Volume 22 | Issue 01

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RACS leadership President’s perspective 4 Treasurer’s budget 6

Spotlight on UNVEILING UNVEILING THE

New beginnings THE COLLECTIONS

COLLECTIONS of the ROYAL AUSTRALASIAN A scientific congress like no other 13 COLLEGE OF SURGEONS New framework to increase access

Unveiling some unusual objects from the fascinating collections of the Royal Australasian College of Surgeons, this book opens with an archetypal GEOFFREY DOWN and symbol of the College, the Great Mace. It continues with an exploration of a to surgery for bariatric patients 15 GEOFFREY DOWN diverse group of objects loosely bound together by type. Furniture, ceramics ELIZABETH MILFORD and silverware vie with paintings and sculpture. A miscellany of surgical instruments, dating mainly from the nineteenth and twentieth centuries, feature the carbolic spray used by Lord Lister at the Glasgow Royal Infirmary, The Indigenous picturedSurgical below. Developed in 1869,Pathways the spray was designed to kill airborne bacteria, but had some side effects. Everyone attending the operation inhaled the spray and if the patient had been anaesthetized using chloroform, the vapour decomposed into chlorine gas. and Program 16 ELIZABETH MILFORD At the other end of the spectrum, a large collection of historic medical books contains many rare and early editions such as those by Vesalius and Paré. Objects often have interesting stories connected to them, contributing Welcome to theto thenew complex web ofRACSTA relationships that have created Chair a surgical College. 19 Confirming the importance of valuing and preserving heritage, Unveiling the Collections will enrich present generations and benefit those in the future. Open house at RACS South Australia 20

HOR BO C OK N S Unveiling the CollectionsA 21

A A USTRALI

HOR BO C OK Introducing the Global Health Section 22 N S A

A A USTRALI

Articles of interest Dr Samantha Pillay 23 Dispatch from New York 24 Cultural change and patient safety: a joint summit 27 Results of the telehealth survey 28 Educators of Merit 29 Digging deeper into Australia and New Zealand road crash statistics 38 Specialist Training Program supports rural health strategy 39 Global Health Historical Deux et deux font cinq: when things do not Correspondence and letters to the editor for Surgical Local instructor team conducts paediatric News should be sent to: [email protected] life support training in PNG 14 add up 42 Editor: Abderazzaq Noor The surgeons of Vanity Fair magazine: Sir T: +61 3 9249 1200 Contributing writers: Sharon Lapkin and Saleha Singh Scholarship William Arbuthnot Lane 44 www.surgeons.org New Zealand surgeon’s ground-breaking ISSN 1443-9603 (Print)/ISSN 1443-9565 (Online). work to change patients’ lives 10 © Copyright 2021, Royal Australasian College of Surgeons. All rights reserved. All copyright is Scholarship supports new renal reserved. The editor reserves the right to change transplant program 18 material submitted. The College privacy policy and disclaimer apply – www.surgeons.org. The College Research scholarship and grant and the publisher are not responsible for errors or opportunities for 2022 48 consequences for reliance on information in this publication. Statements represent the views of the author and not necessarily the College. Information is not intended to be advice or relied on in any particular Research circumstance. Advertisements and products Highlights from the November Annual advertised are not endorsed by the College. The advertiser takes all responsibility for representations Academic Surgery Conference 32 and claims. Published for the Royal Australasian Case note review 34 College of Surgeons by Printgraphics Printgreen. ABN 93 005 519 997 of 14 Hardner Road Mount Waverley, One stop shop for plastic surgery Trainees Victoria 3149 Australia. established 36 Exceptional DCAS program planned 37 Cover image: Ness Flett 4 RACS leadership

President’s perspective

While we have entered a new year, it of Surgeons (RACS) CEO, John Biviano, government and other stakeholders looks like the COVID-19 pandemic will and the General Manager – Fellowship to ensure the long-term sustainability be with us for a while longer. With Engagement, Etienne Scheepers. As well of surgery in our healthcare system. border restrictions coming and going as meeting with Dr Brendan Murphy, the Specific topics touched on during the throughout December and January, I am Secretary of the Australian Government visit included fee transparency and sure it was a very different Christmas Department of Health; Professor Paul the government’s Medical Cost Finder break for many and a strange, but Kelly, the Chief Medical Officer; Dr Nick website, telehealth, reforms to use increasingly familiar, way to start 2021. Coatsworth, infectious disease physician; of the title ‘surgeon’, elective surgery Last year I regularly wrote about how and other members of the Australian during the pandemic and reforms to the College had been forced to adapt by Government Department of Health the management of the Prosthesis implementing processes and different leadership team, we met with the Hon List, among others. It was a productive ways of working that may have taken Mark Coulton MP – Minister for Regional visit with most displaying significant several years, or even decades, to occur Health; the Hon Chris Bowen MP – Shadow engagement in the issues, as well as had the pandemic not hit. The challenge Minister for Health; and others from the interest in collaborating more closely for us in 2021 will be to continue to Professional Services Review Agency, with the College into 2021 and beyond. integrate the lessons learned and the Australian Medical Association, the Another key topic in our Canberra use this experience to allow us to Private Hospitals Association and the discussions was rural health, and the be as productive as we possibly can Consumers Health Forum. recently released Rural Health Equity be and deliver excellent value to our In all meetings we conveyed the view Strategic Action Plan. I would like to membership. that, as Australia overcomes COVID-19 thank past and present members of the I ended 2020 by travelling to Canberra and looks to rebuilding, RACS is keen to RACS Rural Surgery Section who led the with the Royal Australasian College take a more engaged role in working with development of this. The plan is focused Surgical News | Volume 22 | Issue 01 5

on building partnerships and raising In addition to other efforts in New recommendations that will support awareness with our stakeholders to Zealand, we advocated through the further change. ensure there is inclusivity and a shared Ministry of Health for a change to Lastly, I am pleased to share a understanding of health equity for our resident medical officer rotation dates publication titled Unveiling the rural, regional and remote communities. (from pre-Christmas to January- Collections with you. It was written by Later this year, the College will convene February). The change was agreed to by Geoff Down, the College curator, and a forum to deliver a sustainable surgical all District Health Boards and relevant Elizabeth Milford, our archivist. The service in Remote Central and Northern unions and will be implemented in early book focuses on the many significant Australia (RCANS). The forum will devise 2021. and unusual objects in the College strategies to implement a RCANS Training This will be a key year for the future collections. Network and a RCANS selection initiative direction of our College in many ways. I take this opportunity to wish you all a for selecting junior doctors who are Following receipt of a proposal from happy and prosperous 2021. already living, working and committed to the New Zealand National Board in a remote area. February 2020, Council approved the I am also pleased to confirm that RACS establishment of the College Name will continue to support the New Fellows Change Working Group to scope a College Rural Placement pilot in 2021, funded name change. This issue is one that through the Federal Department of will garner a diverse range of opinions Mr Tony Sparnon Health’s Specialist Training Program. and suggestions. The objective of the President working group is to support balanced, Telehealth became an increasing area informed deliberations regarding of focus throughout 2020, and will the College’s name, and will provide continue to be so this year for both recommendations to Council about rural and metropolitan surgeons. Given potential options and timelines for a the potential for healthcare savings member vote. with equivalent safety outcomes and increased health equity, it is important Continuing Professional Development that barriers to the implementation (CPD) is another area of the College that and use of telehealth services are is set for an exciting transformation. investigated. The CPD team is working on a The College recently commissioned comprehensive program that is aligned a report to investigate the factors with your scope of practice and that either prohibit or encourage the supported by a streamlined and implementation and use of telehealth, intuitive online platform. and to examine patient and provider As we transition to the perceptions of telehealth services. The new program in July results of this review provide additional 2021, there will be evidence to support the results of the a condensed CPD telehealth surveys that we conducted requirement from last year, and will be used to guide RACS’ January to June advocacy. The report is available on the 2021. RACS website. The Board of Council We also consulted with the Medical meeting in January Council of New Zealand on telehealth, also accepted unprofessional behaviour, ending a an independent doctor–patient relationship and revised review of the accreditation standards. complaints process. This contained 21 6 RACS leadership The College 2021 finance and budget report

The impact of the COVID-19 pandemic has any ongoing variability in core operational The budget has increased funding to been substantial for all businesses and revenues. support the College’s commitment to not-for-profit organisations throughout Despite these uncertain times, it is more remain the major funder for surgical the world. The Royal Australasian College important than ever that the flow of grants, research, scholarships and of Surgeons (RACS) recognised early benefits to our Fellows, Trainees and philanthropic causes in Australia, New in March of 2020 that it needed to act SIMGs is foremost in our service delivery Zealand and across the Asia-Pacific decisively and place the wellbeing of its funding model. This budget continues region. In partnership with multiple Fellows, Trainees, Specialist International to place a clear priority on strategic government agencies, funding has been Medical Graduates (SIMGs), staff and all investment under the multi faceted accounted for to deliver significant its various stakeholders at the centre Transformation Program. The benefits activities under initiatives such as the of its response. The financial impact to our Fellows, Trainees and SIMGs will Specialist Training Program (STP), Audits was significant and Council, supported be demonstrated over the next year and of Surgical Mortality, Global Health by management, initiated numerous into the future, with improved member and assessments of new and emerging business measures to offset the loss of engagement, a personalised experience surgical technologies by our research operational revenues as effectively as from our website and a new IT platform team ASERNIP-S. possible. This included applying for the to deliver more modern member services, We have also made allowance to fund government JobKeeper wage subsidy education and training. With appropriate important measures to continue to scheme. cross funding from accumulated enhance the Trainee program, advance By the end of 2020, a projected revenue reserves, the operational budget will advocacy and support our members both loss of up to 20 per cent from core not be materially impacted by this professionally and personally during operational funding activities was investment. these times of heightened uncertainty. anticipated. Under these conditions, We know from routine monitoring of It has been difficult to formulate the setting a sustainable financial plan for the website that library resources and annual financial plan during this period. the forthcoming year has required a services are a key area of engagement for However, the core principle of service to ground-up reassessment of current our members. The budget further builds our members remains clear. The budget service delivery models, support systems on this service with an increased level of has been prudently set to address the and changing work practices. Council is annual funding to ensure we can provide things our members value most, while determined that the business should a wealth of relevant content, search continuing to build upon the significant continue to deliver core services to its tools and appropriate support from investment in modern service delivery members in a manner that is fiscally professional library staff. technologies to ensure our members are responsible. This has required a clear engaged and supported throughout their focus on containing expenditures to offset surgical careers.

Figure 1: Figure 2: Budget 2020 Revenue and Financial Position – Trend Expenditure, Surplus/(Deficit)

–Assets –Equity –Liabilities – Cash Reserves $200M $90M $80M $180M $70M $160M $60M $140M $50M $120M $40M $100M $30M

$80M $20M

$60M $10M

$40M $0

$20M $-10M 2021 Budget 2020 Budget 2019 Actual $0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Revenue Expenditure Surplus/(Deficit) Forecast Budget Surgical News | Volume 22 | Issue 01 7

Business categories Category 1 There are three categories of activities that make up the RACS business. Council has Core business long held that Category 1, our core business, should budget for a modest surplus of two per cent, with the aim to achieve long-term financial sustainability. Category 2 is Category 2 for projects delivered under various funding agreements from third parties, primarily Externally funded projects government agencies. Category 3, foundation and investments, are the funds our grants, scholarships and philanthropic causes. Category 3 Foundation and investments

Budget 2021 by business category Category 2 Externally funded projects by portfolio

Category 1 Education: Specialist Training Program Core operations by portfolio (STP) Fellowship Engagement: Research Audit & Education People and Culture Academic Surgery (incl Mortality/Morbidity Education Services Human Resources Audits and ASERNIP-S) Training Services Building Respect Improving Patient Safety Operations: RACS Global Health Research and Innovation Communication and Marketing Internal Services Externally funded project activities Fellowship Engagement are significant in terms of the scope of Policy and Standards Operations contracted work that is performed and Professional Standards Finance the committed funding arrangements. Fellowship Services Information Technology These projects provide specialist training, State and National Offices General Counsel Indigenous and Māori health initiatives, Governance & Council Support audit and international humanitarian Transformation Program assistance. Conference & Events (incl ASC) RACS Global Health is the main driver for the projected overall modest deficit of $33,200. Overall, the core operational budget is set for a minor surplus of $44,000, which The area is being repositioned to capitalise incorporates funding for ongoing investment in the business Transformation Program on its external grant programs with and progressing with the Australian Medical Council (AMC) accreditation conditions. endorsement of its financial sustainable strategy. Revenue growth is targeted at 3.5 per cent, totalling $53.7 million. The Education portfolio represents 57 per cent of the core revenue, being responsible for services Revenue from various external sources related to examinations, skills courses, SIMG assessments and surgical training. is projected to be $18.2 million. The STP agreement administered under the The other main source of revenue is from Fellows’ annual subscriptions under the Education Portfolio accounts for 56 per Fellowship Engagement portfolio. This accounts for 39 per cent of the revenue base. cent of this and totals $10.2 million. Other This funding is essential for the delivery of Fellowship Services across Australia and major funded activities include RACS Global New Zealand, including library and information resources, continuing professional Health, Audits of Surgical Mortality and development and standards, government representation, communication via ASERNIP-S, accounting for $4.4 million, numerous sources and marketing, supporting special interest groups, visitor $1.5 million and $1.9 million, respectively. programs, personal support resources and leading education programs to build respect within the surgical profession. Expenditure totals $18.5 million with approximately $9.5 million or 51 per cent Expenditure is budgeted to grow by 3.1 per cent, totalling $53.6 million. Again, the of overall expenditures related to specialist Education portfolio is dominant, accounting for 38 per cent of overall expenses. This training posts and rural loading hospital is to be expected, as significant event coordination costs and professional staff are payments under the STP contract. Staff required to administer education, skills courses and related research services. resourcing to deliver all programs is the More broadly, staffing is the single biggest service delivery cost at $23.7 million, or 44 other main expenditure, totalling $4.1 per cent of the total cost base. This represents an annual increase of 10 per cent and million or 22 per cent of overall costs. is inclusive of industrial reform initiatives to better support contemporary business It is worth noting that the ASERNIP-S practices, such as productivity and flexible working hours. It is also expected that the business, which was established in 1998 as completion of both the AMC and Transformation Program will allow staff resourcing a core surgical research group, continues to to stabilise to within annual wage growth indexation. grow both its domestic and international client base and is projected over 2021 to increase its funded work by 40 per cent, with revenues of $1.9 million. 8 RACS leadership

Throughout 2021 we will be focusing Category 3 on transitioning to a new Customer Foundation and investments by portfolio Relationship Management (CRM) platform, which will establish a single Education: Operations: record for our members. This will allow Education Innovation Corpus Foundation for Surgery us to build on the existing foundation Educator Scholarship Corpus Scholarship/Research grants and embed new experiences such as Surgical Education Research Prize Investment reserve personalised website content, CPD ASC Visitors Corpus Fellowship Engagement: with streamlined tracking of activities, Indigenous – scholarship programs that are supported Corpus/Scholarships/ASC awards in a consistent manner and creating sophisticated platforms for education, training and learning. The hard work in After taking into consideration the Transformation Program source funding of identifying gaps has been completed $950,000, the overall result is a budgeted deficit of $865,000. and, with the detailed planning and Revenue for all activities is budgeted to be $4.8 million, and mainly relates to the governance oversight, the next two combined five per cent increase target for investment rate of return and funding from to three years of investment will see other sources, such as donations, sponsorship and royalties. some very fundamental changes in Expenditure allocation is budgeted to be $5.7 million including the $950,000 how we continue as a member-based Transformation Program funding. This budget provides for increased commitments of organisation, leading surgical standards, $2.4 million (in 2020 it was $2.1 million) for scholarships, Fellowships, research grants education and professionalism in and other philanthropic endeavours that are predominantly administered under the Australia and New Zealand. Foundation for Surgery. Council has approved a strategic funding aim for future budget years to commit to funding of up to $2.5 million annually. The budget also incorporates Budget 2021 in summary the restructure of funding for program resourcing and support. Council supports this strategically targeted budget, which has been Selection of key 2021 RACS fees conservatively set to provide contingency to enable the business to address Fee description AUD$ NZD$ the ongoing external impacts of the All GST-inclusive (unless otherwise indicated*) 2021 2021 pandemic. Budget 2021 ensures the core Annual subscription 3260 3645 operations of Fellowship Services and Fellowship entrance fee 6105 6830 education and training are appropriately SET annual training fee – RACS 3660* 4505 resourced, and that the Transformation Program is appropriately funded. We Fellowship examination fee 8775* 10,800 also remain strategically committed Pre-vocational – Generic Surgical Science examination fee 4650 5205 to funding surgical research initiatives For summary listing of key 2021 fees refer to RACS website www.surgeons.org and charitable endeavours now and * GST Exempt into the future. Budget 2021 achieves a sound budget, setting a modest deficit Transformation program to build future engagement capacity Since 2019, a comprehensive evaluation of our member engagement and experience with members and all other important has been undertaken with a specific emphasis on how systems and technologies are stakeholders. currently operating to deliver service to the Fellowship and all other key stakeholders. The 2021 capital budget of $4.8 million represents the second year of targeted investment in this program with clearly defined benefits set to deliver a suite of Dr Greg Witherow changes. This includes enhancing our business practices, supported by contemporary Treasurer technologies to improve our members’ service experience, engagement and value with the delivery of relevant and purposeful service that adapts to the changing needs of our members. Surgical News | Volume 22 | Issue 01 9

Spotlight on New beginnings

New Zealand surgeon’s ground-breaking work 10 A scientific congress like no other 13 Welcome to the first Paediatric Life Support training in PNG 14 The Indigenous Surgical Pathways Program 16 issue of Surgical News for 2021

This new year provides a chance to reset and look forward to the many initiatives at the College. We are excited to share new research, new training programs, new offices, new interest groups and a new format for the upcoming Annual Scientific Congress.

Read on to find out more about the new beginnings happening in 2021 at the Royal Australasian College of Surgeons. 10 New beginnings feature

New Zealand surgeon’s ground-breaking work to change patients’ lives

The 2020 recipient of the Royal physiology of the human gut, novel help support the development of four Australasian College of Surgeons (RACS) mechanisms of diseases, new causes of major projects through the University John Mitchell Crouch (JMC) Fellowship, delayed or failed surgical recovery and of Auckland. Each of these projects is Professor Greg O’Grady, is an academic innovative new therapies for patients ‘scalable’ so the solutions can be turned surgeon who develops technological suffering from intestinal failure. into real products used for routine clinical innovations that improve outcomes for Professor O’Grady founded the Surgical care. patients with gastroenterology diseases. Engineering Lab at the University of 1. A novel chyme re-feeding device for With a strong focus on surgical recovery, Auckland in 2017. Then, in 2018, he was patients with enterocutaneous fistulas Professor O’Grady’s work in translational the youngest recipient and only surgeon The chyme re-feeding device is the most research bridges the gap between to lead a prestigious $5 million Health advanced of the four projects. It has basic science and clinical practice – an Research Council Programme Grant in generated a lot of interest in Europe, and approach often referred to as ‘bench to New Zealand. His other awards include has achieved CE marking approval, which bedside’ research. a Master of Gastroenterology Award means it has satisfied all the directives A PhD in bioengineering, along with a from the American Gastroenterology for safety and performance requirements Fellowship in General Surgery from Association and the Vice-Chancellor’s for medical devices in the European RACS, and further training with the Research Excellence Medal from the Union. It has also been approved in Colorectal Surgical Society of Australia University of Auckland. New Zealand and is under review by the and New Zealand have provided a broad Altogether, Professor O’Grady has helped Therapeutic Goods Administration in academic and clinical basis for his work. raise more than $10 million in grant Australia. Rather than writing papers, he recently funding for translational research into The re-feeding device is currently used made a deliberate decision to “focus on gastrointestinal diseases. His work has for patients with complex gut problems, developing real-world products that [he] also contributed to 21 patents and three such as high-output enterostomies and hopes will be useful to a large number of university spin-out companies. enterocutaneous fistulas. “These are people”. The JMC Fellowship is the most often surgical catastrophes that are Professor O’Grady’s research impact has prestigious award offered by RACS, and really crippling for patients,” Professor led to first descriptions of fundamental it was awarded to Professor O’Grady to O’Grady said. “The device takes the losses that come out of the upstream stoma Surgical News | Volume 22 | Issue 01 11

ultimately replace the stoma application that many of these patients wear for several months. Two weeks after surgery “Patients will undergo a leak test and, if their join is intact, they can change to the new device for the remainder of their course – that is, until the time of surgical stoma reversal, which averages about four months.” The device, which Professor O’Grady calls a “stoma-link”, is a “virtual stoma reversal”. He describes it as a piece of prosthetic gut where they “link the two bowel ends back together so that the contents flow out of one and then down the other without the need to have a bag. Project 1: pump device “The concept is that gut contents orifice and re-feeds them back into the They include major psychological then flow back to the colon where distal gut in a safe and user-friendly way impact, as a result of the ‘incontinence’ they belong,” he explained. It is hoped for patients to get oral nutrition back into of bowel contents into the bag worn patients will regain their continence and their systems.” on the abdomen, risk of dehydration confidence and “no longer have to worry about wearing a stoma appliance”. Patients experiencing high-output due to the high volume of small bowel fistulas often require prolonged hospital output, readmissions to hospital, and The stoma link has been a challenging admissions where they’re stuck in interruptions to chemotherapy due to device to perfect during a pandemic, bed, unable to eat and dependent on dehydration. There’s also potential long- with many research studies placed on parenteral nutrition. The device, which term bowel damage due to starvation of hold for at-risk patients. But Professor is a compact pump that fits inside the the gut lining from the diversion and the O’Grady’s team is making good progress. stoma appliance, enables the patient loss of the microbiome. “We have had dozens of iterations and to eat and drink again, come off their Patients may have to persevere with are constantly improving it. I’m confident parenteral feeding, and to leave the a stoma for several months because we’ll get there,” he said. hospital. “It is satisfying to see a major “there is usually a delay until it is safe 3. An early detector system for quality of life improvement for patients to join people back together,” Professor anastomotic leaks to date,” Professor O’Grady said. “They O’Grady explained. “They may be on Anastomotic leaks are a principal take the device home and it becomes part chemotherapy or it may be too soon to do complication of concern following of their ongoing care until we can reverse another operation.” Yet, he added, “after gastrointestinal (GI) surgery and are the the fistula that, in some cases, can a period of time, it’s still actually safe to leading cause of death after colorectal require a wait of many months.” have what comes out of the stoma go surgery. Leaks are very difficult to detect The RACS JMC Fellowship has also back downstream again while waiting for early, and are often diagnosed after the assisted Professor O’Grady’s team to reversal surgery. After about two weeks, patient has entered a cycle of sepsis that develop a chyme re-feeding device for when the join heals, it’s safe to start.” is hard to unwind. premature babies, who end up with Professor O’Grady and his colleagues have “One of the worst complications of GI stomas as a result of complex gut developed a device that he hopes could surgery is when the contents leak out  problems. “It’s been a nice project to work on as it could help a very vulnerable surgical population,” he said. “We have been working with paediatric surgeons to understand the problem and are now close to a clinical trial.”

2. Improved management of temporary ileostomies A lot of patients with rectal cancer end up with temporary ileostomies and the quality-of-life impacts can be distressing. Project 4: gut mapping device 12 New beginnings feature

of the staple line or suture line into the black box at present; it’s very hard to Funding medical research and investing abdominal space,” Professor O’Grady diagnose what’s happening – we have no in young people explained. “We want to detect this as good tests to check whether it’s actually The JMC Fellowship has enabled early as possible and intervene before the moving normally or not.” Professor O’Grady to advance his patient becomes critically ill.” With an Australian designer and a research substantially over the past Professor O’Grady is leading a team of group of engineers, Professor O’Grady year, and he thanked his collaborators, scientists and engineers in developing has developed a cutaneous wearable students, RACS and, most especially, the a novel early warning system for sensor device coupled to a telemetry Crouch and Unsworth family. anastomotic leaks. The device attaches system that records gut activity from “We depend on generosity to get these to a small surgical drain – the type that the body surface. A series of sensors, ambitious research projects off the is put into patients after surgery to drain acting together like a sophisticated ground,” he said. “It’s also important away fluid. The drain collects fluid into electrocardiogram for the gut, are that we support the development of our a small container and it is then sampled attached to a reader device that records talented Trainees who want to learn how using sensors. the small electrical signals from the body. to conduct surgical research. One of my Considerable work has been done on The test can be done in an office current roles is Chair of the Australasian this project due to support from the outpatient setting as the patient eats a Surgical Research Society, and it is always JMC Fellowship. Currently, the trials are meal. The device measures the electrical an amazing privilege to see the quality preclinical and being done on animal signals from the gut while the patient and range of research being performed models in the university lab, but next year fills in a symptom-logging app on an iPad across Australasia by Trainees and Professor O’Grady is planning to take it mini. All of these data are then processed medical students.” through to first in-human trials. in algorithms to generate reports. The RACS scholarships provide 4. A new diagnostic platform for gut With technical development at an opportunities for people to learn dysmotility advanced stage, there are still clinical academic skills at a formative stage of Building a platform for diagnosing gut studies to complete before the product is their careers, Professor O’Grady added. dysmotility has been one of Professor ready. “We’re running a number of studies “If we can support the training of young O’Grady’s long-term goals. “The project in parallel to now evaluate different academics, then we lay the foundations has potential to be a breakthrough gut disorders using the technology,” for entire careers of significant research solution across a broad range of GI Professor O’Grady said. “The engineering impact. This helps the practice of surgery practice, to better evaluate gastric and is certainly a world-first, and we are evolve to the benefit of our patients.” colonic symptoms and to monitor surgical excited to see what the clinical results gut recovery,” he said. “The gut is like a will reveal.”

RACS affirms commitment to ethics in health care

In 2017, the Royal Australasian College It is a government supported, sector- of behaviour and workforce conduct. of Surgeons (RACS) became a proud led voluntary initiative that began with This includes the new RACS Workforce signatory to the Australian Consensus five bodies (RACS included) and has Conduct Policy. Framework for Ethical Collaboration in subsequently grown to more than 60 The College’s evaluation report the Healthcare Sector (ACF), now known signatories. also detailed the formation of the as the Australian Ethical Health Alliance At the end of 2020, RACS was asked to Environmental Sustainability in Surgical (AEHA). complete a self-evaluation form outlining Practice Working Group, which has The AEHA is a collaboration between our progress against AEHA principles. already led a number of important professional bodies, industry In the response, the College highlighted submissions to government enquiries. organisations, hospitals and health our ongoing commitment to the Building To read the full evaluation please visit services associations, regulators and Respect program, including new policies the RACS website and search for ‘AEHA patient advocacy groups to tackle and standards that were introduced guide’. ethical issues within the health sector. in 2020 that are targeted at standards A scientific congress like no other

If 2020 has taught us anything, it is the With this flexibility, the ASC 2021 can be For Fellows interested in attending the ASC unpredictable nature of life that we now anywhere around the globe – get creative physically, we encourage you to go online incorporate into our work, education and and share your experience using the and register now. daily existence. With COVID-19 restrictions hashtag #RACS2021. A new registration category for virtual currently in place, we have planned for Your local RACS STANZ offices will also attendance has been introduced for 500 registrants onsite for the Royal host hubs and more information will be 2021. Register as a virtual attendee and Australasian College of Surgeons (RACS) updated on the ASC website as it becomes you can watch the sessions wherever Annual Scientific Congress (ASC) 2021 at available. The STANZ offices will also be you are, whenever you want. All Fellows the Melbourne Convention and Exhibition happy to help with any questions you must register for RACS ASC 2021, whether Centre. At the time of planning, the number might have, so please reach out. physically or virtually, to obtain Continuing appears feasible; however, we are also Professional Development points. If you ready to scale either downward or upward Convocation ceremony: Melbourne or are watching at a hub without registering depending on the prevailing pandemic local – your choice for the ASC, you cannot claim your points. environment. The ASC 2021 convocation ceremony will For our regular attendees, we know this is be held at the Melbourne Convention and We have been preparing for different different. For members who don’t usually Exhibition Centre presided over by the scenarios and experimenting with new attend the ASC, this is a good one to try. RACS President and senior office bearers. In initiatives so that we can engage many of We truly hope that many of you can join us addition to Melbourne, local convocation you for 2021, and in the years to come. onsite or online to make this an ASC like no ceremonies are also available. Fellows other! Hubs who are eligible to convocate in 2021 We have been in discussion with your are entitled to receive complimentary The 2021 Annual Scientific Congress State, Territory and New Zealand (STANZ) registration for the ASC. An email invitation will run from Monday 10 May to Friday committees and offices to form hubs in to register has been sent to those eligible 14 May. Find out more about how to set your regions. Forming a local hub is a to register. up a hub. If you are hosting a RACS ASC fantastic way to bring your colleagues 2021 hub, please complete an online together to participate in the RACS ASC Registrations form to register your hub at tinyurl.com/ 2021 as a group. You can watch any Registrations for the RACS 89th Annual h7k0lpcr. sessions of your choice, including your Scientific Congress 2021 are now open. As previously mentioned, physical onsite surgical specialty, sessions of interest, Dr Liz McLeod registrations have been limited to 500 the plenaries and the named lectures ASC Coordinator ADD YOURpeople, HUB following local governmentTO THE LIST that suit your schedule. A hub can be any place you like, whether it be at your work, guidelines and health advice. For 2021, home or anywhere with the appropriate onsite registrations have been made connections to stream the content. available only to Fellows of the RACS. 14 New beginnings feature

Local instructor team conducts paediatric life support training in PNG

The Royal Australasian College of continue providing these training courses. remotely by RACS, with Associate Surgeons (RACS), the Port Moresby So a three-day instructor course will also Professor Bruce Lister AM, a paediatric General Hospital and Advanced be provided to participants identified intensivist, and Dr Zafar Smith, an Paediatric Life Support Australia during the advanced course as having emergency medicine physician. Associate (APLS) have formed a partnership and the capacity to become effective local Professor Lister and Dr Smith have been collaboratively designed a project to instructors. There are currently only eight actively involved in training the local team deliver a range of Paediatric Life Support fully accredited local instructors. of instructors over several years. training courses in Papua New Guinea The Generic Instructor Course trains Dr Kone Sobi from Port Moresby (PNG) over the next three years. participants to become qualified General Hospital leads the local team of This project, funded through the Advanced Paediatric Life Support course instructors and is extremely dedicated Department of Foreign Affairs and Trade’s instructors. Through this project, RACS to their development and the continued (DFAT’s) Australian NGO Cooperation and the Port Moresby General Hospital provision of the training in PNG. Through Program (ANCP) and RACS Foundation expect to substantially increase the his effective leadership, mentoring for Surgery, will increase the capacity of cohort of accredited local instructors. It and support, two very competent healthcare workers to effectively respond is estimated that 324 healthcare workers colleagues, Dr Gwenda Anga, a paediatric to, and manage, acutely ill and injured will have access to one or more of these oncologist, and Dr Arabella Koliwan, children presenting to the Intensive Care vital training courses between 2020 and an emergency medicine registrar, both Units (ICUs) of hospitals in Port Moresby 2023. from Port Moresby General Hospital, and Lae. These two hospitals treat over In previous years, RACS has deployed were the primary local facilitators of the 15,000 children in their ICUs annually. Australian-based instructors, who introductory course. Their first course Three related courses will be provided to volunteer their time and expertise, to was conducted for 48 healthcare workers, healthcare workers. The first in the series conduct this and other important clinical including doctors, nurses and community is a one-day introductory course covering training. However, due to the COVID-19 health workers, on 8 and 9 December the basics of emergency paediatric pandemic and travel restrictions, RACS 2020. management, with a focus on the first 10 has not been able deploy any Australian- Dr Koliwan reported that the local minutes of emergency care. Participants based instructors to PNG since February instructors were surprised by how then progress to the three-day advanced 2020. Therefore, for the first time, well they were able to independently course, which increases confidence the one-day introductory Paediatric conduct the training. This is a testament and skills across a range of paediatric Life Support course was provided in to their modesty, but also to their skills emergencies. One of the objectives of this December 2020 by an entirely local team as accredited instructors, which Dr Sobi, project is to increase local capacity to of instructors. Planning was supported Associate Professor Lister and Dr Smith have all played a huge role in developing. We had every confidence in the local team and the COVID-19 pandemic gave them the opportunity to demonstrate their training ability. During the two days of training, Chris Graham, First Secretary at the Australian High Commission in PNG, was on hand to present training certificates to the 48 participants and to formally hand over an Advanced Paediatric Life Support kit, funded by DFAT through RACS’ PNG Clinical Support Program, to the Port Moresby General Hospital.

PNG Paediatric Life Support Instructor Team with Course Coordinator Sister Iobuna. Photo credit: Dr Arabella Koliwan Surgical News | Volume 22 | Issue 01 15

New framework to increase access to surgery for bariatric patients

With almost 12.5 million Australians suffering from obesity, the medical consequences of this disease have created a serious challenge for the Australian healthcare system.

bariatric surgery through the public alone. On this basis, “we can say with hospital system has generated a serious confidence that if we treat patients at a problem of healthcare inequity. particular stage of obesity, we’ll be saving Mr Ahmad Aly, Head of Upper lives”, Mr Aly said. Gastrointestinal Surgery at Melbourne’s Mr Aly noted that a long-running study Austin Hospital, is leading an initiative to of obesity in Sweden has demonstrated redress the socio-economic inequity of the tangible benefits of this approach. access to bariatric surgery. Three years Out of 4047 obese Swedish patients ago, surgeons from ANZMOSS and several who enrolled in the study, 2010 received collaborating bodies, including the bariatric surgery while a control group of Commonwealth Government’s Medical 2037 received conventional non-surgical Services Advisory Committee (MSAC), treatment. Those who underwent formed a joint taskforce to address the surgery enjoyed “a 38 per cent reduction problem. in cancer deaths and a 32 per cent The taskforce discovered that only reduction in cardiovascular death”, he four per cent of total bariatric surgical said. procedures were “completely publicly But patients’ direct involvement in their funded”, Mr Aly said. He noted that the weight-reduction treatment doesn’t end Mr Ahmad Aly current system has evolved around the when they leave the operating theatre. implicit expectation that patients would While exercise and medication can In order to enjoy the long-term benefits have private health insurance, or would be effective methods of weight loss of bariatric surgery, patients must modify otherwise be able to self-pay for their for some patients, it is rare for these their post-operative lifestyles in terms of surgery. He added there was a worrying non-surgical procedures to have a diet and exercise. trend over recent years for patients to long-lasting effect in cases of morbid “It’s all about the patient’s willingness use their superannuation or life-savings obesity. By contrast, bariatric surgery and dedication,” explained Mr Aly. to pay for their surgery. has proven to be an effective treatment “We want to know that the patient is that generates substantial weight loss “We were concerned about this inequity invested in the program.” This is why and can be sustained over the medium of access,” he said. “It is for us, to some the framework also recommends to long term. Bariatric surgery also has a degree, a social justice issue.” As a result, “preoperative engagement processes demonstrable track record of reversing the taskforce focused on more effective that give patients the opportunity to be or mitigating obesity-related health risks means of “delivering what is well-proven certain that it is right for them”. and complications, particularly diabetes. life-saving care to patients who simply This initiative to broaden access can’t access it at the moment”. But approximately 90 per cent of the to bariatric surgery is also fiscally 24,000 bariatric procedures in Australia Composed of medical professionals, sustainable, Mr Aly pointed out, because have been conducted by the private health administrators, government out of 1.5 million obese Australians, “it’s hospital sector. According to National officials and representatives from obesity likely that only two or, at most, three per Bariatric Registry data from 2019, only 22 clinic stakeholder groups, the taskforce cent of patients would actually seek it”. public hospitals have conducted bariatric produced the Public Bariatric Surgery Commonwealth Treasury officials surgical procedures, with 10 performing Framework. Published in October 2020, it have also recognised the fiscal logic of more than 75 procedures annually. A is a roadmap to remediate the burgeoning increasing access to bariatric surgery recent survey from the Australian and public health and social equity problem. to moderate aggregate healthcare New Zealand Metabolic and Obesity The Framework recommends the costs generated by medical conditions Surgery Society (ANZMOSS) suggested adoption a new set of eligibility criteria associated with obesity. only 15 hospitals have a structured called the Edmonton Staging System for elective bariatric surgery program. “It’s not going to happen overnight,” Mr Obesity. This staging system focuses on Aly said. “But we’re accumulating the Because obesity is a disease that is more mortality as an outcome, which does a tools that generate enough goodwill to common among less affluent people more accurate job of anticipating patient get this done.” in the community, limited access to prognoses than reliance on mere BMI 16 New beginnings feature RACS and First Australians – the Indigenous Surgical Pathway Program

For many decades the Royal Australasian faced by the Indigenous Health The challenges faced by the ISPP College of Surgeons (RACS) members Committee (IHC) when implementing the working group can be unique and often have demonstrated a desire to contribute RACS 2013 Indigenous Health position multigenerational, requiring unique and to improving the general health and paper to help rectify this inequity. multigenerational solutions. wellbeing of First Australians. In recent Converting policy into action, and then Underpinning the ISPP is the years, our College has formalised its ensuring such action produces the preparedness to adopt a First Australian ongoing commitment to Indigenous desired outcome is challenging at the holistic approach to wellbeing and health. This has included a multifaceted best of times. health, and draw on the commitment of approach to First Nation health There are so many international RACS Fellows and RACS administrative encompassing areas such as increasing achievements from a minority population staff, as well as upon First Australian the surgical workforce, awareness by of 800,000 within a world population of community values. Moreover, an the Fellowship of the disparity between 8 billion (such as CNN anchor Stan Grant appreciation of Australian Government Indigenous and non-Indigenous health, and Captain Reginald Saunders, recipient policy history, and an understanding of and using our leadership position for of a United States Presidential citation) First Australian community values and positive influence, all starting from within despite historical government policies the unique circumstances impacting upon the College. relegating First Australians to the fringe First Australians is needed. RACS is among the leading Australian of mainstream Australian society. In fact, We look forward to the collective support institutions in this field, contributing to the only impediment to more success is and contribution from RACS, as a whole, solution-driven policies and actions that the power differential created by racism, and hope to be able to demonstrate impact First Australians. limiting their ability to reach critical mass our ongoing leadership, innovation and in the number of doctors and surgeons. One significant example of this professionalism when contributing to commitment is expressed in the RACS The Indigenous Surgeons Pathway Australia’s wellbeing as a complete 2013 Indigenous Health position paper, Program (ISPP) is a long-term, multi- community. which recognises that Indigenous people pronged initiative that recognises The ISPP is partly funded by the are more likely to present for, and comply the need to support those wishing Australian Government Department of with, treatment guidelines if increased to contribute to health equity for Health through the Specialist Training numbers of Indigenous people were First Australians. The solution is, in Program (STP). represented in the medical workforce at part, changing the culture within our all levels of care. institution to honour the rights and The ISPP will be officially launched later in the year. If you would like to know According to 2016 Australian Bureau of value the amazing contributions First more about RACS Indigenous health Statistics data, there are approximately Australians have to offer. initiatives visit surgeons.org/about- 800,000 First Australians. To achieve the Our goals are to inspire First Australians racs/indigenous-health. same ratio of doctors to patients as non- (school students, medical students, Indigenous Australians there need to be those in other health careers) to consider 3200 First Australian registered doctors. a career in surgery. To support them According to available data, there are through preparation for, application to approximately 400 First Australian and completion of Surgical Education registered doctors. and Training (SET); develop a mentor There are currently almost 7000 active program to support RACS Fellows who RACS Fellows, Trainees and SIMGs. This wish to support the program; coordinate translates to roughly 3500 patients per and facilitate collaboration between surgeon in Australia. If applying the same stakeholders; and support our current ‘population per surgeon’ formula to First SET Trainees. Australians, we should have 219 First The pilot project for the ISPP is being led Australian surgeons. Currently, we have by the Royal Darwin Hospital. Health three. service, departmental and mentorship This (rather simplified) demographic standards will be defined and, ultimately, breakdown helps puts into perspective a package will be developed to be the unique circumstances and challenges introduced and applied Australia-wide. Aboriginal & Torres Strait Islander surgeons: demonstrating community values through inclusion, leadership and professionalism

Can you make the cut? 18 New beginnings feature

Scholarship supports new renal transplant program for patients with high BMIs

The Pickard Robotic Training Scholarship has enabled Mr Shantanu Bhattacharjya to reach the final stages of developing a robotic renal transplant program in South Australia for patients with a high body mass index.

Patients with a high body mass index Fellowships in hepato-pancreato-biliary (BMI) are unlikely to make it to the kidney surgery and transplantation. He performed transplant waiting list because a BMI the first live donor simultaneous pancreas higher than 35 makes the transplant and kidney transplant in India in 2008, technically difficult and the outcome less then worked as a consultant in the UK for than optimal. seven years. After immigrating to Australia Of particular concern are the number of in 2016, he set up a steroid-free whole Indigenous patients who need to stay organ pancreas transplant program that’s on dialysis indefinitely because being had 100 per cent patient and graft survival overweight excludes them from the rates since its inception. More recently, Mr waiting list. Bhattacharjya completed his training in robotic surgery. Mr Bhattacharjya’s concern isn’t singular. As well as these patients missing out on For his research on robotic kidney kidney transplants, he worries about the transplants, Mr Bhattacharjya and his cost of ongoing dialysis to the taxpayer. team developed a large animal model of It can cost around $85,000 annually for heterotopic kidney auto-transplantation, dialysis in an urban setting and up to similar to the procedure performed in $124,000 in a remote setting. Annual home humans. “We did four cases of robotic Dr Shantanu Bhattacharjya 1 and four cases of laparoscopic kidney haemodialysis costs about $43,000. this case transplant recipients with higher transplant surgery,” to ascertain which BMIs.” While the cost of dialysis is about the technique was more robust and easier. same as a transplant in the first year, in Now, after developing the model, Robotic surgery provides the the second and subsequent years it is performing the transplants, observing the combination of three-dimensional substantially less. outcomes, and being trained in robotic vision and the flexibility of being able “A transplanted patient is a huge surgery, “we’re almost in the position of to rotate your instruments inside, offering it as a clinical program,” he said. Mr Bhattacharjya explained. “It’s the cost saving to the taxpayer.” seven degrees of freedom that you get For a robotic kidney transplant program with instrumentation. If you’re doing Referring to a 10-year study by the to be truly effective, its design has to cater laparoscopic surgery, you’re actually University of Illinois at Chicago, published for deceased donor transplantation, an operating in two straight lines; whereas, in 2019, Mr Bhattacharjya said the study unpredictable service, rather than a living robotic surgery is more natural – almost has demonstrated that robotic surgery can donor program that is more planned like operating inside the patient.” be used successfully for kidney transplants and predictable. This means robotic on recipients with median BMIs up to 41. transplants would likely be provided out Mr Bhattacharjya said he is grateful of the Royal Adelaide Hospital – the only to the Royal Australasian College of The study reported “one- and three-year quaternary hospital in South Australia that Surgeons and the Pickard Robotic Training patient survival rates of 98 per cent and offers transplantation. Mr Bhattacharjya Scholarship for supporting his research 95 per cent, respectively, among patients consults there, although other options, and reaching the final stages of the with obesity”. Out of 239 recipients, only such as public–private partnerships, are robotic renal transplant program. The 17 developed graft failures and went being explored. He is hoping the hospital program, aimed at Indigenous people with back to dialysis, “resulting in 93 per cent will be able to procure a da Vinci Xi increased comorbidities including obesity, three-year kidney graft survival”.2 When robotic surgical system, which is the new will enable them to live normal lives and compared to a national United States generation robotic system optimised for engage more readily in exercise and weight database, these results were similar to complex surgery with minimally invasive loss. those seen in non-obese patients across surgical options. the same period (2009-2018). “There’s a learning curve associated with REFERENCES Mr Bhattacharjya completed his General any new program,” Mr Bhattacharjya said. 1. Gorham G, Howard K & Zhao Y et al. 25 June 2019. Cost of dialysis Surgery training in India, then higher therapies in rural and remote Australia – a micro-costing analysis. “At first you take a standard risk and as the BMC Nephrology, Spring Nature. Retrieved from https://bmcnephrol. surgical training in the Oxford training biomedcentral.com/articles/10.1186/s12882-019-1421-z. team experience and confidence grows you 2. University of Illinois at Chicago News Release 19 Nov 2019. scheme in the United Kingdom (UK) with Robotic transplants safe for kidney disease patients with obesity. move on to more complicated cases – in Retrieved from https://www.eurekalert.org/pub_releases/2019-11/ uoia-rts111919.php. Surgical News | Volume 22 | Issue 01 19

and gender equity as his main passions. Welcome to new RACSTA Chair, “RACSTA has made some great headway into these areas, even just during my time on the committee,” he noted. “Still, there Dr Charles Jenkinson is much more work to be done.” Dr Jenkinson currently works as a heart transplant registrar at St Vincent’s Hospital in Sydney. “2020 Dr Charles Jenkinson, a Cardiothoracic After high school, Dr Jenkinson attended was a challenging year,” he said. “My Surgery Trainee and the new Chair of the the University of Western Australia, family remained in Perth while I moved Royal Australasian College of Surgeons completing his Bachelor of Medicine and to Sydney. With COVID-19 and border Trainees Association (RACSTA), believes Surgery in 2008. He started his career at closures, the anticipated frequent advocacy and Trainee representation Royal Perth Hospital and spent half of trips across the country have not been have given a fuller and more rounded this time seconded to Broome Hospital as possible. We’re lucky to have spent a sense of purpose to his surgical journey. one of their very first interns. couple of blocks of time together, but I “It started out when I became the Three years later, he married Clare, who hope that people can be kinder and more Cardiothoracic Trainee representative,” he met in high school some years before. compassionate towards those who are he said. “My goals were to improve They now have two children – Cora (six) kept apart from their loved ones by the communication between Trainees, as and Georgia (two). “Being a parent really pandemic.” well as act as a conduit to our Speciality changed my perspective on life, work Training Board. We are a small Trainee and workplace culture,” Dr Jenkinson cohort, only numbering 40 across explained. “I started questioning whether Australia and New Zealand, so I never our culture was really conducive to understood why we weren’t more good patient outcomes, good career connected and engaged, especially satisfaction, and personal health and approaching 2020.” wellbeing. At the same time, I was Dr Jenkinson grew up and was educated representing Trainees to our training Dr Shantanu Bhattacharjya in Mandurah, 80 kilometres south of board, professional society and RACSTA. Perth, Western Australia. His father These opportunities provided a forum ran a veterinary practice and spent the to explore ways in which we can do best part of a decade treating horses things better. Joining the RACS Operate and other big animals over a large with Respect Committee also shaped portion of country Western Australia. my way of thinking about behaviour, Dr Jenkinson’s love for medicine (and professionalism and culture.” surgery in particular) arose from trips to Dr Jenkinson views issues such as leave horse properties and visits to his father’s portability (especially as they affect consulting rooms and operating theatre Trainees changing states or countries), as a child. access to parental leave, flexible training, Dr Charles Jenkinson

POST FELLOWSHIP TRAINING IN UPPER GI SURGERY Applications are invited from eligible Post Successful applicants will be assigned to an Leanne Rogers, Executive Officer ANZGOSA, Fellowship Trainees for training in Upper accredited hospital unit. Year one fellows are P.O. Box 374, Belair S.A. 5052, or email GI Surgery. Applicants MUST be citizens or given the option to preference a state but [email protected]. permanent residents of Australia and New not a hospital unit. All year one placements Successful applicants will need to be able to Zealand. will be in a different state from which you attend interviews on Saturday June 19th in currently reside. ANZGOSA’s Post Fellowship Training Program Melbourne. is for Upper GI surgeons. The program For further information please contact the Application fee of $450 is payable upon consists of two years education and training Executive Officer at [email protected] acceptance of your application. following completion of a general surgery To be eligible to apply, applicants should fellowship. A compulsory portion of the have FRACS or sitting FRACS exam in June program will include clinical research. A 2021. Any exam fails will not be offered an successful Fellowship in Upper GI surgery interview. will involve satisfactory completion of the curriculum requirements, completion of Applicants should submit a CV, an outline of research requirements, minimum of twenty career plans and nominate four references, four months clinical training, successful one must be Head of Unit, (with email case load achievement, and assessment. addresses and mobile phone numbers), to Applications close midnight, Monday 5 April 2021 20 New beginnings feature Open house at RACS South Australia

While 2020 was a difficult year, it ended as well as several past state chairs. Dr to follow. In the meantime, Fellows, on a positive note in South Australia as Sparnon spoke at the ceremony to thank Trainees and SIMGs are welcome to visit the state office hosted an open house all those involved in the move, and said the building at any stage during office event to welcome Fellows, Trainees that he was looking forward to the next hours and familiarise themselves with and Specialist International Medical exciting chapter for the College in South the facilities. Graduates (SIMGs) to the College’s new Australia. The building has three available rooms on purpose-built office at 24 King William Mr King also spoke at the event and level one and six rooms on level two. All Street in Kent Town. said that the College in South Australia rooms will be equipped with the latest The open house provided attendees with had come a long way since he first technology. An online booking system the opportunity to tour the building, commenced his training, when the will be implemented shortly. In the which has been designed to host a South Australia office operated out of meantime, if you would like to confirm wide variety of meetings, symposia, a small office at the Australian Medical any bookings in 2021 please contact the workshops, courses, exams, receptions, Association South Australia building. South Australia office via email at college. dinners and other social functions. The Mr King thanked the many past chairs [email protected]. building also houses all South Australian- in attendance for their foresight in Image: based staff, who previously worked out purchasing the previous South Australia L-r: Gayle Bradbrook, John Biviano, Lesley of two separate office buildings in North building in Palmer Place North Adelaide, Dunstall, Mark Morgan, Maria Cogman, Travis Adelaide. as well as those who contributed to the Dawe, Daniela Ciccarello, Etienne Scheepers and Allan Chapman at the launch of the new office. In attendance at the open house were move into the new office. RACS President, Dr Tony Sparnon, and An official opening for the building will RACS South Australia Chair, Mr David King, occur in early 2021, with more details Surgical News | Volume 22 | Issue 01 21 Unveiling the Collections: a new RACS publication

first object to enter the collections. Developed in 1869, the spray was designed to kill airborne bacteria, but had some side effects. Everyone attending the operation inhaled the spray, and the carbolic landed on the open operating site, causing significant burning of the tissues. At the other end of the spectrum, a large collection of historic medical books illustrate anatomy and the development of surgery. The collection contains many rare and early editions, such as those by Andreas Vesalius and Ambroise Paré. As the College approaches its centenary in 2027, it is important to reflect on its rich history. Although consisting of inanimate objects, the College collections help show how that history evolved. Most of the objects have interesting stories connected to them, and they contribute to the complex web of relationships that have created a 21st century surgical College. The idea for a book about the College a photographer, began the difficult task Unveiling the Collections confirms the collections had its origins in a Heritage of photographing objects that were importance of valuing and preserving and Archives Committee meeting in often located in awkward places. Geoff heritage. The publication will benefit 2017. The College centenary was 10 has been the curator since 2001, and present and future generations. years away, but there was concern the task of writing the descriptions was that Wyn Beasley’s two seminal books made easier by referring to his numerous Elizabeth Milford, RACS archivist about the College, Portraits at the Royal articles in Surgical News. However, some Australasian College of Surgeons (1993) of the items still needed researching, UNVEILING THE and The Mantle of Surgery (2002), needed and investigating the rare books was UNVEILING

updating. undoubtedly one of the most rewarding THE COLLECTIONS

tasks. COLLECTIONS of the ROYAL AUSTRALASIAN Initially, the committee discussed COLLEGE OF SURGEONS the possibility of simply updating the Unveiling the Collections begins with

Unveiling some unusual objects from the fascinating collections of the Portraits book, but Professor John Royle the archetypalRoyal Australasian symbol College of Surgeons, of this thebook opens withCollege, an archetypal GEOFFREY DOWN and symbol of the College, the Great Mace. It continues with an exploration of a GEOFFREY DOWN diverse group of objects loosely bound together by type. Furniture, ceramics ELIZABETH MILFORD had another suggestion. He proposed a the Great Mace.and silverware It vie continues with paintings and sculpture. A miscellanywith of surgical an instruments, dating mainly from the nineteenth and twentieth centuries, feature the carbolic spray used by Lord Lister at the Glasgow Royal Infirmary, publication that included both recent exploration ofpictured a below. diverse Developed in 1869, the group spray was designed toof kill airborne objects bacteria, but had some side effects. Everyone attending the operation inhaled the spray and if the patient had been anaesthetized using chloroform, the vapour decomposed into chlorine gas. and presidential portraits and a selection of loosely bound together by type and ELIZABETH MILFORD At the other end of the spectrum, a large collection of historic medical books contains many rare and early editions such as those by Vesalius and Paré. Objects often have interesting stories connected to them, contributing ‘treasures’, highlighting the College’s is divided intoto the sections:complex web of relationships that presidential have created a surgical College. Confirming the importance of valuing and preserving heritage, Unveiling important history by ‘unveiling’ some portraits, otherthe Collection portraits,s will enrich present generations andlandscapes benefit those in the future. unusual objects from its extensive and seascapes, books and documents, HOR BO C OK N S collections. It would also serve to surgical instruments,A sculpture,

AU LIA acknowledge the contribution of the ceramics and bronzes,STRA and silverware.

HOR BO C OK N S A

A A USTRALI more recent past presidents. An example comes from a miscellany Significant objects from the collections of surgical instruments, dating mainly Main picture: Mr Tony Sparnon, Elizabeth Milford were chosen by Professor Royle and the from the 19th and 20th centuries. A and Geoff Down present the book. College curator, Geoff Down. Works were carbolic spray used by Lord Joseph Lister Above: The cover of Unveiling the Collections. categorised and, in 2018, Les O’Rourke, at the Glasgow Royal Infirmary was the 22 New beginnings feature Introducing the Global Health Section

Among the many disruptions to our daily Members of the section will be Organization Sustainability Development lives caused by the COVID-19 pandemic, encouraged to form hubs in areas such as Goals in Health (SDG3) one of the most significant has been the specialty interests, geographical regions, 3. to focus on strengthening surgery and transition to working from home and specific diseases or academic focuses. health systems, with the aim of providing the rise of the digital workplace. We are These hubs will have the opportunity timely access to safe affordable surgical deeply interconnected globally through to meet online as often as necessary to care for people in our region the online world, and we have come support the needs of their members in 4. to enable non-surgeons who to rely on these digital connections to alignment with the interests of the RACS contribute to global health to apply for bridge the physical and other divides that Global Health Strategic Plan. membership of the section increasingly separate us. “The intention for the section is to 5. to support partnerships to advance We are committed to drawing have easy connectivity between health professional development through opportunity from this worldwide professionals across the Asia-Pacific health education, along with systems challenge and Global Health are working region – a constellation of clinical development. to establish the Royal Australasian networks linked by common interests College of Surgeons (RACS) Global to accelerate our mutual learning “The Global Health Section is an Health Section for Fellows and other and provide the best care to our opportunity to share the wealth of professionals interested in global health, communities,” Chair of Global Health, Ms knowledge, diversity of experience and both in Australia, New Zealand and Annette Holian explained. “The network technical expertise across the health the many countries in which we work will allow free communication and the and international development sector,” internationally. sharing of ideas and documents without Head of RACS Global Health, Philippa Nicholson, said. “RACS Global Health Across RACS, our sections cater to having to book meetings through RACS would like to enable transparent sharing the specific needs of interest groups staff. The number of hubs will be limited of information to support a constantly of Fellows where the interest is only by member interests.” growing program based on current multidisciplinary or cross specialty. The The Global Health Section will serve a experiences and standards.” creation of the Global Health Section variety of interconnected functions, is part of our wider effort to revitalise including: Philippa also spoke of the section’s potential to better connect peers our governance structure, including 1. to provide a forum for surgeons from internationally. “We at RACS Global broadening engagement across the all disciplines and other professionals Health see this as a forum as much for Fellowship. The Global Health Section engaged in global health to connect and Australian and New Zealand practitioners will bring together members including support the RACS Global Health Strategic as for colleagues in the Asia-Pacific and Fellows, anaesthetists, perioperative Plan nurses, other clinicians and international globally.” 2. to focus on capacity building efforts development partners in a collaborative, Membership is open to any RACS in order to meet the World Health supportive and respectful online space. Fellow, surgical Trainee or Specialist International Medical Graduate on a pathway to Fellowship, and medical staff registered with the Australian Health Practitioner Regulation Authority (AHPRA) or Medical Council of New Zealand (MCNZ). Registered medical and nursing staff in partner countries may self- nominate for membership. Each partner country will have a representative doctor, a Clinical Lead, nominated by their Ministry of Health who will be the hub lead for that country. If you are interested in joining the Global Health Section, please contact Global Health Engagement Coordinator, James O’Keefe, at global.health.section@ surgeons.org. Surgical News | Volume 22 | Issue 01 23 Dr Samantha Pillay, paving the way for many firsts

It was work experience, at the age of 15, progress the area of female Urology. We Shopping once a fortnight saved her in Cardiothoracic Surgery that cemented grew the content of female Urology in time and money, while also reducing her Dr Samantha Pillay on a surgical career the curriculum and at scientific meetings. stress and food waste. path. Now she is a self-published author “This attracted surgeons into female “At the end of the day I’m ‘hangry’ of The No Recipe Cookbook – a cookbook Urology and grew recognition from our [hungry and angry] and I have decision- for people who don’t cook. peers. There are now more women in fatigue,” Dr Pillay said of her own Dr Pillay’s journey over 35 years, from Urology,” Dr Pillay reported. “When I experience. “I don’t want to choose work experience to author, has been started my training, Professor Helen from a menu or wait for a meal when I an interesting one. She was the first O’Connell AO was the only female can have dinner on the table in under female to complete surgical training in urologist in Australia. Today that number 20 minutes.” There are no intimidating adult Urology in South Australia. She has grown, although we are still far from glossy pictures in her book. “I call it further trained in female Urology – a place where being a female in Urology, the ‘anti-fancy’ cooking movement,” concentrating on women’s incontinence choosing a career in female Urology, or Dr Pillay said of this choice. “Cooking – becoming the first urologist to being a woman and not choosing a career without a recipe allows me to be exclusively sub-specialise in female in female Urology, are the norm,” Dr creative, take risks and embrace pelvic medicine and reconstructive Pillay said. mistakes. Something I don’t get to do surgery. Bringing awareness has been a driving when I’m operating.” As the first female section chair in South force in Dr Pillay’s life, and she’s carried Australia for the Urological Society of this into healthy eating in The No Recipe Australia and New Zealand (USANZ), Cookbook, which took her 18 months to Dr Pillay served on both the National write and recently reached number one Board of the Continence Foundation of in several Amazon categories. Taking Australia and as their state chairperson on extra responsibilities at work and at from 2011 to 2013. home during the COVID-19 pandemic Born with congenital hip dysplasia, Dr refined Dr Pillay’s time-management Pillay started school in a wheelchair. skills and healthy meal planning. “Surgery maybe wasn’t an ideal career choice for someone who experienced pain on standing, but I was driven, stubborn and the harder it was, the more I wanted to do it,” Dr Pillay said. “Urology had a lot of sit-down surgery and procedures under two hours. I had to be sensible about what speciality I chose and I enjoyed the endoscopic side,” she added. From 2007-2013 Dr Pillay served as chair of the Female Urology Special Advisory Group for USANZ. In 2007, she became the first female scientific chair for the USANZ Annual Scientific Meeting. “It was a great honour to serve in these roles – to be the custodian and to 24 Fellow contribution Dispatch from New York

Dr Diana Kirke’s COVID-19 experience

I clearly remember one of my final days hospital in under 36 hours and back home weekly basis with the stories they shared at work before our second daughter was sheltering in place with my husband and and the strength and teamwork they born. It was 12 March 2020, and I was our older daughter, Delphine. demonstrated. For a detailed account at Elmhurst Hospital Center in Queens, My husband, a neurointerventionalist of their experience I highly recommend New York City. I work there twice a week also at Mount Sinai Hospital, soon an article recently published in JAMA as part of my role as Assistant Professor found himself treating more strokes Otolaryngology Head & Neck Surgery, at Mount Sinai Hospital, where I am than usual due to increased COVID-19 ‘If not us, who? And if not now, when?: both a laryngologist and head and neck related thromboembolism,1 and was Perspective from a COVID-19 Intensive microvascular surgeon. ‘redeployed’ to the frontline to look after Care Unit run by Otolaryngology 3 That particular day we had our first COVID-19 patients in Neuro-ICU. Every residents.’ suspected COVID-19 case in the clinic day he would return home, remove his For eight weeks I barely left our and the residents came to me, looking clothes at the front door, place them apartment, but we were luckier than for guidance. Their anxiety reflected the directly into the washing machine and most, having a large apartment (by New mounting tension in both the city and its then jump immediately into the shower. York City standards) with rooftop access. hospitals since the first case had been These are practices we still partially As the weather improved, we would diagnosed on 1 March. By the end of the adhere to. After our daughters were picnic up there and audibly track the day our fears had been realised. As I left asleep we would have a daily debrief severity of the pandemic by the number the hospital it resembled a scene out on the patients he was treating and the of times we heard the ambulance sirens of an apocalyptic zombie movie, with new developments, including the field in an hour. This was easy for us to do as hordes of unwell patients filing into the hospital that was being built in Central we live just down the street from Lenox hospital and languishing in the entryway Park across from the hospital and the Hill Hospital. At night, after the 7pm clap chairs. I was 37 weeks pregnant at the new patient pods being built in order for essential workers, you could hear a time and I rang my husband, Reade de to expand bed space in the Mount Sinai pin drop. Anyone who has been to New Leacy, immediately and told him I did not atrium, originally designed by I. M. Pei, of York City would know how strange that is believe it was safe for me to return to the Louvre pyramids fame. for the city that never sleeps. work. He had been saying that for weeks. I felt torn as I talked to my colleagues, I returned to work after eight weeks I did go to work the following day at who had very quickly pivoted to respond on 18 May, approximately one month Mount Sinai Hospital but, perhaps rather to the new normal.2 I clearly appreciated after the peak of the surge, when more fortuitously, I had our second child the that I had a different role protecting our than 2000 COVID-19 patients were following week on 18 March, two weeks newborn and oldest daughter (which early. I thought her early arrival was due was certainly a challenge without any to anxiety, but my obstetrician thinks it help), but I felt a sense of survivor’s guilt may have been because I had COVID-19, that I was not on the frontlines as I had due to a similar trend of patients she been trained to be. To help alleviate this was seeing. I will never know for certain, I did what I could remotely. I provided given the lack of testing at that time, counsel with my residents at Elmhurst but I do clearly recall having fatigue and Hospital Center via weekly Zoom calls. extreme shortness of breath, to the point This hospital, which is in one of the most of feeling suffocated, the week prior. At ethnically diverse neighbourhoods in the time I attributed these symptoms to New York City, had very quickly turned being in my third trimester. into the epicentre of the epicentre. The day of Elodie’s birth was chaotic. This group of residents, some of whom Everyone was extremely distracted by the were interns, were now staffing their surge of patients arriving at the hospital own ICU. Like my husband, they looked and rumours of the imminent city-wide destroyed emotionally and physically. I shutdown. Elodie and I were out of the rarely cry but they had me in tears on a Surgical News | Volume 22 | Issue 01 25

a post-COVID-19 voice, airway and swallowing unit at Mount Sinai Hospital, of which I am the lead, to understand and treat this subset of patients. I strongly applaud the Australian and New Zealand federal, state and territory governments’ response to the pandemic, and there have been times when we have had bouts of homesickness. However, while this past year has brought extreme challenges, I am grateful to have been witness to this historic time and to still have the love of my young family to return home to each day.

Dr Diana Kirke, FRACS

Dr Diana Kirke with her family

hospitalised across the Mount Sinai I felt, and still do in the midst of a second Health system. By that stage, Reade surge, extremely well protected at work and I had personally known people and I have recently received the first dose who had passed. I had heard about the of the Pfizer vaccine. It was bittersweet, refrigerated trucks stationed behind the however, when I developed mild airway REFERENCES 1.Majidi S, Fifi JT, Ladner TR, Lara-Reyna J, Yaeger KA, Yim B, et al. Elmhurst Hospital Center to store the swelling and have been subsequently (2020). Emergent large vessel occlusion stroke during New York City’s COVID-19 outbreak: clinical characteristics and paraclinical findings. deceased, but it was still jarring to see told not to take the second dose. Stroke, 51(9), 2656–2663. http://doi.org/10.1161/STROKEA- HA.120.030397. them first hand. One of the first cases 2. Schwam ZG, Jategaonkar AA, Teng MS, Horn S, Lebovics RS, Genden Since May we have been seeing a lot EM, & Wanna GB. (2020). Staying ahead of the curve: early lessons that I performed on my return was a from a New York City otolaryngology department’s organizational of post-COVID-19 patients with voice, response to the coronavirus pandemic. Laryngoscope Investigative COVID-19 tracheostomy. By that stage Otolaryngology, 5(3), 401–403. http://doi.org/10.1002/lio2.400. airway and swallowing disorders and 3. Badhey AK & Laitman BM. (2020). If not us, who? And if not now, the protocols in place had very quickly when?: perspective from a COVID-19 intensive care unit run by in response to this we have established otolaryngology residents. JAMA Otolaryngology Head & Neck Surgery, adapted and matured. 146(11), 997–998. http://doi.org/10.1001/jamaoto.2020.3232.

A new course for supervisors

In 2020 the Royal Australasian College working relationships and improve • identify RACS policies/procedures of Surgeons (RACS) implemented a new, feedback techniques with their Trainees. • describe roles and responsibilities of more contemporary course for surgical As part of the ongoing professional SET supervisors, trainers and trainees supervisors and trainers, designed to development strategy to provide greater better meet their current and future • discuss how to support trainee accessibility of courses, and also in needs. Following a review of the learning and provide a safe learning response to the COVID-19 pandemic, Supervisors and Trainers for SET (SAT SET) environment the RACS education team, together with course, the course was retired and a new surgical stakeholders, has taken an • identify RACS assessment course, Induction for Surgical Supervisors integrated approach in the development requirements and Trainers, was developed. of the new course. Delivered through the • plan how to evaluate their supervision. While the course primarily aims to RACS eLearning platform, the Induction support surgical supervisors and trainers for Surgical Supervisors and Trainers in fulfilling their role, it also looks to course will be a combination of three The first online Induction orf Surgical improve the Trainee experience through online eLearning modules and two Supervisors and Trainers course educating Supervisors and Trainers webinars. is scheduled for mid-2021, with with more contemporary content based registrations opening shortly. To register By the end of this course, participants will on best practice and evidence-based your interest in attending this course, be able to: pedagogy. The course provides greater please email [email protected] support and engagement to supervisors • identify the relationship and the and trainers, which, in turn, will enhance communication pathways between RACS and its training boards PRESENTED BY

SAVE THE DATE Creating healthcare cultures of safety & respect

22—23 April 2021

These virtual sessions will focus on creating a culture of safety and respect in the workplace, by facilitating an assembly of health leaders and culture change practitioners with a common goal of eliminating bullying, discrimination, harassment and incivility in healthcare.

Keynote Speakers

Professor Russell Mannion PhD, FRSA, FAcSS. University of Birmingham Professor Gerald Hickson MD, FAAP. Vanderbilt University Medical Center For more information: tinyurl.com/4f3o6agx Registrations: tinyurl.com/1shmawiq

PROUDLY SPONSORED BY Surgical News | Volume 22 | Issue 01 27 Cultural change and patient safety: a joint summit

Health practitioners across Australia, between positive organisational and “Culture has an impact on patient safety. indeed the world, are working towards workplace cultures and beneficial clinical And culture represents our values, cultural change. But what is culture? How outcomes, including reduced mortality knowledge and experience in action, on is it linked to patient safety? How does rates across a variety of health settings”. behalf of the patients we serve,” he said. cultural change happen? And what can be Often, he argues, culture “is a metaphor for He encourages surgeons and other health achieved when it does? some of the softer, less visible aspects of practitioners involved in cultural change to The evidence linking respectful behaviour health sector organisations and how these start from shared values rather than focus with patient safety is well established and become manifest in patterns of care”, less on barriers to change. Fostering a culture continually increasing. But even with a visible, but no less powerful in influencing in which people feel safe to speak up is at shared commitment to professionalism, patient outcomes. He advocates that an the heart of building a culture of respect. achieving cultural change is recognised under-nuanced understanding of what Ask “what are our shared priorities and as a challenge that takes time. After all, shapes and defines culture in health care values, and how can we link these to most health practitioners already do can limit the impact of the link between strengthen our performance and make it what they think is best for their patients, culture and performance. safe for people to speak up,” he said. and many of us are inherently (and often “Clearly, the relations between culture subconsciously) resistant to change. “In a ‘safety culture’, everyone feels and quality, safety or efficiency are unlikely respected and, therefore, able to work in Five years ago, the Royal Australasian to be straightforward. Culture, although an undistracted way. They can speak up College of Surgeons (RACS) committed important, offers no magic bullet, and the when they see something that needs to be to the Action Plan: Building Respect, challenge becomes one of understanding heard,” Professor Hickson said. Improving Patient Safety. Since then, which components of culture might calls for a safety culture have become influence which aspects of performance,” He recognises that cultural change is not louder and other leaders across the health he said. for the faint hearted and there is no single sector have joined the chorus. In 2017, path that will get organisations to a new Professor Mannion has closely examined cultural destination swiftly. the Medical Board of Australia named the importance of health sector employees ‘collaborations to foster a positive culture speaking out and raising concerns when “Change happens when an organisation is of medicine’ a cornerstone of professional they see poor quality care or unsafe values-driven and has made a commitment performance. practice, in the interests of patient to working together and making it easy for Professor Russell Mannion and Professor safety. He also recognises how complex team members to do the right thing and Gerald Hickson are established leaders this request can be, given there is a voice concerns in a constructive way,” he in the field of patient safety and cultural “widely held perception among health said. “Speaking up supports patient safety. change, and both are keynote speakers at professionals that they will be victimised, We all work in teams; we all have different the summit RACS is hosting with Macquarie ostracised or bullied if they raise legitimate skills and abilities. When team members University, St Vincent’s Health Australia concerns about the work of colleagues or are all respected, nothing gets in the way and the Royal Australasian College of about poor care”. of their performance.” Medical Administrators. Recognising that Professor Hickson is well known in collaboration is key, the summit aims the RACS community and has been an In April 2021, RACS is co-hosting a virtual to foster discussion and share expertise influential adviser as the College has summit on Creating Healthcare Cultures across the health sector to support strived to build a culture of respect in of Safety and Respect, featuring Professor constructive change. surgery. He consistently warns that Mannion and Professor Hickson. A joint Professor Mannion, who is an Honorary the journey of cultural change is more a initiative of RACS, Royal Australasian Professor with the Australian Institute marathon than a sprint. College of Medical Administrators, of Health Innovation, has published Values, he says, are a powerful driver in Australian Institute of Health Innovation extensively on culture in the health sector: creating a culture of safety, partly because at Macquarie University and St Vincent’s what it is, what shapes it, how it is linked to we all want alignment between what we Health Australia, the summit is open to quality and safety, and how changing it can do and what we believe. people across the health sector working improve care and performance. He refers to achieve cultural change. to a demonstrated “consistent association 28 Advocacy Results of the telehealth survey

Last year RACS and the Hunter Medical % of patients were satisfied % of surgeons felt that a ResearchTelehealth Institute conducted an ethics- with the quality of their satisfactory level of care approved academic-level survey of 93 telehealth consultation 77 could be delivered via surgeons and their patients in relation telehealth in half or more The views of surgeons consultations to telehealth. I would like to thank % of surgeons believed everyoneand who their took patients the time to complete 91 that telehealth was this survey and to share it with your appropriate for clinical meetings and to arrange patients.during the pandemic investigations With more than 600 responses by surgeons and more than 1100 responses Patients on the whole had a good experience with telehealth by patients,In August the and response-rate September 2020 was RACS and the Hunter Medical Research significantly better than expected. The Institute conducted an ethics- data that has been generated from the thought their surgeon were satisfied with the approved academic-level survey of % was able to answer their % quality of their telehealth surveys allows us to develop a better surgeons and their patients in relation 97 questions clearly and 93 consultation understandingto telehealth. of Withindividual more thanexperiences six satisfactorily withhundred telehealth responses and guide by surgeons our advocacy and effortsmore and than representations eleven hundred to responses thought telehealth would recommend government.by patients the response-rate was % provided same level of % telehealth to their significantly better than expected. 75 care as a face to face 84 friends I am pleased to be able to share the These are some of the findings. conversation following results from the survey with you all, and I look forward to providing further updates throughout 2021. Having a telehealth consultation resulted in If you would like to know more about the ‘efficiency gains’ for many patients outcomes of the survey or the College’s advocacy in this area please email [email protected]. • Nearly 60% would have had • 18% would have had to have time additional expenses with a face to off work face consult • 18.5% would have had to travel • 93% of patients agreed or strongly more than 100kms agreed with the statement ‘using • 49% would have had transport costs telehealth allowed me to attend my appointments with less • 6.1% would have had interruption to my routine’ accommodation costs

Surgeons on what they would use telehealth for after the pandemic

• Initial consultation 51% • Distance, frail aged, disabled patients 89% • Pre-operative Review 50% • Post-operative review 77% • Routine follow-up 88% • Other 6.7%

For more info : Although 88 per cent of surgeons said they would continue to use telehealth [email protected] after the pandemic, many commented on the additional administrative burden of telehealth during the pandemic, and that this was not sustainable from a financial perspective.

Professor Mark Frydenberg Chair, Sustainability in Healthcare Working Group Surgical News | Volume 22 | Issue 01 29

Get to know your Educators of Merit

Every year the Academy of Surgical achieves other great milestones in life, How do you feel receiving the ASE Educator Educators (ASE) presents the Educator such as becoming a parent. But what I am of Merit award? of Merit award to recognise exceptional probably most proud of is seeing them I was very proud to be awarded the ASE contributions by our surgical educators. become the next generation of teachers. Educator of Merit for the ACT. I have been Some 2020 winners share their thoughts on Any advice for new surgical educators just involved in teaching surgery for over 30 being an educator. getting started? years to medical students, residents, registrars, Fellows and colleagues. Educator of Merit – SET Supervisor/SIMG Don’t forget what it was like to be a junior Supervisor of the Year (Victoria): doctor or surgical Trainee. What do you What inspired you to pursue surgical Dr Kate Martin. Fellow since 2008. wish had been done for you? What did you education? find really important and helpful? Keep I have always been interested in teaching this in mind. surgery, and took the opportunity in Remember our Trainees have lives outside 2013 to start the Master of Surgical of surgery. Being organised will give Education degree. I completed this in your Trainees plenty of time to prepare, 2016 by minor thesis, looking at what whether it’s for tutorials, rotations or motivates senior surgeons to learn new projects. You also need to be reliable. It surgical techniques. I have been involved can be very easy to say ‘yes’ far too often. in teaching spine surgery with the Spine If you have been asked to give a tutorial, Division of the AO Foundation since 2005. ensure you prioritise it accordingly. I avoid What is your proudest moment as a teaching when on call – you can’t be in surgical educator? two places at once. This is harder for those in a rural setting who are, no doubt, Being elected as the chair of the AO Spine on call more frequently, but it is much International Education Commission in better to schedule teaching when you are 2017, overseeing spine surgery education available. in more than 70 countries and over 200 educational events annually. Finally, you never stop learning new How do you feel receiving the ASE Educator teaching skills. Watch those who you Educator of Merit – SET Supervisor/SIMG of Merit award? regard as good teachers. Use their Supervisor of the Year (New Zealand): techniques. (You can even quote them!) Very humbled! Teaching is a very Mr John Lengyel. Fellow since 2017.  rewarding part of being a surgeon and Educator of Merit – SET Supervisor/SIMG I’m now senior enough to have seen a few Supervisor of the Year (Australian Capital of my Trainees all the way through from Territory): intern to consultant. Dr Bryan Ashman. Fellow since 1989. But I’m only carrying on a tradition that I was the beneficiary of from my most junior years. I was given the learning opportunities as a junior doctor by a number of senior surgical colleagues (registrars and consultants) and I realised quite early that passing on the privilege to the next generation is all of our responsibility. What is your proudest moment as a surgical educator? While it’s always lovely to see the smiling faces of Trainees as they receive their scarf or tie at the Fellowship exam, and I’m always proud when a Trainee 30 Educator of Merit

What inspired you to pursue surgical mainstream, and I encourage my Trainees there are many junior surgeons who can education? to think rather than be taught. still teach us – if we are willing to accept With the growth of the internet and readily What do you hope to see in the future of change. accessible information, I was interested to education? The Educator of Merit awards consist of know how the next generation would use it I would like to see the Royal Australasian the SET Supervisor/SIMG Supervisor of to their advantage. There has been a move College of Surgeons (RACS) move away the Year Awards, which recognise the by many institutions to provide courses from politics and compulsory educational exceptional contributions by a surgical and up-to-date online content, assuming campaigns. Surgeons have the ability supervisor/clinical assessor towards that simply transmitting information from to change the course of pathological supporting Trainees and Specialist reputable sources results in learning. processes that have defined end points. International Medical Graduates (SIMGs), Change in behaviour that comes from RACS should promote evidence-based and the Facilitator/Instructor of the Year learning occurs when there is a drive surgical practice because, unfortunately, Award, which recognises the exceptional to find an answer to a problem, or a much decision-making is still cloaked in contribution by a course facilitator or hurdle, in the form of an examination. dogma. an instructor teaching on Professional There are many barriers to learning, What advice do you have for health Development or Skills Education courses. which are enhanced when information professionals who are passionate about Nominations will be open from 1 is only available with payment, or when surgical education? content has a political agenda or a strong February to 31 March 2021. Submit your viewpoint. I would encourage them to think about nomination by including your name and the best learning experiences they have contact details, the name and contact I have nothing to lose and no axes to had, those that changed the way they details of a seconder, and supporting grind. Unfortunately, education today practise, and find methods to replicate comments on the nominee. Please send is prescribed and driven by political that experience for their juniors. Lead nominations to [email protected]. correctness. I don’t consider myself by example, but be humbled by the fact

One College Transformation: making it easier to support you

As part of the One College Transformation You will notice the following changes These improved features will set us program, we are upgrading and enhancing when you log in to your member profile, up to serve you in an enhanced, more our current member profile platform, or eHub from February 2021. personalised way in the future. This is the which is outdated and limited in its self- 1. When you log in to your member first release of several that are scheduled service capability. profile, you will see an enhanced log-in to occur over 2021. We look forward to The One College Transformation seeks to page. sharing updates with you as we progress better support and advance your needs in on the work and planning required. 2. When you click on ‘My Details’ in your today’s constantly changing digital world. profile, you will see a new and improved The vision of the One College We want to improve your online modern profile section where you can Transformation initiative is to build experience with the College by update your: robust, integrated RACS governance, progressively replacing your ePortfolio management and infrastructure, which • contact details with Microsoft Dynamics 365, which will supports all Fellows and provides greater be mobile, secure and connected to all • areas of practice opportunities to be involved in, and feel College platforms, instead of working in • emergency contact information part of, the capability the College offers a silo. the Fellowship, aspiring Fellows, and the • dietary requirements for events The new platform will be called eHub, surgical profession. • communication preferences. and it will personalise content for you, Please email [email protected] if you providing you with a 360-degree view of 3. When you click on ‘My CPD’, you will be have any questions. your information and overall journey with able to navigate to the new interim CPD RACS. We are reducing inefficiency in our system by clicking on ‘CPD 2021’, where systems to improve value for you. you can: Using one platform for all our existing • create your 2021 CPD Learning Plan functions, which are currently spread out • submit an exemption request over numerous platforms throughout the • download your 2021 CPD statement College, will help us to personalise and (when made available by RACS). extend the service we provide. Surgical News | Volume 22 | Issue 01 31

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 Operating with Respect Thursday 11 March 2021 Sydney, New South Wales Friday 19 March 2021 Perth, Western Australia Process Communication Model: Seminar 1 Friday 19-Sunday 21 March 2021 Brisbane, Queensland Operating with Respect Saturday 20 March 2021 Melbourne, Victoria Thursday 25 March 2021 Adelaide, South Australia Non-Technical Skills for Surgeons (NOTSS) Friday 26 March 2021 Canberra, Australian Capital Territory Operating with Respect Thursday 15 April 2021 Auckland, New Zealand Foundation Skills for Surgical Educators Friday 23 April 2021 Sydney, New South Wales Operating with Respect Thursday 29 April 2021 Brisbane, Queensland Conflict and You Friday 30 April 2021 Melbourne, Victoria

Online courses

Course Date Leading out of Drama Monday 15-Thursday 25 March 2021

Academy of Surgical Educator Studio Session Thursday 18 March 2021

For more information email [email protected] or visit our website surgeons.org/for-health-professionals/register- courses-events/professional-development/

Professional Development Faculty expressions of interest

Prospective faculty are invited to submit panel consisting of Chair or senior • becoming part of a collegiate faculty an expression of interest (EOI) to join the representatives from an applicable group Surgical Faculty for two courses: education committee, RACS education • reimbursement of travel expenses specialists and management. • Induction for Surgical Supervisors and incurred where travel is required. Trainers course Professional Development Faculty If you would like to be part of the Faculty Benefits include: • Difficultonversations C for for Induction for Surgical Supervisors Underperforming Trainees course • sharing your knowledge with like- and Trainers, or Difficult Conversations minded professionals with Underperforming Trainees courses, Download the position description at you are invited to express your interest the end of this article for an overview • contributing to the quality by visiting the relevant link below. If you of each course. Faculty selection will improvement and review of wish to express interest in both courses, be based on the applicant meeting professional development please complete both forms. the requirements of the position programming descriptions: • the opportunity to enhance your own Expression of Interest – Induction for Surgical Supervisors and Trainers can be • Induction for Surgical Supervisors and facilitation skills found at: research.net/r/YGZBX5T Trainers position description can be • keeping abreast of the latest found at tinyurl.com/6urtjgbg development in surgical education Expression of Interest – Difficult Conversations with Underperforming • Difficultonversations C with • contributing to the future development Trainees can be found at: Underperforming Trainees position of the surgical community research.net/r/YF7PLTH description can be found at tinyurl. com/6umfjvsm • claiming Continuing Professional Development (CPD) points (refer to CPD Applications to join the Surgical program for more information) Faculty will be reviewed by a selection 32 Academic surgery Highlights from the November Annual Academic Surgery Conference 2020

The Section of Academic Surgery and The next session, on ‘Global Surgery and Liu (SET Trainee) and Mr Chris Varghese Surgical Research Society of Australasia Equity of Care’, included a brief exploration (Honours medical student). Annual Conference was held as a virtual into climate change followed by a panel The feedback from attendees indicated event on 5 November 2020. The compact session with special guests Dr Sarah Tevis, that presentations were well-received, one-day conference showcased the Professor Allan Tsung, Dr Jean-Frederic with most rated as very good to excellent. breadth and depth of research undertaken Levesque and Dr Bridget Clancy. by medical students, junior house officers, We would like to thank Medtronic for their Attendees then heard an inspiring keynote trainees and Fellows. continuing support of the SAS’s activities presentation by Professor Allan Tsung from and also thank all the contributors. We This high-quality, ongoing research Ohio State University on how to ‘Maintain hope 2021 will see a return to in-person will almost certainly pave the way the Passion’, highlighting the importance Academic Surgery and Surgical Research for improved surgical practice and of curiosity, perseverance and adaptability. Society meetings, although we have gained patient outcomes. Registration for the The final session explored training many new insights from hosting a virtual day exceeded expectations with 243 surgeons for the future. meeting. registrations covering both the morning This year’s Jepson Lecture was presented and afternoon sessions. by distinguished surgeon and immediate Professor Greg O’Grady Chair, Surgical Research Society of The November Annual Academic Surgery past Chair for the Academic Surgery Australasia Conference continues to grow and improve Committee, Professor Mark Smithers from year-on-year, both in terms of the content the University of Queensland. Professor Professor Marc Gladman and the amount and calibre of research Smithers provided the inspiring advice Chair, Academic Surgery Committee being conducted in Australia and New to focus on what information and skills Zealand. We were extremely pleased you ‘scatter’ rather than those that you by the quality and number of abstracts ‘gather’ throughout your life. submitted, which totalled 105. The The afternoon session for the Surgical abstract judging panel was hard pressed Research Society of Australasia provided to arrive at the final 40 entrants selected ample opportunity for presenters to to present on the day, with a further 20 demonstrate the variety and depth of offered the opportunity to present an research being conducted in Australia e-poster. and New Zealand. The future of research The morning session for the Section of in academic surgery is in good hands, Academic Surgery (SAS) started with an judging by the calibre of the winning update on the Clinical Trials Network presentations. Dr Brodie Elliott (JDoc) won Australia and New Zealand (CTANZ) by the Young Investigator Award, while the Professor David Watson, followed by the DCAS Award was presented to surgical Association for Academic Surgery (USA) Trainee Dr Georgina Riddiough. Four Travel Best Abstract Winner, Dr Sarah Tevis from Grants were awarded. They went to Ms the University of Colorado, speaking on Sita Tarini Clark (Honours medical student), opioid over-prescription in breast surgery. Dr Paul Heitmann (SET Trainee), Dr Chen Surgical News | Volume 22 | Issue 01 33

Dr Chen Liu Dr Brodie Elliott Dr Georgina Riddiough Travel Grant Award Young Investigator Award DCAS Course Winner

Professor Mark Smithers Mr Chris Varghese Dr Paul Heitmann Jepson Lecturer Travel Grant Award Travel Grant Award

Ms Sita Tarini Clark Professor Allan Tsung Dr Sarah Tevis Association for Academic Surgery (USA) Travel Grant Award Special guest Best Abstract Winner 34 Research Case note review

The College must embrace public reporting of clinical quality registries

Clinical quality registries (CQRs) are A significant difficulty with clinical Clinicians will have greater incentive to mechanisms for monitoring the quality datasets has been case ascertainment collect clinical data if it directly facilitates of health care delivered to a specified and full completion of the clinical dataset, their daily work. For example, cancer group of patients through the collection, even with dedicated data managers. multidisciplinary team (MDT) meetings analysis and reporting of relevant health- Administrative data is often recorded require access to histopathology stage. related information. CQRs have long been in different programs, making it almost If this was placed directly into a central established overseas, but Australia has impossible to integrate within a single repository it would be readily available for been much slower in introducing them hospital, let alone across different the MDT and others who may require it. despite local evidence showing they providers. QI run charts can be directly relevant to deliver significant value. In contrast, financial organisations immediate patient care. A single-point CQRs traditionally use a data manager to use common application programming example assessing hospital performance collect general information. The analysis interface (API) protocols, which permit is ‘door to needle’ time for patients is typically published many months later instant communication across the presenting with chest pain or stroke, and is often of little relevance to those world. Electronic medical records, which can be compared against agreed reviewing it. Particular difficulties occur health APIs and artificial intelligence (AI) benchmarks. A multipoint example if an outlier is identified because previous are addressing these hurdles to permit assessing clinical performance could poor care cannot then be addressed. administrative data from disparate be total treatment time for a patient Other issues include that performance is sources to be downloaded and combined with sepsis, covering the time from normally assessed comparative to others, into a single repository. arrival in the emergency department (from hospital administrative data), so while half are better than the average, The future challenge will be adding clinical to the time of objective assessment of the average may be low. An additional data. Cloud computing will enable the sepsis (from emergency department complexity is the uncertainties related addition of clinical data to databases electronic clinical record), to the time of to risk adjustment, and few CQRs use without geographic restriction. In the antibiotic administration (from electronic absolute, external standards as their recently reported Australian and New prescription record). Any deviation from benchmark. Zealand Emergency Laparotomy Audit – established clinical benchmarks would Quality Improvement report, real-time Quality improvement (QI) is the be immediately evident at an individual clinical data from around the country was framework to systematically improve patient level. outcomes. Processes have characteristics entered onto a cloud database. Run charts that can be measured, analysed, were returned each month and hospital The value of any CQR is greatly diminished improved and controlled. QI is widely used outcomes benchmarked against evidence- if there is not full case ascertainment, in industry, but there are few examples of based standards. The results showed that a complete record, and if hospitals and its application in medicine. Future CQRs recording of preoperative risk assessment clinicians do not view and act on their own are likely to use prospective QI methods – a key QI standard – increased almost data in a timely manner. Overseas CQRs such as run charts (line graphs of data three-fold over two years. have shown that public reporting at the hospital, and even at the clinician level, plotted over time that helps to identify In 2014, the Australian Commission on has improved data quality and outcomes. trends or patterns in a process) to return Safety and Quality in Health Care (ACSQHC) clinically relevant data at near real-time, released its framework for Australian The draft national CQR strategy makes it benchmarked against defined standards. CQRs. In 2019, a 10-year national clear that public reporting is coming to A particular advantage of QI is that poor CQR strategy was published under Australia. In advance of this, the College performance will not suddenly emerge, the auspices of the Australian Health must show leadership and act proactively but will be seen to evolve over time, Ministers’ Advisory Council. Its vision is to ensure that Australian surgical CQRs allowing remedial action to be taken to integrate national CQRs into health are surgeon-led. before harm occurs. informatics systems. Surgical News | Volume 22 | Issue 01 35

One step to achieving this is to make our accreditation. While this might seem By showing leadership, the College is continuing professional development draconian, failure to meaningfully lead on likely to be invited to contribute to the (CPD) program substantially more robust. this issue will cede control to others. organisation of CQRs. It can then ensure Full and timely participation in all CQRs However, the College cannot do this important safeguards are included; for established by the College or its specialty example, that a national outlier policy associations should become a mandatory alone. The greatest barrier to the establishment of CQRs is government’s incorporates the involvement of an part of a surgeon’s CPD accreditation external, independent surgeon. and the accrediting of training posts. failure to address the difficulties that Surgeons and hospitals must be required confront fledgling CQRs when seeking to report their compliance with the national ethical approval, with the College’s Mortality and Morbidity meeting variable requirements for site-specific guidelines. Surgeons accessing their approval, governance of the data and CQR data should be a CPD requirement. sustained funding. These barriers have Surgeons are unlikely to regularly access been acknowledged by the ACSQHC. It is a CQR seeking their personal results. They difficult to understand why these have will almost certainly read an email that been almost insurmountable hurdles in arrives with their personal data. Australia, but not overseas. It reflects Professor Guy Maddern, a lack of government leadership that is Surgical Director of For any non-compliance there must contrary to their stated aims. Legislation Research and Evaluation be real and timely penalties, such to remove these barriers is long overdue. incorporating ASERNIP-S as withdrawing CPD or training

POST FELLOWSHIP TRAINING IN HPB SURGERY Applications are invited from eligible Post requirements, minimum of twenty-four numbers), to Leanne Rogers, Executive Fellowship Trainees for training in HPB months clinical training, successful case Officer ANZHPBA, P.O. Box 374, Belair S.A. Surgery. Applicants MUST be citizens or load achievement, assessment, and 5052, or email [email protected]. permanent residents of Australia and New final exam. Successful applicants will be Successful applicants will need to be able Zealand. assigned to an accredited hospital unit. to attend interviews on Saturday June The ANZHPBA’s Post Fellowship Training To be eligible to apply, applicants should 19th in Melbourne. Program is for Hepatic-Pancreatic and have FRACS or sitting FRACS exam in June Application fee of $450 is payable upon Biliary surgeons. It is a RACS accredited 2021. Any exam fails will not be offered an acceptance of your application. PFET program. The program consists of interview. two years education and training following For further information please contact the completion of a general surgery fellowship. Executive Officer at [email protected] A compulsory portion of the program will include clinical research. A successful Applicants should submit a CV, an outline Fellowship in HPB surgery will involve of career plans and nominate four satisfactory completion of the curriculum references, one must be Head of Unit, requirements, completion of research (with email addresses and mobile phone Applications close midnight, Monday 5 April 2021 36 Research

One stop shop for plastic surgery trainees established

Plastic surgery is a problem-solving Findlay as ACTPRAS provides and collates In conjunction with partner specialty that manipulates and opportunities for research, a forum for organisations, we are developing repurposes cells, tissues and organs ideas, and a platform to disseminate suitable resources to assist researchers to achieve its goals across a broad results in conjunction with local, to develop successful studies, identify spectrum of anatomical sites and national and international colleagues. potential collaborators and participate disease states. There is a strong Since its inception in 2020, ACTPRAS has in others’ studies. ACTPRAS should be a focus on developing new and novel engaged 300 followers through online starting point for trainees and medical techniques and technologies to address media accounts and coordinated two students interested in research. It unmet clinical needs in Plastic and international studies, partnering with forms an essential resource for more Reconstructive Surgery. the United Kingdom Reconstructive experienced clinicians to expand their However, like many specialties, it has Surgery Trials Network. research horizons and broaden their impact across Australia and New been difficult to coordinate research The first, CANVAS, a service evaluation Zealand, as well as internationally. efforts across multiple centres to focusing on absorbable versus non- generate high-impact, clinically relevant absorbable sutures after skin lesion research, as evidenced by the quality excision, has run since August 2020 and low proportion (3.2 per cent) of with 16 collaborators. CANVAS has randomised controlled clinical trials engaged plastic surgeons, plastic Dr Guy Stanley 1, 2 in plastic surgery research. The surgery trainees, Australian General Australian Society of Plastic Surgeons Practitioners, ear, nose and throat (ASPS) has endorsed the creation of surgeons and dermatologists to Australasian Clinical Trials in Plastic, ascertain current suture choice in Reconstructive & Aesthetic Surgery modern practice. Along with the United (ACTPRAS) to encourage high-quality Kingdom networks, 100 clinician surveys Mr Michael Findlay FRACS research output, a development and data on 1000 unique patients have supported by the Royal Australasian been collected. College of Surgeons’ Clinical Trials Network Australia and New Zealand The second project, CIPHUR, is a service (CTANZ). evaluation examining chlorhexidine vs. betadine for upper limb surgery. Out Mr Cody Frear ACTPRAS is a one stop shop for trainees of 300 data collectors worldwide, 26 seeking to get involved in clinical trials Australasian plastics and Orthopaedic in plastic surgery. There are roles in Surgery contributors have been each study for medical students, pre- recruited. SET and SET Trainees, and consultants. Future projects include: AWAKE, a study It is a central portal for ideas through REFERENCES on the efficacy of WALANT surgery, and an interactive platform (found at 1.Agha RA et al. Randomised controlled trials in plastic surgery: a ABACUS, a study of the ReCell® spray- systematic review of reporting quality. Eur J Plast Surg. 2013, www.actpras.com). Our trainees are October, 10;37(2014):55–62. doi: 10.1007/s00238-013-0893-5 on-skin system. 2. Chang EY et al. Quality of clinical studies in aesthetic surgery supported by academic surgeon and journals: a 10-year review. Aesthet Surg J Open Forum. 2009, March; surgical specialty lead Mr Michael 29(2): 144-147. doi: 10.1016/j.asj.2008.12.007 Surgical News | Volume 22 | Issue 01 37 Exceptional DCAS program planned for the 2021 RACS ASC

faculty members encourage and welcome attendees to initiate informal discussions. Previous attendees frequently described the course as inspirational, transformational and well targeted to every level, from medical students to department heads. Faculty regularly comment that there is nothing more satisfying than seeing attendees benefit from the experience. For SET Trainees in General Surgery, attendance at this course is acknowledged by General Surgeons Australia as equivalent to attending one compulsory Trainees’ Day. After the unfortunate cancellation of the special acknowledgement. We are 2020 Developing a Career and skills in thrilled to welcome them in the most We invite you to attend the DCAS course, Academic Surgery (DCAS) course, due to appropriate format come May 2021. whether by joining us in Melbourne or in a virtual space, in May 2021 – you will the COVID-19 pandemic, we are excited The program begins with a session th be impressed and inspired. Research to announce that the 12 annual DCAS exploring the benefits of surgeons is about continuous improvement and course will be held Monday 10 May becoming involved in academic surgery, progress, so come and be part of this 2021, leading into the Royal Australasian and how the incorporation of a research course. College of Surgeons Annual Scientific component in practice will benefit both Congress at the Melbourne Convention the surgeon and patients. Associate Professor Jonathan Karpelowsky and Exhibition Centre. This year, we Co-Chair have adapted our course delivery to Other highlights from the program include virtual sessions to give everyone include Professor Michael Vallely, Associate Professor Colin Martin the opportunity to attend this exciting from the Ohio State University Wexner Co-Chair course in person or online. Medical Center, on the topic of ‘First in Mr Richary Hanney Human Trials’. The keynote presentation, Convenor The morning session will consist of a ‘Disruption and Innovation in Academic hybrid online and in-person format, Surgery’, will be delivered by Professor and afternoon sessions – including Peter Choong from the University of breakout sessions – will only consist of Melbourne. Furthermore, this year’s in-person attendance. As always, we will program will include talks on navigating Further details including registration provide delegates with an exciting range the virtual academic environment and costs and the provisional program can of informative topics that promise to a discussion on diversity, equity and be found at: engage and inspire. inclusion in academic surgery. http://www.tinyurl.com/DCAS2021 We are pleased to have assembled an The content of the two afternoon exceptional faculty from Australia, New workshops will cater to onsite Zealand and the United States who will attendees: firstly those new to research share personal experience and tips or academic surgery, with the topic on what it takes to start, develop and ‘Finding My Niche/Fit and Tools of the continue a productive career in academic Trade’; and secondly, those in early surgery. career development, with the topic As always, we look forward to renewing ‘Trainee-Led Collaborative Trials’. acquaintances with our American For those attending onsite, the day colleagues from the Association for will end with a networking function, Academic Surgery, whose continued where our approachable and engaging support for our DCAS course deserves Digging deeper into Australia and New Zealand road crash statistics

2020 not a good year for road safety

It was a terrible year on the roads in Victoria’s roads during a year where the the aftermath of the death of a young Queensland. In total, 59 more people were state had what was considered by many Brisbane couple killed by a car while they killed on the state’s roads in 2020 than in to be the ‘world’s strictest lockdown’ and were walking their dogs. 2019 (276 deaths in 2020 compared to Melbourne was a ghost town, than two A range of existing vehicle technologies, 217 in 2019). years earlier in a year when travel and including Lane Keep Assist and But despite this alarming statistic from movement were virtually unencumbered. Autonomous Emergency Braking , or Queensland, every other Australian It is a similar story in other parts of infrastructure enhancement, such as wire jurisdiction and New Zealand recorded Australia. In South Australia there was a rope safety barriers, may have helped a reduction in their annual road crash reduction in fatalities, but let’s not forget prevent these tragedies. deaths. that 2019 was a horror year on the state’s The New Zealand Government and Normally a reduction in fatalities would roads – the worst in over a decade, in fact. governments across Australia are to lead to a feeling of cautious optimism, Comparing the 2020 and 2018 figures, be commended for the way they have but 2020 was anything but a normal the 2020 figure is more than 15 per cent responded to the challenges posed by the year. When you take a deeper look at the higher, despite the restricted travel. COVID-19 pandemic. A similar response statistics there is nothing to celebrate. We have seen a similarly disturbing trend is required to the epidemic that is road trauma. Take, for example, Victoria – the in New Zealand. For example, Otago jurisdiction hardest hit by the pandemic. experienced its worst year on the roads We are at a pivotal moment in our two According to the Transport Accident in almost 15 years and has seen a rise countries with respect to road safety. Commission there was an approximate 20 towards the end of the year. We also saw We cannot afford to allow the progress per cent reduction in the number of road another rise in the number of motorcycle of recent decades to stagnate and for fatalities. And so there should have been! deaths in 2020, compared to 2019. our unacceptably high road fatality and serious injury rate to simply become ‘the As we know, our own Royal Australasian While the new year has ticked over, it has new normal’. We must continue to look College of Surgeons (RACS) Melbourne not been a good start to 2021. A rising at ‘new ways of working’, set ambitious office asked staff to work from home from trend in pedestrian deaths has been targets and dedicate the necessary March and they did not return to the office highlighted by the tragic deaths of five resources to eliminate the devastating for the rest of the year. It was a similar young pedestrians in New South Wales in consequences that road trauma has on story right across Melbourne and Victoria. less than two months. This prompted me our society. Our social media was flooded with images to speak out in a recent media article. of normally bustling streets that were “It’s time for change when people are not Dr Valerie Malka completely deserted. When you consider even safe to walk on footpaths. What is Chair RACS Road Trauma Advisory such a dramatic change in lifestyle, a particularly distressing is that often it’s Subcommittee 20 per cent decrease in fatalities seems the result of someone getting behind rather modest. the wheel when they never should have. It is worse when you consider that Repeat offenders need to be off the road,” Victoria’s road death toll in 2020 was one she said. person higher than 2018. To put this into Since these deaths, a Brisbane perspective, one more person died on community has been left reeling in Surgical News | Volume 22 | Issue 01 39 Specialist Training Program supports rural health strategy

The Royal Australasian College of training posts, RACS STP funds several mentorship, governance and Surgeons (RACS) Specialist Training educational projects that support the established structural support, which Program (STP) is pleased to announce that success and sustainability of delivery are more readily available to Trainees the New Fellow Rural Placement Pilot, training to rural and/or Aboriginal and in metropolitan areas. The project which had its inaugural year in 2020, has Torres Strait Islander Trainees. aims to support surgical Trainees to undertake clinical research in rural and been approved to continue in 2021. The Rural Training Positions Gap Analysis remote areas, as they are best placed to In 2020, two General Surgery positions is an STP support project that aims to understand the barriers faced in clinical were funded: one at Royal Darwin increase access to surgical care across decision-making and implementation Hospital and one at Cairns Hospital. Both Australian rural settings. The project within their specific settings. Fellows have had an excellent experience is a qualitative study of the barriers to and given positive testimony through selecting rural placement and practice, Indigenous Health is a major priority for various RACS media channels. strategies to overcome these barriers, RACS as part of its Diversity and Inclusion Plan. The Aboriginal and Torres Strait Following this success in 2020, the and will make recommendations to the Islander Health and Cultural Safety Australian Department of Health Department of Health and RACS based on project team has worked closely with approved an extension of the pilot into research findings. the RACS Indigenous Health Committee 2021, with four positions funded. After Between September and November members to implement a range of a short Expression of Interest round, the 2020, RACS interviewed 29 participants, College-wide changes. These include following four hospitals were successful consisting of Trainees and Fellows, the introduction of a dedicated Cultural in securing funding: Rockhampton about their experience in a rural health Competency, Cultural Safety competency Base Hospital (General Surgery), Royal service. Reported findings are currently and integration of Indigenous Health and Darwin Hospital (General Surgery), Cairns being collated for a final report to the Cultural Safety wording across a range Hospital (Orthopaedics) and Griffith Base Department of Health. of RACS face-to-face and online courses. Hospital (General Surgery). Another STP-funded project is Supporting The project also introduced Course 1 and The STP initiative began in 2010, with Clinical Studies in a Rural Remote Area. 2 in the online learning suite of the new the main purpose being to provide Undertaking clinical studies in a rural multi-level Aboriginal and Torres Islander funding support for accredited training or remote setting can be challenging Health and Cultural Safety courses. posts in non-traditional healthcare for surgical Trainees. They are faced RACS recognises that the strategy to settings. In addition to funding accredited with issues such as lack of resources, close the gap for Aboriginal and Torres Strait Islander people is a long-term plan. STP has funded the new Indigenous Surgeons Pathway Program for Aboriginal and Torres Strait Islander people interested in a surgical path, which aims to increase the number of Aboriginal and Torres Strait Islander surgeons via staged career guidance, starting as early as high school. If you or someone you know is interested in any of the above projects or opportunities, we encourage you to contact the respective sites or our team. More information about STP and its various initiatives can be found at surgeons.org/en/Education/specialist- training-program. The Specialist Training Program is funded through the Australian Department of Health. SAVE THE DATE

Back to the Future Lessons from the Past, Prospects for the Future

3SCTS 2021

The inaugural Tri-Society Cardiac & Thoracic Symposium (3SCTS) A meeting of Cardiac & Thoracic Surgeons, Anaesthetists and Perfusionists of Australia & New Zealand - In conjunction with the ISMICS 2021 Workshop

Wednesday 10 – Saturday 13 November 2021 Cairns Convention Centre, Cairns, Queensland, Australia

In conjunction with: Australian and New Zealand College of Anaesthetists (ANZCA) Australian and New Zealand College of Perfusionists (ANZCP) and Australian & New Zealand Society of Cardiac & Thoracic Surgeons (ANZSCTS)

www.3SCTS.com SAVE THE DATE

Surgical News | Volume 22 | Issue 01 41 The case for separation Back to the Future Lessons from the Past, Prospects for the Future

The term ‘Australasian’ in the name of the Medical Board of Victoria and the that New Zealand has its own Annual our College must really grate with New Australian census data) is that in 1933 Surgical Meeting, which has run Zealanders. So often it is misread or there were 6500 registered medical successfully for many years. New Zealand even miswritten as Australian, thereby practitioners in Australia, giving a total has its own National Board and Chair. excluding our New Zealand colleagues. for the two countries of about 8000. In Some training programs may wish to Even when written correctly, many 2019, in New Zealand, there were 16,908 remain bi-national. Basic science exams people do not know what it means. registered medical practitioners, double may be run as a joint effort. Some definitions of Australasia include the number of the two countries in The main point of this article is to ask Australia, New Zealand, New Guinea and 1928. Is this enough to justify a separate Fellows, particularly New Zealand the neighbouring region of Melanesia. surgical college for New Zealand? In my Fellows, to think about the future of our Others say it includes all of Oceania. I view, the answer is a resounding yes. College. Do we simply look at a name can understand why the New Zealand Medical colleges are not just about change again, or do we look more deeply members of our College might desire numbers, but are also about the into the issues? Should there be a Royal recognition of their country in the name of commonalities of interests and goals. Australian College of Surgeons and a our College. All surgeons and surgical organisations College of Surgeons of New Zealand? 3SCTS The College has previously considered this in our countries aim to improve their Mr Glenn McCulloch question. A ballot of Fellows was taken surgical skills and knowledge. It is FRACS around 2005, on whether to change the relevant that, of the nine surgical College’s name to the ‘Royal Australian specialties that our College trains, four and New Zealand College of Surgeons’. have training boards in New Zealand that It was approved in New Zealand but not are autonomous from their Australian 2021 in Australia and, as a two thirds majority equivalents (General Surgery, Plastic and of members is required for a change to Reconstructive Surgery, Otolaryngology the Constitution, the name remained the and Orthopaedic Surgery). Does this same. imply a degree of desire for separation? This question has arisen again, but I would Our medical systems are also different. The inaugural Tri-Society Cardiac & Thoracic Symposium (3SCTS) like to raise a deeper question. Is it time New Zealand has a single Ministry for a separation of the two countries? A of Health compared to Australia’s A meeting of Cardiac & Thoracic Surgeons, Anaesthetists and Perfusionists divorce by mutual agreement, without eight state and territory departments acrimony and with a vision to the future. of health, as well as our federal of Australia & New Zealand - In conjunction with the ISMICS 2021 Workshop department. Private practice is a greater When the Royal Australasian College component of surgical practice in of Surgeons (RACS) was established in Australia and medical indemnity more 1928, the population of Australia was 6.3 of an issue. The New Zealand Accident million and that of New Zealand was 1.5 Compensation Commission removes the million. Now the corresponding numbers need for the large premiums required of are 25.5 million and 5.1 million. New Australian surgeons. Wednesday 10 – Saturday 13 November 2021 Zealand currently has 65 per cent of the population that both countries combined There is ample evidence of the Cairns Convention Centre, Cairns, Queensland, Australia had in 1928. contributions to our college by our New Zealand cousins – in the form of Is this enough to justify a separate College Presidents, Councillors and Chairs of of Surgeons for New Zealand? Maybe. important committees. New Zealand has In conjunction with: However, if we look at the medical the committed and experienced Fellows Australian and New Zealand College of Anaesthetists (ANZCA) population of the two countries, we see necessary to perform the voluntary work Australian and New Zealand College of Perfusionists (ANZCP) and that in 1927, in New Zealand, there were that keeps our College functioning well. 1283 registered medical practitioners. Australian & New Zealand Society of Cardiac & Thoracic Surgeons (ANZSCTS) Separation does not mean that the The corresponding figure in Australia is common things need necessarily go. harder to find because the states had The Annual Scientific Congress will individual medical boards. A reasonable continue, but it must be remembered www.3SCTS.com estimate (based on the figures from 42 Fellow contribution Deux et deux font cinq (2 + 2 = 5) When things do not add up The equation – part II OPUS LXVII

The first ‘Equation’ article in December 7.30am – one of the first of their kind 2020 in Surgical News recounted the in Melbourne to discuss major head principles implied in the expression, and neck problems in a consultative ‘when things do not add up’; in capacity. The late Brian Fleming, who particular, when dictates and dogmas trained under Howard Eddy in head need to be questioned, and modern and neck surgery, was ‘Chairman of insights supersede entrenched clinical the Board’. Hugh Millar and Steve Kleid practice. George Orwell’s statement were part of the ear nose and throat about ‘Big Brother’, one of the most contingent; and Dick and David Kaufman quoted phrases in the 20th century, is were part of the ophthalmological evident throughout this essay. team. John Hueston, in the Plastic and Orwell was an Eton graduate and became Reconstructive Surgery field, initiated a war correspondent during the Spanish these meetings. Incidentally, it was John Civil War, opposing Franco and fascism. who invited me to attend on my return His wartime experiences reflected his to Melbourne in 1974, after three years opposition to totalitarianism and his working in head and neck surgery in support of democratic socialism. London and the Marsden. Dick Galbraith, renowned eye surgeon, Who would have thought that Orwell had his own experience of the ‘big would have been quoted at a Head and brother’ quote in an episode when flying Neck meeting at the RMH. Needless to in a twin engine Cessna back to base say, I only realised its significance later. The Surprising Adventures of Baron Munchausen from one of the Fiji islands, when he Now let me turn the page over to the by Rudolph Eric Raspe was operating in the Pacific. The aircraft clinical domain, where ‘when things do became engulfed in the dense cloud of not add up’ bells should ring – sonnette border on psychopathy, including an approaching tropical storm. Visibility d’alarme. These clinical cases recall the Machiavellian scheming. Cognitive was zero. Nothing was said, but the Munchhausen pattern of fabrication. dissonance creeps into the equation mood was ominous with anxiety. An SOS when actions and behaviour do not The Baron Munchausen was a soldier was radioed and, thankfully, received match. Note, my findings are based on in the Russo-Austro-Turkish War of by one of those stratospheric American observations without any psychiatric the 1730s. He survived and returned surveillance aircraft almost 50,000 feet qualifications. to publicly reveal his experiences of above – part of a global peace initiative. daring exploits and heroic deeds – all Here’s a worker’s compensation case Their immediate response guided the fictionalised. Baron Munchausen was, where bells should have rung earlier, Cessna to the closest landing site. As in fact, a creation of German writer, before the operations reached double Dick recounted, “What a Godsend”. The scientist and con artist Rudolf Erich figures. Cessna crew conveyed their grateful Raspe. He would falsify and fabricate A patient rotated between consultants thanks, but the response from above while entertaining the masses. As Mark orchestrating and even suggesting came back cryptically in an American Twain said, “Never let the truth get in future procedures to improve function drawl, “big brother is watching you.” the way of a good story”. – all under workers compensation. A Dick told this story at the Head and Neck However, when fabrications and mallet finger splint failed, as did the meeting at the Royal Melbourne Hospital falsehoods occur in a treatment K-wire, as did the tendon graft that (RMH) on his return. These RMH meetings environment, these patients show became infected. This produced septic arthritis of the distal interphalangeal were held every Monday morning at psychological tendencies that can Surgical News | Volume 22 | Issue 01 43 joint (DIPJ) leading to a fusion, before He discharged himself immediately I listened to Carl Orff’sCarmina Burana (a terminalisation, which was repeated – most likely to the care of the next Peter Callan favourite). Carl Orf’s other down the digit (neuroma problems) to an clinician. writings awakened my consciousness eventual Ray amputation. Here is another Munchausen vignette. to some important facts relevant to I met the patient in my medico-legal A nursing aide burnt her digit over the surgical teaching. He said, of music, practice and this is the basis of the interphalangeal joint on a steriliser, “experience first, then intellectualise”, accurate details from his clinical which resulted in a graft, which failed, but I say this can be applied to the records. which was repeated, which failed surgical domain. This is pertinent to any young registrar climbing the publication Another story reflecting Orwell’s writing: again. The joint exposure needed a cross finger flap and after division (the ladder (publish or perish) in any career “If liberty means anything at all it means advancement. the right to tell people what they do not fourth operation) bells were ringing. want to hear.” She decided to go elsewhere. The next Incidentally, I think heads of unit should clinical contact I had with her was in be the prime authors on major papers Here I was caught in the mistaken belief my medico-legal practice where the reflecting their experiences. This avoids that we should always believe the hospital documents listed the sequence delegating to a junior mind lacking patient’s story – well, initially. of workers compensation procedure to the experience, who is really acting as A policeman had a seatbelt injury from date – it reached double figures. someone’s supervised amanuensis. a motor vehicle accident, injuring In other words: multiple operations may Experience puts validity into anyone’s his abdominal wall. Multiple repair equate to a psychologically disturbed writings. As I had with Benny Rank procedures were done at St Vincent’s personality. about a Volkmann’s contracture case of Private Hospital as the wounds kept his. I proposed putting this into print. breaking down. After six weeks and Another Munchausen story came from He discounted my presumptuous offer multiple visits to theatre the wound Shepparton, where Tony Heinz sent me a and his accurate response reflected my was finally healed. The patient was case of an abdominal wound that failed inexperience. ready for discharge and even conned to heal after six operations. On referral, I offered a keystone solution to the I was fortunate at the Western Hospital one of the nursing staff for $15 to pay to be a little independent without for his dry-cleaning bill. I was somewhat problem, which are usually successful. In the postoperative phase the patient too much ‘big brother’ intrusion into inexperienced and did not suspect my clinical development and lateral anything at the time. was full of praise about the surgical expertise at the Western Hospital. But thinking. Such ideas usually evolve while Ten years later, almost to the day, who my bells of experience began to ring and doing midnight emergencies looking was admitted to the Western Hospital I warned my surgical team about such for a quick exit home. However, ‘big following another accident? The very gratuitous adulation. brother’ surfaced later because all my same police officer. Gillian Farrell was publications were peer reviewed. Our the consultant in charge of his admission One evening, on the removal of sutures musical expert and later head of the and was preparing to operate later that before discharge, the wound broke Plastic Surgery Unit at the Western day. But the repeated clinical story of a down and the patient demanded more Hospital, Mickey Pohl, likened my seatbelt injury caused my memory bells narcotics, disturbing the harmony of the independence there to the composer to ring and I recognised him immediately! sleeping ward. Joseph Haydn at the Esterhazy Court. As I verbally confronted him about his I re-explored the wound along the a cloistered musician there he composed clinical trend. convex arc of the keystone from the up to 100 symphonies and established wound on the right side in this right- the quartet as a compositional style. He 1984 by George Orwell handed patient. I surmised she had did not need to compete on the world undermined the wound using her stage from London to Paris and the hand, up to the limits of her fingertips. wide appeal of the audience acted as his On explaining my findings to her, and peer-review process indicating universal my suspicions about her possible acceptance. personality traits or addictions, I P.S. And it has just come through on the copped a tirade of vindictive abuse. My international news services from China initial warnings to my registrars were that everyone there is digitally rated out prescient. of a score of 10 in all aspects of their Now let me conclude with a few lines on personality, reflecting ability, honesty, surgical education because observation integrity and commitment et cetera – is the basis of sound medical practice (as yes, job interviews are possibly now enunciated by Sir William Osler in 1905 superfluous! What a big ‘big brother’. when he was appointed to the Regius Associate Professor Professor of Medicine at Oxford). Felix Behan I revisited these clinical episodes during our 2020 enforced sabbatical one day as 44 The surgeons of Vanity Fair

initially with skeletal changes resulting Sir William Arbuthnot Lane from occupations – changes in bones, cartilages and joints due to occupational posture, pressure, and strain. He (1856-1943) subsequently wrote papers on ‘The anatomy of the charwoman’ and ‘The anatomy of the shoemaker’. Surgical innovator: health educator Lane preferred to work with his own Bt. C.B. MB BS (London) FRCSMS Hon. FACS methods rather than accept standard practice. It was in 1883 that he began Sir William Arbuthnot Lane appeared William Arbuthnot Lane was born on 4 writing on fractures and he concluded in in Vanity Fair on 31 May 1913, with the July 1856 at Fort George, near Inverness, the early 1890s that splints were likely magazine noting, ‘in these days it is well Scotland, the eldest of the three sons to produce permanent injury and that for to note that Mr Lane comes honestly and four daughters of Benjamin Lane, intractable fractures open reduction with by his honours. He is the eldest son of assistant surgeon, 80th Regiment of Foot. rigid fixation was necessary. a Brigade-Surgeon for one thing. He is His family always called him Willie, and Lane began operating on fractures from known as the great exponent of the thus the title of his Vanity Fair portrait 1892, insisting on the most scrupulous operative treatment of fracture by plating was provided. asepsis. He introduced the ‘no touch’ for another. As the family followed its army regiment, technique, thus pioneering aseptic ‘Great as is Mr Lane’s prestige among young William attended schools in surgery and advancing beyond antiseptic the Britishers, he is even perhaps as well eight countries on four continents surgery. He introduced sterile caps, known in America. These strange people before he was sent to school at Stanley masks and gowns in 1900, collaborating admire his type of surgery. It is so skilful House, Bridge of Allan, in Scotland. He with Down Brothers to design and wise and daring. It is “like the pies matriculated at Edinburgh University and instruments for this new form of surgery, Mother made.”’ then decided to follow his forebears in in which no part of an instrument that the study of medicine. entered the wound was to make contact His father, being then stationed at with the surgeon’s hand. Woolwich, entered William as a student Accused of turning simple fractures at Guy’s Hospital in October 1872. The into compound, Lane insisted that the hospital, which was close to London Bridge surgeon do as neat a job ‘when repairing Station, allowed for easy commuting. broken bones as a cabinet maker mending This was the beginning of Lane’s long the legs of broken chairs’. association with Guy’s Hospital: his The frontispiece of his surgical text, earlier ambition to be a physician was published in 1913, reveals the incredible replaced with surgery as he was more breadth of Lane’s surgical procedures: likely to find a vacancy sooner on the he improved whatever he touched. His surgical rather than the medical side at innovations included the removal of a Guy’s. He qualified as a Member of the portion of a rib when treating empyema in Royal College of Surgeons (RCS) in 1877. a child, an operation for cleft palate early Lane was then advised to take a London in life, and plating fractured long bones to degree, which involved retracing his obtain perfect apposition. steps, beginning with matriculation. Lane exhibited imperturbable calm at He did well, gaining the gold medal in any difficulties encountered during Anatomy at the intermediate examination operations. He fascinated his assistants and the Gold Medal in Medicine at the with his extraordinary dexterity and final examination in 1881. The following became renowned on both sides of year, he became a Fellow of the RCS and in the Atlantic as the only surgeon the 1883 proceeded to his M.S. Americans travelled to visit in London. He He was then appointed assistant surgeon operated on socialites, politicians, and to the Hospital for Sick Children, Great royalty – the latter inevitably leading to Ormond Street, and five years later, at 32, his baronetcy in 1913. was elected assistant surgeon to Guy’s Lane joined the Royal Army Medical Hospital. He worked there until he retired Corps on its formation and, during the in 1920. war of 1914-18, organised the Queen’s Lane’s appointment to Guy’s was Hospital at Sidcup for the treatment preceded by six years there as a of facial injuries, where Harold Gillies demonstrator of Anatomy, where and Henry Tonks laid the foundations of he revealed his skills of observation, modern plastic surgery. For this Lane Surgical News | Volume 22 | Issue 01 45 was appointed Companion of the Most Honourable Order of the Bath (CB). He had a successful private practice generating an income of £20,000 per annum by the early 1920s. Contemporary newspapers described him as ‘the best- known surgeon in Britain’. Lane gained a high social position, as distinct from institutional influence. He did serve on the Council of the RCS from 1908 to 1916; however, he was never interested in examining – attending societies to preach rather than exchange opinions. A bibliography of his published writings 1883-1938 was privately printed in 1938, listing almost 400 entries. The last phase of his career began when, using his position, he founded the New Health Society in 1925, a private charity, to spread popular health education To avoid litigation, Lane resigned from She bore him three daughters and a son, throughout the country. Active from the BMA, remaining in practice at his who succeeded as second baronet. Lady 1926-1937, the society’s motto was home, where he was registered with Lane died in April 1935, six months after ‘prevention rather than cure’. Once the GMC until November 1932, when he their golden (50th) wedding anniversary. again, he was a pioneer. His views were voluntarily ceased to practise. ‘Willie’ then proceeded to marry his son- frowned upon by the medical profession, He became obsessed with the danger in-law’s sister, Jane Mutch, five months particularly by the British Medical to general health caused by chronic later, at 79! Association (BMA). constipation and he commenced He died at his London home on 16 January operating on the large intestine with 1943, aged 86: Jane survived him. A short-circuit procedures that came to be memorial service was held at Guy’s on 21 known as ‘Lane’s operation’. His entry in January 1943. the Dictionary of National Biography (DNB) Mr Peter F Burke includes the tag, ‘Sir Arbuthnot Lane, FRACS colon, semi-colon, full-stop.’ In his text, New Health for Everyman, he set out his ‘10 golden health rules’, which to the modern eye appear eminently Images: reasonable. Eat meat only in moderation, Over page: ‘Willie’, portrait from Vanity Fair. include in your daily diet wholemeal Above: Lane’s instruments – bone-holding bread and citrus fruit, drink at least six forceps, bone plates and instruments for fracture management. Left: Sir William Arbuthnot Lane. tumblers of water a day, work/sleep in Below: title pages for some of Lane’s publications. well aired rooms, and exercise night and morning for 10 minutes. Lane himself walked four miles every day, wet or fine. He was tall, rather thin and with a distinguished bearing; he seemingly aged slowly. Although he enjoyed controversy Lyons Tea Shops in England were then he was a kindly and genial man, much at the peak of their popularity; the chain beloved by his friends. opened a Vita-Sun Café at which health foods were available and their vitamin Lane married Charlotte Briscoe of Tinvane content rated on the menu. Lane provided House, Co. Kilkenny, on 25 October 1884. articles such as ‘The Athlete’s Diet’, which were printed on these menus. He also wrote many similar articles for the Daily Mail. This was seen by some, particularly by the BMA and the General Medical Council (GMC), as a form of indirect advertising. 46 Educators of Commitment

Thank you to our Educators of Commitment

The Educator of Commitment Awards Associate Professor Damian Marucci Associate Professor Graham Stewart acknowledge the contribution of the Dr Elias Moisidis Dr Gabriella Vasica Royal Australasian College of Surgeons (RACS) registered Surgical Education and Dr Carmen Munteanu Mr James King Training (SET) supervisors, Specialist Dr Graham Coombes Dr David McCrystal International Medical Graduate (SIMG) Ms Lydia Johns Putra Dr Suchitra Paramaesvaran supervisors and facilitators over a sustained period of time. Mr Jonathan Masters Dr Adnan Safdar Dr Francesco Piscioneri Mr Edward Smith Nine years SET supervisor Dr John Preston Mr Michael Switajewski Mr Naveed Alam Associate Professor Ravi Huilgol Mr Matthew Taylor Mr Adam Zimmet Dr Lubomyr Lemech Mr Murali Reddy Dr Carina Chow Dr Mathew Sebastian Dr Michael Wagels Mr Henry Dowson Mr Ramesh Velu Dr Muhammad Abdul-Hamid Mr Etienne Truter Mr Janaka Wickremesekera Dr Hin Chan Dr Adrian Clubb Mr Kenneth Wong Nine years Dr Ian Elbourne Professional development facilitator Mr Alastair Hepburn Associate Professor Francis Miller Dr David Sainsbury Mr Melvyn Kuan Dr Renata Bazina Dr John North Mr Daniel Marshall Dr Maurice Day Jnr Mr Alan Scott Dr Arvind Vasudevan Mr Michael Edger Associate Professor Marianne Vonau Dr Danella Favot Mr Wan Seow Mr Zet-Sheng (Michael) Ee Mr Franklin Pond Mr Timothy Wagner Mr Nikitas Vrodos Six years SET supervisor Dr Mark Winder Six years Mr Ian Jacobson Dr Pragnesh Joshi SIMG supervisor Mr Michel Neeff Mr Muhammad Abdullah Mr Peter Ferguson Mr Nigel Barwood Mr David Pohl Three years Professor Stephen O’Leary Dr Joanne Dale SET supervisor Mr Simon Dempsey Mr Adrian Fox Mr Harsh Singh Mr Peter Ferguson Dr Nishanthi Gurusinghe Professor Tristan Yan Dr Craig McBride Mr Mohan Jayasundera Dr Sergey Fedorine Dr Neil Price Mr Michael Johnston Associate Professor Jonathan Hong Dr Elizabeth Whan Dr Marianne Lill Mr Tristan Leech Mrs Toni-Maree Wilson Dr Mark Romero Dr David Logan Mr Scott Ferris Dr Emmanouel Roussos Mr Damien Loh Dr Kevin Ho Mr Franko Sardelic Dr Seow Loh Mr Timothy McCullough Surgical News | Volume 22 | Issue 01 47

Dr Thembekile Ncube Dr Wysun Wong Mr Guy Rees Dr Devinder Raju Dr Janelle Munns Dr Susan Taylor Dr Michael Tan Dr Bradley Newell Dr Mary Theophilus Mr Patrick Tan Mr Dinesh Patel Ms Lynn Hemmings Dr Andrew Thompson Mr Michael Pether Ms Julie Napoli Dr Anna Wilkes Mr Rajinder Singh Rai Dr Tzu-Chieh (Wendy) Yu Dr Katherine Wilson Mr Daniel Steiner Dr Mariolyn Rajakulenthiran Mr Edward Yeboah Dr Philip Tan Mr Jose Cid Fernandez Dr Aileen Yen Dr Aleksandra Vujovic Dr Andrew Chang Dr Shinn Yeung Dr Lik-So Yuen Dr Erica Jacobson Dr Alexandra Gordon Dr Andrew Bullen Dr Lynette Reece Mr Simon Harper Mr Charles Fisher Dr Benjamin Teague Dr David Anderson Dr Lachlan Maddock Dr Veronika Van Dijck Dr Arul Bala Dr Juanita Muller Mr Robert Boustred Dr Paul Smith Dr Shannon Thomas Associate Professor Douglas Fenton-Lee Dr Aanand Acharya Dr Catherine Thoo Dr Maria Teresa Nano Dr Ronaldo Bova Dr Yew Wong Mr Brian McGowan Mr Andrew Bridger Mr Michael Wu Dr Juanita Muller Dr Andrew Chang Three years Dr Daron Cope SIMG supervisor Professor Peter Friedland Dr Eric Guazzo Dr Raefe Gundelach Mr Roderick Borrowdale Dr Claire Iseli Professor Deborah Bailey Dr Yuresh Naidoo Dr Sharon Kelly Mr Sumit Samant Mr Hugh Macneil Dr David Waterhouse Dr Samuel Martin Mr Christopher Birks Dr Shane Anderson Mr Jason Donovan Dr Babatunde Salman Dr Thomas Sharpe Dr Milos Kolarik Mr Askar Kukkady Mr Idris Arogundade Mr Damon Thomas Professor Alasdair Sutherland Dr Sydney Ch’ng Mr Michael O’Brien Mr Michael Findlay Dr Peter Harris Mr Robert Gilmour Dr Patrik Tosenovsky Dr John Kippen Dr Jacob Van Der Westhuizen Associate Professor Thomas Lam Three years Mr Julian Liew Professional development facilitator Dr Alexander Phoon Dr Garry Dyke Dr Sandrine Roman Mr Richard Grills Dr Kieran Rowe Dr Richard Hocking Mr Michael Thomson Miss Sarah Hulme

The Academy of Surgical Educators and the affiliated RACS departments endeavour to publish these lists as accurately as possible. If you know someone whose name is missing from the list, please contact [email protected] 48 Scholarships and grants Research scholarship and grant opportunities for 2022

The common facts of today are the products of yesterday’s research –Duncan MacDonald

Apply now! Travel, education and research scholarship and grant opportunities for 2022 For more information, visit surgeons.org/scholarships

Last year was undoubtedly a challenging one as the world grappled with the The scholarships and grants program year ahead onset of COVID-19. While many of our scholarships, grants and Fellowships (scholarships) were put on hold, we now Streamlining our governance look with optimism at this year’s program. Scholarships have now been consolidated from across the College into one program, under the ANZ Scholarship and Grant Committee’s governance, Thanks to our Fellows’ dedication and supported by expert selection panels. New policies and procedures will ensure a donors’ generosity, the Royal Australasian robust approach to program administration through the RACS Scholarships and College of Surgeons (RACS) scholarships, Grants department. grants and Fellowships have grown over the decades. RACS and the Foundation Research and Learning and Development opportunities for Surgery are proud to offer up to 64 To support our streamlined governance, scholarships are now offered in two scholarships this year. This represents a rounds: Research (opening in March) and Learning and Development (opening in significant philanthropic contribution to August). surgical research and training in Australia, Research scholarships provide opportunities to pursue major research projects of New Zealand and the Asia-Pacific region. between one and three years duration. They are usually undertaken through an Following Council approval in 2019, a approved research institute in Australia or New Zealand. Research opportunities series of program activities (following) are paid as a stipend, often via the institute, on behalf of RACS and may include have been undertaken to ensure that as departmental maintenance. our Scholarships and Grants Program Learning and Development grants offer the opportunity to pursue professional grows, it achieves maximum impact for development, training or small investigative research activities in Australia, New our members and the surgical community. Zealand or overseas. They are usually undertaken over a shorter timeframe of RACS is now poised to be an international several weeks or months and are paid as a lump sum directly to the recipient. leader in the provision of scholarships All scholarship recipients are required to report on their activities. for the surgical community. On behalf of the Australia & New Zealand (ANZ) Improving the digital experience Planning is underway for the development of a dedicated online platform that will Scholarship and Grant Committee, I thank enable streamlined applications, selection, recipient reporting and administration. the many Fellows who commit their time Importantly, the platform will allow RACS to improve the delivery, monitoring and expertise to the program. We can be and evaluation of the program to steer the strategy for future success. The proud that these opportunities benefit scholarships web pages are also being redeveloped with new search functionality, not only the individuals who receive them, allowing easier navigation and updated content. but also contribute to the development of research, surgical practice and Promoting social inclusion and gender equity leadership in our local and global surgical A series of affirmative actions are being implemented to encourage equity and communities. diversity in our processes and communications. Boosting our marketing and promotion Professor Henry Woo Our marketing and promotion efforts will be boosted as we include multimedia to Chair, Australia & New promote scholarships through our partner networks, social media and online. This Zealand Scholarship and will raise the program’s profile and encourage high-quality applications. Grant Committee Surgical News | Volume 22 | Issue 01 49

Advertised opportunities are an initial guide Research Scholarships, Grants only. Please visit the RACS scholarship website (surgeons.org/scholarships) for detailed information. The values of and Fellowships these awards are in Australian dollars and are for a tenure of one year unless otherwise stated. Where a higher degree Research applications open is required, it is for a Masters, PhD or the 1 March and close at midnight ACST 12 April 2021. equivalent, or as indicated. Early-career surgeons are Trainees or Fellows within Are you thinking of undertaking research in 2022? The Scholarships and Grants Program 10 years of obtaining Fellowship. FRACS is offering the following research opportunities. applicants may apply where eligible for all We encourage applications from Aboriginal and Torres Strait Islander, Māori and female opportunities listed for Fellows, providing applicants as we support RACS’ focus on: they can provide evidence of completing all - removing barriers to the participation of women in surgery Fellowship requirements by 1 December in the year of application. SET applicants may - recognising that some people experience disadvantage also apply where eligible, providing they - continuing and enhancing initiatives designed to increase the participation of can provide evidence of acceptance into the Aboriginal and Torres Strait Islander and Māori doctors in the practice of surgery. SET Program by 1 December in the year of In August 2021, learning and development grants will be advertised and open to submit application. applications.

John Mitchell Crouch Fellowship Academy of Surgical Educators Eric Bishop Research Scholarship Research Scholarship $150,000 $10,000 $66,000

RACS’ most prestigious scholarship, Supports research into the efficacy of Supports surgeons and Trainees to take the John Mitchell Crouch Fellowship, existing surgical education or innovation time away from clinical positions to is awarded to a Fellow who is making of new surgical education practices. undertake a research project focusing on an outstanding contribution to medical research. Who can apply: RACS Fellows, SIMGs, SET the advancement of surgery or to Trainees and SET applicants. Who can apply: RACS Fellows, SIMGs and fundamental scientific research. SET Trainees enrolled (or intending to Who can apply: RACS Fellows who have Brendan Dooley and Gordon Trinca enrol) in a higher degree. obtained their Fellowship (or comparable Trauma Research Scholarship overseas qualification) since 2006, and MAIC-RACS Trauma Research $14,000 are currently working in their field with Scholarship the intention of using this Fellowship to Encourages research into the prevention $66,000 assist continuation of this work. and treatment of trauma injuries. Established with a grant from the Who can apply: RACS Fellows, SIMGs, Tour de Cure Cancer Research Queensland Motor Accident Insurance SET Trainees, SET applicants and medical Scholarship Commission (MAIC) and matched by the scientists who have not previously Foundation for Surgery to support trauma $125,000 (the scholarship will fund received this scholarship. $100,000. Recipients are required to research in the areas of epidemiology, prevention, protection, rehabilitation gain co-funding of $25,000 from their Catherine Marie Enright Kelly Memorial and immediate or definitive management research department.) Research Scholarship in trauma. The potential benefits Raises funds for cancer research through $66,000 flowing from the research must assist cycling and other events, supported by Queenslanders. Supports surgeons and Trainees to take the Foundation for Surgery and Tour de time away from clinical positions to Who can apply: RACS Fellows, SIMGs and Cure. undertake a research project. SET Trainees. Who can apply: RACS Fellows, SIMGs, SET Who can apply: RACS Fellows, SIMGs and and Trainees. SET Trainees enrolled (or intending to enrol) in a higher degree. 50 Scholarships and grants

Margorie Hooper Scholarship John Loewenthal Project Grant Paul Mackay Bolton Scholarship for Cancer Research $65,000 plus $10,000 accommodation $100,000 per annum for up to two $66,000 per annum for up to two years and travel expenses years Supports a surgeon or Trainee to take Enables successful applicants to Supports surgeons and Trainees to time away from a clinical position to either travel overseas to learn a new undertake a surgical research project or undertake a research project on the surgical skill that will benefit the South to fund an innovative service or piece of prevention, causes, effects, treatment Australian community (preference), equipment. and/or care of cancer. Preference may be or to undertake postgraduate studies Who can apply: RACS Fellows, SIMGs given to projects that are likely to have and reside temporarily outside South and SET Trainees, applying as either an clinical relevance within a relatively short Australia. It is mandatory for the recipient individual or as the lead researcher in a period, applicants currently working in to make a presentation at the South group. SET applicants are ineligible for Queensland or Tasmania, enrolled (or Australia, Northern Territory and Western this grant. Previous recipients can only intending to enrol) in a higher degree, and Australia Annual Scientific Meeting in receive this grant once. early-career surgeons. the year following the conclusion of the Who can apply: RACS Fellows, SIMGs and scholarship. Foundation for Surgery Research SET Trainees. Who can apply: RACS Fellows, SIMGs and Fellowship SET Trainees who reside permanently in Peter King Research Scholarship $66,000 per annum for up to three South Australia. years $66,000 Surgical Education Research Supports Fellows to take time away from Fellowship clinical positions to undertake a research Preference will be given to applicants $77,000 per annum for up to two years project. Preference will be given to early- whose research topic is relevant to career Fellows. surgery outside metropolitan areas and Offered in partnership with the early-career academic surgeons. Who can apply: RACS Fellows. Southeastern Ontario Academic Who can apply: RACS Fellows, SIMGs and Medical Organization and may be used Foundation for Surgery Research SET Trainees, enrolled (or intending to to fund travel, accommodation and Scholarship enrol) in a higher degree. living expenses. In addition, tuition and $66,000 related expenses are funded by Queen’s Professor Philip Walker Vascular University. The commencement date Supports surgeons and SET Trainees who Research Scholarship of the degree is determined by Queen’s wish to take time away from clinical University within 18 months of being $20,000 positions to undertake a research project. awarded. Supports vascular surgery research. Who can apply: RACS Fellows, SIMGs Who can apply: RACS Fellows who intend and SET Trainees enrolled (or intending to Who can apply: RACS Fellows, SIMGs and to enrol in a Master’s Degree in Health enrol) in a higher degree. SET Trainees, enrolled (or intending to Professions Education Program at the enrol) in a higher degree with research faculty of Health Sciences, Queen’s New Zealand Research Scholarship related to vascular surgery. University, Canada. Reg Worcester Research Scholarship James Ramsay Project Grant $66,000

Assists New Zealand-based surgeons and $66,000 $88,000 per annum for up to two years Trainees to undertake a research project. Supports research, preferably with Supports innovative projects or the Who can apply: New Zealand RACS relevance to the surgical care of patients. purchase of state-of-the-art equipment. Fellows, SIMGs and SET Trainees residing in, and who are citizens or permanent Who can apply: RACS Fellows, SIMGs and Who can apply: RACS Fellows, SIMGs residents of, New Zealand. Applicants SET Trainees, enrolled (or intending to and SET Trainees, applying as either an must be enrolled (or intending to enrol) in enrol) in a higher degree. individual or as the lead researcher in a a higher degree. group. SET applicants are ineligible for this grant. Surgical News | Volume 22 | Issue 01 51

Senior Lecturer Fellowship Surgeon Scientist Research Scholarship RACS Post Op $132,000 per annum for up to two $77,000 per annum for up to three years. RACS will fund $66,000, and the years applicant’s Academic Department will podcasts be required to co-fund to the same Assists surgeons and Trainees to undertake their PhD. amount ($66,000) Check out the interviews with Who can apply: RACS Fellows, SIMGs some of the most inspiring Provides salary support for a Fellow, and SET Trainees enrolled (or intending early in their career, to assist them in and forward-thinking industry to enrol) in a PhD. SET applicants are professionals. establishing themselves in an academic ineligible for this scholarship. career in surgical research and education. Developed by RACS, the Post The Senior Lecturer position is defined Herbert and Gloria Kees Scholarship Op Podcasts feature extended as working up to 50 per cent clinical interviews on the latest load and the remainder in research and research across the medical teaching. $66,000 per annum for up to three years industry, as well as practical Who can apply: RACS Fellows. Preference advice that surgeons can will be given to those enrolled (or Supports the advancement of surgical implement in their practices, intending to enrol) in a higher degree. research, technologies, techniques and such as insights on financial treatments. Small Project Grant management, wealth creation, Who can apply: Early-career RACS legal and tax advice and Fellows, SIMGs and SET Trainees. economic forecasts. $10,000 You can subscribe to the For a surgeon or Trainee who wishes to Applications close midnight ACST fortnightly RACS Post Op undertake, or is already undertaking, 12 April 2021 Podcasts on Apple's iTunes a small clinical or research project or or, for those with other who requires some funding to purchase Additional information can be found equipment to carry out a research smartphone models, on at surgeons.org/scholarships. For Stitcher. project. Up to four grants will be awarded. any other queries, please contact the Previous recipients can receive this grant Scholarships and Grants Team on Listen on iTunes up to four times. +61 8 8219 0924 or at Search 'RACS Post Op' in the Who can apply: RACS Fellows, SIMGs and [email protected]. Podcast app on iPhone or in SET Trainees. iTunes on desktop Sir Roy McCaughey Surgical Research Listen on Stitcher Scholarship Search ‘RACS Post Op Podcast' on $66,000 per annum for up to three stitcher.com years

For RACS Fellows, SIMGs and SET Trainees enrolled (or intending to enrol) in a higher degree undertaking research in New South Wales Who can apply: RACS Fellows, SIMGs and SET Trainees. Establish your own named perpetual scholarship Would you like to start your own scholarship or grant in your area of passion or speciality? You can establish your own grant to change lives and see the results of your philanthropy in your lifetime. Please call Jessica Redwood, Manager, Foundation for Surgery, on +61 3 9249 1110 or email [email protected] today. 52 Library

Good reads

Cut with Conviction The cheetah had been disrespectful of his grandchildren... Enough reason for a 40 kilogram, 1.4metre tall Bushman grandfather to track down and kill a ferocious predator with a stabbing spear in solitary combat in the Kalahari Desert, only to suffer near fatal Mr Mike Damp injuries himself. This was one of many such patients confronting Mr Mike Damp in this wonderful tale of a world that now seems so impossibly far away – a heady mix of one man’s adventure through the sort of medical and cultural challenges few modern-day western physicians would ever expect to encounter. This is a story of perseverance and great dedication as well as a reflection of how man’s best intentions and tireless efforts can so easily turn to dust and decay. But above all,Cut with Conviction is a love story; the despairing love for a continent and its people fast being reclaimed by a heart of darkness as unstoppable as the forces of nature that both nurture and destroy as it washes over the vast plains and rivers and mountains of a lost paradise. Then there is the mix of exhilarating joy and sheer terror in a flying doctor’s life in Zululand, of transporting critically ill patients in all weather conditions over some of the most inhospitable terrain, often with little or no navigational aids, while a fellow doctor, seated next to the patient in the cramped space of a small plane desperately tries to keep life going with the aid of basic life-support equipment. Africa is a land of unique and rare beauty that mystifies many with its great contradictions. This story unfolds during the apparent stability of grand apartheid and the turbulent times during its collapse and aftermath. Cut with Conviction is a must-read for all who love adventure, medical issues, flying, travel and Africa.

The History of Surgery Why do we trust surgeons? After all, allowing strangers to work on our unconscious bodies with knives requires an enormous leap of faith. How have we come to believe that surgeons will act in the best interests of our health, rather than in the best Sally Wilde interests of their wallets?

This unconventional history of surgery charts the early twentieth century transformation of public attitudes from ‘buyer beware’ to ‘doctor knows best,’ as surgeons invented traditions appropriate for gentlemanly, and occasionally ladylike, but above all trustworthy, experts. Surgical News | Volume 22 | Issue 01 53

Sad Joys on Deployment A civilian surgeon is taken from his routine practice in Sydney, Australia, and finds that military surgery in war zones distressed by civil war, humanitarian disasters and battlefield conflict is very different from the comforts of home and civilian surgery. This Greg Bruce book describes: • The challenges of military surgery • Surgery for combat wounds • Differences in treatment for friendly forces, enemy forces and local civilians • Conditions during the deployment – accommodations, meals, keeping healthy • Travel to and from the deployment • The good and bad, the satisfying and distressing aspects of immersion in a war-zone • Relationships with the friendly and unfriendly, the helpers and the resisters • Interaction between local civilians and visiting military • Military and cultural tourism • Adjusting back home

Donegal’s Atlantic Way Donegal’s Atlantic Way is a 208 page coffee table photographic book of over 200 images capturing’s Donegal’s beauty combined with a new collection of 25 poems. The pictures tell a story of the unfolding of the day from dawn to dusk and beyond in Donegal’s Michael Sugrue hinterland in the Northwest of Ireland. The poems are for most part linked to the photographs. Through combinations of light, lines and lyrics this book is a must for those who love nature and its rhythm. The production is the end result of eight years labour of love by Michael Sugrue. The introductions from Donegal’s Nobel Laureate in Medicine and Physiology, Professor William Campbell, and Donegal’s favourite son, Mr Daniel O’Donnell, set the scene for the illustrated poetic journey that awaits you. With Pauline, his other half of 36 years, Michael has walked, cycled, climbed, crawled or kayaked nearly every part of Donegal. Originally a Galway man, known to speak a “cúpla focal” or “giota beag”, he is forever torn trying to bypass beautiful locations to get to an end photographic destination in Donegal. Michael likes to surf at Ballymastocker Bay Fanad and says the waves are at times too imaginative for him! He just loves the sea, especially if his four boys are home. Mr Sugrue was inspired by North West Words poetry group to put pen to paper. He is grateful to many who have helped on this eight year journey: his literary editor Gerard Beirne and photographic mentors Eimhear Collins and Rodney O Callaghan. Donegal County Council and local business have supported the project and the income raised from Donegal’s Atlantic Way will be donated to three charities, Donegal Mind Wellness, Letterkenny Hospice and Breast Centre Northwest Research and Development. Michael hopes the book can do justice to some of those magic moments he had capturing them. Introducing the new refreshed look of your benefits platform.

Providing RACS members real-time discounts and offers, your benefits platform has recently refreshed its design. Explore the improved access to your savings and recently launched new benefits! All your shopping needs including real-time and fast access to discounted e-gift cards, whitegoods, and electronic accessories.

New vehicle offers and corporate programs at Tesla, BMW and more

Accommodation, tours, airline lounges and more travel benefits for as business travel returns.

Dedicated brokers for insurance needs, from health and life to income protection.

Financial offers on international money transfers, financial planning and credit cards. surgeons.memberadvantage.com.au

For more information e: [email protected] ph: 1300 853 352. Introducing the Surgical News | Volume 22 | Issue 01 55 new refreshed look of your benefits platform. In memoriam RACS publishes abridged obituaries in Surgical News. Providing RACS members real-time We reproduce the opening paragraphs of the obituary. Full versions can be found discounts and offers, your benefits platform has on the RACS website. recently refreshed its design. Explore the improved access to your savings and recently Mr John Andrew Baird Hokin FRACS in New Zealand, he worked very hard launched new benefits! Our condolences to the family, Plastic and reconstructive surgeon and excelled in both sporting (he was friends and colleagues of the a champion swimmer) and academic 28 November 1936–29 December 2020 All your shopping needs including real-time following Fellows whose deaths fields. John attended Otago University and fast access to discounted e-gift cards, have been recently notified. John Hokin was a prominent Adelaide graduating MB ChB in 1964. He spent whitegoods, and electronic accessories. plastic surgeon, whose career spanned his house officer years in Wellington, 50 years. He is remembered for his talent obtaining basic surgical training, and James T Cummins as a surgeon, his generosity as a teacher, New vehicle offers and corporate married Ros Allen. Having decided on a John A B Hokin and his innovative approach to making career in surgery, he travelled to England programs at Tesla, BMW and more plastic surgery more easily available to his Jacob Johannes (John) de Geus for further surgical training gaining his patients. FRCS (England) in 1971. Accommodation, tours, airline lounges John Hunter Williams In the mid-1990s he pioneered the Cary Mellow FRACS and more travel benefits for as business G E Scarff concept of free-standing day surgeries for John Hunter Williams travel returns. P A Rogers plastic surgery in South Australia, saving patients the inconvenience and the costs FRCS, FRCS(Ed), FRACS David Cull of an overnight stay in hospital. Plastic and reconstructive surgeon Dedicated brokers for insurance needs, Ronald Geoffrey Kay 26 June 1925–20 November 2020 from health and life to income protection. John was a country boy born in the small Patrick John Molloy South Australian town of Balaclava, 90 John Hunter Williams was born G K Williams kilometres north of Adelaide. He was the at Wharewhitu Private Hospital in Financial offers on international money eldest of four children. Both his parents Dannevirke. His father, Charles Skinner R N Westmore transfers, financial planning and credit were teachers, which meant the family Williams, was an Orthopaedic and cards. D Ch Healey moved from country town to country General Surgeon (who was also involved J H Alexander town for several years. He attended in veterinary Orthopaedics) in the Victor Harbor High and then moved on to Manawatu area. He was given the name C D Lewis Adelaide High School. John Hunter in memory of the 18th surgeons.memberadvantage.com.au Richard Hamilton MBBS FRACS century Scottish anatomist-surgeon from St Bartholomew’s, who along with his Jacob Johannes (John) de Geus brother, William Hunter, was a famous FRCS FRACS anatomic and surgical pioneer (and Plastic and reconstructive surgeon possible grave robber) – thus John’s fate 6 July 1940–20 October 2020 was sealed – he just had to become a surgeon. John was born in the Dutch East Indies Informing RACS in 1940, to Dutch parents who were Charles ‘retired’ from surgical practice in For more information If you wish to notify the College of the missionary teachers. The Japanese Palmerston North and became a Surgeon e: [email protected] death of a Fellow, please contact the invaded in 1942 and John and his family and general practitioner in the Far North, ph: 1300 853 352. relevant office: spent the next three years in Japanese based at Kaeo Hospital. Thus started Internment camps (John and his mother a love of the Far North for John. John ACT: [email protected] and sister were imprisoned separately attended Hadlow Preparatory School in NSW: [email protected] from his father). They endured significant Masterton (he was one of 18 pupils). As a NZ: [email protected] hardship, to say the least. After the teenager he contracted polio and was left 1945 liberation of what would become ith left sided weakness; he was able to QLD: [email protected] Indonesia, John and his family returned to recover sufficiently to study at Whanganui SA: [email protected] The Netherlands; subsequently they were Collegiate. TAS: [email protected] part of the large Dutch emigration to New He took up study at Dunedin staying at Zealand in the 1950s. Selwyn College (his father Charles had VIC: [email protected] They spent time living in Whitford and been at Knox). WA: [email protected] Taupaki, but settled in West Auckland Cary Mellow FRACS NT: [email protected] where John attended Avondale College. Despite speaking no English on his arrival Honour roll

Thank you for your extraordinary compassion and generous support to the Foundation for Surgery.

Thanks to you, many more children, families and communities have access to quality surgical care when they need it most.

Every donation makes an incredible difference throughout Australia, New Zealand and the Asia- Pacific Region, but we would like to make special mention and honour the valuable contribution of our 2020 Platinum, Gold and Silver donors. Surgical News | Volume 22 | Issue 01 57

Platinum (lifetime over $100,000)

Mrs Sheila Ann Carter The Head and Neck Surgery Trust Ms Brian Morgan The Ainsworth Foundation Mr Henry Hong Leung Mr Rowan Nicks Mr Eric Bishop Anonymous donor P Marks Investments Mr Paul MacKay Bolton Mrs Eugenie Johnston Mr Gordon Pickard Mr Andrew James Cowle Mrs Alison Kearney Mrs Diana Ramsay Anonymous donor Mrs Gloria Joyce Kees The RANZCO Eye Foundation Mr Brendan Dooley Kimberley Foundation The Surgical Research Society of Dr Katherine Edyvane Prof Paul Mackay Bolton Australasia Dr Mona Girgis Mr Donald Macleish Tour De Cure Limited The Rotary Club of Glenferrie Mrs Lena Elizabeth McEwan The Trust Company of Australia Ltd Prof Ian & Mrs Ruth Gough The Medical Benefits Fund of Mr Philip John Walker The Gray Family Foundation Australia Ltd The William Angliss Charitable Fund

Gold ($10,000-$99,999)

Dr Susan Adams Prof Ian Gough Assoc Prof Paul McCartney Tasmanian Medical Volunteers The Australasian Cleft Lip Hobart Eye Surgeons Mr Glenn McCulloch Anonymous donor and Palate Association Mr John Kearney Anonymous donor The Wilkinson Foundation Mr Peter Dryburgh Kevin Vandeleur Medical Pty Ltd Anonymous donor

Silver ($1,000-$9,999)

Assoc Prof Rupert Atkinson Ms Margaret Chiam Ms Karen Hill Dr Ian Martin Mr Paul Rosen Anonymous donor Mr Harvey Coates Dr Geoffrey Hirst Mr Gerard McCafferty The Rotary Club of Kew Mr Douglas Allan Dr Joan Cosgrove Anonymous donor Anonymous donor Prof John Royle Mr Adrian Anthony Mr David Cottier Assoc Prof Thomas Hughes Mr Michael McFarlane Anonymous donor Mr William Armstrong Prof Ross Crawford Prof John Hunn Mr Richard McMullin Mr Anthony Shakeshaft Dr Michelle Atkinson Mr Terence Darby Mr Ishfaq Hussaini Mr Arend Merrie Dr Brindha Shivalingam Prof Bruce Barraclough Dr Upeksha De Silva The Inner Wheel District 54 Mr David Millons Prof Julian Smith Mr Peter Barrie Anonymous donor Mr Narayanan Jayachandran Dr Ruth Mitchell Prof Russell Stitz Mr John Batten The D’Extinguished Surgeons Mr Richard Jonas Mr Gregory Mitchell Dr Tapukitea Taumoepeau Club Mr Andrew Bean Dr Sanjay Kalgutkar Prof David Morgan Mr John Taylor Mr Douglas Druitt Mr Harvinder Bedi Mr Srisongham Khamhing Assoc Prof Julie Mundy Dr Adrian Teo Anonymous donor Anonymous donor Dr Johannis Kilian Mr Niyaz Naqash Mr Andrew Thompson Mr Falah El-Haddawi Ms Karlene & Mr Richard Kjar Mr Philip Nase Mr Ming Tong Ms Waratah Bell Prof Gavin Fabinyi Mr Andreas Kreis Anonymous donor Mr Michael Troy Anonymous donor Anonymous donor Mr Bal Krishan Mr Rudolph Ngai Mr Harry Tsigaras Ms Mara Bennett Prof Kingsley Faulkner Dr Christine Lai Mr Frederick Niesche Mr Stephen Tudge Anonymous donor Dr Catherine Ferguson Mr Matthew Lawrence Anonymous donor Assoc Prof Nitin Verma Prof. Sir Murray Brennan Mr Hamish Foster Mr John (Fred) Leditschke Anonymous donor Mr Subramaniam Vigna- Mr Benjamin Brooker Mr Bruce French Rajah Dr Fiona Lee Assoc Prof Christopher Perry Mr Nigel Broughton Prof Mark Frydenberg Dr Rosslyn Walker Ms K Lever Mr Leo Pinczewski Ms Belinda Brown Mr Philip Gan Ms Hilary Wallace Mr Tony Lewis Mr William Poate Mr Graeme Brown Dr Susan Gerred Ms Mary Watson Mr Peter Little Dr Timothy Porter Mr Lee Brown Mr John Giles Dr Jefferson Webster Mr Ross Littlewood Mr David Price Prof Ian Campbell Mr Bill Glasson Dr Gregory Witherow Mr Patrick Lo Mr John Ralph Mr Lawrence Carroll Anonymous donor Mr Wai Wong Mr Peter Loder Mr Brian Randall Mr William Castleden Mr Angus Gray Mr David Wood Mr Ken Loi Mr Martin Rees Mr Wei Chang Dr Anthony Green Mr Ivan Yaksich Anonymous donor Dr Maxine Ronald Dr Susan Chapman Mr Bruce Hall Dr Katherine Martin Dr Elizabeth Rose Mr John Chew Mr Nigel Henderson 58

Our sincere thanks to these incredible donors for their kindness and generosity in supporting the Foundation for Surgery during November and December 2020

Silver ($1,000-$9,999) Dr Susan Adams Mr Nigel Broughton Mr Nigel Henderson Dr Christine Lai Anonymous donor Anonymous donor Assoc Prof Thomas Hughes Anonymous donor Prof. Sir Murray Brennan Mr Hamish Foster Mr Richard Jonas Ms Mary Watson Mr Benjamin Brooker Mr John Giles Mr Richard Kjar Mr Ivan Yaksich

Bronze (up to $999)

Mr Dinesh Agarwal Dr Adam Blond Dr Kelvin Choo Mr David De La Harpe Anonymous donor Dr Nikhil Agrawal Mr Robert Bohmer Prof Peter Choong Anonymous donor Anonymous donor Dr Sulman Ahmed Mr Janusz Bonkowski Dr Jivesh Choudhary Dr James Deves Mr Angus Gray Dr Gias Ahmed Mr Gregory Bookless Dr Sharon Chu Mr Anthony Dixon Mr Anthony Gray Dr Sam Alhayo Mr Laszlo Borbely Mr Soong Chua Dr Atsuo Doi Mr Andrew Greensmith Dr Jacqueline Allen Anonymous donor Mr Jason Chuen Dr Chris Donaldson Mr John Griffiths Mr Ahmad Al-Sameraaii Mr Russell Bourne Prof Jonathan Clark Mr Giuseppe D’Onofrio Dr Claudia Gschwind Anonymous donor Mr Peter Boys Mr Graeme Clarke Anonymous donor Mr Mark Guirguis Dr Damian Amato Anonymous donor Anonymous donor Dr Mark Doudle Mr Hettiarachchige Mr Sven Anders Dr Graeme Brazenor Dr Neil Cleaver Ms Sally Drummond Gunawardane Dr Margaret Anderson Mr Jeffrey Brennan Mr Maurice Clifford Mr Benjamin Dunne Dr Indunil Gunawardena Dr David Anderson Mr Russell Brereton Mr Stephen Clifforth Anonymous donor Mr Reuven Gurfinkel Mr William Anderson Mr Matthew Brick Mr Harvey Coates Dr Michael Eaton Dr Ali Gursel Dr Nagy Andrawis Prof Robert Briggs Assoc Prof Andrew Cochrane Dr Oskar Edkins Dr Nishanthi Gurusinghe Mr Frank Anning Miss Ingra Bringmann Dr William Cockburn Dr Johnny Efendy Mr Dennis Gyomber Mr Adrian Anthony Dr Stephen Brockman Mr Allen Cockfield Mr David Ehrlich Dr Mark Haber Dr David Ardern Anonymous donor Dr Jonathan Cohen Mr James Elder Dr Reema Hadi Anonymous donor Mr David Brougham Mr David Colledge Mr Falah El-Haddawi Mr Anthony Hall Mr John Ashwell Ms Belinda Brown Mr Rowan Collinson Dr Mark Ellis Mr Bruce Hall Dr James Askew Mr Clayton Brown Dr Philip Colman Dr Andrew Ellis Dr Celine Hamid Dr Francis Asomah Mr Colin Brown Mr Hugh Cooke Mr James Emmett Mr Terence Hammond Mr Nazih Assaad Mr Michael Bruce Dr Catherine Cord-Udy Dr Raymond Englund Mr William Hanna Dr Hari Priya Bandi Mr Daniel Bunker Mr Gerard Coren Assoc Prof Joseph Epstein Prof Philip Hardcastle Mr Colin Barber Dr William Butcher Dr Toby Corlette Prof Gavin Fabinyi Dr Marguerite Harding Dr Graeme Barber Assoc Prof Anthony Buzzard Prof Minas Coroneo Mr Eric Farmer Ms Ruth Hardstaff Prof Bruce Barraclough Mr Peter Byrne Dr Joan Cosgrove Mr Alan Farnsworth Mr Warren Hargreaves Miss Ginny Barro Dr Stephen Byrne Mr David Cottier Prof Kingsley Faulkner Mr Wade Harper Prof Hugh Bartholomeusz Mr Donald Cameron Mr Richard Coutts Prof Jonathan Fawcett Mr Richard Harries Mr David Bartle Dr Peter Campbell Mr Murray Cox Assoc Prof Kerin Fielding Mr John Harris Mr Robert Bartlett Dr Paul Canty Mr Paul Cozzi Dr Rhys Filgate Mr Henley Harrison Mr Edward Barui Dr Amy Cao Prof Ross Crawford Dr Prudence FitzPatrick Dr Merwe Hartslief Mr John Batten Dr Yugesh Caplash Assoc Prof Geoffrey Croaker Mr John Fleischl Mr Gregory Harvey Mr Iman Bayat Mr Robert Carey Mr Richard Crowley Prof David Fletcher Mr Peter Heathcote Dr Margaret Beevors Mr Lawrence Carroll Dr John Crozier Dr Julie Flynn Mr Craig Hendry Assoc Prof Felix Behan Prof John Cartmill Dr David Cruise Mr Gerard Fogarty Ms Jessica Henegan Assoc Prof Simon Bell Mr Andrew Cavallo Mr Grahame Ctercteko Prof Mark Frydenberg Dr Isolde Hertess Anonymous donor Mr Simon Ceber Dr Nancy Cullen Mr Kwai Fung Dr Timothy Hewitt Mr Simon Berry Dr Michael Park Chae Mr John Cunningham Dr Shanu Gambhir Prof Adrian Hibberd Prof Michael Besser Dr Venu Chalasani Assoc Prof Austin Curtin Dr Michel Genon Dr Nicola Hill Mr Ratnakar Bhattacharyya Dr Jennifer Chambers Dr Christine Cuthbertson Dr Anna Giles Mr Brian Hodgkins Mr Adam Bialostocki Mr Yee Chan Dr Philip Dalton Mr Michael Gillespie Prof Andrew Holland Mr Michael Bickford Mr Stephen Chan Dr Daniel Daly Mr David Gillett Anonymous donor Mr Philip Bird Mr Ken Chao Dr Amitabha Das Dr Anthony Glover Dr David Holthouse Anonymous donor Mr Ashraf Chehata Prof Patricia Davidson Mr Jerome Goldberg Mr Boon-Hung Hong Mr Robert Black Dr Stephanie Chetrit Dr Mark Davies Assoc Prof Augusto Gonzalvo Dr Zhen Hou Mr Peter Blake Dr Bernard Cheung Dr Sami Dayoub Mr Harindra Goonatillake Prof Anthony House Mr Joseph Blaszczyk Prof Ronald Chin Assoc Prof Alan De Costa Mr Andrew Gordon Mr Kevin Huang Surgical News | Volume 22 | Issue 01 59

Bronze (up to $999)

Mr Malcolm Hughes Mr Gregory Leslie Dr Alok Mohorikar Mr Francis Prendergast Dr Alison Smith Mr Pleun Verheul Mr Desmond Hughes Dr Scott Leslie Dr Sheree Moko Mr Robert Pucius Mr Edward Smith Mr Nikitas Vrodos Mr Murray Hyde-Page Ms K Lever Mr Mark Moore Prof Christopher Pyke Mr Adriaan Smith Dr Danielle Wadley Dr Hany Ibrahim Dr Elizabeth Lewis Prof Paul Moroz Dr Raffi Qasabian Mr Durham Smith Mr Timothy Wagner Dr Shabnam Islam Mr Ran Li Mr Philip Morreau Mr Joseph Ragg Dr Kylie Snook Mr Roger Wale Dr Erica Jacobson Dr Andrew Lienert Prof David Morris Dr Simone Ramsay Dr Waldo Solis Dr Patrick Walker Dr Bhavin Jadav Dr David Lieu Dr Stewart Morrison Dr David Rangiah Prof Michael Solomon Dr Rosslyn Walker Mr Dylan James Mr Jake Lim Mr Peter Mutch Dr Prashanth Rao Mr Brendan Soo Dr Douglas Wall Dr Bryon Jaques Dr Henry Liu Dr John Mutu-Grigg Assoc Prof Prem Rashid Mr Samiul Sorrenti Dr Richard Dr Alexander Jay Mr David Liu Mr Jeffrey Myers Dr Nimala Ratnayake Mr John Spillane Ward-Harvey Mr Narayanan Mr Peter Loder Dr Kathiravelpillai Dr Sunil Reddy Mr Peter Spittaler Mr Michael Warner Jayachandran Dr Eu Jhin Loh Nadanachandran Dr Fiona Reid Mr Paul Steedman Mr William Watt Mr Hasanga Dr Brian Loh Dr Rishendran Naidoo Dr Jeremy Richardson Mr Malcolm Steel Mr Robert Webb Jayasekera Dr Hans Lombard Dr Uvarasen Naidoo Mr Dominique Robert Assoc Prof Timothy Mr Andrew Weber Dr Suren Jayaweera Mr Gregory Longfield Mr Niyaz Naqash Mr Ross Roberts Steel Dr Stephanie Weidlich Mr Bevan Jenkins Dr Brendan Louie Mr Denis Nave Dr Christopher Roberts Mr Hans Stegehuis Mr Senarath Mr Michael Johnson Dr Tara Luck Anonymous donor Mr Francis Robertson Ms Wanda Stelmach Werapitiya Mr Peter Johnstone Dr William Lumsdaine Mr Robert North Miss Amanda Mr Maurice Stevens Dr Jennifer Wheatley Prof Martin Jones Mr Ngov Ly Dr John North Robertson Dr Neil Stewart Mr Denis Whittle Dr Sanjay Joshi Anonymous donor Prof Paul O’Brien Mr James Roberts- Emeritus Professor Mr William Widdowson Dr Pragnesh Joshi Mr Timothy Lynskey Mr Clive O’Connor Thomson Bryant Stokes Dr Anna Wilkes Dr Aleksandar Anonymous donor Mr Olubukola Mr Joseph Robin Prof Marcus Stoodley Mr Sean Williams Jovanovic Mr David Macrae Oloruntoba Dr Daniel Robinson Dr Conrad Stranz Mr Richard Wilson Mr Craig Jurisevic Mr Murali Mahadevan Dr Sarah Olson Mr John Rogerson Assoc Prof Jonathan Dr Peter Wilson Dr Janina Kaczmarczyk Stretch Mr Ravi Mahajani Dr Gemma Olsson Dr Maxine Ronald Dr Andrew Wines Dr Allan Kalus Dr Kate Stringer Mr Gregory Malham Dr Corinne Ooi Dr Elizabeth Rose Mr David Winkle Mr Anthony Kane Mr Neil Strugnell Dr Phillip Malouf Mr Mark O’Sullivan Mr Paul Rosen Dr Matthew Winter Dr Yuen Chiu Kang Mr Malcolm Stuart Dr Anna Manolopoulos Mr Halil Ozdemir Dr William Ross Dr Keith Winters Mr Kevin Karpik Mr Michael Sugrue Mr Waisani Mar Prof Richard Page Dr Emmanouel Dr Gregory Witherow Mr John Kearney Roussos Dr Saifulla Syed Dr Timothy Marshall Mr Geoffrey Painter Dr Richard Wolfe Mr Jamie Kearsley Mr Robert Rowan Dr Leong Tan Mr Frank Martin Mr Trevelyan Palmer Dr Hugh Wolfenden Mr Allan Keast Dr Christine Russell Mr Chuan Tan Dr Ian Martin Anonymous donor Dr Johnny Wong Dr Sharon Kelly Mr Grant Russell Mr Timothy Assoc Prof Damian Dr Fiona Panizza Prof Henry Woo Tasman-Jones Dr Stephen Kelly Marucci Dr Amyn Pardhan Dr Leigh Rutherford Mr David Wood Mr Simon Taylor Dr Stuart Kennedy Dr Mikhail Mastakov Dr Sandeep Patel Dr Phillip Sale Mr Michael Woodfield Mr Christopher Taylor Mr Gregory Keogh Mr Richard Masters Mrs Tina Pateras Dr Vera Sallen Assoc Prof Gavin Dr Adrian Tchen Mr Sikander Khan Dr Mathen Mathew Mr Bruce Peat Mr James Sanders Wright Mr Charles Teo Dr Japinder Khosa Mr Simon Matthews Assoc Prof Elizabeth Assoc Prof Margaret Dr Roxanne Wu Schnitzler Dr Sandeep Tewari Dr David Kieser Dr Amelie Maurel Penington Dr Joseph Xavier Mr David Schroeder Dr Richard Theile Mr David King Dr Andrew Mayo Mr Jonathan Dr Samuel Yang Pennington Prof Michael Schuetz Prof Robert Thomas Dr Julia Kirby Mr Mervyn McCallum Dr Rita Yang Mr Travis Perera Mr Joseph Scoppa Dr Michelle Thomas Mr Geoffrey Klug Prof Peter McCluskey Mr Vincent Yap Dr Jacques Perry Dr John Scott Mr Andrew Thompson Mr Simon Knight Prof David McGiffin Assoc Prof John Yeo Dr Emily Perry Dr Venkata Varaha Raja Mr John Thomson Dr Ema Knight Dr Samuel McGinness Dr Tary Yin Mr Michael Pether Seelamanthula Mr Andrew Thomson Mr Brett Knowles Dr Lorcan McGonagle Mr David Young Dr Joel Petit Mr Shibu Sen Gupta Dr Kristoffer Mr Jonathan Koea Mr Derek McGregor Dr Lik-So Yuen Dr Roger Pillemer Mr Peter Shapkov Thorvaldson Mr Helge Koeck Mr Andrew McLean Dr Mario Zotti Mr Marinis Pirpiris Dr David Sharp Dr Daniel Timperley Mr Richard Kyngdon Mr Simon McMahon Ms Meron Pitcher Mr Robert Sheen Mr Francis Tomlinson Mr Richard Laherty Mr Richard McMullin Mr Timothy Pitt Prof Ainslie Sheil Mr David Townend Mr Steven Lai Mr Stuart McNicoll Mrs Rosalynd Pochin Dr Brindha Shivalingam Anonymous donor Assoc Prof John Mr Mark Medownick Laidlaw EP Adrian Polglase Mr Robert Sillar Prof Ramesh Tripathi Dr Felicity Meikle Dr Catherine Langusch Dr Allan Pollack Dr Candice Silverman Mr Michael Troy Miss Philippa Mercer Mr Matthew Lawrence Mr Peter Poon Mr Rodney Simm Mr Etienne Truter Mr Ian Michell Mr David Lawson Dr Raoul Pope Mr Neal Singleton Prof Owen Ung Mr John Miller Mr James Lee Dr Daniel Posel Mr Paul Sitzler Assoc Prof James Mr Ralph Mobbs Mr Tristan Leech Dr Josephine Alexa Dr Suntharalingam Van Gelder Dr Alireza Moghadam Mr Ya’acov Leigh Potter Sivananthan Mr Paul Varley Mr Khalid Mohammed Dr Anthony Leong Mr Vaughan Poutawera Dr Nicola Slee Mr Robert Ventura

All costs for the Foundation for Surgery are provided for by the College so that 100 per cent of your donation can achieve its maximum benefit to the community. To find out more, please join us at www.surgeons.org/foundation “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