available from the College website from December Timor Leste Program 2012: www.surgeons.org College of Surgeons’ Gardens Closing date: 5pm Monday 6 May, 2013. Applicants Royal Australasian College of Surgeons will be notified of the outcome of their application 250-290 Spring Street, by 30 October 2013. East Melbourne. VIC 3002 AUSTRALIA Please contact: Email: [email protected], I would like to donate Secretariat, Rowan Nicks Committee Phone: +61 3 9249 to o u1230r Foundation for Surgery Royal Australasian College of Surgeons

Fax: +61 3 9249All donations 1236 are tax deductible 250 - 290 Spring Street, East Melbourne VIC 3002

Name: Email: [email protected] The RoyalAddress: Australasian College of Surgeons takes the issue ofTelephone: security and privacy Phone: + 61 3 9249 1211 Fax: + 61 3 9276 7431 For further information on these benefits, please contact Member Advantage: Email: Speciality: seriously. Information contained in this form will not be used for any other purposes Call 1300 853 352 or visit www.memberadvantage.com.au/racs Enclosed is my cheque or bank draft (payable to Foundation for Surgery) for $ . NZ Fellows and Trainees call +61 3 9695 8997 Please debit my credit card account for $ . Page 46 / Surgical Mastercard News Visa March AMEX Diners2013 Club NZ Bankcard Surgical News March 2013 / Page 47

Credit Card No: Expiry /

Your passion. Card Holder’s Name - block letters Card Holder’s Signature Date

Your skill. I would like my donation to help support: Your legacy. General Foundation Programs International Development Programs Scholarship and Fellowship Programs Indigenous Health Programs I have a potential contribution to the Cultural Gifts Program Your I do not give permission for acknowledgement of my gift in any College publication Please send your donation to: Foundation. AUSTRALIA & OTHER COUNTRIES NEW ZEALAND Foundation for Surgery Foundation for Surgery 250 - 290 Spring Street PO Box 7451 East Melbourne , VIC 3002 Newtown, 6242 Wellington Australia New Zealand Foundation for Surgery

Yes, I would like to donate to our Foundation for Surgery

All donations are tax deductible

Name: Address: New ZealandTelephone: Dr Nicola Hill Miss Philippa Mercer Mr Gary Stone Mr David Adams Mr Andrew Hill Mr Arend Merrie Mr Howard Swan Email: Speciality: Mr Philip Allen Mr Christopher Mr Philip Morreau Mr Dev Tandon Mr Robert Allison Holdaway ED Mr Robert Orec Mr Christopher Taylor Enclosed is my cheque or bank draft (payable to Foundation for Surgery) for $ . Mr Grant Beban Dr Gordon Howie Dr Zbigniew Poplawski Mr Ian Thomson Please debit my credit card account for $ . Mr David Brougham Mr Peter Hunter Mr Christopher Porter Dr Fiona Timms Assoc. Prof. Ian Campbell Mr Michael Hunter Mr Sudhindra Rao Mr Etienne Truter Mastercard Visa AMEX Diners Club NZ Bankcard Mr John Chaplin Mr Grahame Inglis Dr Helen Rawlinson Mr Ravindranath Ullal Mr Simon Chinchanwala Mr Robin Jackson Mr Bruce Rhind Mr Vipul Upadhyay Credit Card No: Mr Hugh Cooke Expiry / Dr Simon Johnson Mr John Riordan Mr Stephen Vallance Mr Richard Coutts Mr John Keating Mr Ross Roberts Mr Julian White Your passion. Card Holder’s Name - block letters Card Holder’s SignatureMr David Crabb Date Dr Erica Kelly Dr Alex Rutherford Mr David Whitehead Mr Roy Craig Mr Burton King Mr David Schroeder Mr Michael Woodfield Thank you for yourYour skilldonations. I would like my donation to help support: Mr John De Waal Mr Geoffrey Lamb ONZM Dr Belinda Scott Mr William Wright Australia Your legacy. General Foundation Programs InternationalMr Dev Johnelopment Dunn Prog rams Mr Julian Lofts Dr Peter Shapkov Mr Michael Young Scholarship and Fellowship Programs Indigenous HealthMr Stephen Programs Dunn Mr Simione Lolohea Mr David Shaw Mr Robert Aitken Mr David Elder Mr Robert Leitch Dr Lynette Reece I have a potential contribution to the Cultural Gifts ProgrMram James Fenton Mr Stanley Loo Mr Paul Silvester Mr Rodney Allan Mr David Failes AM Mr Gregory Leslie Mr Dominique Robert I do not give permission for acknowledgement of my giftDr in Catherineany College publicationFerguson Mr Murali Mahadevan Mr Graeme Skeggs Mr Robert Allbrook Assoc. Prof. Gregory Falk YouMr Albertr Leung Mr William Roberts Please send your donation to: Mr Adrian Folwell Mr John McDonald Mr Hans Stegehuis Total: Mr Nicholas Anastas Mr Gary Fell Dr John Liddell Mr Francis Robertson Mr Anthony Hardy Dr William McMillan Mr Duncan Stevenson Mr Michael Anderson Mr Gerard Fogarty FouMr Andrewnda Lindsaytion . Mr AJamesUSTRALIA Roberts-Thomson & OTHER COUNTRIES NEW ZEALAND Foundation for Surgery Foundation for Surgery Dr Peter Heppner Mr Stuart McNicoll Mr Ian Stewart $89,800 Dr Matthias Axt Mr Harry Frydenberg Mrs Elizabeth Livingstone Mr 250 Harry - 290 Spri Rossng Stre et PO Box 7451 East Melbourne , VIC 3002 Newtown, 6242 Wellington Prof. Bruce Barraclough AO Mr Kwai Fung Mr John Lorang Prof.Australia John Royle OAM New Zealand Mr Robert Bartlett Dr James Gaffield Mr Hugh Lukins Mr Nihal Samaraweera Mr Edward Bates AM Mr John Giles Dr Kirstie MacGill Mr Huat Saw Dr Edward Bates AM Dr Leon Gillam Prof. Donald MacLellan Dr John Scott Mr John Batten Mr David Golovsky Mr Hugh Macneil Prof. Ainslie Sheil AO Yes, I would like to donate Dr Neil Berry Mr Antony Graham Mr William Maling Mr Robert Sillar OAM to our Foundation for Surgery Prof. Michael Besser AM Mr Anthony Guiney Mr Victor Mar Prof. Julian Smith All donations are tax deductible Mr David Birks Mr Philip Hardcastle Mr Hugh Martin Mr Samiul Sorrenti Dr Frances Booth AM Prof. John Harris Am Mr Frank Martin AM Mr Dean Southwood AM Name: Mr Jeffrey Brennan Mr Trevor Harris AM Dr Michael McAuliffe Dr Johannes Stofberg Mr Russell Brereton Mr Malcolm Hay OAM Dr Gregory McDermant Mr Andrew Tang Address: Telephone: Assoc. Prof. Anthony Buzzard Mr Soon Ho Mr Richard McMullin Mr Theophilus Taylor Email: Speciality: Assoc. Prof. Richard Cade Prof. Andrew Holland Mr Hugh Millar Mr Charles Teo AM Mr Peter Campbell Mr Raymond Hollings AM Mr Neville Minnis Prof. David Theile AO Enclosed is my cheque or bank draft (payable to Foundation for Surgery) for $ . Mr Peter Cant Mr Boon-Hung Hong Dr Bruce Moore Dr Chantel Thornton Please debit my credit card account for $ Mr Raymond Carroll Mr Robin Hooper Estate of the late Dr John Moulton Mr Eric Torey . Mrs Ann Carter Prof. Ronald Huckstep CMG Mr Adrian Munyard Mr Eric Torey Mastercard Visa AMEX Diners Club NZ Bankcard Mr Vidyasagar Casikar Mr William Huffam Mr Donald Murphy Dr Peter Treacy Mr Anthony Cass Mr Jeffery Hughes Mr Michael Neale Mr Pleun Verheul Credit Card No: Expiry / Mr William Castleden Assoc. Prof. Thomas Hughes Mr James Nield Mr Nicholas Vertzyas Mr Gregory Nolan Mr Simon Ceber Mr Stephen Jancewicz Mr Roland Von Marburg Your passion. Card Holder’s Name - block letters Card Holder’s Signature Date Dr Venu Chalasani Dr Larry Kalish Prof. Paul Norman Dr Petar Vujovic Mr James Cheng Mr Anthony Kane Mr John O’Connor Mr Roger Wale Your skill. I would like my donation to help support: Mr Robert Claxton Mr Bhadu Kavar Mr Peter Oatey Assoc. Prof. Bruce Waxman Your legacy. General Foundation Programs International Development Programs Mr Peter Clements Mr Sikander Khan Dr Michael O’Sullivan Dr Diane Webster Scholarship and Fellowship Programs Indigenous Health Programs Mr Harvey Coates AO Dr Japinder Khosa Dr Damien Petersen Mr Neil Wetzig I have a potential contribution to the Cultural Gifts Program Mr Leon Cohen Dr Lee Kiang Mr Kenneth Pettit Dr Jennifer Wheatley Your I do not give permission for acknowledgement of my gift in any College publication Mr John Copeland Mr Paul Kierce Mr Marinis Pirpiris Mr Deepak Williams Please send your donation to: Dr Joan Cosgrove Kimberley Foundation Mr William Poate Dr Roger Wilson Foundation. AUSTRALIA & OTHER COUNTRIES NEW ZEALAND Mr Simon Crowley Mr David Lai Mr Francis Prendergast Dr Andrew Wines Foundation for Surgery Foundation for Surgery 250 - 290 Spring Street PO Box 7451 Mr Owen Deacon Mr Steven Lai Mr Timothy Proudman Assoc. Prof. East Melbourne , VIC 3002 Newtown, 6242 Wellington Mr James Downie Dr Noel Langley Dr Anantha Ramanathan Peter Zelas OAM Australia New Zealand

Page 48 / Surgical News March 2013 Surgical News March 2013 / Page 49 Developing a Career in Academic Surgery Monday 6 May 2013, 7.00am – 4.00pm Royal Australasian College SKYCITY CONVENTION CENTRE AUCKLAND, NEW ZEALAND of Surgeons Provisional Program 2014 Rowan Nicks Pacific 7:00am Registration and Breakfast 7:15am Welcome Islands Scholarship & 2014 Introduction Andrew Hill (Auckland) SESSIoN 1: GENERAl PRINCIPlES Rowan Nicks International Chairs: Mark Smithers (Brisbane) and Julie Ann Sosa (Durham, USA) Scholarship 7:30am What is a career in academic surgery? John Windsor (Auckland) 7:50am Research - How to get research started - ideas, grants, ethics and collaboration Russell Gruen (Melbourne) 8:15am Academic surgery - the essentials - teaching, leadership and administration Timothy Pawlik (Baltimore, USA) 8:40am Discussion 9:00am MoRNING TEA The Royal Australasian College of Surgeons Applicants for the International Scholarship must SESSIoN 2: ToolS oF ThE TRADE invites suitable applicants for the 2014 Rowan be a citizen of one of the nominated countries Chairs: Eric Kimchi (hershey, USA) and Richard hanney (Sydney) 9:15am hoT ToPIC IN ACADEMIC SURGERy - Stem Cells Julie Ann Sosa (Durham, USA) Nicks Scholarships. These are the most listed on the College website from December 2012. 9:35am Bedside to bench to bedside Lillian Kao (Houston, USA) prestigious of the College’s International Awards 9:55am Basic science Carlton Barnett (Denver, USA) Applicants for the Pacific Islands Scholarship and are directed at surgeons who are destined to 10:15am Randomised clinical trials Andrew Hill (Auckland) must be a citizen of the Cook Islands, Fiji, 10:35am Comparative effectiveness research Justin Dimick (Ann Arbor, USA) become leaders in their home countries. Kiribati, Federated States of Micronesia, 10:55am Surgical education/simulation Jeffrey Hamdorf (Perth) 11:15am Discussion The Scholarships provide opportunities Marshall Islands, Nauru, Papua New Guinea, 11:30am lUNCh for surgeons to develop their management, Samoa, Solomon Islands, Tonga, Tuvalu or 12:30pm KEyNoTE PRESENTATIoN - An Antipodean academic odyssey - between the siren call and the rocks Charles McGhee (Auckland) leadership, teaching and clinical skills through Vanuatu; SESSIoN 3: CoNCURRENT ACADEMIC WoRKShoPS: clinical attachments in selected hospitals in Selection Criteria Workshop 1: Interactive Workshop on Workshop 2: Career Development Workshop 3: Presenting your Work Australia, New Zealand or South-East Asia. – The Committee will consider the potential Issues in Research Chairs: Russell Gruen (Melbourne) and Chairs: lillian Kao (houston, USA) Applicants for the Rowan Nicks International and of the applicant to become a surgical leader Chairs: Mark Smithers (Brisbane) David Watson (Adelaide) and Arthur Richardson (Sydney) and Julie howle (Sydney) I want to be an academic surgeon. 1:00pm Writing an abstract Pacific Islands Scholarships must: in the country of origin, and/or to supply a 1:00pm Getting the most out of a team What can I do as a: Eric Kimchi (Hershey, USA) – commit to return to their home country on much-needed service in a particular surgical Justin Dimick (Ann Arbor, USA) 1:00pm Medical Student 1:15pm Writing a paper completion of their Scholarship; discipline. 1:20pm Multiple Faculty Deborah Wright (Auckland) Rebecca Sippel (Madison, USA) Justin Dimick (Ann Arbor, USA) 1:15pm Intern 1:45pm Presenting a talk – meet the English Language Requirement for – The Committee must be convinced that the Marc Gladman (Sydney) Carlton Barnett (Denver, USA) Michael Edye (Sydney) medical registration in Australia or New Zealand applicant is of high calibre in surgical ability, 1:30pm SET Trainee 2:00pm Producing a poster (equivalent to an IELTS score of 7.0 in every ethical integrity and qualities of leadership. Jeffrey Hamdorf (Perth) Gregory O’Grady (Sydney) Eric Kimchi (Hershey, USA) Timothy Pawlik (Baltimore, USA) 1:45pm Fellow 2:15pm Discussion category); – Selection will primarily be based on merit, with Win Meyer-Rochow (Hamilton) Julie Ann Sosa (Durham, USA) – hold a Master of Medicine in Surgery, or his/ applicants providing an essential service in remote 2:00pm Consultant her country’s post-graduate qualification areas, without opportunities for institutional Susan Neuhaus (Adelaide) 2:20pm Discussion in surgery. However, consideration will be support or educational facilities, being given given to applicants who have completed local earnest consideration. 2:40pm AFTERNooN TEA SESSIoN 4: A CAREER IN ACADEMIC SURGERy general post-graduate surgical training, where Value: Up to $36,000 pro-rata, plus one return Chairs: Andrew hill (Auckland) and Timothy Pawlik (Baltimore, USA) appropriate to the needs of their home country. economy airfare from home country 3:00pm Choosing and being a mentor ...... Mark Smithers (Brisbane) – be under 45 years of age at the closing date for 3:20pm Work-life balance ...... Julie Howle (Sydney) Tenure: 3 - 12 months applications. 3:40pm On the shoulders of giants - The legacy of the Otago University Department of Surgery ...... Andre van Rij (Dunedin)

Registrants receive a complimentary copy of Success in Academic Surgery (Part 1) edited by Herbert Chen and Lillian Kao.

Proudly sponsored by: Further Information Presented by: Application forms and instructions are available from the College website: www.surgeons.org Association for Academic Surgery in partnership with the Royal Australasian College of Surgeons, Closing date: 5pm Monday 6 May, 2013. RACS Section of Academic Surgery Section of Academic Surgery Applicants will be notified of the outcome of their application by 30 October 2013.

Cost: $265.00NZD (inc NZ GST). Please contact: Register on the ASC registration form or online at asc.surgeons.org Secretariat, Rowan Nicks Committee There are 15 complimentary spaces available for interested medical students. Royal Australasian College of Surgeons , 250 - 290 Spring Street, East Melbourne VIC 3002 Medical students should register their interest to attend by emailing [email protected] E: [email protected] P: + 61 3 9249 1211 F : + 61 3 9276 7431 Further Information: E: [email protected] T: +61 3 9249 1273 Program correct at time of printing (Feb 2013), however the Organising Committee reserve the right to change without notice.

Page 50 / Surgical News March 2013