Volume 21 | Issue 3 Surgical News

Volume 21 | Issue 3 | Issue 21 Volume surgeons.org

Pages 4–6 Spotlight on | Page 10 Welcome to our new President RACS ASC – one with many firsts and Vice President “A psychologically healthy workplace fosters employee health and wellbeing while enhancing organizational performance and productivity,” Sodexo 2017 Global Workplace Trends

Flexible workplaces are happy workplaces Speak in total confidence to a Converge International consultant. Australia 1300 our eap (1300 687 327) New Zealand 0800 666 367 International +613 8620 5300 or visit convergeinternational.com.au Surgical News | Volume 21 | Issue 3 3

RACS leadership Welcome to our new president 4 Welcome to our new VP 6

Spotlight on RACS ASC 2021

RACS ASC 2021 – one with many firsts 8 Reflections on an inclusive congress 11 A memorable RACS ASC for urologists 13 From the hubs 14 Talent on display in virtual art gallery 18 The creative surgeon 24

Articles of interest Rural General Surgery in Scotland 26 The state of robotic surgery 28 A rare breed of rural surgeon 30 Gendered titles 31 Strengthening the foundation of surgical education 33 Creating safety and respect 37 Fellow profile: Dr Alpesh Patel 39 Aotearoa New Zealand restructures its health services 40 Tour de Cure 42 Scholarships and Grants Program 58 Correspondence and letters to the editor for Surgical Research News should be sent to: [email protected] Editor: Abderazzaq Noor Inspiring students and junior doctors to T: +61 3 9249 1200 | F: +61 3 9249 1219 incorporate research 44 Contributing writers: Rochel Corkery, Fleur Morrison, Saleha Singh. Case note review 56 www.surgeons.org ISSN 1443-9603 (Print)/ISSN 1443-9565 (Online).

© Copyright 2021, Royal Australasian College “A psychologically healthy workplace fosters employee health Historical of Surgeons. All rights reserved. All copyright is The surgeons of Vanity Fair: Sir Morrell reserved. The editor reserves the right to change material submitted. The College privacy policy and and wellbeing while enhancing organizational performance and MacKenzie 50 disclaimer apply – www.surgeons.org. The College The value of surgical mentors 52 and the publisher are not responsible for errors or productivity,” consequences for reliance on information in this publication. Statements represent the views of the author and not necessarily the College. Information is Sodexo 2017 Global Workplace Trends Global health not intended to be advice or relied on in any particular The Pacific Island Program 41 circumstance. Advertisements and products advertised are not endorsed by the College. The advertiser takes all responsibility for representations and claims. Published for the Royal Australasian College of Surgeons by RL Media Pty Ltd. ACN 081 735 Flexible workplaces are happy workplaces Scholarship 891, ABN 44081 735 891 of 129 Bourverie St, Carlton Vic 3053 Speak in total confidence to a Converge International consultant. On a life-changing Canadian Fellowship 34 Cover image: Dr Sally Langley, RACS President Surgeon develops liquid biopsy 36 Australia 1300 our eap (1300 687 327) New Zealand 0800 666 367 Photo credit: Les O’Rourke International +613 8620 5300 or visit convergeinternational.com.au 4 RACS leadership

The College welcomes its 49th president – Dr Sally Langley

Surgical News spoke with the new Royal Australasian College of Surgeons (RACS) President, Dr Sally Langley, to find out more about her and her ambitions for the College. Dr Langley’s term as president commenced on 13 May 2021.

Dr Sally Langley is the College’s 49th Inspired by her father, who was a Christchurch and Auckland. After gaining president. She is the second female general practitioner in Christchurch, Fellowship, she did a six-month stint in president, after Mrs Anne Kolbe (2003- Dr Langley turned to medicine, an interest Vascular Surgery, six months as a hand 2005), in the organisation’s 94 years of furthered by her childhood love of reading and microsurgery Fellow at Louisville, existence. the anatomical section of a children’s Kentucky, and one year at the Radcliffe The Christchurch-born president didn't magazine called Knowledge. Infirmary in Oxford, United Kingdom. think she would be a surgeon. Her first After graduating from Otago University, “I really enjoyed the time spent overseas,” ambition was to be a violinist and she she embarked on her medical career as said Dr Langley. “It felt like a reward doing still plays unaccompanied Bach partitas a house officer for two years. This was something special. I worked in head and and sonatas – no mean feat, as the followed by an additional two years as a neck surgery, cleft lip and palate, and famous musician’s superlative works registrar in Christchurch at Burwood and hand and microsurgery.” for violin are considered the pinnacle of Christchurch hospitals. She then started Dr Sally Langley is a well-respected achievement for any violinist. a four-year training in Plastic Surgery, in Aotearoa New Zealand plastic surgeon. Surgical News | Volume 21 | Issue 3 5

She has worked in both public and private “When I started at the College, I knew on issues such as road safety, protection surgery in Christchurch and Greymouth I had a steep learning curve, but I have of the title of surgeon, gun control and on the West Coast of the South Island for been lucky to work with a lovely group obesity as well as improving engagement more than 30 years. of people – my fellow surgeons, and the with members and other stakeholders. Her work covers the whole spectrum of staff who kindly supported me along “We’ve also got to remain financially Plastic Surgery, including craniofacial, the way. That feeling of fellowship and viable and, importantly, maintain a cleft lip and palate, head and neck, coming together as a team has been a high level of education and the delivery paediatric, reconstructive including particularly enjoyable part of my journey. of courses and examinations for microsurgery, hand surgery, skin cancer We, as surgeons, can get relatively our Fellows, Trainees and Specialist and breast surgery as well as teaching isolated in our specialties and may not International Medical Graduates in these and supervision. see other people in other specialties or COVID-19 times and beyond.” other spheres of work, so connecting “Now, with more staff than I had in earlier with others is great for broadening our When it came to opportunities for the years, I concentrate on skin cancer, perspective.” College, Dr Langley said a continued focus hand surgery, and breast surgery. My on improving surgeons’ wellbeing was department has 10 plastic surgeons, four When asked what she would like to focus paramount. to five surgical education and training on during her presidency, Dr Langley said she had a range of issues to address. “As we extend surgical services, we need (SET) Trainees in Plastic Surgery, several to train enough surgeons so that we can pre-SET registrars, post-graduate year She stressed the importance of being proactive and looking to the future for manage issues such as stress, burnout one and two junior doctors, and we and flexible working hours better.” have fourth year and sixth year medical what was most beneficial to patients and students who spend time with us at the surgical profession. Family is important to Dr Langley who clinics, operating lists and tutorials. I am “The travel restrictions and the rapid spends as much time as possible with her also an intern supervisor for the Medical adoption of virtual technology enabled husband, Don, their four children and nine Council of New Zealand.” one of my goals of achieving less grandchildren. The unassuming surgeon didn’t seek the domestic and international travel. We In her downtime, Dr Langley enjoys position of president. “Having been a were able to hold many meetings and exercising in the gym, biking, and listening Councillor at the College for several years even the RACS Annual Scientific Congress to podcasts, audiobooks (she has I knew the possibility of being elected to as hybrid events, combining face-to- more than 220 titles in her library) and a higher position was there, but I didn’t face and virtual modes. This is also great webinars during her five to 10km runs. think I’d get to be president. I am also for the environment as we expend less pleased, as a woman, to be leading this resources. illustrious College. I hope that it will “I am also passionate about inspire other women to claim their place environmental sustainability. The surgical as leaders in surgery and medicine,” said workforce needs to do much more to Dr Langley. minimise harm to the environment. I am Dr Langley’s favourite podcasts and With more than 20 years in leadership particularly interested in supporting the audiobooks roles, Dr Langley brings extensive work of our Sustainability in Health Care • The Power of Introverts, an audiobook experience to the role of president. She Working Group (SIHCWG), led by Chair by Susan Cain Professor Mark Frydenberg, and the is a former president of the New Zealand • Deep Medicine, an audiobook by Eric Environmental Sustainability in Surgical Association of Plastic Surgeons and Topol has been involved in surgical education Practice Working Group (ESSPWG), led by • This is Going to Hurt, an audiobook by and training throughout her career. Professor David Fletcher.” Adam Kay She was elected to RACS Council seven Equity is also an issue that Dr Langley years ago and served as the Chair of the rates as a key priority. • Women and Leadership, an audiobook College’s Professional Development and by Julia Gillard and Ngozi Okonjo- “We must continue to address equity in Standards Board since 2019. Dr Langley Iweala all its spheres. There are many aspects was previously the Chair of Professional we need to work on such as gender, • Elemental, Radio New Zealand Development. ethnicity and accessibility to surgical podcast on the periodic table Dr Langley was also an examiner in Plastic care. I am pleased that we have a strong and Reconstructive Surgery for nine years focus on building respect in the surgical and spent two years as the New Zealand workforce and the great ongoing work Deputy Chair of the Court of Examiners, on our rural health equity strategy will the entity that conducts the RACS increase access to care, but there is so Fellowship exam. much more we need to do to ensure that Dr Langley generously pays tribute to the surgical workplaces are equitable and many people who helped her during her surgical services are available to all.” Image, over page: Outgoing president Dr Tony Sparnon passes on the time at the College. Dr Langley also highlighted the president's medal to incoming president Dr Sally importance of continuing advocacy work Langley. 6 RACS leadership Meet our new vice president: Dr Lawrence Malisano

Dr Lawrence (Lawrie) Malisano, a former records and was a state championship president of the Australian Orthopaedic finalist in several other events. His best Association (AOA) and Royal Australasian event was the 100 metres backstroke, College of Surgeons (RACS) Councillor, is followed by the 200 metres backstroke. the College’s new vice president. He qualified to represent Australia in Dr Malisano is a Senior Orthopaedic the 1972 Olympic Games in Munich but Consultant at the Royal Brisbane and was unable to go due to lack of funding. Women’s Hospital, Medical Director of His father was invited by the Italian the Brisbane Orthopaedic and Sports government to relocate the family to Italy Medicine Centre and operates out of the – they offered a house and employment Brisbane Private Hospital. on condition that young Lawrie represented Italy in the games. He didn't The son of Italian migrants, Dr Malisano take up the offer. always thought he would become a carpenter until his parents came back Italy’s loss remains Australia’s gain, with from a parent-teacher interview when he Dr Malisano’s three children also achieving was in year 11 and asked him to consider success in their careers and education. Dr Lawrence Malisano His eldest son holds a PhD in materials going to university. build on the important work that has engineering from Oxford University, his occurred in recent years. “I started to read about careers and second son is about to finish his dentistry I found myself gravitating towards program in university, and the youngest, “As a College we managed our response to anatomy, but I also liked engineering. a daughter, is about to complete her the COVID-19 pandemic remarkably well I was accepted into both medicine and master’s in molecular biology. and our COVID response included a rapid engineering and I remember sitting transition to digital platforms, which Dr Malisano joined the College Council in at the front steps of the J D Storey coincided nicely with the One College 2012 and served until 2018, during which Administrative Building at the University Transformation program. This is an area time he became Chair of the College’s of Queensland wondering which option that we need to continue growing as it Professional Standards Committee. to take. I had 10 minutes to make up my will be critical in strengthening our links He rejoined the Council in 2019 as a mind and medicine it was. with each other.” Fellowship Elected Councillor. “I enjoyed medical school and chose Dr Malisano also has a keen interest When asked about his new role, intensive care and general medicine in governance. He is a Fellow of the Dr Malisano said that the College is an terms in my intern year before I applied Australian Institute of Company Directors. to RACS for my primary examination and institution he had always been interested “I remember my first day at RACS Council. subsequently for the surgical training in serving. I went to all the meetings and was very program. I was very well supported by “As a previous president of the AOA impressed with the processes of the surgeons who encouraged me to apply and its vice president for two years, I committees and how they were run,” he for the orthopaedic surgical training have a large knowledge base to draw recalled. “I left the meeting thinking program.” upon. I understand what the role of vice I needed to learn more about governance, president entails—predominantly to After receiving his FRACS in 1988, and I went on the company directors assist the president in achieving the RACS’ Dr Malisano gained post-Fellowship course. It stimulated a lot of interest in strategic plan and working closely with training through an appointment in how companies and boards work and College personnel.” Hip and Knee Arthroplasty at the Royal developing strategies. It also brought National Orthopaedic Hospital, London; a When asked about his ambitions for the out the understanding that boards set Trauma Fellowship at the Ruhr-University College, Dr Malisano said he would like the strategic direction and management of Bochum hospital, Germany; and a to continue the ongoing work to cement implements it. More importantly, it really Reconstruction and Trauma Fellowship at relationships between the College and helped highlight that micromanagement the Sunnybrook Health Sciences Centre in its specialty societies and improve digital isn’t something a board should do. Toronto, Canada. outcomes. “I really enjoy corporate governance Dr Malisano’s career could have taken “I strongly believe in the ongoing need and I think it is an area I will continue to another very different path. When he for the College and surgical societies work in as part of my own professional was 13 and 14 years old, he held the to continually strive to improve development.” Queensland and Australian Age Swimming communication and cooperation, and Surgical News | Volume 21 | Issue 3 7

Spotlight on The RACS ASC 2021

The RACS ASC 2021 in pictures 9 Reflections on an inclusive congress 11 A memorable RACS ASC for urologists 13 Celebrating the art of From the RACS ASC Hubs 14 Talent on display in virtual gallery 18 surgery in a time of The creative surgeon 24 disruption

After postponing the Royal Australasian College of Surgeons (RACS) Annual Scientific Congress (ASC) in 2020, this year’s RACS ASC took place in Melbourne and in hubs around the world, with a record 3706 delegates attending the meeting – the highest ever turnout in its history.

“To survive the changes 2020 presented us with, we have had to find creative ways to adapt our practices, support our patients, and provide care to our communities,” said Professor Wendy Brown, RACS ASC 2021 Convener.

“We constantly needed to be agile and adapt – as the landscape changed, sometimes daily,” said Associate Professor Sebastian King, RACS ASC 2021 Scientific Convener.

“Our surgeons had to rely on the art of what they do, not just the science of what they do. This creative element drives surgeons to continually improve and innovate, and this is what we wanted to showcase at RACS ASC 2021,” he continued.

“In a practical way,” added Professor Brown, “surgeons pursue various artistic interests that translate to their work with patients. We have used a virtual art gallery to present the talents our surgeons have not only with a scalpel but also in music, painting, sculpting and other creative pursuits.” 8 RACS ASC feature The RACS ASC 2021 – one with many firsts

The Royal Australasian College of Surgeons congress aimed to illustrate how we’ve onsite around Australia, Aotearoa (RACS) Annual Scientific Congress (ASC), been creative and agile in our response to New Zealand, the United Kingdom and which took place between 10–14 May this disruptive force in surgical practice. around the Pacific 2021 ended on a high note. A record 3706 We were pleased to collaborate with the • 285 sessions delegates attending the meeting – the Royal College of Surgeons of Edinburgh • 986 posters and 1212 verbal highest turnout in its history. (RCSEd) on the RACS ASC 2021 and enjoyed presentations Day one at the RACS ASC 2021 ended the President’s Lecture delivered by the • 1258 presenters with an evening of celebration as 158 RCSEd President, Professor Michael Griffin • 106 overseas presenters new Fellows received their Fellowship OBE. We also welcomed other high-profile certificates during the convocation guests including Australian Treasurer, the • 153 new Fellows with 83 onsite across ceremony, which was held in multiple Honourable Josh Frydenberg, Secretary Australia and Aotearoa New Zealand locations around Australia and of the Commonwealth Department of and 70 attending virtually Aotearoa New Zealand. Health, Professor Brendan Murphy, who • 3440 people watched the Plenary In a first for the Congress, we created hubs delivered the Syme Oration, and former session on 13 May. Australian Deputy Chief Medical Officer, across Australia, Aotearoa New Zealand Thank you to all the delegates, speakers, Dr Nick Coatsworth. and beyond, enabling those who could sponsors and the many people behind not attend in person to congregate in a It was a week full of great presentations, the scenes who helped make the RACS COVID-19 safe way to virtually enjoy the fantastic speakers and engaged delegates ASC 2021 such a success. The generosity program in a collegiate setting. from around the world. Here are some of spirit exhibited by everyone made the COVID-19 derailed the 2020 Congress facts and figures we gathered on the Congress possible and the unparalleled but served to inspire the theme for 2021, Congress: enthusiasm for the meeting far ‘Celebrating the art of surgery - in a time of • 3706 registrants – the largest outweighed any technical hiccups. disruption’. Encouraging reflection on the number ever at a RACS ASC, with We look forward to #RACS22.  changes to our lives over the last year, the 2860 attending virtually and 846

Seen at the RACS ASC (clockwise from top left): The RACS booth; Dr Tony Sparnon with a convocee at the Melbourne convocation ceremony; Dr Amiria Lynch and Dr Amy Touzell at the Women in Surgery breakfast; attendees relax at the RACS booth. Surgical News | Volume 21 | Issue 3 9

Seen at the RACS ASC (clockwise from top left): Participants at a DCAS session; convocees in Melbourne; Dr Julie Mundy with Colonel Brett Courtenay, presenter of the Sir Edward ‘Weary’ Dunlop Memorial Lecture; Dr Kate Fitzgerald, one of the newly graduated Fellows, with her family; Dr Brendan Murphy speaks at convocation; Mr Suraj Rathnayake and Dr Mahanama Dissanayake; Fijian Health Minister Dr Ifereimi Waqainabete gives the Rowan Nicks lecture. 10 RACS ASC feature

Seen at the RACS ASC (clockwise from top): Attendees at the Women in Surgery Breakfast; Professor Elizabeth Molloy presenting as part of the Surgical Education program; Professor Mohamed Khadra with Dr Tony Sparnon at the opening plenary; the Indigenous Health breakfast; RACS ASC Convener Professor Wendy Brown with Dr Tony Sparnon and Dr Nick Coatsworth; Dr Amanda Foster, Dr Sally Butchers and Dr Christine Lai . Surgical News | Volume 21 | Issue 3 11 Reflections on an inclusive congress

In March of last year, we made the Surgeons Edinburgh (RCSEd). It was a Federal Treasurer Josh Frydenberg and difficult decision to cancel the 2020 Royal wonderful addition to our international the RCSEd College President Professor Australasian College of Surgeons (RACS) engagement, which also extended to the Michael Griffin. Professor Brendan Murphy Annual Scientific Meeting (ASC). However, Asia-Pacific region. eloquently delivered the Syme oration amid COVID-19 restrictions, through the Trying to second guess what the at the convocation ceremony. We were tremendous goodwill and hard work of a environment would be like 12 months honoured that he flew back from Canberra multitude of people, in 2021, we've had a after the declared pandemic was specifically to address our Fellowship in very successful congress that has broken challenging. We understood that our recognition of this special occasion. new ground in many ways. Thankfully, members would be yearning for the Associate Professor Ramesh Nataraja we had the unwavering support of socialisation that occurs at a face-to-face organised an outstanding Global Health Dr Tony Sparnon, our outgoing president, meeting. And yet, the digital platform program that was inclusive and diverse. the College Council and RACS staff, led by provided opportunities for the dispersal of This was well demonstrated in the many our equally committed CEO, John Biviano. information that wouldn't otherwise have combined sessions with the Directors Lindy Moffat and her Conference and been possible, and members did manage section, surgical education, Paediatric Events team, with leadership coming to congregate and socialise in smaller Surgery, senior surgeons, Plastics and from Ally Chen, Binh Nguyen and gatherings across the world. Reconstructive, younger Fellows, General Dr Liz McLeod, constantly amaze me with Professor Wendy Brown and Associate Surgery, quality and safety in surgical the incredible events they always deliver, practice and rural surgery. and 2021 was on a scale like no other. Professor Sebastian King (Convener Abderazzaq Noor and Tracey Volkmer and Scientific Convener) and their 2021 The most confronting, gut wrenching, rallied the communications team, who Melbourne Section Conveners were yet heartwarming moment was when were enthusiastic, consistent supporters remarkable. The various Section Conveners Professor Zaw Wai Soe, a Myanmar and tireless in disseminating information were exemplary in being able to reformat orthopaedic surgeon, addressed the Global to members and other stakeholders using their programs to accommodate the new Health audience from a secret location. He novel and innovative methods. normal. We also need to acknowledge spoke of the devastating situation during and thank our Perth colleagues who the military coup and the execution of From the outset, RACS Council made a had already started planning ASC 2021 young trainees and colleagues close to firm decision, and determined it was but stood aside to allow the Melbourne him, deemed dissidents by the military important to deliver our major continuing program to be delivered. junta. Their unimaginable plight was made professional development RACS event of real for our audience in that session. the year and convocate our Fellows. We Although we couldn’t host our overseas must acknowledge the staunch support of faculty, we were able to have more Meanwhile, our Pacific neighbours the Aotearoa New Zealand and Australian international speakers than ever before. As had access to our digital platform in state and territory offices. The managers usual, there was a feast of material and so their digital hubs and could be equally and regional chairs, as well as society much that I just couldn’t get to, although immersed in the interaction and involved presidents, attended fortnightly working the digital platform remains open for later throughout the program. party meetings in the lead up for more than viewing. But there’s nothing like real time, For the time, the hub concept has been the a year to develop the hubs concept. and some of the highlights for me were perfect solution and there will be learnings the plenaries – the inspiring address by from this year that will no doubt carry Special recognition needs to go to Mohamed Khadra, poet and playwright, Urological Society of Australia and New through to future meetings. It's hoped and the amazing artistry of Chris Edwards, that we will be able to have even greater Zealand (USANZ) who joined the RACS ASC one of our surgeons turned sculptor. When for the first time. Professor Henry Woo engagement of a broader and larger the inevitable digital hiccup occurred, the number of members in years to come. did a remarkable job to pull together a show went on, and our President came to program after the congress planning had the stage and, right off the cuff, regaled the already commenced. Thanks for being Professor Owen Ung audience with his stories of cultivating his Outgoing Chair there USANZ! award-winning liliums. Another highlight ASC Conference and Events We also acknowledge the great was ‘The Art of Communication in a Crisis’ Incoming Chair collaboration from the Royal College of session with Dr Nick Coatsworth, the Global Health URGENT: Will you multiply your gift today?

Every dollar that you give before 30 June will now be multiplied by five! You might remember Dr Trevor’s request, “Too many kids simply do not make it. We need: More training. More surgeons. And more systems.” Please donate today and invest in building the surgical capacity of our Pacific and Timorese colleagues, like Dr Trevor. There is limited time left, and I need your help. Please make a tax-deductible donation today. www.surgeons.org/donations Surgical News | Volume 21 | Issue 3 13 A memorable RACS ASC for urologists

The 2021 RACS ASC will likely be one of Professor Jelle Barentsz (the Netherlands), An onsite session entitled ‘Bread and the most memorable for Fellows for many Professor Kurt McCammon (United Butter Urology’ was dominated by general reasons. The very fact that the RACS ASC States), Professor Caroline Moore (United and paediatric surgeons and, in hindsight, even took place is thanks to the efforts Kingdom), Professor Margaret Pearle the session could more aptly have been of a large team of individuals who made (United States) and Professor Stacey called ‘Bread and Butter Surgery’, given extraordinary contributions. As a RACS Loeb (United States). Professor Freddie that multiple surgical specialties have a Councillor, I was excited that this was Hamdy (United Kingdom) also joined us role to play. the first time we would have program and delivered the 2021 British Journal of A joint Urology and General Surgery session participation by all the nine RACS surgical Urology International lecture. was devoted to the common problem of specialties. This was a significant moment An overwhelming number of 157 inguinal hernia management in the context in RACS’ history. abstracts, the second highest number for of a diagnosis made prior to, during or Our Urology program was held in lieu of our a specialty in the 2021 RACS ASC, were following a radical prostatectomy. standalone Urological Society of Australia submitted to Urology for consideration Following this success, we hope to and New Zealand (USANZ) Annual Scientific and 129 submissions were accepted as continue discussion with USANZ to ensure Meeting, which had been cancelled for either verbal or poster presentations. Such a urology program becomes a long-term 2021. A packed four-day program ran from a positive response from the Fellowship, feature of the RACS ASC. the opening day of the meeting and we and invited faculty and delegates was a were amongst the last out of the exhibition true testament to the partnership RACS centre on the final day. shares with the USANZ. Professor Henry Woo An outstanding feature of the Urology One highlight was a spirited debate with Chair, Research and program was the diversity of presenters our general surgical colleagues over who Academic Surgery and session chairs. In particular, a high should care for acute torsion of the testis. number of the female urologists invited Although there may be conjecture over were speaking or chairing sessions for the which team won the debate, the winners first time in their careers. It goes without are the patients who can be reassured that saying that they were all outstanding (see whether cared for by a urologist or general table below). surgeon, they can count on receiving first class surgical care. On the opening day of the RACS ASC, USANZ established well attended hubs across Australia and New Zealand. These provided a much-missed opportunity for collegiate interaction. This model of USANZ sponsored hubs also provided an opportunity for urologists to interact with relevant industry partners. The concept of multiple local hubs has proven to be a formula worthy of continued development. Our scientific program differed from our usual Annual Scientific Meeting (ASM) format. It provided more general Urology content as well as some content that would be of interest to those outside our specialty. We delivered 20 sessions from national experts in Australia and New Zealand as well as five international visitors, including 14 RACS ASC feature

From the Aotearoa New Zealand hub

The Museum of New Zealand Te Papa the history at Te Papa to enjoy. It was a and inclusive marae (meeting place), at Tongarewa was a superb and most fitting fantastic hybrid conference experience.” Te Papa. Philippa Mercer said having a venue for the inaugural ASC Aotearoa New Choosing the program for the hub was local ceremony made it easier for the Zealand hub. The 33-year-old national challenging, says Philippa Mercer, Chair families of the 11 new Fellows to attend. museum is known to Kiwis as ‘Our Place’ of RACS’ Aotearoa New Zealand National “We chose to hold our convocation and and it certainly became our place for more Committee. “We tried to cater to all tastes. awards ceremony before linking up to than 150 RACS Fellows, Trainees and Plenary and cross discipline sessions were Melbourne, which made the event more Specialist International Medical Graduates well attended and people seemed very family friendly. Also, the audience seemed (SIMGs) who took part in the RACS ASC. comfortable watching some specialty to really appreciate seeing all the New While many delegates watched the sessions on their own devices and Te Papa Zealanders being presented with their proceedings on big screens in one of had many wonderful spaces where people awards.” four venues at Te Papa, others relaxed, could do that. As is always the case with One of those convocating, Mr Victor Kong, with earphones donned and devices in the RACS ASC, many of the lectures and a general surgeon based in Waikato, said hand at café tables or sofas overlooking sessions were extremely inspiring and he thoroughly enjoyed the ceremony. Wellington’s waterfront, to watch other thought provoking. Equally importantly, “Te Marae had a distinct and uniquely sessions of their choosing. the hub enabled people to catch up and Aotearoa New Zealand ambience. This, Sharon Jay, RACS Trainee Association enjoy each other’s company face-to-face, along with a great atmosphere and a very Aotearoa New Zealand’s Representative, which they clearly greatly appreciated.” well organised event, made the special said, “There was so much to learn from all A real highlight of the week for those occasion even more memorable.” the various presentations and it was so fortunate enough to be able to attend easy to go between section talks online, was the local convocation ceremony at Image above: but also from the Aotearoa exhibits and Te Marae, a contemporary, authentic The convocation ceremony Surgical News | Volume 21 | Issue 3 15

From the Edinburgh hub

OBE, led the event and presented the President’s Lecture on communication with cancer patients and their families. Attendees viewed the event as a great success with stimulating discussions and thought-provoking learnings highlighted. RCSEd hopes that by 2022 the College can attend in person and join our Australian In May, the Royal College of Surgeons of 2021. We welcomed live speakers and New Zealand colleagues for the 90th of Edinburgh (RCSEd) was delighted to Professor Jason Leitch, National Clinical RACS ASC. collaborate with RACS for their 89th Director for Healthcare in Scotland, who Annual Scientific Congress. Initially RCSEd covered the impact of COVID-19, safety representatives were planning to attend in surgical practice, and David Sedgwick, Above left: in person. However, COVID-19 required a Consultant Surgeon in Fort William, who Presenters at the Edinburgh hub change in plans and so an Edinburgh hub discussed the provision of surgery in Above right: event was created, allowing the RCSEd remote and rural environments. RCSEd Professor Michael Griffin OBE presents the President's College to host its first in-person event President, Professor Michael Griffin Lecture.

From the Pacific hubs

This year the absence of our friends across the region, especially the countries working closely with RACS Global Health, was deeply felt. In response to the continued closure of the Australian international border, RACS Global Health was proud to create a set of Offshore Hubs, providing an opportunity for surgeons and other overseas health practitioners to join and participate in the RACS ASC online. Participants in this year’s Offshore Hub initiative included Angau Memorial Hospital in Lae, Papua New Guinea, and Guido Valadares National Hospital in Dili, Timor-Leste. Dr Steven James, Head of Orthopaedic Services at ANGAU Hospital in PNG said, “There were a lot of very good presentations, and I would be humbled to have another [chance at] virtual access if and when the opportunity arises.”  Dr Mauricio da Silva Fraga and Dr Jose de Araujo join the RACS ASC remotely from Guido Valadares National Hospital in Dili, Timor-Leste. 16 RACS ASC feature

From the Australian From the Tasmanian hub

Capital Territory hub Meanwhile, Fellows from all over the north of Tasmania descended on the RACS in the Australian Capital Territory Launceston General Hospital Surgical (ACT) hosted a local convocation on Department for sessions. There were Monday 10 May with six new Fellows three rooms live-streaming sessions and convocating. A beautiful, intimate great break out rooms. ceremony was held in the Enid Lyons Alcove in Parliament House. All Fellows attending agreed the hybrid format was very appealing, as the The ACT hub live-streamed sessions operating theatre was only a short walk across the rest of the week, with from the hub so they could come to attendance from ACT Fellows in the office. sessions between cases. The ACT hub held two sub-specialty hubs, one for breast surgery and one for The week closed with a dinner (pictured Paediatric Surgery, as well as sponsored left) in honour of Di Cornish, Tasmania’s sessions by Sanofi. outgoing RACS office manager, and her 39 years of service to the College.

From the South The South Australian convocation ceremony office had the capacity to host up to 10 Australian hub different sessions at any one time. The success of the event was a testament to The South Australian office was well the College’s excellent new facilities at supported, which helped to create an 24 King William Street, Kent Town. Attendees watch a session at the ACT hub excellent atmosphere in the building. The

From the Queensland hub

Queensland hosted a fabulous black-tie charity dinner on Friday 14 May, featuring entertainment from Opera Queensland. Proceeds from the night went to the Foundation for Surgery to fund the important work they undertake.

The Queensland convocation ceremony Surgical News | Volume 21 | Issue 3 17

From the New South Wales hub

Held at the world-renowned Sydney It was the first time the ceremony was The remainder of the week consisted of International Convention Centre on decentralised, and 17 convocees for NSW specialty hubs held at the RACS NSW state Monday 10 May, RACS past President attended the evening. office. This gave members of the College Associate Professor Phil Truskett presided Despite the challenges faced due to the the opportunity to meet in person and over the New South Wales (NSW) pandemic, the personalised setting of a network during the RACS ASC. convocation with RACS NSW past chair hybrid event was widely praised by new Dr Ken Loi and RACS NSW Chair Associate Fellows, their families and friends. The New South Wales convocation ceremony Professor Payal Mukherjee in attendance.

From the Western Australian hub

The recent 2021 RACS ASC convocations celebration of this special achievement. of the ASC, WA state office meeting rooms saw 12 new Fellows convocate at the A three-course dinner at the venue was were open to Fellows to view a range of State Reception Centre in Kings Park, enjoyed by the Fellows and their families, sessions. Western Australia (WA). The formal surrounded by glorious views of Perth convocation ceremony was followed by a city. As part of the WA hub arrangements The Western Australian convocees 18 RACS ASC feature Talent on display in virtual art gallery

As part of the RACS ASC 2021 we displayed a virtual gallery with artwork by our talented members.

Mr David Freedman General Surgery, Victoria

I worked as a rural general surgeon based in Swan Hill from 1978 until 2010 after gaining my Fellowship in 1974. General Surgery is at times a stressful occupation, especially when dealing with emergencies in a rural setting. I found painting very relaxing – it allowed an escape into another world. For most of my professional life I have painted en plein air (outdoors) as a hobby. Retirement allowed more freedom and energy to pursue this, and two years ago I published a book entitled Plein Air Painting: General Principles and Tips for Beginners. Last year, Richard Steele, Gavin Fry and I decided to collaborate to celebrate the beauty and diversity of Australia’s birdlife, culminating in a book entitled Australia’s Birds, for which I painted all 240 illustrations. Painting requires a sharp eye and a deft hand, as does surgery. The best results require an adherence to and understanding of basic principles, and a stepwise approach for both disciplines. As you develop a deeper understanding with experience, you are able to refine your skills. There is much in common but perhaps the biggest difference is the sense of freedom involved. In painting, failures do not matter. A painting can be wiped off, a piece of paper torn up and you are responsible to no one but yourself. This is a liberating feeling after a long surgical career. Surgical News | Volume 21 | Issue 3 19

arts, and indeed my two sisters are names. For example, the ‘Aberdeen knot’ now famed for their creative output, is the same chain stitch that children which often has strong Asian themes learn when they start or finish their first (Renee Liang MNZM, poet, playwright, piece of knitting or crochet. Its renaming and paediatrician, and Roseanne Liang, as a surgical technique perhaps reflects director and screenwriter). I was more of the lack of diversity in the room to tell the a bowerbird, collecting traditional textiles ‘inventors’ that at the time! and embroidery to document skills Doing needlework (and my other creative that have since vanished. These pieces love, crochet) is my safe space, where inspire me to create works that bridge my breath slows and heart rate settles, my Chinese heritage with the Western where I can be mindful and think through culture that I live in, using modern issues methodically while my hands materials such as colourfast cotton and maintain a rhythm. There is actually a Western techniques such as cross stitch, body of neurophysiological research but portraying Asian idioms such as the linking repetitive movements and peony flower. improved executive brain functions – My needlework long predates my surgical one of the reasons we fidget, pen-tap, or training, so the needlework has always doodle when trying to concentrate. informed the surgery much more than I suppose my needlework and woolcraft Dr Rhea Liang the other way around. As a Trainee, simply fulfil that same function while General Surgery, Queensland there were times I would politely ‘learn’ also creating something beautiful in the a surgical technique while immediately process. My Chinese heritage was very important recognising it as something already in to me growing up in New Zealand in existence in, say, lacemaking or garment- pre-internet days. From a young age, my making. I like to respect that heritage sisters and I had an interest in creative by giving techniques back their original

Mr Patrick Meffan With surgery, you start with perfection, Urology, Aotearoa New Zealand when you consider the human anatomy, and then your job is to rectify a problem. This work was inspired by Pine Taiapa By the time you’ve finished it’s bloody and (Ngati Porou), master carver and protégé stitched back together and nowhere near of Sir Āpirana Ngata. the perfection it would have originally Sir Āpirana Ngata, the influential Māori achieved in nature. Whereas with statesman, was the first Māori to woodwork, you start with a rough piece of complete a degree at a New Zealand timber and from that comes an amazing University and my grandmother was a piece of art or furniture, so in that respect teacher under him in the Ruatoria Native it’s the opposite process. School in the 1930s. She became a great I personally get a huge amount from my friend of his. When she left the school, he creative pursuit and when I step into the gave her a table with four heads on it, one workshop I can almost feel my blood to represent each of them and two others pressure drop. There is no perfect carving unknown. This table has been passed and every project teaches me how I can down in my family through my father to improve the next time. This mindset of me and it is now the model for my carving. continually trying to improve, for me, is In this time of inequity, it is a personal and one of the most satisfying parts of surgery  precious link within our very Caucasian as well. family to a very important person in history. As a child, my father was taught to carve by Pine Taiapa and this love of carving was passed on to me. With wood there is the element of grain, which gives carving a certain complexity. Wood is an amazing natural product with a huge array of characteristics to achieve different finished appearances and functions. 20 RACS ASC feature

Dr Sam Gue General Surgery, South Australia

I have been practicing as a specialist surgeon in Adelaide for more than 40 years, mainly as a general surgeon with special interest in colorectal work. I am also involved in Surgical Education and Training (SET) selection, teaching and Dr Gillian Dunlop Mr Chris Edwards examining. I am a Fellow of the English, Otolaryngology Head and Neck Surgery, Plastic & Reconstructive Surgery, Australian, American and International New South Wales Tasmania Colleges of Surgeons. I have exhibited my artwork in Adelaide, At a very basic level there are similarities After a career in Plastic and interstate and overseas. My last between surgery and art. Both involve Reconstructive Surgery I have an interest solo exhibition was held at the RACS thought, training and hand-eye in human anatomy, proportion and the building in Adelaide and was opened by coordination. Beyond this, surgery and art concept of beauty. His Excellency the Governor of South differ significantly. A sound knowledge of anatomy is of Australia. Some of the proceeds were paramount importance to the surgeon donated to the Foundation for Surgery Masterpieces of art evoke a spirit or mood and figurative sculptor alike. I believe and a large painting was donated to the using the language of emotion. As with the enhanced powers of observation South Australian RACS office. other languages, there is a form of syntax and grammar. Consider edges within and appreciation of form gained from I operated on Jack Absalom, a famous an artwork. Too much variety creates a sculpting in clay greatly aided my plastic Australian artist, many years ago and we fractured image but overall uniformity surgery. Conversely, the knowledge of became close friends. He introduced me of edges does not excite or engage the anatomy and human proportion learned to oil painting. Looking around Australia viewer. A balance of soft and hard edges from plastic surgery training has helped and at his work, I was fascinated with the must be reached. The same applies to me with my sculpture. colours of the earth, the blue bushes and other parameters such as shape, colour My chosen medium of bronze appeals to gums, and wanted to recreate these in and paint texture. me for its strength and durability. Having my paintings. I love using oil on stretched undergone the necessary transformation canvas with palette knife, creating layers The focal point of a painted artwork has to embody the subject, it maintains its to achieve a 3D effect. I have my studio increased contrast, colour intensity and own distinctive character. upstairs at home and while I paint, I forget sharpened edges so as to garner attention all my surgical worries. It is the best and draw the viewer in. The periphery, I believe we all have an innate need and way to relax from the busy life and the as with peripheral vision, is more ability to find joy in creation. It is hard to challenging, 24-hour, arduous demands understated. define, but it is generally agreed that art of surgery. These concepts simply do not apply to enhances a feeling of wellbeing both in the performer and the viewer (or listener). I feel surgery is an art and so is painting, surgery. I would argue the parallels are Art can be a great means of escape and which can help with your hand-eye superficial and few. relaxation. It allows for creative risk coordination. Creating and caring go taking and the embracing of mistakes. hand-in-hand and bring not only joy but (Something less desirable in surgery!) fulfilment and happiness. In retirement from surgery, I believe my sculpture has helped me maintain a sense of self-worth and relevance, and acted as a buffer to the not uncommon ‘relevance deprivation syndrome’. Surgical News | Volume 21 | Issue 3 21

Mr Richard Lander Orthopaedic Surgery, Aotearoa New Zealand

Dr David Kaufman I have been interested in photography Opthalmology, Victoria since my secondary school years. My artistic interest was influenced by my I started woodwork 20 years ago after parents who were both talented in encouragement from my mentor, Dick drawing and craft work. My younger Galbraith. He explained that woodwork brother is a professional artist who was similar to what I was used to as a has interests in watercolours, oils and microsurgeon dealing with tissue planes ceramics, and now papermaking and film. Mr Ian Jones and specialised tools, only on a larger Orthopaedic Surgery, Victoria I started with a film camera and have scale. Woodwork, like surgery, requires more recently migrated to digital. I had forward planning with strategies to deal I fell into sketching on a camping and a brief period of dabbling in a home with unexpected complications. Good walking holiday in Turkey about 10 years darkroom, experimenting with chemicals visualisation and attention to detail, as ago. The wives of two accompanying and developing, but that was curtailed well as using the correct tool, applies to surgeons were keen and very proficient by university studies. Now the darkroom both fields. sketchers and, after I expressed some has been displaced by computer software Surgery can be stressful, and I found interest, the next morning I found a programs such as Adobe Lightroom and that a hobby with expert tuition writing pad and HB pencil on the ground Photoshop, allowing creative images to provides relaxation and interaction in outside my tent. be developed digitally on the computer. a non-medical field, working with new I had not had any previous experience The challenge is to create the best of an colleagues, and at the same time having a in painting or drawing but found image ‘in camera’ and then tweak the lot of fun. sketching fun. I accompanied my wife on result in post-production. After the class, I find myself happy and a gardening trip to China the following There is art and science in both surgery enthusiastic. It doesn’t get any better year, and early one morning sat in a park and in photography. In photography, than that! where peonies were in bloom. By the pressing the shutter is the culmination time I’d finished my sketch there was a of the compositional and artistic act, crowd of about 20 people behind me each with the final image appreciated by both offering comments, which seemed to be the photographer and the viewer. In complimentary. surgery, the operation is the culmination On return home, my wife booked me in to of meticulous planning, careful and a masterclass of botanical art with Jenny thoughtful skill, and the execution of Phillips, whom she had known from her processes, to give a satisfying result for school days. I must say I felt a real goose both the surgeon and the recipient. on the first day, walking into a room of Every patient has a story to tell and 15 experts in botanical art with white so does every good photograph. Good gloves on, numerous pencils and multiple photographs satisfy, stimulate and brushes. provoke. They are multilayered and fit a I’ve subsequently enjoyed two formal cultural context, as are patients who wait  week-long courses since then, and one to tell their story. of my roses was included in a fundraising diary put out annually in the past by the botanical gardens. 22 RACS ASC feature

Mr Randall Sach AM Plastic & Reconstructive Surgery, South Australia

I was introduced to working hot glass in 1993. What then began as a hobby interest, has since become a consuming passion. Glass complements and shares many similarities with my previous regular work as a plastic surgeon (with hand surgery as a major interest). Common themes include teamwork, planning and preparation, a technical and scientific basis, manual dexterity, attention to detail, lateral thinking and a creative flair. My plastic surgery background has helped inform a deep interest in aesthetic human forms, of which replication in glass with sculpture techniques is both seductive Dr Jurstine Daruwalla General Surgery, Tasmania and challenging. The technical and Dr Nicola Fleming creative processes continue to inspire Surgical resident, Victoria I completed a combined MBBS and PhD at the ongoing development of my artistic The University of Melbourne. My surgical sculptures, both anatomic and more After growing up in country New South training was through the Alfred and abstracted. Wales, I came to Melbourne to study Austin Hospital, obtaining FRACS in and never left. I am now a PGY3 surgical Many of the skills needed for excellence in General Surgery in 2019. I am currently resident hoping to pursue a career in surgery are equally applicable to working working towards a specialisation in Plastic & Reconstructive Surgery, with a in hot glass, and sculpture in particular. In Hepatobiliary surgery. addition to the common skills mentioned keen interest in surgical education and This image, titled At the Heart of It All, is above, both these practices share careful multidisciplinary research. of a resin cast of the microvasculature of planning in reverse, a strong sense of Learning about the intricacies of the colorectal cancer liver metastases, which 3D proportion and technical precision. hand and its functions was one of the I prepared during my PhD. This image Both disciplines are based on scientific things I enjoyed most when studying demonstrates the disorganised, tortuous principles and share similar training and medicine. It is something that I return to and irregular tumour microvasculature educational activities. repeatedly when searching for a creative formed during angiogenesis. outlet. In this piece, I wanted to explore The tumour vasculature formed during the structures of the palmar and dorsal angiogenesis is essentially the ‘heart’ of surfaces of the thumb and the parallels the tumour and without it, the tumour and variations between the two. cannot establish. The tumour here What has always drawn me to surgery ironically resembles the shape of a heart. is the combination of creativity and This image was taken with a Philips technique combined to produce the best XL30 Field-emission scanning electron outcome for the patient. For me, drawing microscope (Eindhoven, Netherlands) is a way to not only reinforce learning, at a voltage of 2kV and spot size 2. With but a way to appreciate the beauty and acknowledgment to Dr Simon Crawford, complexity of anatomy. Senior Microscopist, University of Melbourne. Surgical News | Volume 21 | Issue 3 23

Dr Nagham Al-Mozany General Surgery, Aotearoa New Zealand

I am of Middle Eastern heritage, and have been raised in France, the United Kingdom and the United Arab Emirates. I immigrated to New Zealand to attend university and completed my undergraduate studies in Pharmacology and Biological Sciences followed by Medicine at the universities of Auckland and Otago respectively. I am a painter. My artwork is constantly evolving. It began with portraits, landscapes and floral designs in my teens and continued throughout university and general surgical training. Though I am Middle Eastern and the only female Colorectal and General Surgeon of this heritage in New Zealand, I am a polyglot, which reflects my childhood upbringing. I am grateful to be able to use this skill set to engage with the diversity of patient ethnicities and cultures within New I am the mother of a 15-month-old baby and patience – all attributes that have Zealand. boy and my husband is a Senior Associate assisted me during my career. The ability In more recent times, I prefer to paint Architect. Learning to juggle the tasks of to use paint as a medium to express my abstract. The medium that I use to paint being a surgeon, a mother and a wife can deepest thoughts and provide an outlet has also changed over the years, from be challenging at times. However, I have for my emotions on canvas has provided oil-based paints to acrylics. I am inspired my artwork that provides ‘me time’ when I me with a channel to express sentiments by other artists, particularly Claude have a few minutes to spare. encountered as a woman, a mother and a Monet, the French Impressionist. I was Art and surgery share the unique ability to surgeon. raised in Paris, which I think may have also reflect reflection, determination, devotion influenced my artwork subconsciously.

Dr Stefanie Schulte PhD discovered the connections between partitions of the canvas. The colours Australian Capital Territory these two worlds. In my opinion, a surgeon themselves are my inspiration – the is an artist, the surgeon must be extremely possibilities of combining and arranging Surgery and Fine Art are two disciplines creative. them are endless. The effects the shades that may not seem to be related. However, In my artworks I like to explore have on each other are fascinating; a colour being married to a surgeon, I have interactions of colour shades and different can change its appearance depending on where it is placed. The strongest parallel between my work and my husband’s work as a surgeon is probably the subtlety of the layers. My paintings, too, are built up by a countless number of very thin layers of colours. Another parallel could be the science. My artistic research almost has a scientific character when I analyse shades of colour and the influence the layers of colour have on each other. It is very invigorating when a painting is finished after many long sessions in the studio and when I am happy with the result.

Visit our virtual gallery at https://publish.exhibbit.com/ gallery/381463704078055736/ marble-gallery-58471/ 24 RACS ASC feature The creative surgeon

The British Journal of Surgery Oration 2021, delivered by Professor Mohamed Khadra AO

Those who are not surgeons tend to of the best outcomes in surgery and are artistic feeds the surgical creativity and think of surgery as a highly technical two of the safest places in the world to the surgery feeds our art. They are a and physical specialty. The thought have an operation. The Royal Australasian continuum of one and the other. that surgeons could be creative causes College of Surgeons has, since its The desire to create beauty out of cognitive dissonance. They box surgeons inception, had a central theme in training the ugliness of disease, to contribute into occupational categories that include us for excellence. something with our creative energy mechanics and carpenters, or in my case Yet there are times when even our best outside the sterility of the operating as a urologist, plumbers. When people skills, clearest thinking or our most theatre, provides, for many of us, the talk of creativity, they often use one small innovative technologies do not yield a counterbalance to insanity and allows us subset of creativity as their measure: desired result. Patients die or are forced to gain an equanimity that physician Sir that is, artistic creativity. We know, for to live a lifetime with complications that William Osler so often expressed as the example, that Picasso or Bach or Monet we have caused. We, as human surgeons, foundational characteristic of an effective were creative. We don’t think of a surgeon are forced to rationalise these injuries. doctor. doing a laparoscopic cholecystectomy as They are cumulative in their effect on our creative. When you ask people to define Anton Chekhov, the Russian doctor and collective souls. Time does not ease the creativity, they often use the words like playwright wrote, ‘Medicine is my lawful pain of the harm we cause. The years only ‘artistic’ or ‘create’. wife, and literature is my mistress. When I condemn. Some of us turn to alcohol and get fed up with one, I spend the night with Generally accepted definitions of other addictive drugs. The data tells us the other.’ creativity encompass more than art. The that 14 per cent of doctors in Australia Oxford English Dictionary defines creativity have an alcohol problem and two per cent For me, writing and art have always as the use of imagination or original ideas have narcotic dependence. Depression been my haven and I have been lucky to create something; Edward De Bono and anxiety are higher per capita in our enough to have four novels published says creativity is the use of ideas and profession than the general population. by Random House. My first book,Making skills to create something that was not We suffer for our craft and our craft the Cut, has become a best seller and has present before. suffers as a result. sold more than 30,000 copies. In some ways the book is also a historical text. Perhaps the best definition of creativity This collective post-traumatic stress It documents what it was like to be a was put forward by Robert E Franken, a disorder has to be resolved. I would resident and registrar in the late 1980s Canadian psychologist and researcher contend that the solution is within us all. and early 1990s, long before safe working living and working near Vancouver. He Using our innate creativity as surgeons hours and ‘woke’ communication with our defines creativity as ‘the tendency to and directing it towards artistic creativity bosses. generate or recognise ideas, alternatives, is an unparalleled mental release. The or possibilities that may be useful in solving problems, communicating with others, or entertaining ourselves and others.’ Using this definition, we as surgeons display creativity daily to make difficult diagnoses, approach challenging operations or deal with patients and their families. Creative surgeons devise new ways of doing operations, new clinical pathways and models of care, and push the boundaries of disease even further towards conquest. The story of surgery, even to our modern day, is rife with examples of invention and innovation. Most of the time, as is evidenced by the data collected on our endeavours, we are successful in our clinical outcomes. Australia and New Zealand boast some Surgical News | Volume 21 | Issue 3 25

of futile care. The story centred on an elderly woman in an intensive care unit and the decisions her family make about her care. It premiered at the Ensemble in Sydney and has played in a number of centres around Australia, including, most recently, a production that has just concluded in Western Australia. I have certainly been lucky with my writing. Currently, when I am not working in my private practice, or being Clinical Director of Surgery, or teaching at the university, I paint. Watercolour, I find, is one of the most challenging things I have ever done. I also make wooden boxes and give them to friends and colleagues. I doubt if my watercolours will ever be hung or my boxes ever be sold. The point is the expression of beauty in whatever form it takes. John Keats, another one of our medical colleagues, wrote in his poem Ode on a Grecian Urn, ‘Beauty is truth, truth beauty, – that is all Ye know on earth, and all ye need to know.’ Some ask, how do you have time to do these things? I think that giving expression to our artistic creativity is important enough to make time. Associate Professor Brian McCaughan, who was my mentor and guide, told me when I was his resident, “Khadra, there are 24 hours in every day, and then there’s the night.” I have lived by that adage since. Judging by the virtual gallery that is part of this conference, I am certain there are many surgeons in the audience who also share their lives with artistic creativity. Creativity is not a commodity isolated to one craft or one mode of expression. It is an innate and limitless resource inherent My second book, The Patient, is about and disaster and who endanger their to all of us. It is the great antidote to a middle-aged manager who wakes up lives for the greater good. Their the emptiness of existence and we, as one morning with blood in his urine. The contribution is supreme and makes surgeons, are luckier than most, because book is not just a story about our health anything I do pale into insignificance. It is creativity is practised and learned, honed system. It is my attempt to examine the called Honour, Duty and Courage. and developed, sourced and expressed in Biblical book of Job. the craft we ply throughout our working All my books are based on real stories and life. Ladies and gentlemen, in reality, we My third book came out of a presentation experiences that I turn into de-identified are all creative surgeons. by our then Prime Minister Kevin Rudd, novels. Arthur Conan Doyle, who was a who came to Nepean Hospital to talk doctor as well as a writer, wrote, ‘There’s about the Health Reform Commission. no need for fiction in medicine for the Professor Mohamed Khadra The book was called, perhaps somewhat facts will always beat anything you AO dramatically, Terminal Decline: A Surgeon’s fancy.’ Taking that advice, I try to tell it View of the Australian Health System. like it is. My fourth book was a story of a surgeon I have also written a play in conjunction who serves his country in the military. with one of Australia’s great playwrights, It is based on interviews with a number of David Williamson. The play is called At Images: our colleagues who have served in wars Any Cost? and it was an examination Professor Khadra's watercolour paintings 26 Rural surgery

Rural General Surgery in Scotland

Perspectives from a general surgeon based in the United Kingdom

The rights of every individual in society to With such small base populations, which particularly in cancer care and, to local and accessible health care provided are used to determine the hospital a certain extent, the demise of the by the state, regardless of ability to workforce, the provision of surgical and general surgeon. However, there has pay, were important recommendations medical services is challenging. Here been a recognition that this shift has of the Dewar Report to the Scottish in Scotland, as in Australia and New advanced too much or too far and that Highlands and Islands Medical Services Zealand, increasing super-specialisation mechanisms are now needed to train Committee in 1912. Shortly thereafter, in training and healthcare provision more general surgeons. well-organised medical services were has led to centralisation of services, established in rural Scotland and this report formed the blueprint for setting up the United Kingdom (UK) National Hospital Service, 36 years later. Remote and rural surgery is delivered in six locations in Scotland: three on islands and three on the mainland. The Island Rural General hospitals (RGH) are situated in Lerwick on Shetland, Kirkwall on Orkney, and Stornoway on the Isle of Lewis; on the mainland they are in Wick, Fort William and Oban. Each hospital has strong links with a city centre hospital for those requiring more specialist care. Each hospital serves a base population of between 20,000 and 44,000 people. However, they are all based in popular tourist destinations. For example, each year, at least one million visitors pass through Fort William, where I have practised for 21 years. Surgical News | Volume 21 | Issue 3 27

or strangulated hernia repaired. The variety of work seems attractive to students on placements in rural RACS Post Op settings. However, during training for surgery, which inevitably is in city- centre units because of case numbers, podcasts this enthusiasm seems to wane and disappear. Furthermore, the imperative Listen to interviews with that each trainee selects a super- some of the most inspiring specialism in order to obtain a Certificate and forward-thinking industry of Completion of Specialist Training (CCST) mitigates against certification of a professionals. rural general surgeon. Developed by RACS, the Post Academic and professional support for Op Podcasts feature extended rural general surgeons in Scotland and interviews on the latest other countries in the North Atlantic research across the medical comes from the Viking Surgeons industry, as well as practical Association (VSA). The VSA has held advice that surgeons can annual meetings in the locations of each implement in their practices, of the hospitals for updating by super- such as insights on financial specialists and enabling these city- management, wealth creation, centre consultants to experience the Professor David Greenaway, in his legal and tax advice and report ‘The Shape of Training Review’ challenges of rural surgery. In response economic forecasts. (2013), states that the four to six years to the present pandemic, the VSA of training after the two foundation teamed up with the Faculty of Remote, You can subscribe to the years should be more general to Rural and Humanitarian Healthcare at fortnightly RACS Post Op provide surgeons who can practice RCSEd (FRRHH) to provide a series of Podcasts on Apple’s iTunes or independently in elective and emergency webinars on rural surgery which have on Stitcher if you have another attracted more than 500 surgeons from general surgery, or go forward for smartphone model. further specialist training or fellowships. more than 50 countries. This has been a valuable collaboration for our rural The provision of a Rural Surgical surgeons and is in keeping with the Fellowship funded by the Scottish Listen on iTunes primary objective of FRRHH ‘to improve government is an important the health outcomes of individuals living Search ‘RACS Post Op’ in the development to enable surgeons to top and working in remote, rural, austere Podcast app on iPhone or in up their training over six to18 months for and life threatening areas of the world’. iTunes on desktop broad-based clinical work. This is one positive outcome of the global Listen on Stitcher Rural general surgery has provided pandemic for rural surgery in Scotland. a very fulfilling career for me, with Search ‘RACS Post Op Podcast’ on stitcher.com special interests in colorectal, urology Mr David Sedgwick and trauma. It is possible to continue FRCSEd providing a safe and sustainable surgical service in the RGHs because of managed clinical networks and multidisciplinary teams, which includes joint operating and close collaboration with super- specialists in the city-centre hospitals. This has been outlined in the 2016 Royal College of Surgeons Edinburgh (RCSEd) report on ‘Standards informing delivery of care in rural surgery’. Over the past 30 years, many reports have been produced that define the way to Top image: provide rural surgical services but many Nevis Range across Loch Linnhe, Fort William, a of the recommendations have not been beautiful place to live and work instituted. This has to be rectified in Image over page: some way or we envisage rural patients Viking Rural Surgeons (l-r) Mr Gordon McFarlane, Mr David Sedgwick and Mr Stuart Fergusson at the having to travel up to four hours to have annual conference at the Royal College of Physicians their appendix removed, abscess drained and Surgeons, Glasgow 2017 28 Fellow contribution

The state of robotic surgery

Robotic surgery began in Australia in 2003, to use it. Nowhere has this been more to challenge the existing monopoly. having commenced in the United States obvious than the introduction of These machines will come with lower in 2002. Urology was the first surgical telerobotic surgery. The manufacturers of costs and enable provision of machines discipline to take up robotic surgery, the robot, mainly engineers not surgeons, in the public system where Surgical mainly robotic radical prostatectomy. developed a brilliant new technology. Education and Training (SET) occurs. This Since its introduction, there have been We have recognised the true benefits second generation of robotic surgery significant barriers to its adoption. These of minimally invasive surgery since the will also embrace application of artificial can be summarised in three points. introduction in the 1990s of laparoscopic intelligence in surgical procedures, and First, scepticism about the perceived surgery, which disseminated through certain parts of operations such as suturing benefits of robotic surgery compared to many surgical disciplines. Minimally and wound closure may be automated. The traditional open and laparoscopic surgery; invasive surgery provides small incisions, cost of robotic machines is likely to reduce robotic enthusiasm was once described as reduced blood loss, reduced length of by about one third when competitive ‘gizmo idolatary’. hospital stay and earlier return to normal technologies are introduced. Robotic procedures will be undertaken in many Second, the capital cost of the robot being activities. Robots added a third and fourth dimension to laparoscopy being three- more disciplines, including General Surgery around $4 million prevented installation with cholecystectomy, appendicectomy of these machines in the financially dimensional 10 times magnified view for the surgeon, and digitised telestrated and hernia repair. Other disciplines to constrained public hospital system, where embrace robotics include bariatric, registrar surgical training occurs. This intuitive hand movements, rather than the counterintuitive movements used in Colorectal, Ear Nose and Throat (ENT), meant that graduate Fellows of the College gynaecology and Cardiothoracic Surgery. of Surgeons (FRACS) have to do a second laparoscopy. expensive Fellowship to learn robotic We have just witnessed the end of the Based on sales of $5.3 billion in 2019, surgery after graduation. first generation of robotic surgery led Goldman Sachs has predicted that the worldwide robotic market will increase Third, there is no validated curriculum by the Intuitive Surgical Company with the da Vinci machine from 2000-2021. incrementally after the emergence of new for credentialing to proficiency in robotic competitors. The prediction is the market surgery. Vendors have thus far provided In 2022, there will be at least three new robotic surgical machines available in will be worth $14.1 billion in 2025, and the education and credentialing for robotic $24 billion in 2030. surgery. In Australia this means a brief Australia from three different providers: online instructional video on how to drive Medtronic, Cambridge Medical Robotics In 2018, an independent commission, the robot, called ‘buttonology’.Then a and Medicaroid Corporation (developer of established by the Royal College of single porcine live animal surgery, followed the Japanese Kawasaki Hinotori machine). Surgeons of England, published a report by mentorship by another colleague in one Intuitive Surgical Company’s da Vinci on the ‘Future of Surgery’. This report or two early cases. As has often been the machine has proven to be the Rolls Royce describes how the surgeon’s role will case in the digital age, the introduction in robotic surgical technology. It remains change in the next 10 years. The surgeon of fancy new technology outstripped the to be seen whether the new machines of the future will have multiple skills. ingenuity and ability of those destined will be equivalent or at least good enough They will have to understand the language

CMR Versius robotic system Surgical News | Volume 21 | Issue 3 29

Left: William Halsted, who inspired the traditional training model, taught at the Johns Hopkins Hospital in 1902. Right: The da Vinci surgical system of medicine, genomics, robotic surgery, The issue of robotic education, training robot laboratory, away from the high engineering, bio- engineering and and credentialing is the most vexed. Most pressure operating room. molecular biology. Surgeons will need of our surgical trainers trained in open and In 2022, there will be high-quality, high- improved leadership, managerial and laparoscopic surgery and have then had to fidelity, synthetic 3D computer generated entrepreneurial skills. learn on the job to use the robot without human organ model systems for surgical access to a structured training pathway. Previous training systems involved training. These models will replace There is a dearth of expert robotic surgical seven years of training with a seven- reliance on cadavers and live animals for trainers in Australia. The year 2022 will see day working week and no vacation. This training. The models will allow repetitive a significant change in surgical delivery in is clearly not suitable for the modern surgical procedures for surgical Trainees Australia. Trainee and nor should it be. How do to work towards scored proficiency before we overcome the barriers to modern Robotic training could allow surgeons to finally going to the operating room. registrar surgical training in robotics? learn more quickly through the application The eventual outcome of a formal We need to consider safe working hours, of modern educational methods. An ideal structured robotic surgical training the limited number of operations to train scenario would involve online learning pathway for our SET Trainees will be on human patients, and the reasonable with quizzes before moving on to a enhanced training. Hopefully by shorter desire for modern surgeons to have simulation-based training. and better training we could eventually their training time reduced. The present The Australian Medical Robotics Academy reduce surgical complications for six year training path seems too long. has developed a fully validated approach patients, a most worthwhile societal There are already simulation metrics, to surgical training so that surgeons objective. which can test the aptitude of a potential can learn more quickly and adapt by trainee surgeon, which objectively assess Professor Anthony J application of modern educational hand-eye coordination and visual- spatial Costello AM MD FRACS, methods. Following scored proficiency in FRCSI orientation. The simulation metrics can simulation, the surgeon can operate on also identify rapid adapters for whom simple procedural models in a dedicated training can be expedited.

Mimic simulator Professor Anthony J Costello 30 Aotearoa New Zealand

A rare breed of rural surgeon

to quality assurance, and the ongoing John epitomises the criteria for this education and training of individual award through his continued involvement doctors and other healthcare staff. of more than 30 years in the development John holds medical registration in General of a high standard of surgery in rural or Surgery in both Aotearoa New Zealand provincial settings. He has demonstrated and Australia. He is also registered as his commitment to his own quality a vascular surgeon in Aotearoa New assurance activities, as well as that of Zealand. In 2014, he became a general his department and hospital. Throughout surgeon in Kalgoorlie and held a position those 30 years he has also dedicated with the Flying Surgical Service in himself to the education and training of south-west Queensland. surgical and other healthcare staff in the rural sector. From 2005 to 2014, John was Chief Medical Advisor and Medical Director for the Bay of Plenty District Health Board (DHB). He worked as a general surgeon in Tauranga Hospital where he was involved in General Surgery training. During his nine years with Bay of Plenty DHB, he had significant involvement in community health and health promotion activities, including general practitioner liaison and medical support to the New Zealand Red Cross. His hospital roles included Mr Kyngdon with his award. chairing both the Ethics and the Clinical Governance Committees of the District Rural Surgeons Award winner, Mr Richard Health Board. John Kyngdon, known to the RACS From 1986 to 2005 John was a general community as John, is one of the very and vascular surgeon in Gisborne, few rural or provincial surgeons who has working in the public hospital and also in worked in both Aotearoa New Zealand private. During this time he was Clinical and Australia. Director of Surgery and also Hospital John was presented with the Royal Supervisor for Basic Surgical Training. Australasian College of Surgeons (RACS) In addition to his clinical and hospital Rural Surgeons Award at the Aotearoa governance activities, John served as New Zealand National Committee meeting an elected member of the New Zealand last December. The Rural Surgeons Award National Board for nine years, ending his acknowledges significant contributions to time on that Board as its Chair. He was surgery in rural settings in Aotearoa New Convener for the Rural Surgery Section Zealand and in Australia. These include of the RACS ASC in Auckland in 2013, in conspicuous and continued involvement Brisbane in 2016 and again in Bangkok in of at least 10 years to the development of 2019. a high standard of surgery, a commitment Surgical News | Volume 21 | Issue 3 31

Gendered titles: a badge of honour or time for a change?

straightaway. This was the trigger for show me respect just by addressing me a decision I made as the convener of as ‘Mr’ or ‘Dr’. We have all worked so hard the 2018 RACS Combined Tasmanian for so many years that I know when I have Annual Scientific Meeting and Trauma gained the trust of others and confidence Symposium to use the title ‘Dr’ for all in my skills and ability to look after them surgeons attending the meeting (except or their children. for individuals with academic titles). This opinion piece is most certainly not No surgeons that I know of came back an attempt to instruct other Fellows not to protest or request a change. I was to use gendered titles but to highlight a certainly proud of the contribution made, change that is coming. As we all know, especially as I was practising in Tasmania, change is inevitable, and nothing is a place that, along with Victoria, has permanent (traditions included) in life the highest use of gendered titles in the and as surgeons. We don’t need to hold on 2 country among Fellows. to gendered titles just because this is how Since returning to Adelaide in 2020, I was it has been for centuries, and especially delighted to participate in the Women’s taking into consideration the reason and Children’s Hospital social media behind it in the first place. campaign together with my colleague, Mr and Miss or just Dr? Are gendered Dr Amy Jeeves (plastic surgeon) to Dr Michael Ee FRACS titles confusing and discriminatory? change gendered titles for all surgeons As the only profession left still using from ‘Misters’ to ‘Doctors’. Being the gendered titles, it is worth considering first hospital in the country to do so was why this practice began in the first a reflection of the strong leadership place centuries ago. Back in the 16th displayed on this issue. I have also been century, barber surgeons (Mister) inundated with many congratulatory were performing surgeries under the messages for this and I hope to do my directions of university medical degree part to keep this momentum going and physicians (Doctor), and these different a change amongst surgeons around the titles were used to differentiate the country and across the Tasman. two groups of individuals. Interestingly, As a paediatric surgeon, I would say surgeons in 1730 had no right to be the use of any titles can be a barrier to called ‘Doctor’.1 We certainly don’t communication with young people and REFERENCES have physicians directing surgeons children. Introducing myself as ‘Michael’ 1. Loudon I, ‘Why are (male) surgeons still addressed as Mr?’; BMJ. how to operate anymore but we still 2000; 321(7276):1589-1591. without the ‘Dr’ to patients and other 2. Neuhaus SJ, ‘The ties that bind: what’s in a title?’; ANZ J Surg. work closely together to look after our health workers has become routine. It 2018;88(3):136-139. vulnerable patients, all as doctors. So do is certainly not that I am uncomfortable we need distinguishing gendered titles with the title, but to most children, anymore? teenagers and other health workers An article published in the Australia and this is a barrier that can be overcome New Zealand Journal of Surgery in 2017 easily. Often, being less formal (and on this topic by Associate Professor authoritative) is effective. As I frequently Susan Neuhaus caught my attention remind myself, I don’t need others to 32 QASM QASM Connects webinar series

The Queensland Audit of Surgical QASM Connects – 2021 webinar series Visit the QASM workshops and seminars Mortality (QASM) is hosting a new series program webpage to find out more at of free webinars under the banner QASM • Webinar one (completed) https://tinyurl.com/ybjsccpe Connects from 2021 onwards. QASM Thursday 15 April 5 pm Connects will be held three or four times a Dr David Grosser – Popliteal vein If you have any questions please contact year and will be presented by surgeons. compression syndrome the QASM team: [email protected] Surgeons can contact QASM to discuss Dr Grosser presented on the topics they would like to share with their importance of altering the perception peers or are interested in learning about. that the main cause of DVT and PE is QASM Connects – 2022 webinar series The QASM Connects webinar series is open idiopathic. program to all surgeons, registrars and Trainees. • Webinar two • Webinar one Surgeons are encouraged to register and Thursday 29th July 5 pm (AEST) Thursday 17 February 2022 learn what their peers feel is important Dr Stephen Allison – Continuity of care Dr Leong Tan – Cervical collars in for patient care. elderly patients Dr Allison will present on the importance of hand-over and the Dr Leong Tan will be presenting on the continuity of care for admitted management of elderly patients being patients. treated with cervical collars. • Webinar three • Webinar two Thursday 7th October 5 pm (AEST) Dates and speakers to be confirmed Dr Joanne Dale – Big bowel big problem • Webinar three Dr Dale will present on the early Dates and speakers to be confirmed diagnosis and timely treatment of bowel obstructions. Surgical News | Volume 21 | Issue 3 33

Strengthening the foundation of surgical education to improve patient care

The College is developing a Professional knowledge, skills and behaviours in outlined in the curriculum, your potential Skills Curriculum aligned with and surgical practice. will not be reached.” highlighting the importance of the We are developing this curriculum According to Margaret Bearman et al., Surgical Competence and Performance because ‘multiple studies have ‘Trainees may also find themselves Framework. demonstrated that improvements in working in an environment that requires The framework, available in the Royal nontechnical [professional] skills such as practice without supervision even though Australasian College of Surgeons’ (RACS) communication and surgical teamwork they are still in training.’3 To sufficiently Surgical Competence and Performance can improve patient care, patient safety, equip Trainees and SIMGs, Bearman and Guide, reflects the standards we hold as operating room efficiency, and patient her colleagues suggest empowering a profession and our commitment to the outcomes.’1 them to negotiate environments where community to deliver high quality patient The curriculum aims to develop surgeons there is limited feedback. They must be centred surgical care. Comprising 10 of the future. Future-thinking anticipates equipped appropriately to manage their competencies, the framework forms the the healthcare system will shift from own learning. foundation of the development, practice a ‘model of physician self-governance, “One of our goals in developing this and assessment of surgeons at all stages autonomy and paternalism to a model of curriculum is to help Trainees and SIMGs of their career across all areas of surgical co-creation, partnership with patients, become self-directed learners, and to practice. based on mutual respect and trust, enable them to plan their own learning The new RACS Professional Skills transparency, shared decision making, pathway,” said Mr Adrian Anthony, Censor Curriculum will be aligned with eight out shared learning and accountability.’2 in Chief and General Surgery Fellow. of the 10 competencies. Dr Rebecca Garland, Chair of the Having a curriculum to refer to will • Communication Professional Skills Curriculum Working increase the graduates’ confidence when • Collaboration and teamwork Party, and Otolaryngology Head and Neck they become Fellows and supervisors surgeon, explains how the curriculum themselves and operate within the • Cultural competence and cultural is being formulated. “A working group clinical setting. safety comprising Fellows from all specialities We intend for the curriculum to provide • Health advocacy meet regularly to work with the College Fellows, as surgical supervisors, with a to develop the curriculum,” she said. • Judgement and clinical decision making guide that will help them to efficiently and “Because the curriculum will be broad effectively supervise and assess Trainees • Leadership and management enough to reflect all our specialities, we and SIMGs in their clinical activities. • Professionalism need input from a wide range of Fellows.” Supervisors will have clear statements • Scholarship and teaching Making surgical education better for the of learning outcomes that must be future demonstrated by Trainees and SIMGs at Medical and technical expertise are The new curriculum will support Trainees identified stages of their development. specific to each surgical specialty. This and SIMGs as they learn and demonstrate curriculum is planned to complement the “There is a common myth that suggest professional skills deemed essential existing curricula offered by our Specialty you can’t teach someone how to be a by the College. The curriculum will give Training Boards. teacher, but that is absolutely untrue,” Trainees and SIMGs clarity on how they said Associate Professor Philip Truskett, This was a key requirement of the develop their professional identity while General Surgery Fellow. “You can teach accreditation review of surgical training highlighting what they are assessed on someone how to be an effective teacher, a by the Australian Medical Council and and the standards of performance they compassionate leader and to be part of a Medical Council of New Zealand, and is need to achieve within each competency. team. These so-called ‘soft skills’ can be aligned with other Australasian colleges “Skills such as communication, learned.” such as the Royal Australasian College of professionalism, collaboration and Physicians. “This curriculum will be a powerful teamwork are considered to be tool to assist in surgical teaching and The curriculum is being created to foundational skills,” said Mr Philip learning,” said Dr Garland. “It will provide provide surgical Trainees, Specialist Morreau, Paediatric Surgery Fellow. “It supervising Fellows with a framework to International Medical Graduates (SIMGs) doesn’t matter how strong your medical use when they work with a Trainee or  and supervisors with consistent and and technical expertise is, if you have (continued on p37) standardised expectations of the required not developed all the professional skills 34 Fellow contribution Dr Steven Craig on a life-changing Canadian Fellowship

It was 33C degrees when we flew out After our first night in Canada, we of Sydney, and -26C when we arrived in scurried from the empty outdoor car Calgary. We stepped out of the airport’s park to the mall to buy clothes. (Only heavy double doors and our two-year-old later did we realise that the ‘parkade’ daughter, shocked by the cold, screamed, signs we kept seeing were directing us “Bad Canada!” We ran back inside, tore to the underground heated carpark, open our bags and put on almost every where everyone else had parked.) That item of clothing we had. afternoon, in our ‘proper’ Canadian winter clothes, we had a snowball fight in the In 2018 I elected to take time away from park opposite our apartment, and Canada my visiting medical officer (VMO) positions was no longer ‘bad’. in New South Wales to undertake further education in two areas of particular A few days later, I was issued the interest, namely endocrine surgery regulation white lab coat with my name and surgical education. These are also emblazoned on it, and I set off to start specialty ‘areas of need’ in the districts my American Association of Endocrine that I am employed. To further my Surgeons Fellowship. Once I’d figured education in these areas, I developed a out that there was no ‘tea room’ (“Oooh comprehensive educational program in the tea room?! Is the Queen coming or North America. something?!”) and to look instead for the The family enjoying the Canadian winter. ‘doctors’ lounge’, things went smoothly, I was accepted to commence an American despite the lack of tea – and the terrible Association of Endocrine Surgeons was fortunate to complete ancillary coffee. (AAES) Fellowship at the University rotations through endocrine medicine, of Calgary under world-renowned My experiences – clinically, and in terms radiology and pathology. I gained endocrine surgeon Dr Janice Pasieka. of research and teaching – were varied valuable experience in retro-peritoneal The AAES Fellowship is merit-based and and valuable. The case volume was adrenalectomy, the application of highly competitive, with only 25 Fellows broad and covered the full spectrum of intraoperative PTH in primary and tertiary selected for high-volume sites across endocrine surgery, with consistently hyperparathyroidism, sternotomy for the the entire United States and Canada. This challenging and complex cases, befitting management of goitres, and the surgical fellowship met the clinical component a major university hospital. There were management of gastro-intestinal neuro- of my educational goals, and it further regular clinics for general endocrine endocrine tumours. developed important academic skills in surgery, genetic endocrine conditions, My preceptors, Dr Janice Pasieka and teaching and research. and neuro-endocrine tumours, and I Dr Adrian Harvey, were meticulous. Their interest in the intricacies and nuances of current endocrine surgery, and how it might be applied to practice, was impressive. It also appealed very much to my academic bent and to my love of the exquisiteness of endocrine surgery. Fellows’ meetings were held every Monday at 7am, come snow or shine, often based around a current controversy in endocrine surgery that I would need to research, present, and defend. I was also immersed in the history of endocrine surgery (a favourite topic of Dr Pasieka), including founding figures and contributors, and how the specialty has evolved over the years. Complementing my clinical experiences were some great research opportunities, Dr Steven Craig with Professor Janice Pasieka Surgical News | Volume 21 | Issue 3 35

Strengthening the foundation of surgical education (continued from page 35)

an SIMG experiencing difficulty in their journey, particularly in areas such as communication, judgement and decision making, and the newest addition of cultural competency and safety. “Many surgical trainers and Fellows recognise when these skills need to be developed in training and the curriculum gives us a way of articulating those skills with a common language. Dr Steven Craig receives the Selwyn Taylor award from Professor Gerard Doherty of Harvard University. “In my time as chair of training in the mostly centred around my interest made it less efficient. Things are generally Training and Education Committee, a in thyroid cancer. Most valuable was well-organised, but perhaps a little division of the New Zealand Society of my work in the lab of Dr Oliver Bathe, slower, and there seemed to be a lot of Otolaryngology, Head & Neck Surgery, a translational surgical oncology red-tape in the system: bureaucrats I noticed that many boards were researcher. Together, we developed a would decide, for example, who your facing similar challenges with these prognostic gene assay for thyroid cancer, secretary would be, not you. competencies. It makes a lot of sense to which is currently being moved towards Overall, our time in Calgary was life- come together to develop an over-arching commercialisation. I was fortunate changing. The Fellowship delivered on framework we can reference.” to present this work at the recent its promise to build my clinical expertise, We envisage the curriculum as being International Association of Endocrine and allow for and support higher-level part of an ongoing cycle of quality Surgeons meeting in Krakow, Poland, academic work. improvement in surgical education and winning the Dr Selwyn Taylor Award for training and professional development. best scientific presentation. I was also As with most travel, our understanding of It will be integrated with existing skills given opportunities to lead a number the world and how people live expanded courses and will complement the medical of scientific papers and book chapters too. Our girls are now among the most and technical curricula components and was supported by the Fellowship to intrepid four- and six-year-olds we know. offered by our Specialty Training Boards in attend conferences across North America. They’ve skied Canadian black runs, hiked through the woods carrying ‘bear spray’ partnership with specialty societies and Like Australia, Canada’s population is and cut down our own real Christmas associations. aging, multicultural, yet largely Anglo- tree. My wife was just as adventurous The curriculum presents a program of Saxon, with similar first-world health and even more tenacious, completing a increasing complexity from early to issues, such as obesity. There are pockets marathon while also carrying bear spray, late Surgical and Education Training of significant disadvantage, including and triumphing over wild kids on snowed- (SET), providing both supervisors and among Indigenous people. Canada is both in days, as well as on long summer days Trainees a clear pathway to track areas heavily urbanised (concentrated along the when the sun sets after 10pm and nobody for development during the SET program. southern border) and dispersed, and many could sleep. The College will actively engage Fellows patients have to travel long distances for to develop the curriculum, by meeting tertiary appointments. We trick-or-treated, had a magical white Christmas and ate our body weight in regularly with Specialty Training Boards Of course, in Australia, those patients ribs at the annual Calgary stampede. (both Fellows and training managers). usually show up. In Calgary, when We left Calgary with heavy hearts, but We will collect feedback and instructions there’s 80 centimetres of snow, and with perhaps the best possible souvenir: on how well the competencies have been your condition isn’t life-threatening, our six-week-old baby with a Canadian addressed. you just stay home and skip your clinic passport. We look forward to sharing more about appointment (if you haven’t already the curriculum with you soon. travelled south to Arizona for the winter). Dr Steven Craig FRACS We were also often unable to discharge REFERENCES patients because of the snow, particularly 1. Kawaguchi AL, Kao LS. Teamwork and Surgical Team–Based Train- ing. Surg Clin North Am. 2021;101(1):15–27. if they lived in the Rockies. 2. Henriksen K, Oppenheimer C, Leape LL, Hamilton K, Bates DW, Sheridan S, et al. Envisioning Patient Safety in the Year 2025: Eight Perspectives. Adv Patient Saf New Dir Altern Approaches (Vol 1 It was interesting to work in an entirely Assessment) [Internet]. 2008;3–15. Available from: http://www. ncbi.nlm.nih.gov/pubmed/21249853 public system. While the Canadian public 3. Bearman M, Brown J, Kirby C, Ajjawi R. Feedback That Helps Trainees Learn to Practice Without Supervision. Acad Med [Internet]. health system is well-resourced, I felt 2020;Publish Ah(2):205–9. Available from: https://journals.lww. com/academicmedicine/Abstract/2021/02000/Feedback_That_ perhaps the lack of a private comparison Helps_Trainees_Learn_to_Practice.33.aspx 36

Surgeon develops liquid biopsy to improve outcomes for paediatric oncology patients

procedure is less invasive for children Sydney, he regularly tutors undergraduate and testing can occur more often. The and postgraduate students towards opportunity for repeated non-invasive higher degrees. testing offered by the liquid biopsy Associate Professor Karpelowsky has means that more accurate information served and currently serves on a number is available to clinicians. This has the of committees, including the Sydney potential for the use of more adaptive, Children’s Network Human Research personalised treatments, and ultimately, Ethics Committee and the Australasian a better outcome for patients. Association of Paediatric Surgery The liquid biopsy allows researchers to Executive Committee. He has led working study the DNA of cancer cells retrieved parties for the Section of Academic from the bloodstream to identify Surgery into research requirements any changes that have occurred and for the Royal Australasian College of determine the success of cancer Surgeons. He is currently on the section of treatments, such as chemotherapy and Academic Surgery Executive Committee targeted therapy. and the convener of the annual Associate Professor Karpelowsky said the Developing a Career in Academic Surgery grant had made it possible to progress (DCAS) course. this research, attract additional funding Alongside his interest in the use of liquid Associate Professor Jonathan Karpelowsky and to form international collaborations. biopsies in the molecular monitoring Associate Professor Jonathan While further research into liquid of sarcomas, Associate Professor Karpelowsky, recipient of a John biopsies for paediatric oncology patients Karpelowsky’s areas of research include Loewenthal Project Grant, has is needed, the results to date have been long term follow-up in thoracic conditions developed a multi-modal liquid biopsy extremely promising. of childhood, augmented intraoperative approach for the molecular monitoring reality for cancer surgery navigation and of sarcomas. The method is less invasive “I’m very grateful to the College for randomised trials in childhood surgical than traditional tissue biopsies and offers the wonderful opportunity the grant conditions. the opportunity for the oncology team has given me,” Associate Professor His paediatric surgical clinical interests to monitor treatments and their impact Karpelowsky said. “It certainly has borne focus on paediatric surgical oncology and on cancer cells in the bloodstream more fruit and enabled me to move forward minimally invasive surgery for thoracic closely. with this research in a really important way.” conditions of childhood. A paediatric surgeon and Associate Associate Professor Karpelowsky said Professor at the University of Sydney, Associate Professor Karpelowsky’s that since arriving in Australia, he has Associate Professor Karpelowsky is history in medicine spans continents. The been impressed by the care and training dedicated to improving the outcomes beginnings of his interest in the field can available through its health service. of children and adolescents with solid be traced to his childhood in South Africa, tumours. His main position is at The when he lost an 11-year-old friend to “Australia has an enormous amount Children’s Hospital at Westmead, with bone cancer. to be proud of with its freely available appointments at Royal Prince Alfred He originally started training in thoracic clinical care and training opportunities. I Hospital and Westmead Private Hospital. surgery before undertaking both his adult thoroughly enjoying working as a surgeon here.” He and his team at the Advanced and paediatric specialist surgical training, Molecular Diagnostics Laboratory within which he completed in 2006. He then However, the ability of surgeons to access the Children’s Cancer Research Unit achieved his PhD at the University of Cape protected time to pursue research can have used the grant to develop the liquid Town. be more challenging due to the paucity biopsy approach using similar technology He is passionate about educating the of paid academic positions. He sees to that used in the non-invasive prenatal surgeons of the future and is the current the College as having a crucial role to genetic testing in pregnant women. immediate past chair of the Board of play in ensuring that surgeons are able to carry out vital, lifesaving research While a traditional biopsy would require Paediatric Surgery, which supervises and to collaborate with international an incision with the accompanying risks paediatric surgical training across researchers by awarding grants like the and side effects, Associate Professor Australia and Aotearoa New Zealand. As one he received. Karpelowsky’s process means that the Associate Professor at the University of Surgical News | Volume 21 | Issue 3 37

Creating safety and respect in healthcare cultures

The Royal Australasian College of importance of a ‘speaking up’ culture, and of the obligation for self-regulation in Surgeons (RACS) is widely recognised for as well as the complexities inherent medicine. its sustained commitment to fostering in creating it. This included the need In the context of speaking up about a safety culture and promoting respect to differentiate bullying from under- unacceptable behaviour, presenters in health care. In April, the College performance, lack of staff clarity about brought together by the Royal collaborated to organise the Creating what issues should be raised, questions Australasian College of Medical Healthcare Cultures of Safety & Respect about the motivations of whistle- Administrators (RACMA) spoke of the Conference, to help progress cultural blowers and “organisational resistance value of pre-rehearsed responses in the change and explore the role of different to bad news”, when “people in positions face of racism, sexism or other prejudice. healthcare agencies in meeting this of power are vested in narratives of One such example that gave was, ‘I was enduring challenge. success”. The invisibility of actions taken having a great day until you made that More than 250 people now working in in response to issues raised was also casually racist/sexist remark.’ They also Australia and Aotearoa New Zealand a deterrent to speaking up. Professor asserted that people don’t have to be in a to effect cultural change in health care Mannion discussed the National Freedom leadership role to make such statements, registered to join in our first combined to Speak Up Guardians in the United the most senior person in the room holds virtual summit, which recognised RACS’ Kingdom, a National Health Service the responsibility to call it out. mandated program recognising the role leadership and sustained commitment Dr Christine Lai showcased RACS’ Building to building a culture of respect through of speaking up in safe and respectful healthcare cultures. He spoke about the Respect program and shared her insights surgical education, cultural change and into what we have learned. It is pleasing complaints management. frequent gap between organisational intention and resourcing, and of the that conference delegates have since Collectively, speakers called time on systemic barriers to effecting change. followed up with their interest in our describing the problems in healthcare work, given multi-party collaborations culture and called for evaluations of Conference speakers advocated for are key to building a culture of respect. collaborations to support cultural change interventions and actions to implement RACS is proud to have collaborated in the that support behavioural change. in health care that foster safety and respect, arguing that a shared endeavour organisation of the April 2021 Creating In keynote addresses, Professor Johanna from employers, educators and Healthcare Cultures of Safety & Respect Westbrook, of Macquarie University, professional associations was essential. Conference, with Macquarie University, St and Professor Russell Mannion, of the Both individual and systemic change is Vincent’s Health Australia and RACMA. University of Birmingham, spoke about needed, given that good people in bad the idea of incivility contagion, which systems lead to bad outcomes. compromises team performance and therefore patient safety. Long-time adviser to RACS and keynote speaker Dr Gerry Hickson shared Professor Westbrook discussed research research indicating how the failure to findings about the poor performance address disrespectful behaviour leads of teams exposed to rudeness. She to more lawsuits and more poor patient said some groups (often younger staff, outcomes, has a negative impact on nurses and non-clinical staff) were more culture and performance, and causes at risk of incivility and unprofessional organisational reputation damage. Dr behaviour, which was prevalent across Hickson was adamant that “you don’t the sector. Other research found skills in have safety without respect,” and he said ‘speaking up’ were associated with lower that “teaching our people to talk to each odds of experiencing frequent bullying other in the moment” was a feature of and reduced the impact of bullying. the Vanderbilt University system, which Speaking up is about She explored how rudeness increased has shaped RACS’ approach to cultural problem solving, individuals’ cognitive load by stealing change. He described professionalism not judging. resources away from the task at hand. as “the body of knowledge owned by the Associate Professor Payal Mukherjee Professor Mannion spoke of the profession, distinguished from mere skill”, EAR NOSE & THROAT SURGEON Helping surgeons say goodbye to bad posture, neck pain and eye fatigue.

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AUS2021-5-SURGNEWPENTAX.indd 1 20/5/21 10:16 am Surgical News | Volume 21 | Issue 3 39

Fellow profile: Dr Alpesh Patel

“slowly changing, and I was on the cusp of working under about the offer and he gave it.” Alpesh is the first doctor in his family. me the best advice, which I share with my A sports lover, Dr Patel played hockey colleagues, house officers and registrars. growing up. “I gravitated towards He said, ‘You will be an orthopaedic Orthopaedics when I saw the injuries on surgeon for the next 30 years, and you the field. Physically helping people and want to go to work every day enjoying the hands-on approach of the speciality what you do. Base your decision on your intrigued me and sparked my interest.” passion.’” After completing his medical training, “In New Zealand it’s tough to get Dr Patel spent six months as Spine positions, so some young doctors take Fellow in Middlemore hospital – the up the first offer. But if your heart isn’t in first in the hospital. Since he was also your chosen field, it’s best to wait – even interested in hand surgery, he undertook if it takes time to understand what this is. a year’s Fellowship at Sydney’s Royal It’s a small price to pay for the remainder Northshore Hospital. He then went to of your career,” Dr Patel advised. Vancouver General Hospital for a year at a Dr Patel’s second passion is running, and Quaternary Spine Referral Centre, which in May he completed the Hawkes Bay Helping surgeons say goodbye to bad served 4.5 million people. “It was here Marathon. “I’ll put my shoes on anywhere What would you do if you had a hard day that I was introduced to the O-Arm, which I can,” he said, “whether before work, in of surgery? Run, of course, to reduce takes X-rays in a 360-degree arc that between work, or after work”. posture, neck pain and eye fatigue. stress. connects to a navigation system to allow This love for the outdoors is shared by Dr Alpesh Patel is passionate about us to place instrumentation into the spine his doctor wife and three young children. accurately,” he said. The world’s first surgical loupes to incorporate PENTAX’s unique PRISMVUE deflection prisms orthopaedics and running. He advocates Next month they are going bushwalking following one’s passion to his family and offer the surgeon a bright, magnified view of the operation field whilst maintaining an upright, When Dr Patel returned to Aotearoa New with Dr Patel’s mother. They are looking colleagues. Zealand, there was only one O-Arm at forward to skiing and snowboarding this forward-facing posture. The proper posture prevents the surgeon’s head from interfering with the Dr Patel grew up in South Auckland. Christchurch “and I was keen to acquire winter, and come summer the beaches overhead surgical lights and helps you maintain a bright, magnified operating field. He was born in Middlemore Hospital, one in our area and helped raise funds for beckon them. The perfect wellbeing where he is now an Orthopaedic it,” he said. “It has been a great tool, both antidote for all the family. Make the change to PENTAX NF2 PRISMVUE surgical loupes and say goodbye to lousy working Surgeon and Clinical Lead for the Supra for patients, and registrars as it gives posture, neck pain and eye fatigue. Regional Spinal Cord Injury service. As them confidence placing screws around a Governance Group member of the the spine.” With more than 700 spine New Zealand Spinal Cord Injury Registry surgeries being performed annually at What are you: (NZSCIR), he is involved in collaborative Middlemore Hospital (Dr Patel performs • Reading? research of Spinal Cord Impairment in about 200) the O-Arm has been a boon. The Happy Runner by David Roche New Zealand and Canada. He operates For Dr Patel it is the intricacies of spinal and Megan Roche, MD on spinal injuries along with adult surgery – the challenges, the advent of • Watching? degenerative conditions, infections, robots, and the ever-evolving field of Seaspiracy Scan the QR code, visit primary and secondary tumours of technological advances – that makes his the spine, and tetraplegic upper limb • Listening to? osseogroup.com.au/pentax profession exciting. Earlier in his career Group surgery. However, he noticed a lack he was offered a lucrative job at another Running podcasts on the way to or call 1300 029 383 to learn more Osseo of people of colour and women in his hospital but specialising in a different work, and pop or hip hop at the and book an in-office demo. chosen speciality – something he feels is sub-speciality. “I told the surgeon I was operating theatre. AUS2021-5-SURGNEWPENTAX.INDD

AUS2021-5-SURGNEWPENTAX.indd 1 20/5/21 10:16 am 40 Aotearoa New Zealand Aotearoa New Zealand restructures its health services

to communities and more nationally specialties providing a regional service connected. (i.e. across DHB boundaries) should be diminished, allowing for the creation of What will the reform look like? The Ministry of Health will refocus to better national and integrated specialty become the lead advisor to government networks. This will particularly affect the on matters of health. A new organisation smaller specialties such as Neurosurgery, will be created, Health NZ, to take Cardiothoracic, Vascular and Paediatric responsibility for the day-to-day Surgery. Currently, service development running of health services, meaning the is very ad hoc, often done in isolation, and 21 District Health Boards (DHBs) will is typically short-term. Hopefully, having become obsolete. A new Māori Health a single Health NZ will enable improved Authority will be created with the aim long-term planning. of improving outcomes for Māori, and Secondly, our College has already to provide tailored health services for applauded the recognition of inequalities Māori where Māori models of care can in the system and has indicated it will flourish. It will work in partnership with do everything it can to support the Health NZ to commission care across the initiatives to correct these. Exactly how country. Finally, it will establish a new the commissioning of Māori services Public Health Agency within the Ministry will affect surgery is not yet known, but of Health to respond to threats to public RACS will be actively working to ensure it health, such as pandemics. succeeds.

For a number of years, the health sector What does it mean for hospital and Thirdly, the plan makes no mention and the public have been concerned specialist care? of significant increases in funding, so about the apparent inadequacies and The review identified a need for greater it is likely that there will be ongoing shortcomings of some of the services consistency of care across the country. pressure around resourcing of services, provided by Aotearoa New Zealand’s Care should be offered where it is especially surgical services. It behoves us health services, including ongoing accessible and practical, and the costs to continue to use our limited resources inequities of access and quality that need to be better managed. The review wisely without compromising the quality particularly affect disadvantaged and proposed wider regional networks, of care we provide. vulnerable groups. This concern led to coordinated services, and improved Spencer Beasley and Sarah Rennie the instigation of a Health and Disability access for those in rural areas. The new Aotearoa New Zealand Surgical Advisors Review, commissioned by the government service aims to provide greater certainty in 2018. where more specialist or complex care is required, less fragmentation of services, In April 2021, the government released and less competition between districts For more information see: https:// its response to the review with its plan to for staff and resources. dpmc.govt.nz/our-business-units/ strengthen the health system to ensure transition-unit/response-health-and- every Aotearoa New Zealander can access What will these reforms mean for disability-system-review/information the right care at the right time. It observed surgeons? that the health system is supported At present there is little detail of how the by a dedicated workforce, but that the plan will be implemented, but there are system has become overly complex and some likely consequences for surgical fragmented. It committed to a single services. nationwide health service with structures Firstly, the impediments caused by the that ensure government is both closer current DHB structure for those surgical Surgical News | Volume 21 | Issue 3 41 The Pacific Island Program – how are we doing?

Since 1995, the Royal Australasian in partnership with in-country clinical and the Pacific,” said Dr Sione Pifeleti, a College of Surgeons (RACS) has been teams supported the delivery of more Pacific Island Program participant and working with health partners in Pacific than 1700 surgical procedures. These Otolaryngology Ear Nose and Throat (ENT) island countries to improve access to occurred across eight Pacific island registrar in Samoa. surgical care through the Australian countries and 11 specialties. It also However, among the Pacific surgeons aid–funded Pacific Islands Program provided more than 1300 professional interviewed, there were also calls for PIP (PIP). PIP, now in Phase-V (2016-2021), development opportunities for Pacific to support stronger reporting against aims to increase access to surgical care surgical healthcare workers. competency frameworks, including across 11 Pacific island countries by Pacific surgeons were interviewed formalised workforce development plans providing education and training to about their experiences participating and Continued Professional Development Pacific surgeons, nurses and other health in PIP. Many reported that they valued (CPD). Other Pacific interview respondents workers and by supporting surgical PIP highly for the clinical opportunities felt there was work still to be done to teams to deliver surgeries locally. it provides. Almost 90 per cent of improve PIP’s strategic alignment to In May 2020, RACS Global Health surgeons and other healthcare workers Pacific surgical priorities. commissioned a mid-term review of PIP surveyed felt that their participation in (2016-2021) to identify opportunities to Going forward, opportunities to PIP was ‘very’ or ‘extremely’ beneficial strengthen its ongoing implementation ensure PIP’s ongoing impact, including to their professional development. and impact. those identified in the review, will be Many highlighted the importance of the considered in consultation with Pacific Over a million people in Pacific island professional support provided through and implementing partners as part of the countries do not have access to essential PIP, which had increased their confidence design of the next phase of PIP. surgery when they need it. RACS and exposed them to development recognises that investing in people is opportunities across a range of clinical RACS Global Health is committed essential to increasing access to health and surgical specialities they would not to increasing the sustainability and care in these countries and meeting the otherwise have had. relevance of PIP and supporting regional ongoing needs of Pacific communities. efforts to increase access to safe surgical “My confidence and courage to care for Pacific communities. To understand PIP’s performance perform urgent life-saving operations and identify opportunities to ensure have significantly increased from my its success into the future, RACS involvement in PIP. It is important to The Pacific Islands Program is an commissioned a mid-term review of have PIP volunteers continue to mentor, Australian aid initiative implemented the program. The review included 35 engage, enable, evaluate and audit the by the Royal Australasian College interviews, and 79 online surveys with work that I do to support ENT in Samoa of Surgeons on behalf of the Australia- and Aotearoa New Zealand- Australian government and delivered based specialist medical volunteers, in partnership with the Pacific and Pacific stakeholders and healthcare community, Ministries of Health, workers. specialist colleges and associations, and partners. The review found that PIP has delivered well against its mandate to support If you are a health professional service delivery which would not and interested in volunteering or otherwise have been available and to supporting RACS Global Health please provide in-country training through contact [email protected] on-the-job experience and the delivery of courses. Between 2016 and 2019, RACS deployed 178 specialist medical volunteers (including surgeons, anaesthetists, specialist nurses and other healthcare workers) to provide training and mentoring to Pacific surgical and other healthcare workers via PIP. Accumulatively, through PIP, Dr Sione Pifeleti, a Pacific Island Program RACS specialist medical volunteers, participant and ENT registrar in Samoa 42 Fellow contribution Tour de Cure SA Discovery Tour 2021: persistence rewarded with satisfaction

Squeezing every last drop out of whatever life serves up to you

What does one do when life deals you a COVID-19 came to stay. Unfortunately, I in the field of cancer, organisations that seemingly never-ending supply of lemons? was gifted the opportunity to become an support people along their cancer journey, To quote Elbert Hubbard, “You start a expert lemonade producer throughout and cancer education and prevention lemonade stand!” 2020. programs. TDC is a significant supporter of I have a feeling that 2020 may well be I have been involved with Tour de Cure the RACS Foundation for Surgery. Over the remembered as the Year of Lemonade. (TDC) – an organisation that exists to last 15 years, TDC has raised more than Many people had to pivot, re-imagine ‘Cure Cancer and Change Lives’ – for the $66 million, supported over 550 cancer or just postpone their plans for 2020 last five years. They raise funds, through research projects, helped fund 45 cancer when, like an uninvited, distant relative, large group bike tours, for researchers research breakthroughs, and has spread their prevention message to over 160,000 school children around Australia. Each year since 2007, TDC have run a Signature Tour. This is a nine-day challenge, held in different parts of Australia, for riders who have raised funds throughout the year. When I first heard of the organisation in 2015, I had a relatively embryonic interest in bike riding. I wondered if I would ever be able to get to the level where I could ride 150km a day, for nine days straight, and climb approximately 15,000 metres of vertical ascent during those days on the bike. As is the case for too many, I have had many unwanted brushes with ‘the Spanish Dancer’ and have managed many patients through the effects of this terrible affliction. I saw TDC as an opportunity to both improve myself and, by suffering a small amount on my bike, help lessen the suffering of others due to cancer. The first South Australian (SA) Discovery Tour was in 2016 and I initially trained and fundraised to participate in these annual Tours. I found them extremely worthwhile adventures, and after completing a few I began to wonder, could I take on the Signature Tour? All the planets seemed to align as 2019 was progressing. I had saved up annual and long service leave and I thought it was now or never to commit to the My support crew training I knew would be required for such Surgical News | Volume 21 | Issue 3 43

On the road between Clare and Tanunda an arduous task. I set out my training tours, I was suddenly thrown into helping participated in the SA Discovery Tour program, some 10 months in advance, to navigate the medico-political turmoil 2021. One hundred and ten riders and and set about building up my stamina that was elective surgery cancellations, 40 support crew set off from Clare on 9 and losing as much weight as possible the management of the surgical response April 2021 and, over the next three days, to make climbing the endless hills more to COVID-19 in SA and trying to survive my we battled head and side winds, mixed achievable. private practice closure. I couldn’t even with rain and sunshine, to travel a very My plan was to complete both the continue my bike riding due to lockdown circuitous route through Tanunda and Signature Tour (March-April 2020) and directions. All I knew was that my plans Hahndorf ending in McLaren Vale after the SA Discovery Tour (May 2020) and lay in tatters. However, I quickly realised 350kms. The relief of actually getting out then enjoy a bike riding holiday through that I was fortunate to be able to self- on the road was palpable. The physical Tuscany and The Dolomites. The latter isolate in the beautiful Adelaide Hills. and emotional challenges were hard but the rewards of new friendships, goals would be the prelude to spending three The loan of an indoor trainer from a friend achieved and a real sense of being part months in Italy with my wife, enjoying my and the discovery of amazingly life-like of something outweighed any hardships long-awaited long service leave. cycling video apps enabled me to keep up experienced. My training progressed really well. As with my riding. I lost count of the number those who ride bikes will attest, it never of hours I spent on that trainer, first During what was a difficult year for gets easier, you just get a bit faster. By completing both ‘virtual’ Signature and SA all, I kept telling myself that missing mid-March 2020, I had arranged a locum Discovery Tours, to acknowledge all my out on travel was not a matter of life for my private practice, raised more financial supporters, then riding ‘virtually’ or death, but the alternative of having than $30,000 and was possibly in the around Italy. uncontrolled COVID-19 infection in the community, potentially overwhelming best physical shape I’d been in since my Looking back, I believe that the unending our health system, certainly was. I count teenage years. I was ready. Bring it on! support of my family, coupled with myself fortunate that I had something planning, commitment, persistence, Well, it was certainly on, but not in the so worthwhile to focus my energies on dedication and resilience, all of which way I had been anticipating. In short, the and that I was able to turn the sourest of have enabled me to navigate my surgical COVID-19 pandemic led to the cancellation lemons into sweet lemonade. of all my planned activities for 2020. To career so far, helped me to survive this say this was a devastating blow would be potentially dark period of time. I was Mr Philip Worley FRACS a massive understatement. determined to make the best darned lemonade that I could! Instead of challenging my body, mind and spirit to complete the TDC and Italian bike Eighteen months of training later, I finally 44 Research

Inspiring students and junior doctors to incorporate research into their daily practice

The Surgical Trainee Organisation for least one peer-reviewed publication. Dr Benji Julien, JMO Dr Upuli Pahalawatta, Radiology Tanishq Khandelwal year 3 Dr Sharon Laura, Breast and General Research Central Coast Collaborative “Being involved in the Registrar medical student surgeon STORCC is unique as the chair of the CovidSurg study provided “Participating large multicentre “I was lucky enough to be involved “Ongoing research is so important in (STORCC) was founded in Gosford on me with a great insight into with the COVIDSurg team at research group is a prevocational junior research projects has introduced medicine. We are constantly gaining the Central Coast of New South Wales large multinational studies. me to protocol development and Gosford Hospital. I thoroughly new knowledge through doctor. As a regional site, surgical It was a pleasure to be able increased my understanding of enjoyed the experience of being research and using this to improve in 2016. Within two years it participated to work with colleagues clinical surgery. Being involved in part of an international multi patient care. As a clinician, it is a registrars rotate on a six- or 12-month from home and around the centre trial of this magnitude, and in its first international collaborative the ethics process has allowed me pleasure and a privilege to be a part placement. However, junior doctors world to contribute to a to efficiently apply for increasingly it gave me a great perspective of of that. I feel proud to be part of such trial: Ileus Management International study with genuine benefit complicated individual research how research is conducted at such an important large research project and students have at least a two-year for patient care worldwide”. a grand scale. I think the (IMAGINE), protocol for a multicentre, projects. STORCC has provided and enjoyed working with my mini placement. Medical students at the multiple opportunities for learning coordinators at Gosford were team on the Covid SurgWeek observational study of ileus after and teaching. The collaborative amazing at keeping us informed of project.” University of Newcastle Central Coast Dr Benji Julien, JMO Dr Upuli Pahalawatta, Radiologymodel, increasesTanishq the scopeKhandelwal of year 3 what we neededDr to Sharon do and Laura, making Breast and General colorectal surgery. In 2020 STORCC “Being involved in the medical student us aware of all the developments Clinical School in Gosford can complete Registrar resident initiated research projects surgeon was the largest Australasian site in the TheCovidSurg Royalstudy Australasian provided College“Participating of Surgeons, large multicentre and allows for“I more was luckyambitious enough to be involvedin the project ever“Ongoing since we research signed is so important in their five-year program locally, and me with a great insight into research projects has introducedprojects." with the COVIDSurg team at up. Definitely wouldmedicine. be interested We are constantly gaining CovidSurg week study, the largest ever throughlarge multinational the Section studies. of Academicme to protocol Surgery, development and Gosford Hospital. I thoroughly in getting involvednew with knowledge STORCC through historically over half return as interns It was a pleasure to be able enjoyed the experience of beingagain and I will keep a look out for surgical trial with more than 140,000 recognised the importanceincreased of supporting my understanding of research and using this to improve for a two year placement. This is due to to work with colleagues clinical surgery. Being involved in part of an international multi any other opportunitiespatient care. that mightAs a clinician, it is a patients from 116 countries. thefrom development home and around theof scientificallythe ethics processliterate has allowed me centre trial of this magnitude, andpop up in the futurepleasure!” and a privilege to be a part the Clinical School’s research project world to contribute to a it gave me a great perspective of trainees, and in 2017 establishedto efficiently the apply for increasingly of that. I feel proud to be part of such Trainee-led regional networks in General program that encourages medical student study with genuine benefit complicated individual research how research is conducted at such an important large research project Clinicalfor patient Trials care worldwide Network”. of Australiaprojects. STORCC has provided a grand scale. I think the and enjoyed working with my mini Surgery have changed the paradigm for a involvement in assisting junior doctors, multiple opportunities for learning coordinators at Gosford were team on the Covid SurgWeek and New Zealand (CTANZ). Trainee-led amazing at keeping us informed of collaborative approach to research and surgical trainees and consultants. By and teaching. The collaborative project.” collaboratives have a dual model,purpose, increases as thethey scope of what we needed to do and making have proven to be very effective globally in working together in mini teams, a strong resident initiated research projects us aware of all the developments both promote a culture of trial design, and in the project ever since we signed delivering large multicentre clinical trials. sense of camaraderie and teamwork and allows for more ambitious conduct governance at a formativeprojects." stage of up. Definitely would be interested The West Midlands Research Collaborative, is created, which adds to the positive in getting involved with STORCC surgical training. This ultimately produce again and I will keep a look out for experience for medical students any other opportunities that might founded in 2007, was the earliest surgical surgeons who are both efficient consumers participating in clinical studies. This pop up in the future!” trainee-led collaborative trials network in of research and actively involved in it. the United Kingdom. By 2016, there were program provides long-term stability for 33 documented surgical trainee research their involvement and sustainability for the As one of the earliest Australasian trainee organisations and this number continues organisation. As a regional hub, the Central led surgical trials networks, STORCC was to increase. The research collaboratives Coast has reduced access to research actively involved in the foundation of use a corporate authorship model that support and funding. The trainee-led CTANZ. STORCC is proud to report that its recognises the work of individuals who research collaboratives are independent of members contributed to the Australian contribute to the project as a PubMed traditional research funding and therefore arm of the randomised controlled trial citable co-author. STORCC now has more work particularly well in hospitals where SUNRRISE in 2020, which was supported by than 150 team members who each have at resources are limited. a successful Medical Research Future Fund grant of more than $780,000. Trainee research networks require the support of a mentor, who provides arm’s STORCC also contributed to the length guidance. As the Surgical Specialty international medical student led trials by Lead Prevocational Doctor and Central the GlobalSurgCollaborative (Global Surg3 Coast general surgery clinical academic, – Quality and outcomes after global cancer I facilitated STORCC’s development surgery: A prospective, international by focusing on its importance to the cohort study). entrepreneurial and experiential pedagogy Key research projects for STORCC in 2020 of medical student and junior doctor and 2021 include being part of a series academic education. As past chair of the Critical Literature Evaluation and Research Dr Benji Julien, JMO Tanishq Khandelwal year 3 Dr Upuli Pahalawatta, Radiology Dr Sharon Laura, Breast and General Dr Benji Julien, JMO Tanishq Khandelwal year 3 “Being involved in the medical student Committee, I identified the importance Dr Upuli Pahalawatta, Radiology Dr Sharon Laura, Breast and General Registrar surgeon “Being involved in the Registrar medical student surgeon CovidSurg study provided “Participating large multicentre “I was lucky enough to be involved “Ongoing research is so important in of providing students and trainees the CovidSurg study provided “Participating large multicentre “I was lucky enough to be involved “Ongoing research is so important in me with a great insight into with the COVIDSurg team at me with a great insight into research projects has introduced with the COVIDSurg team at medicine. We are constantly gaining research projects has introduced medicine. We are constantly gaining opportunity to apply their epidemiological large multinational studies. Gosford Hospital. I thoroughly large multinational studies. Gosford Hospital. I thoroughly me to protocol development and new knowledge through me to protocol development and new knowledge through knowledge and to develop proficiency It was a pleasure to be able increased my understanding of enjoyed the experience of being research and using this to improve It was a pleasure to be able increased my understanding of enjoyed the experience of being research and using this to improve to work with colleagues clinical surgery. Being involved in part of an international multi patient care. As a clinician, it is a to work with colleagues part of an international multi in large scale clinical trial research from home and around the the ethics process has allowed me centre trial of this magnitude, and pleasure and a privilege to be a part clinical surgery. Being involved in patient care. As a clinician, it is a world to contribute to a to efficiently apply for increasingly it gave me a great perspective of of that. I feel proud to be part of such from home and around the the ethics process has allowed me centre trial of this magnitude, and pleasure and a privilege to be a part participation, capacity to effectively study with genuine benefit complicated individual research how research is conducted at such an important large research project for patient care worldwide”. a grand scale. I think the world to contribute to a to efficiently apply for increasingly it gave me a great perspective of of that. I feel proud to be part of such projects. STORCC has provided and enjoyed working with my mini manage a local research site, and multiple opportunities for learning coordinators at Gosford were team on the Covid SurgWeek study with genuine benefit complicated individual research how research is conducted at such an important large research project amazing at keeping us informed of national leadership capability in project and teaching. The collaborative project.” for patient care worldwide”. projects. STORCC has provided a grand scale. I think the and enjoyed working with my mini model, increases the scope of what we needed to do and making coordinators at Gosford were resident initiated research projects us aware of all the developments multiple opportunities for learning team on the Covid SurgWeek management. in the project ever since we signed amazing at keeping us informed of and allows for more ambitious and teaching. The collaborative project.” projects." up. Definitely would be interested model, increases the scope of what we needed to do and making in getting involved with STORCC us aware of all the developments Dr Benji Julien, JMO Dr Upuli Pahalawatta, Radiology Tanishq Khandelwal yearagain 3 and I will keep a look outDr for Sharon Laura, Breast and General resident initiated research projects “Being involved in the medical student any other opportunities that might and allows for more ambitious in the project ever since we signed Registrar pop up in the future!” surgeon up. Definitely would be interested CovidSurg study provided “Participating large multicentre “I was lucky enough to be involved “Ongoing research is so important in projects." me with a great insight into with the COVIDSurg team at in getting involved with STORCC research projects has introduced medicine. We are constantly gaining large multinational studies. Gosford Hospital. I thoroughly again and I will keep a look out for me to protocol development and new knowledge through It was a pleasure to be able enjoyed the experience of being any other opportunities that might increased my understanding of research and using this to improve to work with colleagues part of an international multi pop up in the future!” clinical surgery. Being involved in patient care. As a clinician, it is a from home and around the the ethics process has allowed me centre trial of this magnitude, and pleasure and a privilege to be a part world to contribute to a to efficiently apply for increasingly it gave me a great perspective of of that. I feel proud to be part of such study with genuine benefit complicated individual research how research is conducted at such an important large research project for patient care worldwide”. projects. STORCC has provided a grand scale. I think the and enjoyed working with my mini multiple opportunities for learning coordinators at Gosford were team on the Covid SurgWeek and teaching. The collaborative amazing at keeping us informed of project.” model, increases the scope of what we needed to do and making resident initiated research projects us aware of all the developments and allows for more ambitious in the project ever since we signed projects." up. Definitely would be interested in getting involved with STORCC again and I will keep a look out for any other opportunities that might pop up in the future!” Surgical News | Volume 21 | Issue 3 45

Dr Benji Julien, JMO Dr Upuli Pahalawatta, Radiology Tanishq Khandelwal year 3 Dr Sharon Laura, Breast and General “Being involved in the Registrar medical student surgeon CovidSurg study provided “Participating large multicentre “I was lucky enough to be involved “Ongoing research is so important in me with a great insight into research projects has introduced with the COVIDSurg team at medicine. We are constantly gaining large multinational studies. me to protocol development and Gosford Hospital. I thoroughly new knowledge through It was a pleasure to be able increased my understanding of enjoyed the experience of being research and using this to improve to work with colleagues clinical surgery. Being involved in part of an international multi patient care. As a clinician, it is a from home and around the the ethics process has allowed me centre trial of this magnitude, and pleasure and a privilege to be a part world to contribute to a to efficiently apply for increasingly it gave me a great perspective of of that. I feel proud to be part of such study with genuine benefit complicated individual research how research is conducted at such an important large research project for patient care worldwide”. projects. STORCC has provided a grand scale. I think the and enjoyed working with my mini multiple opportunities for learning coordinators at Gosford were team on the Covid SurgWeek Dr Benji Julien, JMO Dr Upuli Pahalawatta, Radiologyand teaching.Tanishq The collaborativeKhandelwal year 3 amazing at keepingDr Sharon us Laura, informed Breast of and Generalproject.” “Being involved in the Registrar medical student what we neededsurgeon to do and making CovidSurg study provided model, increases“I was the lucky scope enough of to be involved “Participating large multicentreresident initiated research projects us aware of “allOngoing the developments research is so important in me with a great insight into research projects has introduced with the COVIDSurg team at in the projectmedicine. ever since We we are signed constantly gaining large multinational studies. and allows forGosford more ambitiousHospital. I thoroughly me to protocol development and up. Definitelynew would knowledge be interested through It was a pleasure to be able projects." enjoyed the experience of being increased my understanding of in getting involvedresearch withand STORCCusing this to improve to work with colleagues clinical surgery. Being involved in part of an international multi patient care. As a clinician, it is a from home and around the centre trial of this magnitude, andagain and I will keep a look out for the ethics process has allowed me any other opportunitiespleasure and thata privilege might to be a part world to contribute to a to efficiently apply for increasingly it gave me a great perspective of of that. I feel proud to be part of such pop up in the future!” study with genuine benefit complicated individual research how research is conducted at such an important large research project for patient care worldwide”. projects. STORCC has provided a grand scale. I think the and enjoyed working with my mini multiple opportunities for learning coordinators at Gosford were team on the Covid SurgWeek and teaching. The collaborative amazing at keeping us informed of project.” model, increases the scope of whatof weinternational needed to do and making COVIDSurg studies that resident initiated research projects usreported aware of all the on developments the optimal timing of surgery and allows for more ambitious in the project ever since we signed projects." up.following Definitely would SARS-CoV-2 be interested infection and the in getting involved with STORCC againimportance and I will keep aof look SARS-CoV-2 out for prophylactic any other opportunities that might popvaccination up in the future!” prior to elective surgery. STORCC also contributed to a Lancet publication highlighting the expected increase in global demand for cancer surgery from 9.1 million to 13.8 million procedures over the next 20 years. It warned of the need to meet a significant increase in the clinical workforce of nearly 200,000 additional surgeons and 87,000 anaesthetists globally. This study demonstrated global inequity, with cancer patients in low- and lower middle-income countries up to six times more likely to die from complications within 30 days of Above: surgery, compared to those in high-income The STORCC team includes (l–r): Amrita Nair, Ashe DeBaisio, Amanda Dawson, Log Tung La and Colby Stevenson. countries. In 2021, STORCC is proud to participate in the CTANZ supported POSTVenTT (POST operative Variability in anaemia Treatment STORCC MEMBERS A Noor, T Cordingley, M Zhang, YS Lee, and Transfusion) audit, which aims to D Abulafia, EJ Loh, K Tran, K Muir, Elizabeth Lun (current Chair) increase our understanding of variability C Stevenson. in adherence to anaemia management Andrew Drane (immediate past Chair) Medical students guidelines and to assess the impact of Colby Stevenson (founding Chair) E Devan, L Buith-Snoad, R Kaul, anaemia management in clinical care Amanda Dawson (Surgical Specialty Lead) S Thong, V Yu, C Leung, C Saab, P Lin, following major surgery. M Park, S Fitt, V Ly, B Zhu, S Sebastion, It is vital to keep the collaborative Consultants R Simpson, S Holmes, T Khandelwal, conversation going as we want to support S Laura, S Clark, S Bengeri, P Stewart, R Amoils, N Bahtigur, A Gojnich, B Macnab, a healthy and vibrant surgical academic B Munro, P Hamer, A Tchen, K Kwok, A Fatima, A Middleton, L Vance, J Gaul, community. We would love to support E Latif, K Wong, P Chen, R Poon, Z Hou, P Ireland, N Taylor, LT Lai, A A Nair, your participation in collaborative I Gunawardena, R McGee, D Wong, B Short, V Thirugnanasundralingam, J Wong, research – let’s chat. LH Le, A Dawson. HJS Jun, R Hengpoonthana, XM Woon Shoo Tong, B Blackman, G Dennis, JMO and registrars L Charman, C Chu Wen Lo, A Mozes, H Han A Drane, E Lun, K Tree, U Pahalawatta, J Ma, Associate Professor Tan, E Wall, A Au, I Deng, J Myooran, B Lim, H Narroway, T Ewington, K Chew, C Zhang, Amanda Dawson FRACS J Phan, A Yeoh. A DeBiasio, I Liang, V Lee, TY Ngan, J Kane, S Khanijaun, H Luo, P Ghosal, D Steiner, E Taylor, A Chong, B Buckland, S Van Ruyven, M Kaufman, C Parkin, H Cheah, S Miles, S Somasundran, W Ziaziaris, B Julien, D Jolly, B Mortimer, 46 ASOHNS

Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS) Annual Scientific Meeting

17–19 September 2021, Melbourne, Victoria, Australia

The Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS) Annual Scientific Meeting (ASM) is the premier education and networking event for the Otolaryngology Head and Neck Surgery community in Australia. This year marks the 71st anniversary of the Society’s Annual Scientific Meeting. With the restrictions of COVID-19 felt locally, nationally and internationally, ASOHNS intends to hold a physical meeting in Melbourne, welcoming most delegates in person, and providing a strong virtual connection to their overseas colleagues. Their rapid pivot to a fully online meeting in March 2020 provided the expertise and wisdom Dr Kate Heathcote Dr Sujana Chandrasekhar to administer a high-quality virtual Dr Chandrasekhar attended medical Having completed her ear, nose and attendance option. school at Mount Sinai School of Medicine throat (ENT) training, she undertook a The attendance of two keynote sponsors in New York City, graduated at the age six-month Fellowship with Professor is made possible by the support of the of 22, and completed her residency in Jean Paul Marie in Rouen, France where Royal Australasian College of Surgeons Otolaryngology-Head and Neck Surgery she trained in pioneering techniques (RACS): Dr Sujana Chandrasekhar, at New York University Medical Center of laryngeal reinnervation. She went an otologist/neurotologist from the in New York. She then completed her on to complete a further Fellowship at United States, and Dr Kate Heathcote, a Fellowship in Otology and Neurotology at the Royal National Throat Nose and Ear consultant laryngologist from the United the House Ear Clinic and Institute in Los Hospital in London before taking up her Kingdom (UK). Both speakers will present Angeles, California. consultant post in Poole. on a range of topics including updates in Dr Chandrasekhar served on the full-time Dr Heathcote established the Centre for neurotology, changes to guidelines and academic faculty of both the University Airway Voice and Swallowing in 2013 and pathways to leadership in otolaryngology of Medicine and Dentistry of New Jersey has worked to develop it as a cutting-edge as well as updates in laryngology. Medical School and Mount Sinai School of centre offering advanced techniques to Dr Chandrasekhar practises in New York Medicine, before entering private practice NHS patients. As well as multidisciplinary City and Wayne, New Jersey, and has a in New York City in October 2004. She is voice clinics, the centre runs treatment passion for ear and balance patient care currently Director of Neurotology at the clinics using transnasal techniques and as well as teaching, humanitarian work, James J. Peters Veterans Administration diagnostic clinics in conjunction with and developing leadership skills and the Medical Center, Otologist/Neurotologist gastroenterology. empowerment of others. at the New York Head and Neck Institute, Since returning from France, she has Elected by their 12,000 members in Clinical Professor at Hofstra-Northwell worked at introducing techniques of August 2014, Dr Chandrasekhar is the SOM, Clinical Associate Professor at Icahn reinnervation to the UK and disseminating president-elect of the American Academy SOM, and holds staff privileges at several the techniques globally via courses and of Otolaryngology-Head and Neck Surgery New York and New Jersey hospitals. conferences. Working with colleagues (AAO-HNS) and the third woman and the The second speaker, sponsored by at Southampton Children’s Hospital, first person of Indian descent to hold RACS, is Dr Kate Heathcote, a consultant Dr Heathcote has established a that office. She previously served as chair laryngologist at the Robert White Centre national centre for paediatric laryngeal of the AAO-HNS Board of Governors and for Voice, Airway and Swallowing in Poole reinnervation. Dr Heathcote is on the is secretary-treasurer of the American Hospital National Health Service (NHS) council of the British Laryngological Otological Society. Foundation Trust in the UK. Association and the scientific committee of the European Laryngological Society. Surgical News | Volume 21 | Issue 3 47

Status quo remains in Tasmania

The Gutwin Government has been re- The statement provided background state election to be held this year, with elected in Tasmania and will govern in information on each of these issues and governments also being easily re-elected majority after winning 13 of the state’s then posed a series of questions. To view in Queensland and in Western Australia. 25 House of Assembly seats. RACS’ Tasmanian election statement, There are no more state or territory The remaining 12 seats will be held by the as well as responses from the Liberal elections scheduled for 2021. However, it Labor Party (nine seats), the Greens (two and Labor parties, please visit the RACS is anticipated that an Australian Federal seats) and newly elected Independent MP website. election will be held either late this year Kristie Johnson. Following the election, it was announced or early next year. Before the 1 May poll, the Royal that the state’s new Health Minister will Once a federal election is called, RACS Australasian College of Surgeons (RACS) be the Deputy Premier, the Honourable will once again send a national election Tasmanian Committee sent an election Jeremy Rockliff. RACS congratulates statement to all major parties contesting statement to the major parties. The Minister Rockliff on this appointment. The the election. If you would like to find out statement identified six key focus areas Labor Party Shadow Minister for Health is more, or to suggest key topics that you relevant to surgery. These issues were: Bastian Seidel. would like the College to raise prior to the Over the next four years, the committee election, please contact the RACS Policy • Compliance management and research and Advocacy team at racs.advocacy@ at the Tasmanian Health Service will continue to meet and work with the government and the opposition surgeons.org • Elective surgery waiting lists to progress issues of public health, • Rural health particularly those raised in the election statement. • Tasmanian Audit of Surgical Mortality The Tasmanian election was the third • Use of the title ‘surgeon’

Ascend Surgical and Medical is an Australian owned company supplying surgical and medical technologies to the Australian Healthcare Industry. As the exclusive distributors for STILLE surgical instruments in Australia, we look forward to providing our customers with this premium range, with the renowned 30 year warranty and the best after sales service and support. STILLE produces the finest, hand crafted surgical instruments in the world meeting the highest 17-19 September 2021 demands of surgical perfection. Melbourne Convention and Exhibition Centre, Melbourne, Victoria To learn more about the famous STILLE range, please contact Including the Otorhinolaryngology Head and Neck Nurses Group Inc. 24th National Conference us on 1300 784 893 or [email protected] or visit the Stille Page on our website at https://www.ascendsurgical.com.au/ The ASOHNS ASM is excited to present our keynote speakers for 2021 stille-surgical-instruments/ Dr Sujana Chandrasekhar Professor Marci Lesperance Otologist/neurotologist, New York Professor of Otolaryngology-Head Eye and Ear Infirmary of Mount and Neck Surgery - University of Sinai - The Mount Sinai Hospital Michigan, Mott Children’s Hospital, Ann New York, USA Arbor, USA

Kindly supported by the RACS Visitor Grant Program

Ms Kate Heathcote Dr Kris Moe Consultant Otorhinolaryngologist - Board certified surgeon - UW Medical Poole Centre for Voice, Airway and Center and Harborview, Chief of UW Swallow, Poole Hospital Facial Plastics and Reconstructive Dorset, United Kingdom Surgery, UW Professor of Head and Neck Surgery and Neurological Kindly supported by the RACS Visitor Grant Program Surgery, Seattle, USA

Early registration is open for the ASOHNS ASM 2021. For further information and to register, please visit asm.asohns.org.au 48 Education activities

Education activities The Professional Development Program aims to support surgeons in aspects of their professional life, encouraging professional growth and workplace performance. Life-long learning through professional development can improve our capabilities and help us to realise our full potential as surgeons as well as individuals.

Face-to-face courses

Course Date Region Clinical Decision Making Wednesday 14 July Brisbane, Queensland Wednesday 18 August Melbourne, Victoria Conflict and You Thursday 5 August Brisbane, Queensland Foundation Skills for Surgical Educators Thursday 15 July Melbourne, Victoria Saturday 31 July Perth, Western Australia Non-Technical Skills for Surgeons (NOTSS) Friday 30 July Auckland, Aotearoa New Zealand Operating with Respect Thursday 1 July Adelaide, South Australia Thursday 8 July Christchurch, Aotearoa New Zealand Friday 16 July Canberra, Australian Capital Territory Thursday 12 August Melbourne, Victoria Friday 20 August Sydney, New South Wales Process Communication Model: Seminar 1 Friday 25 June Auckland, Aotearoa New Zealand Process Communication Model: Seminar 2 Friday 6 August-Sunday 8 August Brisbane, Queensland Promoting Advanced Surgical Education Friday 30-Saturday 31 July Sydney, New South Wales Surgeons as Leaders Friday 6 August-Saturday 7 August Sydney, New South Wales Wednesday 25 August-Thursday 26 August Broome, Western Australia Writing Medico Legal Reports Wednesday 21 July Sydney, New South Wales Tuesday 24 August Melbourne, Victoria

Online courses

Course Date Leading Out of Drama Tuesday 15-Thursday 24 June Educator Studio Session featuring Dr Bryan Ashman on ‘Old dogs, new tricks: what motivates Wednesday 23 June experienced surgeons to learn new surgical techniques’ Conflict and You Thursday 29 July Educator Studio Session featuring Dr Bryan Ashman on ‘Narcissism or empathy: should Wednesday 4 August personality traits be assessed prior to selection for surgical training?’

For more information email [email protected] or visit our website surgeons.org/education/professional-development Surgical News | Volume 21 | Issue 3 49

Access to safe, quality healthcare has never been more important November Annual Academic Surgery Conference 2021 The Surgical Research Society of Australasia would like to If the Foundation for Surgery can raise $300,000 from invite abstract submissions for the upcoming November compassionate colleagues by 30 June, every dollar you Annual Academic Surgery Conference. give will now have five times the impact! Date: 4 November 2021 Please donate now and invest in building the surgical Location: SA State Office, 24 King William Street, Kent capacity of our nearest neighbours to save the lives of Town, SA. children, families and communities. Abstracts open: 1 July 2021 Abstracts close: 31 August 2021 COVID, cyclones and flooding have dramatically increased their need, and they urgently need your help. For more information: Access to adequate healthcare has never W: tinyurl.com/NAASC2021 been more critical. E: [email protected] T: +61 8 8219 0900 Please make a tax-deductible donation #SAS2021 #NAASC2021 today at www.surgeons.org/donations

Early SAVE THE Registration DATE and Abstract USANZ Submission VICTORIAN Now Open SECTION MEETING FRIDAY 22 OCTOBER 2021 Melbourne, Victoria

The 3SCTS 2021 is now accepting abstracts. To submit an abstract for consideration by the Organising Committee, visit the Symposium website at www.3SCTS.com.

Platinum Sponsor Key Dates Abstract Submission Deadline: Friday 30 July 2021 Abstract Notifications to Authors: Friday 20 August 2021

Closure of Early Registration: Sunday 17 October 2021 Symposium Supporter www.usanz.org.au 50 The surgeons of Vanity Fair

Sir Morell MacKenzie: Disease of the throat (7 July 1837-3 February 1892)

Kt. MRCS LSA (MRCP)

gig while visiting patients, never regaining by Manuel Garcia in 1855. consciousness. From that time MacKenzie specialised, At 16, Morrell MacKenzie became a clerk proposing a hospital for Diseases of in the City of London, still dreaming of the Throat. Sir James Paget declared entering the medical profession and that he might as well found a Hospital attending evening classes in natural for Diseases of the Great Toe. The history and chemistry at King’s College. laryngoscope was ridiculed as a toy, His maternal aunt lent him money for declared to be useless, and The Lancet his fees, and he enrolled as a medical observed, ‘without its use, throat student at the London Hospital where diseases were perfectly well treated by subsequently he was described as one every general hospital in London’. of its most distinguished pupils, winning Singing and public speaking interested the Senior Gold Medals for Surgery and MacKenzie, who said, “without an Clinical Medicine. artistic enunciation sound loses one In 1858, MacKenzie took the then usual of its greatest charms”. He published examinations for ‘College and Hall’ his lectures to doctors in the form of diplomas, Membership of the Royal pamphlets, such as the 1863, On the College of Surgeons (MRCS) and Licentiate Treatment of Hoarseness and Loss of Voice. of the Society of Apothecaries (LSA). The correct practice then, as now, was On qualifying, he was appointed House for a consultant to see only such patients Sir Morell MacKenzie Surgeon at the London Hospital. as were referred to him by another Sir Morell MacKenzie was Vanity Fair’s Again, assisted by his aunt, he spent a doctor and not to retain them as his own ‘Man of the Day’, No. 387: his caricature, year in Paris followed by a year in Vienna patients. MacKenzie, however, had no entitled Disease of the Throat, the work and Budapest. In 1859, fate intervened qualms in accepting and treating the of Carlo Pellegrini, ‘Ape’, appeared on 15 when he encountered Professor Johann numerous patients who came to him October 1887. Czermak, and the laryngoscope, invented directly, in addition to accepting medical Vanity Fair noted that he, ‘took to looking referrals, which explains some of the down people’s throats for guineas. His British medical profession’s antipathy success in private practice was great towards him. and immediate, and in a few years after In 1862, he founded the free dispensary setting up, he could give to physicians for ‘Diseases of the Throat and Loss of who had been established a lifetime, Voice’, which in 1865 moved to larger a score of patients and a beating. He premises in Golden Square, previously became a specialist. Sir Morell has long the London Homeopathic Hospital. been the physician and friend of all MacKenzie renamed it ‘The Hospital singers and actors.’ for Diseases of the Throat’. In 10 years, Morell descended from the Highlands it treated almost 38,000 outpatients Scottish family of MacKenzie in Ross- and 949 inpatients. It also achieved a shire: his father was Dr Stephen reputation for postgraduate teaching McKenzie, a general practitioner in unsurpassed in Europe, involving more Leytonstone, Essex, then a country village than 2300 medical graduates. on the edge of London. In 1863, he married Miss Margaret Bouch, Born on 7 July 1837, the eldest of eight who was to become the mother of two children, Morell proved to be a delicate sons and three daughters. In 1864, he child. He was earnest and reflective, and passed the examination for Membership his early education was interrupted by of the Royal College of Physicians (MRCP). illness. At 14, Morrell was called out of Morell MacKenzie’s first book,The Use of school and taken home to find his father the Laryngoscope in Diseases of the Throat, dead: his father had been thrown from his Surgical News | Volume 21 | Issue 3 51 was published in 1865. This was later Highness Frederick, the Crown Prince critics and earned him the censure of the followed by the two volumes of Diseases of Germany, reason unspecified. On his Royal College of Physicians. of the Throat and Nose. The first volume arrival, the German medical staff, none Between 1888 and 1892, MacKenzie fell was published in 1880 and the second in of whom were laryngologists, submitted easy prey to various illnesses, including 1884. that the Prince had throat cancer and influenza and his old enemy, asthma. In 1870, aged 33, MacKenzie moved to required an immediate laryngectomy. He passed his nights dozing in a sitting 19 Harley Street, where on the ground MacKenzie’s laryngoscope next confirmed posture and his sleep was always broken: floor there were consulting rooms, a a tumour involving the left vocal his former exuberant energy disappeared. laboratory and dispensary, and a huge cord. However, in an early example of He died suddenly at just 54 years of age on waiting room. On the first floor, drawing evidence-based medicine, he insisted on 3 February 1892, and was buried near the rooms stretched right across the house; confirmatory histopathology. On three country home he loved, in the churchyard MacKenzie said to his wife, “My dear, occasions MacKenzie resected as much of St Mary’s Church, Wargrave, close to now you have a new duty in life, fill these of the tumour as he could, however, each the river Thames. rooms!” The couple soon became known time the eminent pathologist, Professor for dinner parties attended by the most Rudolf Virchow, opined that the tissue Mr Peter F Burke famous actors and opera singers of the obtained contained no neoplastic element. FRCS FRACS DHMSA day, although MacKenzie was seldom A month later, Frederick attended the present. London celebrations for the Golden MacKenzie’s medical practice in the 70s Jubilee of his mother-in-law, Queen and 80s was said to be the largest in the Victoria: MacKenzie was knighted in This page: world. By the 1880s, he was earning September of that year by the Queen for (L-r) The Crown Prince Frederick; Frederick the Noble Fig. upwards of £15,000 a year. His usual his services to medicine and Frederick. 21, c) tracheostomy d) false passage e) pre-sternal abscess; fee was two guineas, operations were Frederick the Noble, bookcase; Ape caricature Disease of the However, Throat, 15 October 1887. infrequent and on a minor scale. the tumour MacKenzie dictated all his continued to correspondence to his amanuensis, and grow, and either although he purchased one of the first a tuberculous typewriters to cross the Atlantic, this or syphilitic was soon abandoned, due to patients’ aetiology was complaints regarding the ‘impersonal also queried, the appearance’ of typescript. latter favoured. At the 1884 International Congress of In February 1888, Frederick almost died Medicine in Copenhagen, MacKenzie of asphyxia and an urgent tracheostomy was elected President of the Inaugural was undertaken by an inexperienced Section of Laryngology. German surgeon. Subsequently there were many problems with management On 18 May 1887, MacKenzie received of the cannula, culminating with the a message requesting that he proceed digital formation of a false passage to Berlin urgently, to see His Imperial resulting in a pre-tracheal abscess. The unfortunate Frederick died on 15 June 1888, with MacKenzie observing, ‘thus passed away the noblest specimen of humanity it has ever been my privilege to know’. The autopsy confirmed cancer. Over this period there had been great antagonism between MacKenzie and his German ‘colleagues’: MacKenzie recorded his account of the case in 1880 with The Fatal Illness of Frederick the Noble, which not only created a sensation but was condemned by MacKenzie’s many British 52 Fellow contribution The value of surgical mentors – academics

Part II OPUS LXIX “We make a living by what we get, but we make a life by what we give.” –Winston Churchill

Bill Manchester Bob Thomas Gordon Clunie Bob Marshall

In those post-Madrid days in 1972 after scene on Benny’s suggestion created the focus of lavish entertainment with Professor Bill Manchester of Auckland a mental quandary at a crossroad in many international personalities. Even University had acknowledged my my career. Benny was right when he John Hueston was a guest there before Angiotome concept, my wife Mariette suggested I was being used there, which I arrived. Ian regarded me as a type of and I entertained Bill and his wife over led to my return to Melbourne and to inexperienced sommelier to select the Dover Sole and Chablis at a restaurant marriage. The Antipodes has been very French wines for his black-tie dinner in Piccadilly, London. There I gleaned kind to me ever since. And now I can look exploits entertaining hospital CEOs information about his surgical style and back askance at Samuel Johnson’s words to international surgeons – a trend I his perfectionist traits. Bill was really the of 1777: ‘when a man is tired of London, continued on my return to Melbourne but Benny Rank of New Zealand and a recently he is tired of life’. with my wife’s French cuisine. published biography by Earle Brown and One of the first surgical minds was In an earlier article of Surgical News, titled Michael Klaassen is titled Perfection. The Professor Gerald ‘Charlie’ Westbury from Canons of Plastic Surgery, I reflected on basic mantra of the Buddhist philosophy the Westminster Surgical Head and Neck my plastic surgical mentors. Now I will is a repeated chant seeking perfection – Unit. A protégé of Sir Stanford Cade, who focus on the influence of my academic Bill’s mantra. escaped the Bolsheviks in 1917 without associates in my career. Our mentors selected us as protégés, a word of English and became Vice Professor Emeritus Gordon Clunie had really as a mirror of their own President of the Royal College of Surgeons a background in the academic world in personalities, to become plastic surgeons. (RCS). Charlie reflected a survivalist style the Department of Transplant Surgery If they liked us, they invited us into of Sir Stanford’s that no problem was too at the University of Queensland, having the fold, as we do likewise for the next big and no incident too insignificant to emigrated from Edinburgh in 1968. Sam generation of surgeons. The axiom that ignore, as noted before. Mellick recalled to me how this Scottish knowledge, when based on experience, Ian Wilson is the next branch of the family left Edinburgh at -4C to arrive in creates wisdom is implied. However, with mentoring tree, a product of the Scottish Brisbane to 34C. Gordon achieved his the newer generation’s selection process surgical fraternity from Edinburgh Edinburgh Fellowship in 1963 and his involving submitting numerous papers University, having worked under five academic style in teaching and research and presentations to increase their point surgical knights there. He moved onto reflecting the Scottish surgical tradition score, their clinical perspectives are the London scene as the Head and Neck – they call Edinburgh ‘the Athens of the harder to assess. And who gives a bad Surgeon between Westminster, the Royal North’. Gordon became Director reference to anyone? Marsden and St George’s hospitals. In his of Surgery at the Royal Melbourne My London experience over a three-year house in Chelsea, where I used sometimes Hospital (RMH) after Professor Maurice period stands out remarkably from a to be his security tenant while he was Ewing, who arrived from London’s mentoring viewpoint. Leaving the London on overseas lecture tours, his home was Hammersmith Hospital. Prince Henry Surgical News | Volume 21 | Issue 3 53

Hospital in 1937 was to become this arrangement emerged, Dick some clinical perspective to his text. the Hammersmith in the Antipodes, Bennett, as the Director of Surgical My Angiotome concept, where if there according to the late Don Marshall’s Oncology, wanted it under his is a nerve supply there must be a blood recollections. But the war said no. domain and not a subspeciality in supply. This has an embryonic basis, keeping with world trends. I agreed which he acknowledged. I think I recall During those early years in reconstructive wholeheartedly, relinquishing any Head him saying, “Felix, we are on the right surgery, I would see Gordon regularly to of Unit terminology. Subsequently David tram.” My initial meeting with Bob was discuss ideas for the Australia and New Speakman, Michael Henderson and the at the College course for the Primary in Zealand Journal of Surgery (ANZ Journal), chemotherapist Grant McArthur have 1967, where he was stylishly groomed of which he was editor at the time. He created an International Centre for in a beige linen suit, straight out of Hardy would assiduously read every article Melanoma Treatment, at Peter Mac. Amies in Saville Row. Yes, he took his coat that came across his desk. As a primary off in the 35C heat and gave off the cuff mentoring source, his advice was always My earlier clinical experience in the best description of the muscles of the crisp and synoptic: “Felix, if you have melanoma began as a student in Brisbane back I can recall. got something new to say get off your under Neville Davis and Professor Les derriere and get it into print.” His other Hughes. Their rule of thumb was simple: Finally, as a gourmet king I always major observation to me was in relation ‘level I melanoma, one centimetre remember his concertinaed style of to integrity in publishing: “If you publish clearance; level II, two centimetres; level organising mussel shells. (Guess who locally, you will own it.” This must have III, three centimetres’. Umpteen papers now does this now every time he eats reflected his experience overseas as an keep surfacing regarding such excisional mussels?) This technique reflects his editor, referring indirectly to plagiarism or dimensions, including fascia, but Neville organisational mind and is a mirror of his scientific poaching (a future publication). Davis introduced me to the importance surgical skills. of excising fascia as a trilaminate factor Professor Bob Thomas was another Finally, on planning retirement, his in management. Additionally, closing academic associate and was Professor of decision was simple: “Felix, it doesn’t a large defect aesthetically with the Surgery at the Western Hospital before take a clever mind to pay $15,000 keystone flap fulfils the requirements becoming Director of Surgical Oncology indemnity insurance while your income is of oncological management and artistic at the Peter MacCallum Cancer Institute $12,000.” Amen Bob, I loved your mind. closure. (my alma maters). Fortuitously, he was Let's not forget what Mozart did in I now conclude with some recollections also another Editor of the ANZ Journal. He composing his string quartets after on Professor Bob Marshall, who taught advised me, when discussing my initial leaving Haydn at the Estherházy me politics and wisdom. David Scott keystone publication in 2003 saying, estate: he dedicated his compositions recently reminded us that each of the “This new concept will have far-reaching accordingly – I do likewise to my surgical Marshall clan - Bob, Vernon and Don – implications and you should be the single mentors. author.” Thank you Bob for your editorial were Heads of Department individually at Associate Professor input (at present the National Library the former Prince Henry’s Hospital. Just Felix Behan of Medicine, Maryland, United States of as Hammersmith was severely damaged America lists 187 keystone publications). in a World War II air raid, similarly Prince Henry’s would also succumb, but to the Professor Dick Bennett came from the wreckers ball in 1994. Grey Turner, the Department of Surgery at St Vincent’s to President of the RCS, gave the College his the Peter MacCallum Cancer Institute and A correction, with thanks to Irwin oak table, as he had no children to pass it was also another ANZ Journal Editor. Faris: Maurice Ewing came from the down to. Hammersmith and Felix Eastcott came My own career at Peter MacCallum Bob’s textbook, Living Anatomy, is from St Mary's, having graduated at the began 40 years ago in the field of head merely a conversational piece, painting Middlesex University. Again, this correction and neck surgery under Brian Fleming, a picture of living anatomy not unlike elucidated the fact that DeBakey did the while my Plastic Surgery career focussed Last’s publication. Gray’s tome now has first endarterectomy – unpublished. on melanoma. It was intriguing to become volumetrically a doorstop. Bob hear Brian’s comments over morning puts applications into Living Anatomy and tea (which I made), quoting from RMH his subtitle, ‘structure as the mirror of Board meetings about Gordon Clunie, function’, harkens back to Wolff’s Law of who was held in awe because ‘what 1892. Gordon wanted Gordon got’. Gordon even allocated research funds to Brian to Geoff Kenny, the anatomist from Brisbane publish his series of parotidectomies. and subsequently Melbourne, introduced me to this concept of structure and At Peter MacCallum I was instrumental Living function, where historic principles keep in establishing the first multidisciplinary Anatomy resurfacing. by combined consultative melanoma Professor clinic with radiotherapist Jill Ainsley Bob personally delivered his book to my Robert and chemotherapist Michael Millwood. rooms one Friday afternoon and noted Marshall When the clinical significance of that the way I thought anatomically gave REGISTER NOW https://tinyurl.com/P4PMelbourne21

PREPARATION FOR PRACTICE MELBOURNE WORKSHOP 21-22 AUGUST 2021

BUILDING BLOCKS FOR STARTING CPD FOR FELLOWS OUT IN PRIVATE PRACTICE This educational activity has This two day workshop will provide surgeons, final year been approved in the RACS CPD Program. Fellows who participate trainees and practice managers with information and can claim one point per hour in practical skills to set up and manage private practice. Maintenance of Knowledge and Skills. LEARN ABOUT: - Issues involved in setting up private practice. VENUE - Practical strategies and tools for practice operations. RACS - Melbourne 250-290 Spring Street - How to develop a practice framework and improve Melbourne East, 3002 practice performance Contact: - Managing practice staff, staff contracts and Victorian State Office employment relations P:9249 1254 E: [email protected] https://www.surgeons.org/about-racs/racs-offices/victoria Surgical News | Volume 21 | Issue 3 55

QASM Annual Seminar 2021 Surgery – Timing is Everything

The Queensland Audit of Surgical Mortality • Dr Jill O’Donnell (Queensland, Vascular Visit the QASM seminar Eventbrite link (QASM) 2021 annual seminar will be held Surgeon) to register your interest in attending: on Thursday 18th November 2021 at the • Mr Neil Wetzig (Queensland, General https://www.eventbrite.com.au/e/ Sunshine Coast Health Institute (SCHI), Surgeon) qasm-seminar-surgery-timing-is- located at the Sunshine Coast University everything-tickets-154504592395 Hospital (SCUH), 6 Doherty Street, • Prof Marianne Vonau (Queensland, Birtinya, Queensland 4575. Neurosurgeon) If you have any questions about this event, please contact the QASM team at A live webinar is also available for those • Mr David Stoney (Queensland, General [email protected] unable to attend in person. For those Surgeon) attending at the venue, there will be • Mr Sanjeev Naidu (Queensland General limited tickets to two live sessions in Surgeon, Queensland State Committee) the SCHI’s Simulation Rooms (12.30pm during the lunch break and 3.30pm after the seminar closes). The Live Simulation Parking will be available on the SCUH Sessions will be streamed into the campus with approximately 3,500 car auditorium and via the webinar. parking spaces (P1 and P2) designed with sufficient capacity to accommodate the Confirmed speakers include parking requirements of all staff, students • Dr Manimaran Sinnathamby (Northern and visitors. The daily fee is $15.60 Territory, General Surgeon) (accurate at the time of publishing). • Graham Reeks and Melissa Fox (consumer representatives) 56 Research

Case note review

Tragic outcome from prosthetic joint infection

A patient in her early 70s had an elective The patient was transferred to hospital Enterobacteriaceae) and Pseudomonas. right total knee replacement (TKR) C for further assistance from their Despite optimal antibiotics (as for severe osteoarthritis at an outer Orthopaedic unit and for an opinion from per infectious diseases advice and city hospital (hospital A). There were Plastic Surgery about possible wound debridement cultures) the patient comorbidities of obesity (BMI 40) and coverage. This transfer was delayed continued to deteriorate. General hypertension. On postoperative day five for three days due to a bed shortage. medicine and dietitian reviews were she was transferred to hospital B for After another three days, the patient ongoing. Difficulties with oral intake and rehabilitation. She remained afebrile but was transferred back to hospital A, as malnutrition resulted in nasoenteric tube some ongoing wound ooze, thought to the hospital C Orthopaedic team were feeding and later a post-pyloric tube be cellulitis, was noted and treated with not happy to treat an infected TKR. No was placed via endoscope. The patient dressings followed by cephalosporins. procedure was undertaken at hospital C. required intensive care unit admission. Eleven days later she was transferred Staphylococcus epidermidis was grown There was consensus between back to hospital A due to persistent after a further repeat washout and poly orthopaedic and plastic consultant bleeding and possible septic arthritis. She exchange at hospital A. Two days later, surgeons to proceed to above knee underwent washout and poly exchange, Clostridium difficile was grown from faecal amputation at a little over two months although the wound was unable to be samples and three days after that Candida following the original TKR. There were closed, with ongoing intravenous infusion species were grown from urine samples. a further five washouts and revision of cephazolin. Wound cultures resulted in The patient was treated with vancomycin amputations, with a delayed primary no bacterial growth. and metronidazole. closure at three weeks following the Two days later there was a repeat The following day the patient was patient’s initial amputation. Two weeks washout and vacuum-assisted wound transferred to hospital D through later, she suffered a pulmonary embolus closure (VAC) dressing change. Further the registrar, with no consultant and commenced therapeutic heparin. Two wound cultures still resulted in no communication taking place. On arrival days after that, she had severe abdominal bacterial growth. Another washout at hospital D, the patient was noted to pain. The patient was reviewed and was and VAC dressing change occurred two be malnourished with low albumin. The thought to have a duodenal or colonic days later, with no wound cultures next day, she underwent removal of all perforation but was not considered an undertaken. Five days later there was implants, extensive debridement and operative candidate. Palliative care was a further washout and VAC dressing insertion of a static antibiotic cement started, and she died four days later. change. This time, Corynebacterium spacer due to extensive infection and a Comment tuberculostearicum, Staphylococcus large soft tissue defect down to necrotic This case demonstrates the difficulties haemolyticus and Staphylococcus bone. She had three further washouts, in diagnosis and management of a epidermidis were grown, resulting in debridements and VAC dressing changes prosthetic joint infection, and the intravenous vancomycin being added to every three or four days. There was problems with accessing detailed intravenous cephazolin. growth of ESBL enterobacter (extended- information from case notes that are a spectrum ß-lactamase producing Surgical News | Volume 21 | Issue 3 57 mixture of paper and electronic records There was no record of any difficulty or from four different hospitals. The records otherwise with insertion. There was no from hospitals A, B and C contained record of an autopsy. few consultant notations. In a case like ANZASM Clinical Directors’ comment this, where a serious and prolonged In situations where infection of a joint complication of sepsis has occurred prosthesis is suspected, antibiotic following an elective procedure, there therapy without concomitant early would have been numerous consultant- aggressive surgical treatment greatly to-consultant conversations about the impairs the likelihood of successful patient. It would help if more attention treatment. Protocols should be in place was paid to notation of such discussions. that facilitate communication between There was a delay in the diagnosis transferring institutions for effective of a prosthetic joint infection. Poor management of suspected joint communication by the Orthopaedic team infections to ensure early transfer at hospital A led to the unnecessary of patients back to their treating transfer to hospital C and therefore surgical doctor (or Centre of Expertise) further delay in treatment. At hospital for provision of appropriate surgical D, there appeared to be better care. Consultant-to-consultant documentation and more consultant communication is imperative input, although ongoing sepsis remained throughout. despite multidisciplinary efforts to manage this. Professor Guy Maddern, It is unclear whether the patient’s Surgical Director of abdominal pain (said to be due to bowel Research and Evaluation perforation) was related to insertion of incorporating ASERNIP-S a post-pyloric tube under endoscopy.

ACT Annual Scientific Meeting 2021 Advancing Operative Techniques – Improving Your Skills

Friday 27 August 2021 National Museum of Australia, Acton, Canberra ACT

Conveners Invited Speakers Registrations and Abstracts Now Open

Dr Hari Bandi Professor Michael Solomon Mr Stephen Halcrow Registrations and abstract submissions are now open for the FRACS Recipient of the Henry Neurosurgeon (retired) ACT ASM 2021. Co-Convener Windsor Lecture 2021, Professor of Surgical Professor Antonio Di Ieva To register, visit: Research, University of Professor of Neurosurgery - www.tinyurl.com/actasm2021 Sydney, Academic Head, Macquarie University Department of Colorectal Dr David Surgery, RPA To view the provisional program, visit: Rangiah Mr Duncan Stevenson Honorary Associate www.tinyurl.com/act21program FRACS Professor Jeffrey Hamdorf Professor, Research School of Co-Convener AM Computer Science Director, Clinical Training and Call for abstracts for verbal and poster presentations are now open and must be submitted by 1 July 2021. To submit, visit: Evaluation Centre Dr Hazel Serroa-Brown Professor of Surgical 2021 ACT RACSTA www.tinyurl.com/act21abstracts Education Representative A breakfast session will be offered pre-meeting, sponsored by Professor Paul Smith AM Minister Rachel Stephen- The Bongiorno Group. ACT Orthopaedic Surgeon Smith - OrthoACT, Director of ACT Minister for Health Orthopaedic Surgery The meeting will be followed by a dinner at Sage Dining Rooms, To award the Educator of the Gorman House. Tickets are now available, register online on Ms Kate Burgess Year and Outstanding Service www.tinyurl.com/actasm2021 Senior Program Coordinator, to the Community Professional Standards, RACS Thank you to our Gold Sponsor 58 Scholarships and grants

Scholarships and Grants Program

Learning and Development grant opportunities open in For SET Trainees August 2021 for 2022 activity. Indigenous Program – SET Trainee One Outcomes advised in November 2021. Year Scholarship $20,000 each (up to three scholarships given)

Are you interested in pursuing For Fellows May fund SET registration fees, SET course professional development, training fees, SET examination fees, research or a short-term research activity with Morgan Travel Fellowship projects, mentoring programs, travel the support of a RACS Learning and to attend conferences and/or relevant $11,000 Development grant? professional development activities. The Scholarships and Grants Program Supports travel to gain clinical experience Who can apply? Aboriginal, Torres Strait 2022 Learning and Development round or conduct research. Islander and Māori SET Trainees will open for application in August 2021. Who can apply? Early-career – RACS Poate Family Plastic & Reconstructive RACS, through the Foundation for Surgery, Younger Fellows Surgery Travel Grant is one of the largest funders of surgical research and education worldwide. Bongiorno National Network Younger $1500 The Scholarships and Grants Program Fellows Travel Grant Supports travel to obtain further supports surgeons and other health $10,000 training and experience in plastic and professionals to learn, facilitate change reconstructive surgery and improve the quality of surgical care Supports post-Fellowship studies and and practice in Australia, Aotearoa New furthering surgical experience overseas. Who can apply? Plastic and Reconstructive Zealand and the Asia-Pacific region. Who can apply? Early-career – RACS SET Trainees Learning and Development activity is Younger Fellows usually undertaken over weeks or some COVID-19 impact on months within the grant calendar year, Rural Surgery Fellowship for Provincial with funds paid directly to the recipient at Surgeons scholarships and grants the beginning of the year. $10,000 each (up to three Fellowships given) Given the continued challenges of COVID-19 and its impact on travel, We encourage applications from Supports regional and rural surgeons Learning and Development grants for Aboriginal and Torres Strait Islander, to travel and develop existing skills or 2022 that allow for ‘overseas’ activity Māori and female applicants as we acquire new skills. will include travel from Australia to support RACS’ focus on: Who can apply? RACS Fellows – Aotearoa New Zealand and vice versa, • removing barriers to the participation non-metropolitan with preference given to activities that of women in surgery can be undertaken in either country. Medtronic Younger Fellows Travel Grant • continuing and enhancing initiatives Applicants who wish to travel designed to increase the participation $7500 each (up to two grants given) internationally will need to substantiate of Aboriginal and Torres Strait Islander why the activity cannot be undertaken and Māori doctors in the practice of Supports post-Fellowship studies and in Australia or Aotearoa New Zealand surgery. furthering surgical experience overseas. and that their reason to travel has been Please visit surgeons.org/scholarships to Who can apply? Early-career – RACS confirmed (for example a conference is read the Scholarships and Grants Program Younger Fellows proceeding). conditions and further information on Applications to Global Health Queensland Younger Fellows Grant each of the opportunities listed. scholarships and grants have been $2500 paused for 2022 activity. For further information, please contact If you are a recipient of a 2020 the Scholarships and Grants Team: Supports travel to obtain post Fellowship training, and/or supports return to scholarship or grant who elected to defer Ph: +61 03 9249 1216 practice in Queensland. completion of your activity to December Email: [email protected] 2021, and you are unsure that you can Who can apply? Early-career – RACS now complete your activity by December www.surgeons.org/scholarships Younger Fellows (Queenslanders only) this year, please contact scholarships@ surgeons.org. We are keen to work with you and discuss the options available for your specific circumstance. Surgical News | Volume 21 | Issue 3 59

For Fellows and SET Trainees For non-RACS members

Pickard Robotic Training Grant Pickard Robotic Training Grant Indigenous Program – ASC Peer Support Award $100,000 – divided amongst recipients $100,000 – divided amongst recipients Up to $5000 each (up to two awards given)

Supports training and/or research Supports training and/or research Supports final year medical students and opportunities to expand expertise in opportunities to expand expertise in doctors interested in surgery, to attend innovative robotic techniques. innovative robotic techniques. RACS 2022 Annual Scientific Congress. Who can apply? RACS Fellows, SET Who can apply? Non-RACS surgeons and Who can apply? Aboriginal, Torres Strait Trainees, non-RACS surgeons and health health professionals, RACS Fellows and Islander and Māori doctors and final year professionals (South Australians only) SET Trainees (South Australians only) medical students who have previously attended an Annual Scientific Congress Stuart Morson Neurosurgery Grant Anwar and Myrtha Girgis SIMG Grant Indigenous Program – Davison Family Grant $30,000 $10,000 $2500 Funds travel to support early-career Supports migrant, refugee and asylum neurosurgeons who wish to advance their seeker doctors experiencing financial Supports doctors who have the potential experience and skills in neurosurgery by hardship to gain the professional to inspire and attract young people to the undertaking further training or research. development required to practice surgery field of surgery and who, without financial assistance, may be unable to contemplate Who can apply? RACS Younger Fellows, SET in Australia or Aotearoa New Zealand. a career in surgery. Trainees and non-RACS neurosurgeons Who can apply? Doctors who are recent migrants or of refugee or asylum seeker Who can apply? Aboriginal and Torres Hugh Johnston Travel Grant background Strait Islander doctors wishing to undertake postgraduate surgical training $10,000 Skills Training Faculty Grant Indigenous Program – Career Supports travel for RACS Fellows and $10,000 Trainees to take time away from clinical Enhancement Grant (medical students) positions to gain specialist knowledge and Provides a professional development $2000 each (up to six grants given) expertise. opportunity to senior Skills Training Faculty in recognition of their significant pro-bono work. Supports final year medical students who Who can apply? RACS Fellows and SET are interested in pursuing a surgical career. Trainees Who can apply? Senior instructors or directors (including RACS members) in a Who can apply? Aboriginal, Torres Strait Murray & Unity Pheils Colorectal Travel RACS skills training program Islander and Māori final year medical Grant students Indigenous Program – Career $10,000 Enhancement Grant (junior doctors) Rural Junior Doctors Surgical Skills Course Grant Supports travel to obtain further training $5000 each (up to six grants given) and experience in the field of colorectal $1500 Supports junior doctors to acquire surgery. knowledge and skills that will strengthen Supports rural or regional junior doctors Who can apply? RACS Fellows and SET their surgical career pathway. to undertake a surgical skills course in a Trainees Who can apply? Aboriginal, Torres Strait rural or regional location. Islander and Māori junior doctors Who can apply? Rural or regional junior Aziz Hamza Rural Surgery Grant doctors – registered with JDOCs and $1500 Indigenous Program – ASC Award members of the Rural Surgery Section. Up to $5000 each (up to six awards given) Assists in delivering quality surgical care to people in remote and regional Australia Supports final year medical students and and Aotearoa New Zealand. doctors interested in surgery to attend Who can apply? Early-career – RACS RACS 2022 Annual Scientific Congress. Younger Fellows and SET Trainees Who can apply? Aboriginal, Torres Strait Islander and Māori doctors and final year medical students

Advertised opportunities are an initial guide only. Please consult the RACS Scholarships and Grants Program webpages surgeons.org/scholarships for detailed information. The values of these opportunities are in Australian dollars and are for a tenure of one year unless otherwise stated. Early-career surgeons are Trainees or Younger Fellows (within ten years of obtaining Fellowship). FRACS applicants may apply where eligible for all opportunities listed for Fellows, providing they can provide evidence of completing all Fellowship requirements by 1 November 2021. SET applicants may apply where eligible, providing they can provide evidence of acceptance into the SET Program by 10 December 2021. In addition, Specialist International Medical Graduates (SIMGs) who meet the eligibility requirements outlined at surgeons.org/scholarships may apply to opportunities open to SET Trainees. We’ve revved up your member benefits!

If you’re looking to buy, lease, rent or insure a car – or just save on petrol or car accessories – your first stop should be your College benefits program. As a member of the program you get:

• Up to 20% discount on novated leasing through Private Fleet and Vehicle Solutions • Discounts on MotorBuys Car Buying Service • Discounts and exclusive benefits on Tesla vehicles and energy products • Up to 10% off car rental through Hertz and Europcar • The exclusive benefits of BMW Corporate with the purchase of a new BMW • Discounted car insurance through Bingle, Vero, Avis and Budget • Up to 5% off petrol at Caltex and Ampol service stations with pre-purchased eGift cards • Discounts at Supercheap Auto with pre-purchased eGift cards

With your College benefits program you can travel in style AND save money. Visit your benefits website today for more information and get ready to roll!

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1300 853 352 [email protected]

MEA5022 Car Mag Press Ad 210x297mm C1.indd 2 23/4/21 5:22 pm Surgical News | Volume 21 | Issue 3 61 In memoriam RACS publishes abridged obituaries in Surgical News. We reproduce the opening paragraphs of the obituary. Full versions can be found on the RACS website.

Fredy Jacob Daniel MBBS MS FRACS James May AC MD MS FRACS FACS Our condolences to the family, Cardiothoracic Surgeon Vascular Surgeon friends and colleagues of the following Fellows whose deaths 25 May 1939–22 February 2021 1934–2021 have been recently notified. Fredy was the surprise second twin born Professor May was an outstanding at home in a small town in southern academic surgeon, teacher, and trainer of India in 1939. In spite of his medically generations of surgeons in this country. Mr Adrian Vorbach (SA) challenging start to life, Fredy thrived Professor May provided a remarkable Dr Belinda Mary Scott (ANZ) at school, completing his education in service to both the University of Sydney Mr Timothy McGahan (QLD) a boarding school some 80 kilometres and Royal Prince Alfred Hospital (RPAH) from his hometown. This was the same Emeritus Professor James May (NSW) over many years. As well as being the school his older brother, Willy John Bosch Professor of Surgery, Professor May Mr Colin George Davis (NSW) Daniel, had attended. After secondary was Head of the Division of Surgery at the Mr Fredy Jacob Daniel (VIC) school the two brothers’ academic paths RPAH from 1979 to 1995, and Head of the diverged with John coming to Melbourne We’ve revved up your Mr Peter Crowe (NSW) Department of General Surgery at that to study medicine and later completing hospital from 1979 to 1988. Professor his surgical training, while Fredy went to May was seen by his surgical colleagues medical school at Manipal Medical College as the ‘father of vascular surgery’ in member benefits! in Udupi, Southern India, and then on to Australia, and he held an outstanding the Kanpur Medical College to undertake international profile in this discipline. a Masters in Surgery. Having completed his basic surgical training, Fredy worked Professor May was responsible for the If you’re looking to buy, lease, rent or insure a car – or just save on petrol or at the Calicut Medical College Hospital in introduction of endovascular surgery in car accessories – your first stop should be your College benefits program. northern Kerala, India. It was there that Australia and has served on many national As a member of the program you get: Fredy, a surgical registrar, met Dr Valsa and international endovascular societies. Thomas, an intern doing her surgical This included Member of the Board rotation. They decided to marry in 1969. of Directors of both the International • Up to 20% discount on novated leasing through Private Fleet and Vehicle Solutions Society for Endovascular Surgery, and • Discounts on MotorBuys Car Buying Service From there, Fredy applied for and was the International Society of Endovascular successful in achieving a position in • Discounts and exclusive benefits on Tesla vehicles and energy products Specialists. Indeed, he was elected thoracic surgery at the Royal Melbourne President of the latter Society from 2005 • Up to 10% off car rental through Hertz and Europcar Hospital in the early 70s. This was the to 2007. Professor May also served as • The exclusive benefits of BMW Corporate with the purchase of a new BMW beginning of a new life in Australia for the President of the Australian and New Informing RACS him, his wife Valsa and 10-month-old son, • Discounted car insurance through Bingle, Vero, Avis and Budget Zealand chapter of the International Dennis. Society for cardiovascular surgery, and • Up to 5% off petrol at Caltex and Ampol service stations with pre-purchased eGift cards If you wish to notify the College of the death of a Fellow, please contact In his early years in Australia, Fredy from 2001-2004 he was President of the • Discounts at Supercheap Auto with pre-purchased eGift cards the relevant office: completed cardiac surgical training International Society for cardiovascular ACT: [email protected] at St Vincent’s Hospital in Melbourne, surgery. With your College benefits program you can travel in style AND save money. Visit your benefits under Mr George Westlake and Mr John Professor May’s academic contribution to NSW: [email protected] Clareborough, cardiothoracic surgical website today for more information and get ready to roll! endovascular surgery was outstanding. NZ: [email protected] training at Royal Melbourne Hospital, He served on the editorial boards of most working closely Mr Ian McConchie, and QLD: [email protected] of the major national and international spent two years training in paediatric journals of surgery. racp.memberadvantage.com.au SA: [email protected] cardiac surgery at the Royal Children’s This obituary was provided by Dr Raffi TAS: [email protected] Hospital. Qasabian FRACS. VIC: [email protected] This tribute was written by colleagues: Hamish Ewing, Siven Seevanayagam, Simon WA: [email protected] Knight and Fredy’s wife Valsa and daughter 1300 853 352 NT: [email protected] Deepa. [email protected]

MEA5022 Car Mag Press Ad 210x297mm C1.indd 2 23/4/21 5:22 pm 62

A very special thanks to all those who have already donated to the Pledge-a-Procedure campaign

to support our partners in the Pacific and Timor-Leste. Unprecedented COVID-19 outbreaks. Life-threatening cyclones and flooding. Poor health equity. What more can communities of the Pacific and Timor-Leste endure this year? We urgently need your help to support them, and until 30 June, your impact will be multiplied. You might remember Dr Trevor’s request, “Too many kids simply do not make it. We need: More training. More surgeons. And more systems.” Please Pledge-a-Procedure to donate today and invest in building the surgical capacity of our nearest neighbours and our Pacific and Timorese colleagues, like Dr Trevor. Now, more than ever, it is time to show our support to our partners in the Pacific and Timor-Leste. We still have a long way to go to meet our goal, so please donate at www.surgeons.org/donations/

Our sincere thanks to these incredible donors who supported the Foundation for Surgery in April and May:

Gold/Platinum Mrs Julia Farrell Mr Gordon Pickard Prof David Scott

Silver

Mr Douglas Allan Mr Stan Guilfoyle Prof Peter Morris Dr Nicola Slee Mr Adrian Anthony Dr Indunil Gunawardena Anonymous donor Assoc Prof Susan Taylor Mr Lawrence Carroll Mr Mark Hehir Mr John Owen Ms Hilary Wallace Prof John Chalmers Mr Nigel Henderson Mr Theodoros Partsalis Dr Gregory Witherow Mr Simon Crowley Anonymous donor Mr David Price Dr Jessica Michelle Yin Mr Martin Duncan Dr Ian Martin Ms Barbara Ralph Dr Kirsten Finucane Dr Lorcan McGonagle Dr Elizabeth Rose

Bronze

Dr Sarah Aitken Dr Peter Bentivoglio Mr Peter Byrne Mr Harvey Coates Mr Iswadi Damasena Mr Russell Aldred Dr Maria-Pia Bernardi Mr Peter Campbell Assoc Prof Andrew Assoc Prof Peter Danne Dr Chris Allan Anonymous donor Mr Paul Carney Cochrane Anonymous donor Dr Jacqui Allen Dr James Besanko Prof John Cartmill Dr Jon Cohen Dr Marie Shella De Robles Dr Aymen Al-timimi Mr Eben Beukes Mr Anthony Cass Dr David Colledge Dr Upeksha De Silva Anonymous donor Dr Ratnakar Bhattacharyya Dr Anne Cass Dr Trevor Collinson Anonymous donor Dr Luke Lyiambian Anthony Mr Ben Birch Mr Sean Chan Dr Rowan Collinson Dr Thomas Dean Mr Mohamed Ashour Mr Peter Bird Mr Stephen Chan Mr David Cooke Anonymous donor Dr Mich Atkinson Mr David Bird Mr Ashraf Chehata Dr Emma Corrigan Dr Parthena Deskoulidi Mr Alexander Auldist Dr Sarah Birks Mr John Chen Mr David Cottier Dr Shymal Dhar Miss Caroline Baker Anonymous donor Dr Deborah Cheung Mr Grant Coulter Dr Raminder Dhillon Prof Andrew Barbour Ms Ruth Bollard Dr Bernard Cheung Mr Richard Coutts Dr Polbert Diaz Dr Richard Barnett Mr Laszlo Borbely Dr Wee Yan Chia Mr Murray Cox Ms Gillian Dickinson Emeritus Professor Bruce Anonymous donor Dr Colin Chilvers Mr Colin Cox Dr Anthony Dilley Barraclough Dr Bernie Bourke Mr Wai-Ting Choi Assoc Prof David Croaker Anonymous donor Dr Gerard Bayley Mr Tom Bowles Dr Kelvin Choo Dr Trent Cross Mr Peter Dobson Mr Andrew Bean Mr Adam Boyt Ms Yvonne Chow Prof Phil Crowe Dr Eric Donaldson Dr Gordon Beaumont Miss Ingra Bringmann Mr Godwin Choy Mr John Cunningham Mr Basil D'Souza Miss Yong Zhi Beh Assoc Prof Brian Brophy Dr Ruth Christie Dr Ian Curley Dr Ertugrul Durmush Dr Christopher Bell Mr Martin Bruening Dr James Churchill Dr Richard Curran Dr Michael Ee Assoc Prof Simon Bell Mr Andrew Bui Dr Mara Clarson Assoc Prof Austin Curtin Assoc Prof Elisabeth Elder Mr Roger Bell Dr Sally Butchers Anonymous donor Dr Christine Cuthbertson Mr Falah El-Haddawi Prof Ian Bennett Mr Christopher Byrne Anonymous donor Dr Peter D'Alessandro Dr Jodie Ellis-Clark Surgical News | Volume 21 | Issue 3 63

Bronze Anonymous donor Dr Anita Jacombs Dr David Mccallum Mr Jagdish Prasad Mr Durham Smith Mr James Emmett Mr Dylan James Mr Bernard Mcentee Dr Subhita Prasannan Dr Ruth Snider Dr Nicholas Ensor Dr Graham Jeffs Dr Brian McGowan Mr Julian Pribaz Mr David Stary Mr Aliakbar Estakhri Mr Rob Jensen Dr Derek Mcgregor Miss Kimberley Prince Mr Malcolm Steel Ms Ruth Evans Dr Eshwarshanker Assoc Prof Anthony John Mr Robert Pucius Ms Wanda Stelmach Prof Gavin Fabinyi Jeyarajan Mcguinness Dr Vaibhav Punjabi Dr James Stephenson Dr Michael Facek Dr Ashish Jiwane Mr Nick Mcivor Mr Stephen Purchas Dr Scott Stevenson Dr Sian Fairbank Dr Anne Rachel John Mr Richard McMullin Prof Chris Pyke Assoc Prof Graham Stewart Dr Eric Farmer Dr Emily Jones Mr Stuart Mcnicoll Dr Raffi Qasabian Mr Lance Stiefel Dr Trafford Fehlberg Mr Bruce Jones Dr Sally Meade Mr Christopher Que Hee Dr Marcus Stoodley Mr Ross Ferguson Dr Irene Kaiboni Dr Tulsi Menon Ms Tam Quinn Dr Kate Stringer Mr John Ferguson Dr Anthony Kane Miss Philippa Mercer Mr Senthilkumar Rajavel Mr Neil Strugnell Dr Teagan Fink Dr Sanjaya Karunaratne Mr David Merenstein Sundaramurthy Mr Robert Stuklis Dr Michael Fish Mr Jamie Kearsley Dr Tracey Merriman Dr Prashanth Rao Assoc Prof Douglas Stupart Mr William Fleming Anonymous donor Dr Kenneth Merten Dr Haroon Rasheed Dr Michael Swinden Emeritus Professor David Prof Alan Kerr Dr Philip Middleton Assoc Prof Prem Rashid Mr Konstantinos Syrrakos Fletcher AM Dr Fadil Khaleal Assoc Prof Brian Miller Mr Siva Ravindran Assoc Prof Mark Sywak Dr Cosmin Florescu Dr Sikander Khan Anonymous donor Mr Luke Rayner Dr Alwin Tan Dr Julie Flynn Dr Japinder Khosa Mr Peter Milne Dr Matthew Read Mr Dev Tandon Dr Wallace Foster Dr Sebastian King Mr Rodney Mitchell Anonymous donor Dr Viliami Tangi Dr Jane Fox Mr Stephen Kleid Dr Alireza Moghadam Dr Mifanwy Reece Dr Douglas Taylor Prof Mark Frydenberg Dr Neill Kling Dr Peter Moloney Dr Mariana Rego Mr Duncan Taylor Prof David Gillatt Assoc Prof Cherry Koh Dr Nicholas Moncrieff Assoc Prof Michael Reid Ms Patricia Terrill Dr Michael Gillespie Dr Carrie Kollias Anonymous donor Ms Fiona Reid Mr Michael Terry Mr David Gillett Dr Ingo Kolossa Anonymous donor Dr Andrew Riddell Mr Kumar Thangaraj Prof Peter Gilling Dr George Kourtesis Ms Alayne Moreira Dr John Riordan Dr Bibhusal Thapa Dr Jeremy Goad Dr Sekharipuram Krishna Dr Joanna Morgan Dr James Ritchie Dr Richard Theile Mr Ian Gollow Dr Sebastianus Kwon Mr Nigel Morlet Mr Dominique Robert Dr Thyaparan Dr Ahmed Goolam Mr Thomas L Dr Mark Muhlmann Dr Patricia Roberts Thiruchelvam Mr Dan Gordon Mr David Lai Assoc Prof Payal Mr Ross Roberts Mr Mahiban Thomas Ms Alexandra Gordon Dr Mary Langcake Mukherjee Mr Francis Robertson Anonymous donor Dr Jenny Gough Prof Howard Lau Mr Michael Muscio Mr James Roberts-Thomson Prof Stephen Tobin Anonymous donor Dr Sharon Laura Dr Korana Musicki Mr Jason Rockey Dr Gert Tollesson Dr Jennifer Green Mr Matthew Lawrence Mr Uvarasen Naidoo Mr Myron Rogers Mr Eric Torey Mr David Griffith Mr Angus Lecuona Dr Rishendran Naidoo Anonymous donor Mr Simon Tratt Dr Megan Grinlinton Dr Arvind Lee Mr Sanjeev Naidu Dr Sandrine Roman Anonymous donor Mr Garry Grossbard Dr Fiona Lee Dr Sasikaran Nalliah Dr Maxine Ronald Assoc Prof Philip Truskett Dr David Grosser Mr Tristan Leech Mr Ahmed Naqeeb Prof Franklin Rosenfeldt Dr Domenika Turkiewicz Dr Ashok Gunawardene Mr Daniel Lenaghan Dr Warwick Nettle Prof John Royle Prof Owen Ung Ms Nishanthi Gurusinghe Dr Yuen Leow Mr Mark Newman Dr Michael Rudd Dr Petrus Van Rooyen Mr Dennis Gyomber Dr Lori Lerner Dr P Newton Mr Andrew Ryan Dr Peter Vanniasingham Anonymous donor Miss Elizabeth Lewis Mr George Ngaei Dr Phillip Sale Assoc Prof David Veivers Mr Geoffrey Hannell Mr Tony Lewis Mr Thang Nguyen Dr Lucia Saliba Dr Petar Vujovic Dr Sarah Hanslow Mr Andrew Lienert Mr Arjuna Nirmalananda Dr Naveen Salutagi Dr Pauline Waites Dr Warren Hargreaves Mr Julian Liew Mr Vachara Niumsawatt Mr Paul Samson Mr Roger Wale Dr Craig Harris Dr David Links Dr Dion Noovao Mr Merrick Sanderson Dr David Walters Dr Robert Harris Dr Jocelyn Lippey Mr David North Mr Chaminda Saranasuriya Dr Richard Ward-Harvey Mr John Harris Dr Darren Lituri Mr John North Mr Alan Saunder Assoc Prof Bruce Waxman Dr Henley Harrison Miss Madalena Liu Assoc Prof Peter Nottle Mr Philip Scarlett Dr Michael Weymouth Dr Julian Hayes Dr David Lockwood Dr Fiachra O Mr David Schroeder Dr Benjamin Wheeler Mr Brian Haymet Dr Peter Loder Deasmhunaigh Mr David Sedgwick Dr Thomas White Dr Rasika Hendahewa Dr Simione Lolohea Dr Jill O'Donnell Dr Venkata Seelamanthula Mr Wilhelm Wiggett Dr Craig Hendry Mr Kaleb Lourensz Dr Mick O'Halloran Dr Susan Seifried Mr Gerard Wilkinson Dr Michael Hii Dr Mark Lynn Prof Stephen O'Leary Mr Gregory Self Dr Stephen Wilkinson Mr Brandon Hitchcock Dr Suzanne Ma Mr Olubukola Oloruntoba Dr Maryanne Selim Mr Nigel Willis Dr Jason Hockings Dr Mark Joseph Macaranas Dr Gemma Olsson Dr Christopher Selvaraj Mr Raymond Wilson Mr Damien Holdaway Mr Craig Mackinnon Dr Katherine Ong Dr Ekrem Serefli Assoc Prof Teresa Withers Anonymous donor Prof Donald Maclellan Dr Judy Ou Mr Gaurang Shah Dr Chung Won Dr Rossi Holloway Anonymous donor Mr David Pan Dr Koroush Shahsavar Mr Enoch Wong Assoc Prof Jonathan Hong Assoc Prof Murali Dr Fiona Panizza Haghighi Prof Henry Woo Mr George Hopkins Mahadevan Dr Chandrashekar Patel Miss Rezvaneh Shakerian Dr Roxanne Wu Anonymous donor Dr Suresh Mahendran Dr Sze-Lin Peng Dr Philip Sharp Ms Rita Yang Dr Yeqian Huang Prof Peter Malycha Dr Jens Peters-Willke Dr Peter Sharwood Assoc Prof John Yaxley Dr Timothy Hucker Ms Avanthi Mandaleson Dr Heidi Peverill Mr Idrees Sher Mr Edward Yeboah Dr Kevin Hung Dr Scott Mansfield Mr Trung Pham Mr Hamish Shilton Dr Andrew Zacest Prof David Hunter-Smith Mr Teariki Maoate Dr Grant Phillips Dr Robert Sillar Dr Natalie Zantuck Dr Andrew Huo Mr Waisani Mar Assoc Prof Marinis Pirpiris Mr Sanjay Singh Mr Xiao-Bo Zhang Anonymous donor Dr Peter Martin Mr Turab Pishori Mr Louis Sisk Dr Mark Jackson Mr Paul Mason Ms Meron Pitcher Dr Grahame Smith Dr Ollapallil Jacob Dr Phillip Mathews Dr Kenneth B F P'ng Ms Meta Smith Dr Abraham Jacob Anonymous donor Mr William Pollard Mr Stephen Smith

All fundraising administration costs for the Foundation for Surgery are provided for by the College so that 100% of your donation can achieve its maximum benefit to the community. To find out more, please join us at www.surgeons.org/foundation Tailored Medical Indemnity Insurance for Specialists

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IMPORTANT General disclaimer: This document has been prepared for the purpose of providing general information, without considering your individual objectives, financial situation or needs. It is not intended to be legal, accounting, tax or financial advice and should not be relied on as such. You should consider whether the information is appropriate for you, and seek professional advice, having regard to your objectives, financial situation and needs. Product Disclosure Statements, policy wordings, and full terms and conditions are available by contacting us on 1800 128 268 or by visiting avant.org.au. While every care has been taken in the preparation of this document, Avant Mutual Group ABN 58 123 154 898 (Avant Mutual) and its related entities make no representation or warranties as to the accuracy or completeness of the information and will not be liable for any loss or damage, however caused (including through negligence), that may be directly or indirectly suffered by you or anyone else in connection with the use of information provided.* Professional indemnity insurance and the Practice Medical Indemnity Policy available from Avant Mutual are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765 (Avant). Avant arranges Avant Business Insurance as agent of the insurer Allianz Australia Insurance Limited ABN 15 000 122 850, AFSL 234 708 and may receive a commission on each policy arranged. tPrivate health insurance products are issued by The Doctors Heath Fund Pty Ltd, ABN 68 001 417 527. ^Avant Life Insurance products are issued by NobleOak Life Limited ABN 85 087 648 708 AFS Licence Number 247302 (NobleOak). All general insurance is issued by Avant. Avant Life Insurance is a registered business name of Doctors Financial Services Pty Ltd ABN 56 610 510 328 (DFS). DFS provides administration services on behalf of NobleOak in respect of life risk insurance policies issued by NobleOak and administration services on behalf of Avant in respect of general insurance policies issued by Avant. $Doctors Wealth Management is a registered business name of Doctors Financial Services Pty Ltd ABN 56 610 510 328, AFSL 487758. Doctors Wealth Management Financial Advisers are Authorised Representatives of DFS. ^^Not all members are eligible for a Loyalty Reward Plan (LRP) reward, see avant.org.au/lrp. The provision of an LRP reward will be determined by the Avant Board’s annual assessment of financial performance. ~The Getting Started in Private Practice (GSIPP) discounts do not apply to previous or existing members of the GSIPP scheme and only apply from the first year a member becomes eligible and subject to eligibility rules, see avant.org.au/newprivatepractice. #The Retirement Reward Plan (RRP) is entirely at the discretion of the Avant Board and no member will be eligible to receive a Retirement Reward Dividend until such time as the Board declares a dividend in favour of that member, see avant.org.au/rrp. © Avant Mutual Group Limited 2021. MJN-594 05/21 (DT-1798)