SURGICAL NEWS the royaL Australasian College of Surgeons Vol 15 No 1 jan_feb 2014

Advocating best practice Championing standards for quality care p28

Burns skills in Dili Deadlines The College’s Timor-Leste program Are you making yours? Censor-in-Chief continues its support to build Simon Williams discusses the work skills in the region behind those important dates

The College of Surgeons of 11 27 Australia and New Zealand Read all about Professional Development’s Successful year workshops on page 40 March-April 2014 Professional development supports life-long learning. College activities are tailored to the needs of surgeons and enable you to NSW acquire new skills & knowledge while providing an opportunity for 17 March, Sydney reflection about how to apply them in today’s dynamic world. National Simulation Health Educator 2 14 Training (NHET Sim) 8 April, Sydney workshops & activities Keeping Trainees on Track (KTOT) QLD 26 March, Gold Coast Keeping Trainees on Track (KTOT) Supervisors and Trainers Keeping Trainees on Track categories is broken down into for SET (SAT SET) (KToT) behavioural markers that can be used 3-5 April, Gold Coast to assess your own performance as Surgical Teachers Course 25 February, Adelaide; 29 4 March, Melbourne; 26 March, well as your colleagues. April, Melbourne Gold Coast; 8 April, Sydney 9 April, Brisbane This course assists supervisors This 3 hour workshop focuses on Finance for Surgeons Polishing Presentation Skills and trainers to effectively fulfil how to manage trainees by setting 31 March, Adelaide the responsibilities of their very clear goals, giving effective feedback important roles. You can learn and discussing expected levels of This whole day course establishes a SA to use workplace assessment performance. You can also find out basic understanding of how to assess Writing Medicolegal Reports achieving strategic goals, monitoring tools such as the Mini Clinical more about encouraging self-directed a company’s performance using a performance, and contributing to an 25 February, Adelaide 24 July, Brisbane Examination (Mini CEX) and Directly learning at the start of term meeting. range of analytical methods and analysis of strategic risk. You will Supervisors & Trainers for SET (SAT SET) financial and non-financial indicators. This 3 hour evening workshop Observed Procedural Skills (DOPS) have an opportunity to explore risk 18 March, Adelaide that have been introduced as It reviews the three key parts of a helps you to gain greater insight for an organisation and learn how Communication Skills for Non-Technical Skills for Surgeons part of SET. You can also explore financial statement; balance sheet, into the issues relating to providing to monitor and assess risk using Cancer Clinicians (NOTSS) strategies to help you to support income (profit and loss) and cash expert opinion and translates the practical tools. 29 March, Melbourne trainees at the mid-term meeting. It flow. Participants learn how these understanding into the preparation of 31 March, Adelaide high quality reports. It also explores is an excellent opportunity to gain In four hours you will learn evidence- statements are used to monitor AMA Impairment Guidelines Finance for Surgeons insight into legal issues. based, step-by-step communication financial performance. the lawyer/expert relationship and 5th Edition: Difficult Cases This workshop is also available as skills that break down the challenge the role of an advocate. You can an eLearning activity by logging into of delivering negative diagnoses to Polishing Presentation Skills learn how to produce objective, 13 August, Sydney the RACS website. patients and relatives. A trained-actor well-structured and comprehensive The American Medical Association VIC 9 April, Brisbane steps in mid-way through the morning reports that communicate effectively (AMA) Impairment Guidelines inform 24 February, Melbourne Process Communication to run a role play exercise where you The full-day curriculum demonstrates to the reader. This ability is one medico-legal practitioners as to National Simulation Health Educator a step-by-step approach to planning of the most important roles of an (PCM) – Part 1 practice newly-learned communication the level of impairment suffered Training (NHET Sim) skills in a safe environment resembling a presentation and tips for delivering expert adviser. by patients and assist with their 28 February – 2 March; a real-life scenario. Theoretical linking, your message effectively in a range decision as to the suitability of 28 Feb – 2 March, Melbourne Melbourne plus a video and discussion, form of settings, from information and Strategy and Risk a patient’s return to work. While Process Communication Model Part I PCM is one tool that you can other parts of the program offered in teaching sessions in hospitals, to Management for Surgeons the guidelines are extensive, use to detect early signs of partnership with the Cancer Council conferences and meetings. they sometimes do not account 4 March, Melbourne 7 August, Brisbane miscommunication and turn Victoria. for unusual or difficult cases Keeping Trainees on Track (KTOT) This whole day workshop is divided ineffective communication into Surgical Teachers Course that arise from time to time. 11 March, Melbourne effective communication. This into two parts. Part one gives an This 3 hour evening seminar Non-Technical Skills for 3 - 5 April, Gold Coast Academy Educator Studio Session workshop can also help to Surgeons (NOTSS) overview of basic strategic planning compliments the accredited AMA detect stress in yourself and The Surgical Teachers Course and provides a broad understanding Guideline training courses. The 14 March, Melbourne 18 March, Adelaide; 15 April, others, as well as providing you builds upon the concepts and skills of the link between strategy and program uses presentations, case Conjoint Medical Education Seminar with a means to reconnect with Melbourne developed in the SAT SET and KTOT financial health or wealth creation. studies and panel discussions to individuals you may be struggling This workshop focuses on the non- courses. The most substantial of It introduces a set of practical tools provide surgeons involved in the 15 March, Melbourne to understand and reach. The technical skills which underpin safer the RACS’ suite of faculty education to monitor the implementation of management of medico-legal cases Academy Educator Studio Session PCM theory proposes that each operative surgery. It explores a courses, this new course replaces strategies to ensure their success. with a forum to reflect upon their the previous STC course which was There is also an introduction to a 29 March, Melbourne person has motivational needs that behaviour rating system developed Contact the Professionaldifficult Development cases, the problemsDepartment they developed and delivered over the committee’s and board’s role in risk Communication Skills for Cancer must be met if that person is to by the Royal College of Surgeons of on +61encountered, 3 9249 1106, and the steps they be successful. These needs are Edinburgh which can help you improve period 1999-2011. The two-and-a-half oversight and monitoring. applied to satisfactorily resolve Clinicians Part two of the course focusesby email [email protected] different for each of the 6 different performance in the operating theatre day intensive course covers adult the issues faced. Please note: 15 April, Melbourne learning, teaching skills, feedback on setting strategy; formulatingor visit www.surgeons.org - select Health personality types; each person in relation to situational awareness, Fellows will still need to attend AMA Non-Technical Skills for Surgeons represents a combination of these communication, decision making and and assessment as applicable to the a strategic plan, the strategicProfessionals then click on Courses & Events training to be accredited to use AMA (NOTSS) types, but usually one is dominant. leadership/teamwork. Each of these clinical surgical workplace. planning process, identifyingwww.surgeons.org/for-health-professionals/ and guidelines. register-courses-events/professional-development 29 April, Melbourne Supervisors & Trainers for SET (SAT SET) summer lifestyle post op president’s 10 page perspective lifestyle section 10 page Summer contents lifestyle section inside

building when conducting overseas aid MARVELLOUS MELBOURNE and this is certainly the case. We should An insider’s view on what makes Victoria’s capital a great place post op to live in or visit appears in Surgical News be proud of our achievements thus far. each season Greetings Our first project, partly funded by the from Myanmar Foundation for Surgery, is the Primary Trauma Care Course. Initially conducted in Yangon with close supervision it is A nation opening up to the world now run in Mandalay and Naypidaw as well as Yangon and the course is now self-sustaining and needs very little Mike hollands President outside oversight. This was followed by a request to train Emergency Physicians. 42 With the assistance of the Australian College of Emergency Medicine, our College has played a major role training 18 Emergency Medicine doctors. I must regular emphasise the course was taught and pages assessed by the Emergency Physicians. When I last visited there was no such 2 PD Workshops thing as an Emergency Medicine 6 Relationships & Advocacy Physician. On arrival in Casualty a 9 Surgical Snips 12 patient was registered and then referred 14 Curmudgeon’s Corner to a hospital team for workup. There 15 Dr BB G-loved was no real understanding of urgency 19 Poison’d Chalice or triage. 24 Case Note Review Seventeen of the 18 candidates passed. 48 Book Club Myanmar has requested we train another 16 doctors and this course will commence in February, 2014. We have am writing this from Myanmar The spectrum of pathology encountered also conducted two ATLS Courses with where I am attending the 60th is quite different to Australia and New wonderful assistance from surgeons Annual Scientific Meeting of the Zealand. Tuberculosis remains a major in Singapore, Malaysia, Thailand and Myanmar Medical Association. public health issue; snake bite and Hong Kong, many of whom funded IMyanmar is a country approximately tetanus remain the second and third most themselves. the size of New South Wales and Victoria common indications for admission to ICU. Richard Perry and his team have also combined, with a population of 60 million Investigations are used sparingly although conducted Surgical Skills Courses which 40 people and 189 ethnic groups. Naypyidaw there is a functioning MR machine in have been very well received. While is the capital, although Yangon remains the Yangon general. not a College activity there is an active largest city and commercial capital. When patients and their families have cardiac surgical presence with Australian Over the past two years or so Myanmar to pay, it is amazing how much more teams visiting Yangon General Hospital. has undergone substantial political change Correspondence to Surgical News should be [10] International Development cautiously investigations are ordered. I Where to next? James Kong, who has sent to: [email protected] with a democratically elected government, SURGICAL NEWS Volunteers under the College’s Timor-Leste attended a clinicopathological correlation played an enormous role facilitating Letters to the Editor should be sent to: THE ROYAL AUSTRALASIAN COLLEGE OF SURGEONS VOL 15 NO 1 albeit with some caveats to true democracy. [email protected] JAN_FEB 2014 program continue to improve skills in the region meeting at Yangon General. We discussed this work and without whom we would As a whole, people I meet are delighted T: +61 3 9249 1200 F: +61 9249 1219 a case of a caecal cancer presenting have achieved much less, is keen to [16] Professional Development with the changes. As the nation opens up W: www.surgeons.org conduct further courses including There is sure to be something for you among the politically it opens to the world. I visited two in a 16-year-old girl as a per anal ISSN 1443-9603 (Print) / ISSN 1443-9565 (Online) ATLS, Surgical Skills and hopefully, range of quality courses offered this year years ago and cannot get over the changes in intussusception, a case of Caroli’s disease Surgical News Editor: David Hillis in a 4-year-old, a cholangiocarcinoma, some non-technical skills such as TIPS © 2014 Royal Australasian College of Surgeons [20] Annual Scientific Congress 2014 what is a very short time frame. two interesting ureteric anomalies, and a or NOTSS and MOSES. James has also All copyright is reserved / The editor reserves the rights Not long now! The ASC in Singapore is already Healthcare systems in Myanmar are more to change material submitted / The College privacy Advocating complex parotid mass among others. raised funds for a training centre in policy and disclaimer apply – www.surgeons.org / best practice generating great interest among the surgical and sophisticated than we might imagine. The The College and the publisher are not responsible for Championing standards for quality care p28 anaesthetic communities links between university and hospital remain While not the healthcare system we Yangon and hopes that our College will errors or consequences from reliance on information in would expect in Australia or New Zealand, play an advisory role. this publication. Statements represent the views of the [22] Academic Surgery strong and the principles of post-graduate BURNS SKILLS IN DILI DEADLINES The College’s Timor-Leste program Are you making yours? Censor-in-Chief continues its support to build Simon Williams discusses the work I believe we can be proud of the author and not necessarily the College. Information is skills in the region behind those important dates education are respected. There is, for example Myanmar is doing okay. Perhaps we should The College of Surgeons of Australia and New Zealand Meetings held at the end of last year featured a range of not intended to be advice or relied on in any particular 11 27 a three year Masters program for orthopaedic ask whether our College should contribute accomplishments of our College and circumstance. / Advertisements and products adver- quality presentations, from Chair, Section of Academic Trainees. The leaders of the medical to on-going capacity building. I think the Fellows in Myanmar. To my mind tised are not endorsed by the College The advertiser on the cover: Surgery, Richard Hanney takes all responsibility for representations and claims / community are often the orthopaedic brief outline above has identified the need the work we have done thus far Published for the Royal Australasian College of Surgeons Advocating best practice, the [26] Foundation for Surgery work of Professional Stand- surgeons, something I have noticed in other for improvement. Our College has always demonstrates clearly that we are making by RL Media Pty Ltd. ACN 081 735 891, ABN 44081 When ‘Sorry you have cancer’ hits home. An open letter to 735 891of 129 Bouverie St, Carlton. Vic 3053. ards at the College, p 28 surgeons and their families from Michael and Sally McAuliffe developing countries. had the defining principle of capacity a meaningful contribution. Relationships and Advocacy

The recent festive season provided many The College supports both Government examples of the end-result of excessive The Letter to the Editor read: and broader community action to alcohol and an ever-lengthening list of “Surgeons are on the ‘frontline’, along with police, ambulance officers, nurses, acknowledge the problem of alcohol victims; innocent and otherwise. Emergency Department staff and others, when confronted with the adverse misuse, to introduce legislation and Most reasonable people across consequences of alcohol excess in the community. regulation to protect the community, Australasia recognise our attitude Sadly, the ability to inflict alcohol-fuelled violence is sometimes beyond the encourage appropriate alcohol use and to drinking is an issue, and in polite medical profession’s ability to heal it. embrace and model ways of responsible conversations condemn it, but then with The Royal Australasian College of Surgeons has applauded and supported drinking. a shrug condone it and say, “But what the police campaign ‘Operation Unite’ since its inception and we are This is not about wowserism; it is about can we do – that is just the way it is”. convinced that, as a community, we must rethink our attitudes to alcohol. addressing the issues of violence, trauma The alcohol-fuelled ‘king-hit’ and the Alcohol-fuelled violence has become a blight on our society. Being drunk and tragedy that result from excessive fate of the seemingly innocent victims should not be acceptable. Being drunk and violent must be condemned. consumption and misuse of alcohol. dominated headlines in recent weeks. I As a nation we have to recognise that there is a problem and, as a nation, A fundamental role for the College is to heard an interview with the mother of an we have to take action. The College is calling on community leaders and the ensure that those responsible for setting alleged perpetrator who said, essentially, public to champion the ‘HOT’ issues. and implementing policies that impact she felt sorry for the victim, but drunken These are: Hours – Outlets – Taxes (HOT). We need to reduce the number on the health of the Australian and New violence is to be expected because “boys of ‘Hours’ alcohol is available, particularly after 2am. We need to reduce the Zealand communities are well-acquainted will be boys”. number of ‘Outlets’ where alcohol can be bought in our community. We need with the views of surgeons. Perhaps even worse is the presumption to tax alcohol appropriately to instigate change. The College has an impressive record of that nothing can be done because the If nothing changes then nothing changes – and that means we as a nation achievement and leadership in this regard, alcohol industry is “too powerful”. will have admitted that drunkenness and the idiotic and bloody violence it but we are under no illusion as to how long Everyone can see there is a problem inspires in our streets, in our homes and on our roads is just the way we are. and hard this battle will be. Personally I am and we are reminded of the issue’s “Surely that is an admission we cannot make. looking forward to it. existence with almost every evening Oh, and by the way – Happy New Year. news bulletin. Our media drips with stories and images of violence and harm and echoes with the ‘tsk tsk’ of those who want things to change, but are bereft of a plan. What has been missing is a construc- tive recommendation on how to address the problem. Increasing the penalties for IT’S TIME reckless antisocial behaviour may be ap- The HOT issues: propriate, but is not the answer. As we did with the issue of compulsory wearing of seat-belts in cars and bicycle helmets, the College Hours, Outlets has identified the key aspects of the alcohol-related harm issue that need to be thrashed out and has instigated a and Taxes campaign to bring about change. The College’s campaign to reduce The College has instigated a campaign alcohol related harm in our community to bring about change in the area of has been encapsulated in the mnemonic Overseas model shown. alcohol-related violence ‘HOT’ and that stands for Hours, Outlets and Taxes; the three key areas where we believe change must occur. INTRODUCING THE ALL-NEW QUATTROPORTE. ZAGAME MASERATI Michael Grigg The campaign has already attracted 430 SWAN ST, RICHMOND VIC 3121 Vice President After ample anticipation, the new Quattroporte is here. A harmonious blend PH: 03 9270 7000 A/H: 0407 874 604 early media and public attention. ZAG.COM.AU | LMCT 9479 of seductive design and innovation. The new Quattroporte GTS boasts a 3.8 In the week before Christmas, a ‘Letter litre V8 engine delivering 530hp at 710Nm of torque for blistering performance. s the great majority of us brush wide recognition of an issue that has been to the Editor’ titled Surgeons’ ‘HOT’ Distinctly Italian and iconically Maserati, this sports saloon is now even more the remnants of the beach from front-of-mind for many of us. advice to battle alcohol-fuelled violence responsive offering luxurious comfort and intuitive control. The powerful new our feet and return to work, The misuse of alcohol in the was sent to major newspapers under my Quattroporte S with 410hp at 550Nm of torque, is also available for order. A So, if you’ve ever dreamed about owning a Maserati Quattroporte, it’s now time. I welcome you all to 2014 on a more community and the associated trauma signature. I am pleased to report that sombre note than usual. and harm such misuse generates is the the letter was published prominently in The College expects this will be a quintessential ‘elephant in the room’ for many leading newspapers throughout maserati.com.au break-out year with regard to community- communities on both sides of the Tasman. the country within 24 hours.

6 Surgical News january / february 2014 Surgical News january / february 2014 7 surgical snips

what’s Post Fellowship Training in Upper GI Surgery making Applications are invited from Applications are invited from eligible eligible Post Fellowship Trainees Post Fellowship Trainees for training in news Upper GI Surgery. for training in HPB Surgery. New plaque for The ANZHPBA’s Post Fellowship Training College founder ANZGOSA’s Post Fellowship Training Program is for Hepatic-Pancreatic and A reunion of sorts brought together the descend- Program is for Upper GI surgeons. Biliary surgeons. The program consists of ants of College founding member Sir Louis Barnett as a new plaque was unveiled in Hampden The program consists of two years two years education and training following in New Zealand’s South Island last November. education and training following completion of a general surgery fellowship. The plague recognises the home of the surgery completion of a general surgery A portion of the program will include great, also best known as the pioneer in the fellowship. A portion of the program research of Hytatids. Grandson Dick Barnett as- clinical research. A successful Fellowship Emergency gift will include clinical research. A sisted in unveiling the plaque, recalling his visits to Fellow Douglas Stupart granted a Christmas gift to a family from in HPB surgery will involve satisfactory successful Fellowship in Upper GI Hampden House. Geelong, Victoria, when he performed emergency neurosurgery “We were always greeted with a smile,” he said. surgery will involve satisfactory completion of the curriculum requirements, on December 25. Otago Daily Times, November 23, 2013 completion of the curriculum completion of research requirements, Eleven month-old Taral Nash was seemingly okay after a fall from his change table, but was transported to hospital as a safety requirements, completion of minimum of twenty four months clinical precaution. A lump on Taral’s head appeared research requirements, minimum of training, successful case load achievement, soon afterwards, forcing Mr Stupart into twenty four months clinical training, assessment, and final exam. Successful lifesaving surgery to remove the blood clot successful case load achievement, and relieve bleeding. applicants will be assigned to an accredited and assessment. Successful “It was a nice example of how different hospital unit. applicants will be assigned to an members of the team come together; it was a pretty difficult situation, but was accredited hospital unit. To be eligible to apply, applicants should have made as easy as it could have been,” Mr Stupart said. FRACS or sitting FRACS exam in May 2014. For further information please Geelong Advertiser, January 10 Any exam fails will not be offered an interview. contact the Executive Officer at [email protected] For further information please contact the Executive Officer at [email protected] New bones u NZ New Years Following the birth of 3D printing, To be eligible to apply, applicants should have Applicants should submit a CV, an outline of Honours a new medical breakthrough could FRACS or sitting FRACS exam in May 2014. Any career plans and nominate four references, one have surgeons drawing new bones exam fails will not be offered an interview. must be Head of Unit, (with email addresses Officer of the NZ Order with a ‘biopen’. and mobile phone numbers), to Leanne Rogers, of Merit (ONZM) In an Australian world first, the Applicants should submit a CV, an outline of Executive Officer ANZHPBA, P.O. Box 374, Dr Tearikivao Maoate, of ‘biopen’ would contain stem cells career plans and nominate four references, one Christchurch. For services to Belair S.A. 5052, or email [email protected]. and growth factors and be used to must be Head of Unit, (with email addresses Pacific health. and mobile phone numbers), to Leanne Rogers, repair damaged and diseased bone. Professor Stephen Richard With the prospect of the invention Executive Officer ANZGOSA, P.O. Box 374, Belair Applicants will need to be able to attend S.A. 5052, or email [email protected]. Munn, of Auckland. For ready for human trials in five years, it interviews which will be held late May 2014 in services to health. has been handed to Professor Peter Applicants will need to be able to attend Melbourne. Choong at St Vincent’s Hospital. interviews which will be held late May 2014 in Member of the NZ Order “We hope to use the biopen to of Merit (MNZM) Melbourne. Applications close 5pm, Friday March 28th actually print out material that Dr Allan Leslie Panting, of 2014. helps create the bone with cells Nelson. For services to Applications close 5pm, Friday March 28th 2014. in it,” Professor Choong said. orthopaedics. Adelaide Advertiser, December 5, 2013

8 Surgical News january / february 2014 Surgical News january / february 2014 9 International Development

The best for burns Volunteers from the Australian and New Zealand Burn Association held a week-long course on the management of burn cases for 33 doctors, nurses and physiotherapists in Dili

FellowS John Harvey and Ian Leitch with Karen Murphy

small team of one doctor and management is expensive and time four nurses at the Hospital consuming; but within basic limits they Nacional Guido Valadares are capable of dealing with what they (HNGV) in Dili, Timor-Leste, confront, including injured children. Ahas been the backbone for providing much “We were keen to enhance the skills of needed care for burn victims. The team, led the local surgeons, but also to train the by Dr Joao Ximenes, received training and junior doctors who will soon be spreading Their resources can mentoring through the College’s Timor- out across the country and who will often be stretched at times Leste Program. There will now be greater be the first to see the injured patient.” “ given that modern support and expertise available from the 33 doctors, nurses and physiotherapists New skills burn management is who participated in a burns management Dr Joao Ximenes is Timor-Leste’s first expensive and time course organised by the College and doctor with plastic surgery skills. He has Fellow John Harvey with consuming delivered at the National Hospital in developed his skills in both cleft and palate Timorese doctors August 2013. surgery and burns management with ” The course, led by volunteers from guidance and mentoring from long-time the Australian and New Zealand Burn volunteer Dr Mark Moore. Dr Ximenes Association (ANZBA), was delivered in spoke of the developing workforce. response to requests from the Timor- “We have a few doctors, including the have limited materials and they teach us Mr Leitch said he first heard about the Mr Leitch, who has had a long burn management principles that could be Leste Ministry of Health, HNGV and three surgical Trainees being trained by how to use what we have here. need for more expertise at the Hospital association with Timor-Leste since he first followed for every burn including initial first national doctors to help Timor-Leste the ATLASS program, who have good “Every week we receive burns patients Nacional Guido Valadares from Plastic went there in 2000 as surgeon to the UN aid, resuscitation, assessing the depth of the improve its management of burns cases. skills for managing burns. We also have from everywhere, all over Timor-Leste.” Surgeon Mr Mark Moore. Military Hospital, said that it was this burn, infection control, graft surgery and the It was provided as part of the College’s four burns nurses who provide good care The Trainees who took part in the “He told me that the two local doctors, melding of formal instruction and practical management of scars and contractures. Australian Timor-Leste Program for for burns. They can manage wounds in course said the most important things Dr Joao Ximenes and Dr Joao Pedro real-time teaching in the operating theatres He said he and Mr Leitch acted only Secondary Services (ATLASS II), funded the ward, but they don’t yet have the skills they learnt from the course were how to Xavier, were finding that an increase in and wards that was found to be most as advisors in theatre to the local doctors by the Department of Foreign Affairs. or knowledge about physiotherapy and manage burns patients in Emergency, how the number and severity of burns cases valuable for the participants. during the August visit. The HNGV receives at least one how to prevent contraction.” to manage airways of patients with burns was straining their resources, so we got He also said that demonstrating “We were scrubbed and at the table, complex burns patient each week. Doctors Dr Ximenes said that following the to the face and neck areas, how to do a together to see how we could help solve alternative management strategies in a but all the surgery was done by local and nurses at the national hospital can training, he had observed the surgical proper escharotomy, how to accurately the problem. clinical situation and then subsequently doctors,” he said. now provide the specialist care needed. Trainees assisting with burns cases, identify the percentage of burns and how “We decided that a modified form of the being able to show the result had been a “We advised on techniques and made However, there is still a need for better with two of the Trainees recently to correctly administer IV fluids to adults Emergency Management of Severe Burns powerful educational tool. suggestions and in theatre and during immediate care at the referral hospitals demonstrating a good skin graft on a and children. (EMSB) course would be the most useful, Associate Professor John Harvey, also a ward rounds discussed when to conduct for patients presenting in the districts. large burn in the female surgical ward. Members of the visiting team who given language barriers and so instead of member of the visiting team, is Head of graft surgery and how to do it.” Associate Professor John Harvey from “Since 2008, burns patients and plastics delivered the course included retired a one-day course, this training spanned the Burns unit at the Children’s Hospital “The timing of the visit fortuitously ANZBA who led the course in August 2013 patients have been my responsibility. This Plastic Surgeon Mr Ian Leitch, Paediatric a working week and was designed to be at Westmead and has taught the EMSB coincided with the presence of a number said the doctors in Dili have the expertise course was very important to improve my Burns Surgeon Associate Professor taught as an integrated course by surgeons, course in a number of countries including of patients with acute burns at different to treat severe burns, but within limits. own skills and knowledge about burns. The John Harvey, burns nurses Ms Siobhan nurses and a physiotherapist to emphasise Fiji, Singapore, Bangladesh and Vietnam. stages of resolution and an acute “Their resources can be stretched course taught us to use simple materials, Connolly and Ms Diane Elfleet and the team approach which characterises He said the guiding principle behind it admission of a child with a 20 per cent at times given that modern burn which we have here in Timor-Leste. We only physiotherapist Ms Cheri Templeton. modern burn care.” and the modified course was to set down deep flame burn.” u

10 Surgical News january / february 2014 Surgical News january / february 2014 11 International International Forum at Development the RACS 2014 Annual Scientific Congress Sands Expo and Convention Center, Marina Bay Sands Association and our orthopaedic in Singapore colleagues across Indonesia.” Professor Cumming, who visits Monday 5th & Tuesday 6th May Indonesia around four times each year, said he was deeply honoured to have Theme: Working together for received the Sultan Hassanuddin Award. our patients “When I first began working in Convenor: Glenn Guest Indonesia, I would often be working in hospitals that had no bandages, no fluids, The 2014 International Forum in jointly not even proper beds with mattresses convened by the Royal Australasian and linens, so it is a great delight to say College of Surgeons, Australia and New that medical care there now is almost Zealand College of Anaesthetists and the Alliance for Surgery and Anaesthesia unrecognisable,” he said. Presence (ASAP). “Over the years many Indonesian surgeons have stayed at my home and Provisional Program Associate Professor John Harvey with Timorese doctor Dr Joao Ximenes work awarded great friendships have been formed too. “Yet having such a commitment Monday 5 May Associate Professor Harvey said the majority of burns to assist can be somewhat selfish, so • The global burden of surgical disease cases seen in Timor-Leste involved accidents related to Orthopaedic surgeons Professor Bill Cumming and I particularly wish to thank my wife Professor Stephen Bickler, San Diego cooking including children falling into fires or boiling Marion who has been integral to all my • The Emergency and Essential Condi- Professor Joe Ghabrial have received the highest liquids, women whose skirts have caught alight or work both in Australia and overseas.” tions we must treat to improve global award that can be bestowed for services to the nation surgical outcomes through the effects of exploding kerosene stoves. in recognition of their efforts to help establish an Professor Ghabrial works across the • The Lancet Commission for Global Sur- He said he believed the burns management course had Hunter and New England region of NSW, gery: metrics for global surgery Prof been a great success and that team members were keen to orthopaedic training program across Indonesia is a specialist in spinal surgery at the Russell Gruen, Prof David Watters and maintain contact with their counterparts in Dili, to provide Royal Newcastle Centre and John Hunter Dr Rowan Gillies future support and, where possible, help with resources. at a time when the country had no Hospitals and was the 2007 recipient of the • Peri-operative Mortality Rates: Making He praised the work of the College undertaken since With Karen Murphy orthopaedic surgeons. Australian Orthopaedic Association’s Medal a global impact. How will they help? Timor-Leste gained Independence. Now there are hundreds of such for his decades of service to the specialty. • Rowan Nicks Keynote Lecture: Datuk “I think the input of the College has been critical specialists with programs now underway Now the convener of the Orthopaedic Harjit Singh (Malaysia) in helping to provide structure around which the Outreach program in Indonesia, Professor • Surgical and anaesthetic education pro- he Sultan Hassanuddin Awards to provide sub-specialist training. grams: Improving health outcomes and East Timorese people can build their own health care were presented to Professor For the past 10 years, both Professor Ghabrial said in a presentation given last making an impact; case studies from the system,” Associate Professor Harvey said. TGhabrial at a lavish ceremony Cumming and Professor Ghabrial have year that Bali had now become one of region. What can the College contribute? “The fact that much of the work done by the College at the Makassar University in South been working to help establish a Bali the six national centres for the Board of • Keynote Lecture has been based around mentoring is one of the keys to Sulawesi, Indonesia, in September last Training Program following a request for Orthopaedics exams. its success in that such relationships help us to remain year while Professor Cumming will assistance by the Indonesian Orthopaedic As a further demonstration of their Tuesday 6 May sensitive to the local culture and aware of both resource receive his award this year. Association. commitment to Indonesia, last year • Presentations by RACS Rowan Nicks limitations and skills required. In 2010 and 2011, both surgeons were “When we began this program, Bali only Professor Ghabrial and Professor Scholars “It means that we get to hear directly what the medical also awarded Honorary Fellowships of had two orthopaedic surgeons and now Cumming also became the convenors • Hypothetical: Achieving the Common professionals of Timor-Leste need so that we can then the Indonesian Orthopaedic Association, it has 17, two Professors of Orthopaedic of the first pre-exam course offered to Good in the Aid Maze. Conflicting work to meet that need, if possible, which is exactly the receiving pure gold medals which are Surgery, two PhD’s and 40 Trainees. Trainees in Bali which is open to all priorities: Government vs Organisa- thinking behind this burns course. traditionally only presented to past “With the combined efforts and senior Trainees in Indonesia. tions vs Individuals, Brain Drain, Role of trainees, Whose standards? Who “People still die of preventable burns in Timor- Presidents. commitment of health authorities and They plan to hold the courses twice a really benefits from research? Is my Leste and one of the aspects of this training visit that Professor Cumming, a recipient of local orthopaedic surgeons and the year and are in the process of developing best good enough? I particularly enjoyed was working with the young the College’s International Medal in Indonesian Orthopaedic Association, an Fellowships to allow Trainees to expand • Keynote Lecture: Dr Kelly McQueen, doctors who I hope will go out and spread the message 2005 for his lifetime commitment to the entire new orthopaedic floor has been their skills in Australia. President, ASAP of burns prevention out across the country.” Orthopaedic Outreach Program run built at the Sanglah Hospital in Bali,” Professor Ghabrial said: “We are very • Measuring the effectiveness of surgi- Ms Siobhan Connolly is currently the Chair of the through the Australian Orthopaedic Professor Cumming said. proud to have received this award which cal and anaesthetic interventions: ANZBA Nursing course and was one of two nurses who Association, has been working in “All work done within the new clearly represents a significant recognition dollars, DALYS and dilemmas wrote the new Burns Management course. Indonesia as a surgical educator, examiner orthopaedic facility now comes under from the Indonesian authorities and • Keynote Lecture She said that spreading the delivery of the material and co-ordinator since the 1970s. the supervision of Professor Siki and respect for our program.” • Improving health outcomes by target- ing specific conditions requiring ter- over four days had allowed participants to learn new Professor Ghabrial has been providing Professor Astawa, the Dean of the Both surgeons said they wished to tiary expertise: Club foot, Cleft palate, techniques, engage in discussions and practice new skills. his skills to the Trainees of Indonesia as a University of Udayana in Bali. thank the Indonesian Orthopaedic Cataracts, Middle ear infection “In Timor-Leste, even simple things can be an issue surgical educator and examiner since 2004. “It has proved so successful, in fact, Association, the National College of for the nursing staff – like the cotton balls that have An Emeritus Associate Professor at that there are now four training centres Orthopaedic Surgery and Trauma, Participants at the International Forum must register for the Annual Scientific to be made and sterilised at the end of each day – and the University of New South Wales and in Eastern Indonesia in Bali, Surabaya, the Universities of Indonesia and the Congress: http://www.racsanzca2014.com experiencing this helps to keep our own working lives in now retired from operating, Professor Malang, and Makassar which is a great orthopaedic surgeons and Trainees with perspective.” Cumming began working in Indonesia credit to the Indonesian Orthopaedic whom they have worked.

12 Surgical News january / february 2014 Surgical News january / february 2014 13 Curmudgeon’s Surgeon’s in Corner health memoriam

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

John Dickson, Queensland Fellow John Grant, That’s not Mind the gap? Yes we do! NSW Fellow How do you view a reasonable fee? Malcolm Douglas, nice at all Victorian Fellow Do you really need to know about my day? John McIlwaine, They were desperate. Doctors like though he always warns them of the risks Dr BB G-loved New Zealand Fellow myself and the surgeon who first of ongoing pain, the dangers of loose operated, could not and would not advise prostheses and failure to fuse. Daryl Nye, by professor grumpy the subsequent procedure, but as the I did consult your College to read a Victorian Fellow thought this month I would share re-exploration offered a hope, albeit a Position Paper on excessive fees. This is some of the issues raised to me small one, the straw was grasped. The not an issue only for surgeons, but it was Richard McArthur, by some of your patients. You are Ave Rages increased their mortgage, I acknowledged that some surgeons charge Victorian Fellow probably aware that patients do noted the procedure appeared to go well a great deal over the top of what a health here is one thing that really meaning, as in what a nice party, what consultI their GP about anticipated or real at least initially, but before long there were fund will reimburse. Your patients are in Patrick Browne, annoys me and that is nice people, the dish of Mongolian health care costs, particularly when facing complications that required transfer to the a vulnerable position, particularly those Tasmanian Fellow meaningless words of “social stewed sheep gizzards was nice. large out of pocket expenses for surgical public system. with malignancy or severe pain. treatment. I hope you will appreciate their Now they were under the care of a They are often desperate, have difficulty John J McCarthy, lubrication” – I am sure that That creates its own problem. If Tyou know what I mean. “Have a nice it has truly been a pleasure to meet plight. different team and Dr Razor Sharp kept a comprehending all their options, or NSW Fellow day” is the worst offender. The words someone how do we curmudgeons For years, often decades, they have low profile secure in the knowledge they even the financial implications of their Frank Szalassi, are not really offensive; it is the saying say it and mean it? “It has been so faithfully subscribed to private health had been dutifully warned that some of treatment. A specialist has an obligation insurance always believing that the costs Queensland Fellow of them that offends curmudgeons and, nice to meet you” will, after this these complications could occur. Some to consider that a second opinion may be I suspect, a large part of the population. article, be a very suspect statement as of private health care would be covered. months later the terminal Ave Rage passed advisable or that a second consultation The person saying the expression my readers (both of them) will know Many pay small gaps and these rarely on, but the family were always grateful should be arranged before making a could not give a damn if you are going what I really mean. complain; it is rather the few patients that ‘everything possible’ had been offered. decision. Multi-disciplinary meetings We would like to notify readers to run over your cat, stub your toe or Even worse in the social lubrication who are charged substantial, seemingly They had paid top dollar for ‘the best’. Dr (when available) offer an opportunity for that it is not the practice of smash a bottle of Grange Hermitage. stakes are shop assistants (usually exorbitant gaps. Razor Sharp was thanked at the funeral. peer review and shared decision-making. Surgical News to publish obituaries. All the person wants is you out of their young women) who in the course of Imagine the plight of Mr or Ms Ave Then I was consulted by the Diss The Code of Conduct of your College When provided they are published shop and on your way. They should the transaction ask what you have Rage who had been referred to Dr Faceteds. The father of the house was states: along with the names of deceased be saying, “We have finished our done today or what are you are going Razor Sharp because he or she is ‘the suffering severe back pain without “A surgeon will when charging a fee Fellows under In Memoriam on the transaction, now get on your way and to do today. I used to grunt and mutter best’! Mr and Ms Ave Rage reside in significant neurological impairment, for professional services ensure that it College website www.surgeons.org suburbia, where they live prudently, have consulted Mr Slit Quick who offered a is reasonable and does not exploit the go to the Fellows page and out of my shop.” something benign like cook the accumulated a few hundred thousand click on In Memoriam. The expression “It has been so nice meat I have just bought. I have also prompt procedure, but with a gap of tens patient’s need.” to meet you” often means, “What a contemplated saying something like, in super, still have a mortgage as well as of thousands of dollars collected up front. The College informed me that they pain you are and I am so glad that you “This morning I found the cure for supporting their kids at university. There was no wait and watch, no can’t recommend any particular fee Informing the College are going. I am never asking you to cancer and won the Nobel Prize for Then tragedy strikes, one of them trial of physiotherapy or conservative schedule, though there are reasonable If you wish to notify the College of dinner again.” Or it may mean, “I now Medicine,” but I suspect that would develops first a tumour, then within 18 treatment with adequate analgesia ... No fee schedules able to be referred to and the death of a Fellow, please contact see why your husband/wife complains have been met with, “That’s nice”. months a recurrence, and is referred to the pain was great, the patient couldn’t the patient is entitled to be made aware the Manager in your Regional Office. about you all the time.” In any event, As I have matured as a Razor Sharp, who sports a reputation cope (he wasn’t advised to), the need for of them. My surgical sources all wished They are rarely does it express that it has been a curmudgeon, I have tried saying, “It is for doing what most other surgeons a procedure was implied to be urgent, to remain nameless, but none wanted to ACT: [email protected] pleasure to meet a person. none of your business”. The problem do not do – still offer some chance of a so Slit Quick found space on the next defend gaps that reach five figures. NSW: [email protected] The word “nice” is a word that with that is that some of these twitty cure, though with the risk of significant available operating list. I am happy to report also that most NZ: [email protected] curmudgeons hate with a passion. girls seem to take offence and you complications. But then Mr Razor Now we know that the best patients surgeons I refer my patients to either QLD: [email protected] It is overused. Everything is nice – have to change butchers or bakers Sharp is ‘the best’, so he charges top to select for surgery with back pain have charge a small or reasonable gap. The SA: [email protected] parties, people, dinner and so on. I was as the next week they avoid serving dollar. The Ave Rage’s were expected either urgent neurological indications or cases discussed above are fortunately TAS: [email protected] delighted to learn that the original you. It is a good thing we don’t need to pay many thousands of dollars gap. that nerve root pain has not responded atypical, and relate to a small number VIC: [email protected] meaning of “nice” when it was first used candlestick makers nowadays as This was correctly divulged to them over several weeks. Mr Diss Faceted of surgeons who I honestly believe are WA: Angela.D’[email protected] 700 years ago was “unimportant or there are some tempting retorts to the beforehand, financial consent was duly consulted me two years later, with regard deliberately and determinedly milking NT: [email protected] trivial”. If you ever hear a curmudgeon question of what are you going to do and appropriately given. Indeed the Ave to significant ongoing pain. Maybe it the system for their own ends, with using the word you can be certain that with the candles which you have just Rage’s were required to pay the gap before was just bad luck. Mr Slit Quick assured neither the best interests of their patients he is using the word in its original bought. the surgery could be conducted. me most of his patients are responders nor their profession at heart.

14 Surgical News january / february 2014 Surgical News january / february 2014 15 Professional Development

arly last December, you will have Medical Expertise, Judgement andProfessional Decision Development Making, Activities It is from this base that all faculty Other courses available Technical Expertise, Professionalism, Health Advocacy, received a copy of the guide to Communication, Collaboration, Management and training can emerge, customised to the There is a suite of programs looking at Active Learning College professional development Leadership, Scholarship and Teaching, Medical Expertise, area of expertise required by the individual RoyalJudgement Australasian and College Decision of Surgeons Making, Technical Expertise, improving our communication skills. activities for 2014, Active Learning AProfessionalism, Guide to the Health Advocacy, Communication, participant and the specific teaching activity. This includes the very popular Process Ewith your Peers 2014: Expand knowledge ActiveCollaboration, Learning Management and Leadership, Scholarship The Foundation Skills course is a generic with your Peers and Teaching, Medical Expertise, Judgement and Communication Model course that gives with Your Peers 2014 and learn new skills. This booklet details Decision Making, Technical Expertise, Professionalism, course in supervision and instruction great insight into how we can better an extended program with many exciting Health Advocacy, Communication, Collaboration, particularly suited to new supervisors and There is sure to be something for you among Management and Leadership, Scholarship and Teaching, understand, motivate and communicate opportunities on offer – some for the first Medical Expertise, Judgement and Decision Making, instructors and to late stage Trainees. more effectively with our colleagues, the range of quality courses offered this year Technical Expertise, Professionalism, Health Advocacy, time – and which builds on a successful Communication, Collaboration, Management and family and friends. Part 1 of the course program in 2013 (almost 1100 participants Judgement and Decision Making, Technical Expertise, Developments to will be held in both Melbourne and Expand knowledge and learn new skills in 59 face-to-face activities, plus a further Adelaide and Part 2 (a more advanced Julian Smith Medical Expertise, Judgement and Decision Making, existing courses 190 participants in online learning). Technical Expertise, Professionalism, Health Advocacy, course) in Sydney. Chair, Professional Development Communication, Collaboration, Management and As an extension to the Foundation Skills Chair, Academy of Surgical Educators The 2014 program continues to reflect Leadership, Scholarship and Teaching, Medical Expertise, course for surgical educators, a number The majority of us are called on from the changing environment for health Judgement and Decision Making, Technical Expertise, Professionalism, Health Advocacy, Communication, of revisions will also take place to existing time-to-time to deliver talks, lectures and care professionals and offers a variety of Collaboration, Management and Leadership, Scholarship courses that address the teaching and other presentations to groups of colleagues learning and delivery modes focusing and Teaching, Medical Expertise, Judgement and Decision Making, Technical Expertise, Professionalism, scholarship competence. These include a or others; if you would like to hone your mainly on the non-technical competencies. Health Advocacy, Communication, Collaboration, skills in this area, the one day Polishing Management and Leadership, Scholarship and Teaching, re-work of the Supervisors and Trainers Medical Expertise, Judgement and Decision Advocacy, for the Surgical Education and Training Presentation Skills course would be an Communication, Collaboration, Management New courses and program (SAT SET), both online and ideal way to do this and will be held in workshops face-to-face programming, along with Brisbane and Sydney this year. The College has been successful course, which will again be offered in the Keeping Trainees on Track (KTOT) And finally, communication specifically in obtaining funding from the several locations in Australia, New Zealand program and translation of this into an with patients with cancer, are covered in Commonwealth Rural Health Continuing and at the Annual Scientific Congress in online resource. depth in the Communication Skills for Education (RHCE) grants program to Singapore. The Acute Neurotrauma: Enhancing Cancer Clinicians courses, which will be develop and deliver four workshops Clinical Decision Making: A Complex head injury management amongst rural held in Melbourne, utilising simulated in rural and remote Australia that will Competency is a three hour workshop clinicians workshops will continue patients to enable you to practise your help surgeons, anaesthetists and scrub designed to enhance understanding of into 2014 following receipt of additional skills. practitioners to work together more your decision-making process and that of RHCE funding. This workshop provides Management and leadership can be effectively in the operating theatre. your Trainees or colleagues. The workshop the foundation for improved head injury challenging areas and ones for which few The program is entitled NOTSS, will provide a roadmap of how the management with the aim of equipping of us have been prepared. Two courses that ANTS and SPLINTS: Working together surgeon forms a decision. This algorithm clinicians with the skills to deal with are particularly useful for those of you to help perioperative teams in rural illustrates the attributes of expert clinical cases of neurotrauma using equipment who are considering taking on managerial and remote locations and will utilise decision-making and has been developed commonly found in rural hospitals. roles in hospitals etc. are Strategy and Risk material developed by the Royal College to improve clinical decision making Workshops, focusing on training in Management for Surgeons – a one day of Surgeons of Edinburgh, the University processes. It will be particularly useful burr–hole surgery for head trauma course to be held in Brisbane and Finance of Aberdeen and the National Health for a supervisor dealing with a struggling emergencies will be offered in two for Surgeons that is also a full day course Service. The frameworks used are the Trainee or as a self-improvement exercise. locations in the second half of 2014. An and will be available in Adelaide. Non-Technical Skills for Surgeons Training Standards: Interpretation and eLearning package consisting of a series of Earlier in this article, I referred to the (NOTSS), Anaesthetists’ Non-Technical Application is also a three hour workshop four modules is available on our website. work being undertaken under the auspices Skills (ANTS) and Scrub Practitioners’ List designed to enhance supervisors’ and In 2014, the Professional Development of the Academy of Surgical Educators. of Intra-operative Non-Technical Skills trainers’ understanding of the surgical Department will work closely with In addition to the courses already (SPLINTS), all of which were originally training curriculum and how to foster the Regional Offices to deliver the mentioned, we will continue to offer the derived from studying teamwork in the competent and proficient surgeons. The Preparation for Practice course. Surgical Teachers course in 2014. This is aviation industry. course offers a framework and guide for This two day workshop is a great a substantial two and a half day course The first part of the workshop day will the assessment of Trainees against the nine opportunity for younger Fellows and providing an in-depth look at principles of discuss human factors research, team College competencies. late stage Trainees to learn about adult learning, teaching skills and giving work and team dynamics then discuss Early in the year, the Academy of the essentials for setting up private feedback in the surgical workplace. It will similarities and differences between Surgical Educators will be developing practice. The focus is on practicality be held in Auckland, Sydney and on the the three different craft groups. The a Foundation Skills in Supervision and experiences provided by fellow Gold Coast. 9 second part of the day will give you the and Facilitation course and piloting surgeons and external speakers. By Other program developed specifically for opportunity to assess both yourself and it in late 2014. The Foundation course attending this course, you will have the our surgical educators include Graduate your colleagues in the intraoperative in surgical education, will describe the chance to speak to senior Fellows who Programs in Surgical Education offered setting. The NOTSS, ANTS and SPLINTS basic standards expected of our surgical have experience in starting up private in conjunction with the University of course will complement the NOTSS educators. practice and get tips and advice. Melbourne and which can lead to an exit u

16 Surgical News january / february 2014 Surgical News january / february 2014 17 Professional Surgical Development Services

level of your choice (Masters, Diploma or If you prefer an online learning Other individual program sponsors “Uneasy lies the head that wears the crown” (Henry IV, Part 2, Act 3 Scene 1) Certificate). experience, there are additional programs include: mlcoa, Cancer Council Victoria, The National Simulation Health that are delivered in electronic format only. Rooms with Style, eReports and Covidien. Educator Training (NHET-Sim) program, These include SET Selection Interviewer I would like to thank these organisations My better half walked in and saw the distanced look on my offered in collaboration with Health Training (SET SIT), an online module that for supporting the College professional face and the glass almost empty before me. Filling it up, it was Workforce Australia, will continue with takes approximately one hour to complete development activities in 2014, thus she who quoted Shakespeare at me! She was being provocative – day long workshops in Sydney and and that provides a wealth of information ensuring that our programs are affordable I did have that sense. Melbourne as will the webcast Academy of value to Fellows involved in selection of and accessible. “How’s the head with the crown – uneasy?” Well, it was close, Educator Studio Sessions. Trainees onto the SET program. So, as you can see this year is shaping but then she is hardly a Bardophile. For those of you with an interest in Other online modules released during up to be an exciting one as we attempt “I am trying to balance the paradox of Shakespeare,” I said. medico-legal work, there will be an 2013 were the Australian Indigenous to address your needs by developing “You know how I strongly support his statements in ‘All’s Well evening workshop in Brisbane in July on Health and Cultural Learning module and delivering a range of new activities. That Ends Well’, Act 1 Scene 1.” She looked at me, not all that Writing Medico-legal Reports and the and the Intercultural Learning for I encourage each of you to consider sympathetically. “You know, ‘Love all, trust a few, do wrong to three-hour course AMA Guidelines 5th Medical Specialists module, both of which attending one or more of these courses. none’. Well it is almost impossible to balance with his lines from Edition: Difficult cases course will also be have been funded by the RHCE program Of course, we always welcome your ‘The Merchant of Venice’, Act 4, Scene 1.” available in Sydney the following month. and which will be valuable in developing ideas and comments about how we My better half who does not always have the patience of a saint, Finally, we will be offering two Building health advocacy and interpersonal can continually improve the range and stared, sighed, took my glass and sat down. I continued with the towards Retirement courses – in Sydney communication skills. content of professional development line that says, “I am not bound to please thee with my answer.” She and in Perth that may appeal to those of initiatives. took a substantial ‘biopsy’ of the liquid in the glass. It clearly passed you contemplating a change in focus in Sponsorship of the test because she kept hold of it. More was obviously expected. the latter stage of your career. The full I tried to verbalise what was troubling me. “You know my day program covers maintaining health professional development Full details can be found in your first principle of management – keep the people who don’t and well-being, career options after at the College Professional Development booklet or like me away from those who are still undecided – well it is surgery, superannuation and legal advice, This year we welcome three global sponsor alternatively, please refer to the College becoming harder with the changes that we are implementing.” community involvement and building partners in Avant Mutual Group, Applied website. Registrations are open now. She frowned at me; she was very aware of the dangers of change post-retirement networks. Medical and Bongiorno National Network. management. In fact we had joked about change management gone wrong, and that “Hell is empty and all the devils are here” would be the outcome! (‘The Tempest’, Act 1, Scene 2). No wrath like a surgeon denied. “You’re just feeling a little sorry for yourself,” she replied. “So what is it that is really worrying you?” The 2014 program continues to reflect Of course she was right. Whether people liked me or not was the“ changing environment for health care not a determinant, though I would of course prefer the former. professionals and offers a variety of learning poison’d No, what was worrying me was much more insidious – I had and delivery modes been sensing the coalescence of gathering dark clouds on the chalice horizon for some time now. Clouds that threatened a storm with the capacity to engulf the professional world that I inhabited and What doth the year hold? had sought to strengthen. ” Was the future of our profession truly at risk or was I just getting older? Probably both. Possibly the most important, professor U.R.Kidding most valued aspect of my professional life was the freedom, the autonomy to act in the best interests of my patients. It was a value that I had sought to instil in my Trainees and indeed the t was that glorious time around Christmas and New Year, surgeons working in the health service. Could it withstand the where you are ‘around’, but you try and convince people gathering forces arrayed against this seemingly simple value? you are ‘not really around’ and wasn’t there someone The truth was, I feared, not. else who could look at that case? (Conversely, trying to And then she surprised me again, as she has the endearingly convinceI those that pay your salary i.e., the CEO, that you are irritating habit of doing repeatedly, with an entirely accurate around when you are not really!) quote: “The miserable have no other medicine but only hope” Certainly I didn’t see any good reason to sit in my poorly (‘Measure for Measure’, Act III, Scene I). air-conditioned office waiting for the time to pass. And so I was As she rose from the chair preparing to leave me somewhat at home – using this ‘quiet’ time of year for some reflection. open-mouthed, she turned and said, “Actually my favourite quote Unfortunately, I had been able to spend a good part of the when I think of you is from ‘King Richard III’, Act 3, Scene 4.” afternoon thinking about the problems behind and the “Which is?” I asked, regretting the words as soon as they left challenges ahead ... why was I doing that? Maybe I should have my lips. gone to the cricket and tried to barrack for the Poms – they had “Off with his head!” needed all the help they could get. The phone rang, was I around?

18 Surgical News january / february 2014 Surgical News january / february 2014 19 asc Scholarships 2014

Peter Jones Oration Professor John Huston Hamilton Russell Lecture Buckingham May 5-9 2014 Assoc. Professor Carol-Anne Moulton Edward (Weary) Dunlop Lecture Scholarship Mr Peter Sharwood Archibald Watson Lecture Professor David Watters Scholarship recipient attends the American College of Surgeons 2013 Annual Meeting Program review in Washington DC Upper GI and Bariatric These sections have been convened by Professor Wendy Brown and Mr Paul Laura Wang Trainee, NSW Burton. The visitors include Professor Robert Mason who has a major interest in the palliation of dysphagia in oesophago- s the 2013 recipient of and Trainees alike to relax and gastric malignancies. Dr Jaime Ponce the John Buckingham mingle. from the US and Professor Weiner from ATravel Scholarship, I was Each day was packed with Germany will discuss the evidence for privileged with the opportunity many interesting and provoking various bariatric procedures. to attend the American College academic sessions. Many of Surgeons (ACS) meeting this concurrent sessions for each Plastic and Reconstructive Surgery year, as a representative Trainee of subspecialty were run by the Dr Mark Hanikeri is the convenor for this the Royal Australasian College of who’s who of international leaders extensive section program. The visitors Surgeons. It was Dr Buckingham’s of each field. In addition to the are Professor Joseph McCarthy, Professor vision to foster closer personal and academic and scientific sessions, Phillip Blandeel, Dr Filip Stillaert and academic relationships between I was struck by the number Dr Marc Mureau. The extensive program our two countries and the mission of sessions on cost-effective overlaps with head and neck surgery, of this esteemed grant. healthcare, leadership and life- breast reconstruction, hand surgery, the This was my first attendance at balance sessions at the American international forum section, burn surgery an ACS conference and I was very College meeting. and facial reconstructive surgery. excited to attend a meeting with The international attendants more than 5000 other surgical were invited to attend special lunch Orthopaedic surgery attendants. Members of the and dinners organised specifically Dr Richard Lander has assembled a Residents and Associates Society to facilitate international relations. The Convocation and Welcome program covering regional anaesthesia, (RAS) were extremely welcoming I had the pleasure of meeting Reception is on Monday, May 5, at the shoulder surgery, foot and ankle surgery, and involved us completely in many international and Australian Not long now, Sands Expo and Convention Centre. At paediatric orthopaedics as well as a its academic and social activities surgeons at the meeting including this convocation there will be two new segment on current practice and updates during the four-day conference. the recipient to the John Murray honorary Fellows and eight other senior in orthopaedics. I arrived on Sunday to a very scholarship, Dr Julie Howle Singapore ASC members of our profession who will quiet Washington DC; the US and Dr Stephen Smith. I also be acknowledged for their outstanding In addition to the above sections federal shut-down, meant that was pleasantly surprised to find The College 2014 Annual Scientific Congress in contributions to surgery and the College. there will be section programs from there were no politicians or many of these events to be run by Singapore is already generating great interest On this special occasion this will be a the International forum (Dr Glenn lobbyist and very few tourists in Australian Fellow, Stephen Deane. among the surgical and anaesthetic communities combined reception with our anaesthetic Guest), Senior Surgeons (Professor town, much to the dismay of the In summary, it was an absolute colleagues and an evening not to be Bruce Waxman), Younger Fellows many taxi drivers in the city. I honour and privilege to be missed. (Dr Jason Chuen), Women in Surgery attended the RAS meeting with awarded the John Buckingham Martin Richardson, ASC 2014 Convener The theme of the congress is ‘Working (Dr Kate Drummond) and the Trainees its members and three other Scholarship this year. The ACS Sayed Hassen, ASC 2014 Scientific Convener Together for our Patients’ and we will have Association. international Trainees from Italy, meeting was not only academically several joint sessions with our anaesthetic Lebanon and Ireland. interesting, but also a unique colleagues. In addition to the named I was thoroughly impressed at opportunity to meet Trainees he 2014 Annual Scientific the provisional program because it will lectures we previously mentioned, there We sincerely trust you will join us in the size and level of organisation and consultants from around the Congress will be at the Sands quickly book out. are further lectures of interest including: Singapore for what is shaping up to be of the RAS committee. We heard world. The academic and social TExpo and Convention Centre at In the previous article we mentioned BK Rank Lecture our most memorable ASC joined by our many impressive campaign networking events were very well Marina Bay Sands. As well as exceptional some of the highlights of this Annual Professor Joseph McCarthy anaesthetic colleagues. speeches prior to the election of organised and I would not hesitate conference facilities, the accommodation Scientific Congress (ASC), some of the Rupert Downes Memorial Lecture Register now through the Congress the new RAS committee. In the to encourage other Trainees to at Marina Bay Sands is first class so named lectures and a short review of Air Vice-Marshal Assoc. Professor Hugh website asc.surgeons.org evening, an informal cocktail event apply for this grant in the coming reserve your room as soon as you receive some of the section visitors and programs. Bartholomeusz at a local bar allowed consultants years.

20 Surgical News january / february 2014 Surgical News january / february 2014 21 collaboration in Adelaide

Academic Surgery Developing a Career in Academic Surgery Monday 5 May 2014, 7:00am – 4:00pm SANDS EXPO AND CONVENTION CENTER MARINA BAY SANDS, SINGAPORE

Provisional Program collaboration 7:00am Registration and Breakfast 7:15am Welcome Michael Hollands (President, Royal Australasian College of Surgeons) Introduction in Adelaide SeSSion 1: A CAReeR in ACADeMiC SURGeRY 7:30am - 9:00am Chairs: Sandra Wong (Ann Arbor, USA) and Christobel Saunders (Perth) Forum and dinners held alongside the College What is a career in academic surgery? Philip Crowe (Sydney) Academic Surgery – the essentials Academic Section and the Surgical Research 1 Research – How to get research started – ideas, grants, ethics and collaboration Timothy Pawlik (Baltimore, USA) Society meetings complemented the quality of 2 Teaching, leadership, administration Julie Ann Sosa (Durham, USA) presentations over three days 9:00am MoRninG TeA 9:15am HoT ToPiC in ACADeMiC SURGeRY - Comparative effectiveness Research Caprice Greenberg (Madison, USA) Chair: John Windsor (Auckland) Richard Hanney Chair, Section of Academic Surgery SeSSion 2: CAReeR DeVeLoPMenT 9:40am - 11:20am Chairs: Julie Ann Sosa (Durham, USA) and Philip Crowe (Sydney) 9:40am I want to be an academic surgeon What can I do as a: ate last year, Stephen Tobin, the The Academic Section meeting on Medical Student Arthur Richardson (Sydney) College’s Dean of Education, and Thursday convened an inaugural mid- Trainee – The pros and cons of fulltime surgical research during training Tarik Sammour (Auckland) Fellow Vincent Lam (Sydney) Professor Julian Smith convened career workshop for academic surgeons, L Consultant Mark Smithers (Brisbane) an inaugural Forum for the Academy an initiative of Professor Andrew Hill 11:20am LUnCH with the faculty and small discussion groups of Surgical Educators in Adelaide on from Auckland. Ian Bissett described his Wednesday, November 13, addressing the thoughts when considering ‘Do I want 12:20pm KeYnoTe PReSenTATion - ACADeMiC LeADeRSHiP Carlos Pellegrini (President, American College of Surgeons) this time describing exciting genomic Future Direction for Surgical Educators. to be a Head of Department?’ before SeSSion 3: ConCURRenT ACADeMiC WoRKSHoPS 1:00pm - 2:40pm work defining and working towards Cutting edge insights provided at a Professor David Hackam from Pittsburgh potential elimination of devastating Workshop 1: Tools of the Trade Workshop 2: Career Development Q & A Workshop 3: Presenting Your Work well-attended dinner-based function discussed ‘Research training for the necrotising enterocolitis in premature Chairs: Julie Ann Sosa (Durham, USA) Chairs: Caprice Greenberg (Madison, USA) Chairs: Guy Maddern (Adelaide) complemented the established meetings Surgeon-Scientist’. infants. Professor Chris Breuer described and Wendy Brown (Melbourne) and Russell Gruen (Melbourne) and ian Bennett (Brisbane) of the College Academic Section and the Remarkably, these two erudite a thrilling journey in tissue engineering Bedside to bench to bedside Multiple faculty Writing an abstract Surgical Research Society held on the gentlemen from different hemispheres John Windsor (Auckland) Julie Margenthaler (St Louis, USA) that has led to synthesis of ‘neovessels’ for Frank Frizelle (Christchurch) following two days. and specialties each reflectively illustrated Basic science Writing a paper venous, arterial and congenital cardiac Michelle Locke (Auckland) Michael Cadogan, an Emergency their talk with the same African proverb: Michelle Locke (Auckland) Timothy Pritts (Cincinatti, USA) deficiencies. If ever current research Timothy Pawlik (Baltimore, USA) Department physician from Perth, “If you want to go fast, go alone. If you Randomised clinical trials Andre van Rij (Dunedin) Presenting a paper has remarkable clinical and financial David Watson (Adelaide) Sandra Wong (Ann Arbor, USA) provided visionary insight into want to go far, go together.” No other Wei Zhou (California, USA) implications, this was it. Marc Gladman’s Outcomes research The ANZ Journal of Surgery – What the ‘e-innovations in Medical Education’. advice is so consistently provided from and others unit from Concord Hospital and the Niraj Gusani (Hershey, USA) Editor wants and where the Journal Opening more doors than just Facebook academic meetings, nor is any truer in University of Sydney had six posters and Surgical education and research Attendees to bring along their own current is going and Twitter, his illustrations of contextual clinical practice. We will always achieve or past research challenges for a masterclass John Harris (Sydney) podium presentations, more than any Stephen Tobin (Dean of Education, RACS) with the faculty learning highlighted approaches to cut more and better in collaboration than we other. through the white noise of unsubstantiated will in professional isolation. 2:40pm AfTeRnoon TeA The three-day series of meetings, opinion on the internet to share valuable Guy Maddern spoke to ‘The shadowy helpfully sponsored by Covidien, will SeSSion 4: A CAReeR in ACADeMiC SURGeRY 3:00pm - 4:00pm discussion between respected peers. world of academia’ as only he could. The Chairs: Timothy Pawlik (Baltimore, USA) and frank frizelle (Christchurch) next year likely be concertinaed into two, Websites such as the Healthcare afternoon sessions usefully considered 3:00pm Choosing and being a mentor Andrew Hill (Auckland) providing every academic surgeon the Hashtag Project (http://www.symplur. attributes of different models of teaching 3:20pm Work-life balance Julie Howle (Sydney) opportunity to benefit from experience com/healthcare-hashtags) provide hospitals in an environment of increasing 3:40pm On the shoulders of giants Russell Gruen (Melbourne) such as this year’s. The Academic Section a starting point for exchanges with accountability and governmental defines an academic surgeon as a leader informed colleagues. Margaret Bearman, intrusion into training processes. Registration Cost: A$255.00 per person who has chosen: from Monash University, discussed the Professors Glyn Jamieson and Andre Register online at www racsanzca2014 com or email dcas@surgeons org for a registration form • to acquire specific training and role of ‘Communities of Practice’ in van Rij spoke at a delightful 50th There are fifteen complimentary spaces available for interested medical students. Medical students should register their interest experience in research and/or education, medical education. The term thoughtfully anniversary commemorative dinner of the to attend by emailing dcas@surgeons org or for further information telephone +61 3 9249 1273 and refers to the multiple collaborations Surgical Research Society of Australasia As per Regulation 4.9.1a for the SET Program in General Surgery, Trainees who attend the RACS Developing a Career in Academic • to make these dimensions a significant Surgery course may, upon proof of attendance, count this course towards one of the four compulsory GSA Trainees’ Days. with which we work each day in the that evening, before the Society meeting part of their career. operating room, in our offices and the following day. There, nearly 60 Presented by: Proudly sponsored by: lecture theatres. Rick Iedema, Professor attendees were privileged to hear original Association for Academic Surgery in partnership with the Royal Australasian College of Surgeons, of Communication from Sydney, closed work from aspiring academic surgeons We welcome all surgeons looking to RACS Section of Academic Surgery Section of Academic Surgery out the evening discussing ‘Promoting in many surgical specialties as well as broaden their own perspectives, as we Progressive Independence in your surgical exciting seminal work in paediatric look forward to next year’s meetings Trainees’. He provided a series of valuable surgery. being even more interesting than this illustrations of lessons learned from video Leigh Delbridge convened the meeting year’s, if possible. noTe: new RACS fellows presenting for graduation in 2014 will be required to marshal at 3.30pm for the Convocation Ceremony. recordings of clinical teams in action. where David Hackam spoke again, CPD Points will be available for attendance at the Course with point allocation to be advised at a later date Information correct at time of printing, subject to change without notice 22 Surgical News january / february 2014 Surgical News january / february 2014 23 Audits of Brian Smith Surgical Mortality summer Memorial Award lifestyle Grants Program - Colorectal Disease

Applications are Case Note invited for funding in 2014 towards research Review post op and surgical training in the area of colorectal Death from sepsis and multi-system disease. failure after delayed diagnosis of a Brian Smith was a perforated duodenal ulcer 10 leading Melbourne page surgeon whose main surgical interest Guy Maddern lifestyle was disease of the Chair, ANZASM section colon and rectum, and this Award seeks middle-aged patient was Assessor’s comments to support medical brought in by ambulance to There was a significant delay in research and further Athe ED of a major metropolitan diagnosis of a perforated viscus in enhancement of hospital with sudden onset of severe this case (nearly 24 hours) and this is the surgical skills thoracic back pain while using a highly likely to have contributed to and knowledge of transcutaneous electrical nerve the death of this middle-aged patient. researchers and stimulation machine for chronic However, the presentation (acute practitioners having fibromyalgia. thoracic back pain) was very atypical. a special interest in The patient had a number of The abdomen was noted to be soft and comorbidities including type 2 colonoscopy, colonic non-tender. diabetes, asthma, scoliosis, anaemia cancer and the applied I have never seen an anterior and a history of renal calculi. The anatomy, physiology or perforation of a duodenal ulcer patient was on multiple medications. pathology of the colon present in this way. It appears that Chest x-ray was said to be normal and or rectum. free sub-phrenic gas was not seen on ventilation/perfusion scan was negative the chest x-ray. An erect chest film to Up to $30,000 is for pulmonary embolism. Analgesia include the diaphragm is necessary available per award. was given and the patient was admitted to see this, and the chest x-ray might More than one award to the short stay ward for observation have been supine. might be made. Travel with no definite diagnosis. The following morning, renal costs may be funded Overnight there was hypotension at colic was considered, leading to the as part of an Award. times, responding to intravenous fluid abdominal CT scan that showed the boluses. The following morning the ED free gas. There would not, on the face Consultant suggested the possibility of it, have been a clear indication for Applications will be evaluated of renal colic in view of past history. an abdominal CT prior to this, but a by a specialist committee and The patient was then referred for an patient presenting with severe thoracic should be made as follows: abdominal CT scan which showed free back pain often has serious pathology intra-abdominal gas and fluid. (e.g. an aortic dissection) and a chest Application Form and The surgeons were consulted and CT should have been performed. This Lodgement: Email the patient prepared immediately also might have picked up the free sub- [email protected] to obtain for theatre. Triple antibiotics were diaphragmatic gas. an Application Form with MARVELLOUS given. The patient was hypotensive Once the diagnosis was made the lodgement details set out on induction of anaesthesia. At surgical and ICU management appears therein. operation a perforated anterior to have been exemplary. Unfortunately MELBOURNE For further information duodenal ulcer was found with gross the patient’s gross sepsis and telephone ANZ Trustees: peritoneal contamination. Repair comorbidities proved insurmountable. An insider’s view on what makes (03) 8655 8083. of the perforation and peritoneal My view is that the diagnostic delay Victoria’s capital a great place washout were performed. The patient was understandable; however, an erect The closing date for to live in or visit required inotrope support throughout. chest x-ray or a thoracic CT might applications is Full ICU measures were instituted have allowed earlier diagnosis. When a post op 12 March 2013. postoperatively, but the patient chest x-ray is performed it should be, appears continued to deteriorate and died in wherever possible, an erect film with Surgical shortly after admission. diaphragm views. News each season 24 Surgical News january / february 2014 summer summer Member of the Victorian Regional Committee, Dr Nicole Yap praises the qualities of her home town “I feel incredibly fortunate to have received lifestyle such training and support both in Australia and lifestyle Europe, but I take the most pleasure from having happy, healthy patients.” Dr Yap is on the Executive Committee of the Victorian Regional Committee of the College and was recently re-elected for another term after already serving four years. She said she joined the Committee to give back to the College and the profession in recognition of the support given to her through her training and early days in practice. She said the Victorian Committee was investigating a number of surgical care issues such as the establishment of a paediatric transitional care service to enable better management of children with congenital abnormalities as they move into adulthood, and the benefits or otherwise of concentrating certain specialties such as transplant surgery into specific centres. “We are not lobbying for or against such matters, we are simply discussing the likely impact of any change to the current health model in Victoria,” she said. “Our focus, as it is with the College as a whole, is to determine if any changes can improve patient outcomes.” Dr Yap is also the current President of the Australian Chinese Medical Association of Victoria (ACMAV), her second time in the position. In 2011, Dr Yap, with the assistance of the ACMAV committee, organised a small medical A surgeon’s guide to women feel depressed and anxious after such team to visit Xian, China, to treat orphaned surgery, yet breast oncoplastic surgery offers such children with congenital abnormalities. women a way to overcome this. “Plastic Surgeon Ian Holton from Geelong was “Many Fellows will know of the work done by instrumental in allowing this visit to go ahead,” Professor Clough because he has been an invited she said. speaker many times. “We worked in collaboration with Starfish ictorian Breast, Endocrine and Melanoma “He taught me to concentrate on the final Orphanage, who take in children who have been Melbournesurgeon Dr Nicole Yap credits her good fortune result, not just post surgery but also in relation to abandoned because of deformities. Vin being offered an opportunity to work under adjuvant treatment outcomes, in the treatment of “We had 20 children lined up for surgery but, the supervision of renowned breast surgeon Professor breast cancer. unfortunately, chicken pox broke out so we could Krishna Clough at the Clinique Bizet in Paris as “Instead of starting down the path of treatment only treat 15. It was still an amazing experience providing the opportunity to change her approach to and then seeing what we can do to improve the to not only meet the children and be able to help breast surgery. outcome later, we consider a range of plastics them, but also to grow professional relationships Dr Yap, who works from St Vincent’s Hospital and procedures at the outset, such as using breast between Australian and Chinese surgeons. This the Lorna Sisley Breast Clinic, Monash Hospital in reduction surgery to reduce the effects of radiation was consolidated when we were asked to share our Melbourne, said she uses her knowledge of plastic treatment post lumpectomy. knowledge of our particular specialities by giving and oncology surgery to create a holistic approach to “Some women have always wanted breast presentations to the hospital medical staff.” patients with breast cancer. She said that while she reduction surgery for example, and when I tell Born and raised in Melbourne and widely performs a complete oncological outcome, attention to them I can treat the cancer and conduct such travelled, Dr Yap said it was Melbourne’s dynamic the aesthetic result was considered from the outset of reduction surgery in one procedure they are multicultural atmosphere that she loved the most, treatment. delighted. an urban culture expressed from fine dining to the “In my view, the breast is the symbol of womanhood, “We also undertake mastectomy procedures cafe culture, from high fashion, to world sport, reproductivity and female sexuality,” she said. followed by breast enhancement reconstruction and from the arts to street graffiti. “Surgery to the breast is akin to defiling this and when it is complete, many patients feel better This is Dr Yap’s guide to what makes Melbourne 2 empowerment by destroying body image and many about themselves than they did prior to surgery. so marvellous. u 3 summer summer

lifestyle A FASHIONISTA’S FANTASY lifestyle FOOD FABULOUS FOOD LIVING THE GOOD LIFE OUTSIDE THE CITY LIMITS Melbourne is renowned for its world Melbourne’s population of a little over 4 million residents is made up not only of people from all over Dr Yap also said that no visitor’s guide to Melbourne would be class fashion and design with global the world, but also the descendents of earlier arrivals with 140 distinct cultures now represented in complete without a mention of the nearby wine regions such brands and local labels attracting Victoria’s capital city. Nowhere is this global influence felt more often and more deliciously than it is as the Yarra Valley (pictured) and the Mornington Peninsula, customers from around the country in the food culture of the city from the tucked away Tapas Bars, to world-class Japanese, Chinese and both of which are easy day trips from the city provided a and the region. With annual fashion French restaurants, to the pizzas of Little Italy in Carlton to the dim sum and doughnuts of open-air designated driver can be found. Both districts offer not highlights including the Summer markets. A self-confessed “foodie”, Dr Yap listed her current favourites as Koko at Crown, Shoya in only fine wine, but good food, local markets, lovely vistas, Fashion Week and the fashion Market Lane, the Flower Drum, Shanghai Dynasty, Guy Grossi’s Florentino, Vue de Monde, France historic gardens and galleries. And finally, no-one should visit frenzy that is the Melbourne Cup Soir and Mo Vida. She said: “I absolutely love eating out in Melbourne because there are so many Melbourne without driving the Great Ocean Road. Carved Carnival. cuisines to choose from and also because there is such a deep appreciation for good and interesting in rock and winding around the rugged southern coast of Melbourne’s more temperate food here. There is the option of dining at well known and highly regarded restaurants, but it can also Victoria, the Great Ocean Road is one of the most spectacular climate lends itself to stepping out be an adventure finding the new places that are constantly opening up both in the CBD and tucked war memorials in the world, having been built by soldiers who in style. Some of the unique big away in suburbs.” survived the horrors of the First World War. labels that now call Melbourne home include Alannah Hill, Dolce & Gabbana, Karen Millen, Paul Smith, Prada, Scanlan & Theodore, Zara, Claude Maus, Alpha60 and Arabella Ramsay, while the major department stores such as David Jones and Myer remain in permanent competition to attract the best from around the world. Dr Yap recommended visitors take their time to wander the laneways and arcades of the city where hidden design gems could be found, stopping frequently for coffee. “I love the laneway and coffee culture of Melbourne as much as I love its fashion, so I highly recommend combining the two,” she said. “The fashion available in WHERE THE WILD THINGS ARE Melbourne is incredibly good and While Melbourne often boasts I often find when I travel overseas about its “liveability” status, it is that Melbourne buyers pick the best not only the inhabitants of the A SMORGASBORD OF SPORT of the best on offer in Europe which human variety who enjoy what It might involve a tiny ball lofted over the fairway, a fluffy ball smashed is excellent for time-poor people like the city and surrounds have over the net or a hard leather ball belted into the boundary. It might me.” to offer. The Melbourne Zoo, be a ball danced down the pitch, punted through the big sticks, located only kilometres from the knocked out of a scrum or hooped into the net. It might involve city centre, is Australia’s oldest human pedal power, the horse power of potent engines or plain old and now houses 320 animal horse power itself, but if a sport can be played, there is every chance species. With a particular focus on it is not only played in Melbourne, but passionately followed. Now conservation, the Zoo is highly the city plays host to some of the most important sports events on the regarded for its Orang-utan world calendar including the Formula One Grand Prix, the Australian Sanctuary and Asian Rainforest, (Tennis) Open, the Melbourne Cup Carnival and, of course, the mighty while the Australian Outback and Boxing Day Cricket Test. Dr Yap, who cycles and plays a poor but the Butterfly House are perennial valiant game of golf, said she loved the atmosphere in her home city favourites. In the city centre when the circus comes to town. itself is the Melbourne Aquarium “I enjoy going to watch some of the major golf tournaments – mainly where visitors can get up close to see what a good game of golf looks like – but I really love the and personal with such cute creatures as penguins and seahorses or, for Melbourne Cup,” she said. “It’s a wonderful experience and I’ve been more of a thrill, dive with sharks. Outside Melbourne to the East is the to Ascot which doesn’t even come close. If you haven’t experienced the Healesville Sanctuary while to the West is the Werribee Open Range fun, the glamour and fashion, I’d recommend you find time to visit Zoo. As the brochure says, why travel thousands of kilometres for a 4 Melbourne during the first week in November.” taste of Africa when it is available just 30 minutes from town? 5 summer summer

Following lifestyle fortune lifestyle General Surgeon Mr Derek Brockwell makes best “I have greatly enjoyed meeting and working with these surgeons and specialists and would even describe use of his skills in rural and regional locations it as being one of the highlights of my time in Australia. “I believe that people in rural, regional and remote areas benefit from the skills brought by people like me who have decided to leave their own country, many of whom are highly trained senior specialists. “Once language may have been an issue, but not so much anymore and I think this cross-pollination across countries is a wonderful thing, both for the profession of surgery and the care of patients.” A former marathon runner and now enthusiastic cyclist, Mr Brockwell lives with Helen and the family dog at Leith, a small town that lies at the mouth of the River Forth, 300 km north of Hobart. Each year, they travel back to South Africa and New Zealand where they have children and grandchildren. Still, despite all this globe-trotting, there are still places he wishes to visit and work in. “I’d like to work in the smaller countries of the Pacific such as Samoa and Tonga just for that experience and to do what I can for people there,” he said. “I would have liked to have been involved in some of the College’s service visits to these countries, but when you work in a smaller hospital that has only two surgeons “I started doing this as a way of exploring Deciding to pursue surgery, he did his surgical you can’t really put your hand up, even though you want mainland Australia and to have the opportunity by Derek Brockwel training through the same university and at the Groote to, because it puts too much pressure on your colleague. to live and work in places that I would otherwise Schuur Hospital, a large, public, teaching hospital “Since I’ve been here, indeed for all my working life, never get to see,” he said. situated on the slopes of Devil’s Peak in Cape Town. I’ve worked a 1 to 2 on-call roster meaning I have only hen the youngest child of General “Many of these small regional hospitals are “This hospital was where the highly acclaimed ever had every second Christmas off and every second Surgeon Mr Derek Brockwell left home mostly run by locums now which adds a different Professor Chris Barnard conducted the first heart Easter and that has been quite tough, but now that I Wfor university 15 years ago, he and his wife challenge to the work because you have to develop transplant in the world and to study and learn under have the time I very much like to use it.” Helen decided to leave home also to live and work a team from scratch, understand quickly what him felt like a great privilege,” Mr Brockwell said. Mr Brockwell said that along with that extra time came wherever fortune took them. skills are available and determine the work you can “In those days we were given very broad, very both a more difficult adjustment to retirement than he had They packed up their life in Pietermaritzberg, an and can’t do safely as a team. extensive training before the modern era of early sub- expected and a growing yearning to go home. elegant, Victorian city that lies between Johannesburg “Most of my work consists of triaging patients, specialisation and we did cancer, vascular, abdominal, “I found to my surprise that I wasn’t as secure in and Durban in South Africa and first settled in Grand deciding which patients need immediate transfer to head and neck surgery and one of the first operations retirement as I thought I’d be,” he laughed. Cayman where Mr Brockwell worked as a general larger centres, such as trauma and cancer patients I assisted on was a heart transplant. “I thought I’d enjoy the relaxation and peace, but I surgeon before they moved again to allow him to take or elderly patients with co-morbidities with a “I have always been very glad for this broad-based found it hard to deal with the fact that all of a sudden up a rural posting on the South Island of New Zealand. responsibility to make the most efficient and training because rural areas all around the world still people didn’t need my help any more. One year later, with the two still in the grip of effective use of the Royal Flying Doctor Service. need general surgeons, so in a way it has allowed me to “My family needs me, my dog needs me and my wanderlust, Mr Brockwell first came to Australia to “I also deal with the general procedures you’d have the life I wanted, not just in terms of being able garden needs me, but that’s not quite the same. work in Alice Summers before he successfully applied expect such as appendix, hernias, endoscopies and to travel and work, but to help a broad cross-section of “I have also found that with this extra time, I’m for the position of General Surgeon at the Mersey laparoscopies. patients. thinking more about the past, looking through old Community Hospital in Tasmania. “I enjoy this work a great deal. I like exploring “Young surgeons often find this range of work quite photographs and such, and the desire felt by both Helen There they have remained for the past 13 years, but the new towns and their surroundings, meeting confronting which is one of the reasons that Australia and I to be closer to our children and grandchildren is just one year into his retirement, those itchy feet have surgeons from around the world who also now has such a problem attracting and retaining growing stronger. returned and now Mr Brockwell has taken to picking undertake this locum work and, of course, doing surgeons in rural and regional areas. “I’m still registered in South Africa and I’d like to up locum work one week per month in regional and my best to help the patients.” “Yet, at the same time, Australia has been fortunate work in parts of East Africa I haven’t explored yet, so we rural towns upon the mainland. Mr Brockwell grew up in Zambia before moving to have had the skills and services of surgeons and will see. So far he has worked in Broken Hill, Bega, Gladstone to South Africa where he did his under-graduate medical specialists from many countries including “Maybe next year we’ll move back home. Life is full of and Port Hedland and is planning an upcoming visit to medical training at the Cape Town University from India, Iran, Russia, South Africa and even possibility, which is really wonderful.” 6 Lismore. before working for a short while as a GP. Romania to fill those gaps. With Karen Murphy 7 heart summer summer

lifestyle From lifestyle the heart Dr Anantha Ramanathan speaks of the stress relief in writing poetry in his native language

egional NSW vascular surgeon Dr Why do you write in Tamil? Anantha Ramanathan was born Tamil is my first language and I was in Sri Lanka and spent most of taught to write poetry in Tamil, but more his childhood there before moving than that it is a wonderful language toR New Zealand, where he completed the to work with. It is very phonetic, it has majority of his surgical training. lots of nuances in that the same word Moving to Australia three years ago, Dr can mean different things in different Ramanathan retains his links to the culture contexts. Tamil poetry is also very flexible of his birth by writing poetry in Tamil, one in that the rhyme can be in the first of the oldest languages in the world. Last words, or last and it uses a variety of year, a collection of his poems was published metres and rhythms. in India, Australia and Canada. He talks to Tamil poetry has a tradition spanning Surgical News about the beauty of the Tamil back over more than 2000 years and language and the serenity he finds in poetic Tamil itself is one of the oldest living inspiration. languages in the world alongside Hebrew and Old Chinese. It is also a beautiful When did you start writing poetry and looking script and I get great satisfaction what do you enjoy about it? being part of that tradition, even in just a This all began about 30 years ago from small way. my school days in Sri Lanka. There is a strong culture of poetry there and we were Do you find it hard to work in Tamil encouraged to create poems based on when you spend your working days in traditional Tamil themes and rhythms. an English-speaking environment? I fell in love with both the intellectual It is a challenge to retain the richness of endeavour of it and also the satisfaction of the language when I use English all day, expressing ideas as clearly and as beautifully but I speak Tamil at home with my wife as possible. Then, once you have the idea you which helps. I also keep up-to-date with work on it again and again until it is as good the culture and Tamil poetry through the as it can be and the finished product feels Internet and my friendships with other 8 like the birth of a child, in a way. Tamil writers. u 9 Ceylon sunset on lake in Sri-lanka summer Academic Surgery lifestyle

When and where was your of a Kookaburra birdsong. It won book published? acclaim from the visiting academics. It was first published in India last Before that I presented another January and later in Australia and poem about a girl with Down’s Canada, both countries that have very Syndrome who is raped during the Study surgeons’ non-technical skills vibrant Tamil communities. We chose war. She is unable to express her to publish in India first, however, feelings to others because she cannot because that is where all the experts talk, but nevertheless she has the Discover how your non-technical skills influence patient outcomes and pundits in Tamil poetry are to be same feelings as any other human and the team you lead in the Operating Room found and fortunately I received mostly praise being. This poem also touched the hearts of a lot of from them. people. coordination and developing a shared in Singapore, I invite Fellows three to 13 I did receive some criticism, though, because I coined Guy Maddern a new word which is not altogether accepted in such an Do you find it hard to find the time to write Chair, ANZASM understanding; years post Fellowship to step into the OR historic, traditional art form and also contravened some poetry as a busy surgeon and does having such • leadership, support and maintenance of and participate in live research into this rules in some of my poems. I also sent a copy to the an interest enhance your working life? standards. fascinating field. Set aside 45 minutes teacher who first inspired me to write poetry who still I can always find the time; it’s waiting for inspiration to shared understanding and goals to immerse yourself in an engaging OR lives in Sri Lanka and he said it was of a professional strike and the idea to arrive that is the frustrating aspect between all members of the Non-technical skills are vital for safe simulation and it may change the way standard which was pleasing. of poetry. Yet, when it does arrive and the words flow Ateam are essential elements to be intraoperative patient outcomes, but are you practice. and you get the beat you can work on the idea in the car developed to maximise patient safety in not addressed explicitly in the training Help in the development of What themes do you write about? or even in the gym. the Operating Room (OR). Studies have of surgical Trainees. Trainees have benchmarks, view your performance on About half the poems are about romantic love with Writing Tamil poetry is a passion of mine and there shown that while surgeons frequently traditionally learnt in an unstructured video, receive one-on-one feedback from others about nature, spirituality, philosophy and politics. is no doubt that it provides great stress relief. It allows give feedback on the technical skills of manner in the OR by watching the a skilled debriefer and assist your College Even though the civil war in Sri Lanka is considered over, me to forget about all the day-to-day stuff and immerse Trainees, there is hardly any feedback good, and sometimes bad, habits of their in this important research program. This writing political poems does make me a bit nervous at myself in a very different world and in a different way given on non-technical skills, which have mentors. valuable opportunity is without cost to times, but still I think poets need to be bold. of viewing the world. It gives me great sustenance and an equally significant impact on patient The Research, Audit and Academic you and it is anticipated that sessions will allows me to go back into my surgical life renourished. outcomes. Surgery Division (RAAS) has conducted fill fast. What reactions have you received for the a year-long project of research into the poems in Australia? What other artistic endeavours are you Non-technical skills include: use of simulation to teach non-technical There is a bustling Tamil literary scene in Sydney and working on now? • situation awareness, gathering skills of surgery to Trainees. A significant after the publication of the book I got invited to present I have recently finished writing a novel in Tamil that information and anticipating the future amount of data has resulted from 160 To book your session contact: Assoc poems at a number of venues which I appreciated. will be published in February. The literal translation of course of the operation; simulations. The next step is to develop Prof Wendy Babidge, Research, Audit and In September, I presented a poem at an International the title from Tamil is ‘I am my Father’, but the idea best • making decisions based on the available benchmarks for performance of these Academic Surgery at wendy.babidge@ Conference in Sydney. Part of that poem describes the translates into English as ‘It is all Within Yourself’. options, implementation and review; non-technical skills. surgeons.org or T: +61 8 8219 0917. 10 Australian landscape and birds and was set to the beat With Karen Murphy • communicating with the team, At the 2014 Annual Scientific Congress

Surgical News january / february 2014 25 foundation Education for surgery and Training Yes, I would like to donate to our Foundation for Surgery

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Name: the genetic and epigenetic Address: Telephone:An open letter mechanisms in Colorectal Email: Speciality: to surgeons and Cancer (CRC) through work We don’t shoot at the QIMR Berghofer their families Remember, there is more to deadlines than you think Enclosed is my cheque or bank draft (payable to Foundation for Surgery) for $ . Medical Research Institute in from Michael and Queensland. Please debit my credit card account for $ . Sally McAuliffe They have funded many other surgeon and who organises themselves so Mastercard Visa AMEX NZ Bankcard surgical projects, but it is this ex- Simon Williams that they meet specified deadlines should citing new collaboration with the Censor in Chief be rewarded for doing so. Allowing a Credit Card No: Expiry: / Foundation for Surgery that will doctor to register after the closing date and help them access the full breadth uring the American Civil War, compete for a training place is not fair to Your passion. Card Holder’s Name - block letters Card Holder’s Signature Date and depth of surgical expertise in both sides sometimes imprisoned those who do the right thing. Nor is it fair Your skill. I would like my donation to help support: Australasia. Dcaptured soldiers in areas defined – albeit to a much lesser extent – to those General Foundation Programs International Development Programs Since 2011, in memory of our only by a boundary drawn around them. who also missed the deadline and simply Your legacy. Scholarship and Fellowship Programs Indigenous Health Programs son Connor, our family has These soldiers were warned by their accepted that they had missed the boat. Educational Programs raised more than $120,000 to captors that if they crossed the boundary The deadlines for examinations are I have a potential contribution to the Cultural Gifts Program assist Tour de Cure to fund these they would be shot. That boundary became less about fairness than about planning. Your I do not give permission for acknowledgement of my gift in any College publication important research projects. known as the deadline. Anyone who has been an examiner will Much of this support has come The College too has deadlines, and while know that putting on a College exam is no Please send your donation to: AUSTRALIA & OTHER COUNTRIES NEW ZEALAND from members of the surgical going over them has consequences, being easy feat and requires extensive planning. Foundation. Foundation for Surgery Foundation for Surgery 250 - 290 Spring Street PO Box 7451 community and it is rewarding shot is not one of them. Examination deadlines are put in place East Melbourne , VIC 3002 Newtown, 6242 Wellington Australia New Zealand to see our family, friends and Each year, particularly around the time for so that the Examinations staff can get surgical colleagues support our applying for a place on the Surgical Education Board sign-off of candidates and once involvement with Tour de Cure. and Training (SET) Program and registering the final number of candidates is known, Being on a cycling tour with for examinations, my colleagues and I in the prepare schedules, confirm venues and Tour de Cure is a fantastic College Education portfolio get pleas from accommodation and engage examiners. experience that allows you to people who have missed the deadline. Not just in education, but across the meet many wonderful riders College deadlines are not imposed College, we have engaged staff to perform When ‘sorry you have and support crew and to hear overnight. Notice is given via the College our administrative duties. Our policies the stories of cancer survivors, website, with additional reminders usually and procedures are designed to produce families who have lost loved published in the weekly email newsletter transparency and certainty and also to cancer’ hits home ones to cancer and from those Fax Mentis. Examination timetables are ensure the efficient use of staff time. The currently undergoing treatment. published months in advance, with well- efficient use of staff is important in keeping n any given day in Australia, the Royal Children’s Hospital in Brisbane, committed to fund an annual surgical It is a great reminder of the established (perhaps even ‘traditional’) our costs to a minimum. 300 people will hear the phrase, involving many rounds of chemotherapy, grant, administered through the College, privilege and responsibility of sitting times each year. It is important to remember that one O“Sorry, you have cancer.” countless hospital admissions, numerous to advance a cure for cancer. being a doctor and a surgeon. Missing a deadline can be devastating to of the nine College competencies is Many of them will be told by surgeons. CT and MRI scans and multiple operations Tour de Cure is a highly successful There is always a need for the individual, but it is not fatal. In the vast professionalism. Although the College For many of you this is a phrase you say including removal of 70 per cent of his liver. and professionally managed organisation further donations to continue majority of cases it simply means waiting will teach this during the life of the to patients; it is not one you think you will He did all this with the cutest smile that, since its establishment in 2007, to support cancer research until the next opportunity. The Fellowship training program, the attainment of that ever personally hear. Certainly, with a young on his face and he was always incredibly has expanded its annual calendar of projects. Tour de Cure invites the Examination is conducted twice a year, competency begins in medical school, if family, you never believe you will hear, brave. Sadly, he was not one of the lucky fundraising activities from a 1500km surgical community to support as are the Clinical and Surgical Sciences not before. An element of professionalism “Sorry, your two-year-old son has cancer.” ones and in July 2006, aged three, our 10-day Signature Tour to hosting this collaboration by making a exams. Selection is once a year. is accepting accountability for one’s own In 2005 Michael was undertaking an beautiful son died leaving a hole in our four-day country tours in Queensland, donation to the Foundation for It is understandable that people who miss decisions and actions. orthopaedic Fellowship in Auckland. Life hearts and a suffering so intense that no New South Wales and Victoria, partnering Surgery Tour de Cure Cancer deadlines will seek any opportunity to get an College office bearers are however was fabulous with two gorgeous children parents ever imagine will happen to them. with Iron Man Melbourne and other Research Scholarship and to extension to the deadline. However, anyone not without compassion, and nor does and another on-the-way. It is our personal journey and it is major corporate events. perhaps also consider becoming seeking such an extension should also be the College aim to crush the aims and One day our son Conor complained of our direct involvement with both the So far this dedicated team has funded a rider or part of the support prepared to accept that it may not be given. aspirations of Trainees, IMGs and doctors a ‘sore tummy’. Michael felt an enlarged Foundation for Surgery and philanthropic 137 cancer research, support and crew on one of their upcoming Entry into the SET program is competitive. wishing to join our profession. liver and the next day an ultrasound cycling organisation, Tour de Cure that prevention projects and carries the ‘Be Fit, tours. Each program lists the prerequisites for Forgetting, leaving things to the last revealed he had liver cancer. We makes us proud to announce a new Be Healthy, Be Happy’ educational message applying, that if not met make the candidate moment, not knowing about published desperately hoped he ‘only had localised collaboration between the two groups. to schools in the towns they cycle through. Donations can be made on the ineligible. Remembering to register in the four information, and contacting multiple liver cancer’, but the CT scan revealed Through the combined expertise of the Projects they have funded in past donation form in this, and each to five week registration period, and then, Fellows at the same time does not generate metastatic hepatoblastoma. Foundation for Surgery and the dynamic years include The Melanoma Institute issue, of Surgical News. All if approved to apply, lodging an application sympathy. Raising a legitimate issue with Our world changed. One day we had an and driven team at Tour de Cure, the of Australia’s effort to identify the donations are tax deductible. For in the three week application period, is as the College before a deadline has passed active happy two-year-old, the next we were intention of the collaboration is to establish biomarkers that are related to the more information on Tour de Cure important as having undertaken a mandatory may, and could lead to a solution. told he had a 50 per cent chance of survival. a perpetual cancer research scholarship. development of resistance in each please visit tourdecure.com.au rotation in an emergency department. But always remember, we won’t shoot Conor had 15 months of treatment at To enable this, Tour de Cure has patient’s melanoma and understanding The doctor who wants to become a you.

26 Surgical News january / february 2014 Surgical News january / february 2014 27 Professional Standards

cover story

Adv cating best practice Ways which the College is working to improve matters that impact you and improve the care of our patients

Graeme Campbell Chair, Professional Standards Committee

he College has been engaged in of Patients in Intensive Care Units position a variety of activities throughout paper addresses intermittent concerns T2013 to ensure that our voice is raised by some surgeons regarding who heard on matters that impact surgeons has control and responsibility for patients and the care of our patients. admitted to a hospital under the care of a surgeon and then transferred to an Elective Surgery Urgency intensive care unit (ICU). The preparation Categorisation of the paper involved consultation with The College recently worked with the specialty societies and the College of Australian Institute of Health and Intensive Care Medicine of Australia Welfare (AIHW) on elective surgery and New Zealand (CICM) to deliver categorisation. This collaboration follows a statement that has applicability a request from the Council of Australian across specialties and which promotes Governments for the AIHW to work the importance of multidisciplinary with the College to propose national collaboration in patient care. definitions and a package of measures Drug Use that will produce greater consistency for The College is aware that many members the paper recommends that a surgeon Designing a Flexible record activities and it is hoped that the half of the year and will be accompanied elective surgery urgency categories for of society may voluntarily use a range ensures that the fee is reasonable and does transition towards online recertification by an e-Learning module to support and all Australian public hospitals, enabling and Streamlined of drugs that have a pharmacological not exploit a patient’s need. Discussion will make it easier for Fellows to verify encourage Fellows to monitor and reflect consistent application across all states and Approach to CPD effect for personal pleasure or satisfaction of surgical procedures with a patient and participation. on their performance. Participation in this territories. The project is just one example The CPD program is integral to rather than medicinal purposes. The their family can be emotionally charged multi-source (360°) performance review of the College’s on-going efforts to maintaining professional standards and position paper makes it clear that the and the paper emphasises the importance will contribute significant points towards increase its engagement with government reinforces not only our commitment to What to look for in 2014 College does not condone the use of of gaining informed consent, including In 2014 we will continue to explore CPD requirements. to ensure that health policy that directly our patients, but also defines Fellowship As a Fellowship-based organisation, our illicit substances by Fellows, Trainees or allowing sufficient time for the patient to avenues to improve the services offered impacts our profession is developed in contemplate the procedure and fee before of the Royal Australasian College of voice is only as strong as the contribution International Medical Graduates (IMGs) by the College to Fellows. Participation in consultation with surgeons who are best undertaking a course of treatment. Surgeons as representative of excellence of our members. We have recently under any circumstances and outlines the CPD will remain a focus of our activities positioned to advise on the realities of The development of these position in surgical care. This year has seen a launched a Professional Standards page consequences to surgeons if they engage in 2014; particularly minimising the time surgical practice. papers demonstrates to regulatory transition from a triennial program to on the College website to highlight some in this conduct at both a College and taken for Fellows to enter their CPD and regulatory authority level. authorities, our colleagues in other an annual model. The change to the of the important contributions that we exploring technologies that can support Setting the Standards specialty fields and the public that we are program will make it simpler for Fellows all make in advocating for better health streamlined processes. As we transition for Excellence in Patient Excessive Fees both able and willing to set expectations to participate, enables the College to outcomes in the community. On this page Care and Professionalism While the College has not received any around professionalism beyond the better support those Fellows who may be towards a digital College, this will include you will find details on how to contact the development of a CPD app that can A number of important position complaints about this issue from patients, operating theatre. These papers outline struggling with their requirements and your Professional Standards Department statements were developed by the there are anecdotal reports of a small the expectations we place upon ourselves provides the basis for a more responsive be used on iPhones and iPads. who are available to assist all Fellows. I professional standards portfolio in 2013. number of surgeons charging extremely as Fellows of the College and the steps approach to adjustments to the CPD We will also be releasing a Multi-Source encourage you to get involved with the high fees for surgical procedures. While that may be taken to address poor program as required. In addition, the CPD Feedback e-Tool based on the College College and provide feedback on the Intensive Care Units surgeons can make their own judgement conduct when there is a breach of these Online diary has recently been upgraded Surgical Competence and Performance issues impacting you, your practice and The Areas of Responsibility and Control on the fees they charge for their services, standards. and streamlined to make it easier to guide. This will be available in the first your patients.

28 Surgical News january / february 2014 Surgical News january / february 2014 29 Education and Training

One ground on which a decision Proof and defences is not necessarily a mind which has not file are examples of circumstances which of the College may be challenged An allegation of apprehended bias does given thought to the subject matter or one should not amount to apprehended bias. – either in an appeal or the courts not by itself mean that it is proven, which, having thought about it, has not If, as a board or committee member, – is by alleging “bias” on the part of however. Apart from any dispute formed any views or inclination of mind supervisor or clinical assessor you are the decision-maker. In this context, as to the underlying facts, there are upon or with respect to it, as held by the in doubt about the potential for bias bias extends to what is termed defences available to the College and High Court of Australia. or apprehended bias, the best option is “apprehended bias” as well as “actual the decision-maker. Organisations to seek advice before commencing the bias”. This means that even if a such as the College, as opposed to A high threshold decision-making process. You should decision-maker was not in fact biased, Ministers of the Crown, government The High Court has also held that what contact the secretariat of the relevant but a reasonable argument can be made departments and statutory authorities, has to be shown by the party making the board or committee who will either be Bias out that the decision-maker could have sometimes been held to be subject allegation of apprehended bias is that able to clarify your concerns or refer the in decision making have been perceived (apprehended) to to a less strict form of the rule against the decision-maker’s mind was incapable matter to In-House Counsel for further have been biased, then this alone may bias. Of particular significance may be of alteration. This is a high threshold consideration. constitute bias. the practicalities of decision-making to meet. So it is not every involvement in a complex, member-based structure, which a College decision-maker (or Meaning of bias which have given rise to the principle of member of a decision-making body) The meaning of bias has been necessity. Sometimes it is unavoidable, may have had previously with the matter considered in numerous court cases. for instance, to have a particular or related matter which will give rise to Bernadine McNamara is the College In- In summary, bias means a closed mind member on a panel because of a lack (apprehended) bias. Being aware of a House Counsel, providing legal advice to on the part of the decision-maker as of a reasonable and suitable alternative previous decision, having views on the the College, its boards and committees, to the outcome of the matter being appointment. standards required of Trainees and IMGs, particularly in relation to Trainee and IMG considered. Effectively the decision- Further, a decision-maker’s mind does being aware of a Trainee’s or IMG’s past matters, and contracts. maker has pre-judged the matter. not have to be a blank. An unbiased mind performance and having read the person’s Natural justice demands that the decision-maker must bring an impartial and unprejudiced mind to the matter to be decided. While sometimes bias may be Royal Australasian College of Surgeons demonstrated during a hearing of the matter (e.g. at a board or committee 2014 WA, SA, & NT ANNUAL SCIENTIFIC MEETING meeting, or in an interview with the complainant), more commonly a challenge is based on alleged apprehended bias arising from the decision-maker’s previous involvement with or consideration of the matter. Increasing challenges to College For example, if a member of a College decisions and allegations of bias panel or committee convened to make a decision about a person: • has participated in the making of a Phil Truskett previous decision about the same Chair, BSET person, or • has supervised, or is related to, the Increasingly, College Education decisions he College Education portfolio person, are being challenged, with Trainees and makes many decisions in relation that member (or proposed member) International Medical Graduates engaging legal Tto Trainees, IMGs and others may be alleged on appeal to have been representation to assist them. In response to (such as applicants for SET). Decisions biased, in the sense that there was a Save the date this the College now has the services of an in- may be made through Specialty boards or reasonable apprehension of bias in house counsel to provide advice and assistance other College boards or committees, or by the circumstances. Unfortunately, a 8 10 August 2014 to the specialty training boards. Bernadine individuals. Many of these decisions may successful allegation of bias on the part McNamara, the In-House Counsel, made a be subject to judicial review, meaning that of one member of a decision-making The Pullman Resort, Bunker Bay, WA presentation to the Board of Surgical Education they can be challenged in a court of law. body will taint the decision of the whole Theme: The introduction of new technology in If you would like to contribute to the content of the meeting, please email and Training regarding bias, which is an issue As an alternative to proceeding straight body. Such a decision may be directed by Surgical techniques - the do’s and don’ts! that has been raised in some recent appeals. to the courts, the College offers an your ideas and suggestions to the Appeals Committee or court to be re- Convener: Mr Richard Martin I have asked Bernadine to summarise her internal avenue of appeal via the Appeals made (i.e., made afresh) by a differently [email protected] presentation for ‘Surgical News’. Committee. constituted body.

30 Surgical News january / february 2014 Surgical News january / february 2014 31 In the News

n a world-first study, the National longest hours of any age group and are “Most are highly intelligent and many Mental Health Survey of Doctors and the most likely of any group within the are perfectionists who have very high Depression risk IMedical Students was undertaken medical profession to have a current expectations of themselves who often late last year for the independent national diagnosis of depression or anxiety, are end up working in environments where mental health agency beyondblue. the most likely of any age group to they have limited control. among Trainees The survey analysed the responses to have suicidal thoughts and rate highest “That is a potent mix, and when such a detailed questionnaire completed by on the three burnout factors of high doctors can’t achieve the outcome they The largest survey of doctors ever undertaken more than 14,000 medical personnel across emotional exhaustion, high cynicism are aiming for, they often internalise that anywhere has revealed that medical students, junior Australia. and low professional efficacy; frustration and distress. doctors and Trainees are experiencing significantly Conducted by Roy Morgan Research, • 4.5 per cent of respondents listed “Competition also appears to be a the survey found that while surgeons bullying and 1.7 per cent listed racism factor because many medical students higher rates of depression, anxiety and suicidal experienced relatively low rates of as causes of stress and distress. have grown up as children being the thoughts than the general Australian community depression and anxiety compared to brightest in their cohort until they join a colleagues in other specialties, junior While the survey indicated that cohort of the brightest. doctors who worked longer than 50 hours surgeons experienced relatively low rates “Our survey suggests this can lead to with Karen Murphy per week suffer significantly higher rates of anxiety and depression in comparison levels of psychological distress which are of psychological distress, think more often to other medical colleagues, beyondblue double that of the general population. about suicide, and are more burnt-out CEO Ms Kate Carnell AO said that all “The medical profession as a whole than their older colleagues. indices of psychological distress across needs to design ways to reduce the stress While oncologists and specialist medicine were far too high. suffered by young doctors and give paediatricians experienced the highest She said the survey indicated that the them the support they need during a rates of depression and anxiety among surgical profession had higher levels particularly stressful time in their lives.” qualified specialists, surgeons and of risky drinking than other sectors of Ms Carnell also said responses to emergency medicine specialists were medicine while having the fourth highest questions relating to the stigmatisation found to be the most likely to drink at rates for bullying listed as a cause of stress. of mental illness within the medical moderate risk levels. She called on all medical colleges to read profession were particularly concerning. The survey also found that female the findings of the survey and consider She described it as “confronting” to doctors had higher rates of anxiety than strategies to limit the distress being find that four out of 10 respondents their male counterparts and that the experienced by colleagues, particularly believed they would be thought less of medical profession as a whole retained young doctors. if they admitted to suffering from some significant levels of stigma towards people “This is the biggest survey of its kind degree of psychological distress. with a mental illness. ever undertaken and there is no doubt “For the medical professional to hold now that the medical profession has a such views is quite confronting and Specific findings of the survey include: major problem and it is time to act,” Ms makes you wonder what they think of • One in five medical students and one in Carnell told Surgical News. their patients,” she said. 10 doctors had suicidal thoughts in the “beyondblue is calling on all medical “In this era, clearly you would expect previous year, compared with one in 45 colleges and medical schools to put this doctors to understand that conditions people in the wider community; at the top of their agenda, because it is such as depression and anxiety are • Oncologists are the most psychologically up to the medical profession to stand up clinical conditions that can be treated distressed specialists while doctors, such and come up with ways to reduce stress and managed, particularly if they are as researchers and administrators, who and improve the quality of work life for addressed early. do not deal with patients think about all medical professionals.” “Junior doctors need support not suicide more often; Ms Carnell said medical schools stigmatisation; they need sufficient • Male doctors work longer hours should teach students how to deal downtime to remain psychologically and engage in more risky drinking with stress and also how to manage robust and they need to be taught how behaviours, but female doctors are more patient expectations, professional to deal with stress – and the time to act psychologically distressed and think disappointment and competition. is now.” about suicide more often; She also called on senior consultants Ms Carnell said the high rates of • Perceived stigma is rife with almost half to remain mindful of the psychological depression and anxiety could be of respondents thinking doctors less health of Trainees as they moved through addressed by the medical profession likely to appoint doctors with a history their training programs. developing a mental health strategy, of depression or anxiety and four in 10 “One of the key factors relating to the designing new guidelines around agreeing that many doctors think less mental distress being experienced by working hours and providing better of colleagues who have experienced a young doctors is long working hours, mental health education in universities to mental illness; but another relates to the type of people reduce stigma and increase psychological • Doctors aged 30 and under work the attracted to medicine,” Ms Carnell said. resilience.

32 Surgical News january / february 2014 Surgical News january / february 2014 33 REGISTER NOW

Fellowship Services “Revalidation” Friday 14 March 2014 Fellows in need Hilton On The Park, Melbourne, Australia. The Executive Directors of Surgical Affairs can help This one day seminar, held by The Royal Australasian College of • a significant practice related threat or challenge, John Quinn Executive Director of Surgical Affairs (Australia) • difficulty with colleagues or ‘competitors’, or in the workplace Physicians, the Royal Australasian College of Surgeons and the Royal generally, College of Physicians and Surgeons of Canada, will explore the subject of • ill health, he College aims to be of service to all Fellows, Trainees • a legal matter – perhaps the accusation of malpractice or revalidation for medical practitioners and discuss potential development and and International Medical Graduates (IMGs) on a more commonly a complaint from a patient or relative about approaches with input from international faculty. Tpathway to fellowship through all phases of their communication, surgical career. To that end the College supports Trainees • less than expected outcomes. and IMGs throughout their training or period of oversight, However, there are a plethora of scenarios that can lead to a younger Fellows with preparation for practice and all Fellows distressing situation where assistance or guidance is required, Program Highlights with continuing professional development, sectional interests, or simply an opportunity to discuss the situation with a the path to retirement, senior surgeons and much more. supportive independent colleague. • Debate “Should revalidation replace CPD?” The College is also aware that crises of various types can impact It is recognised that Fellows appreciate being able to on surgeons at any time. The College wishes to help Fellows in confidentially discuss matters with a practising surgeon with the • Panel discussion with regulators need. There are two Executive Directors of Surgical Affairs (EDSA) breadth of experience of the types of crisis that surgeons may – one in Australia, Dr John Quinn and in New Zealand, Mr Allan face. It is fair to say that some Fellows may have reservations • Evolution of CPD towards revalidation Panting. Either of the EDSAs may be able to offer assistance, as dis- about contacting or seeking advice from the EDSA on the basis cussed further here, but first what do we mean by a Fellow in need? that the discussion might in some way be used against them. • Assessing clinician performance It is not unusual for Fellows to seek help at the time of a While conflicts may occasionally exist you may be reassured that personal crisis. The crisis could be the result of confidential discussions will never be used against you. Please • Current approaches to remediation and future directions don’t hesitate to seek help from the EDSAs, in the first instance. How can the EDSA help? Of course for many Fellows in • Featuring high calibre international and local speakers need, their lawyer, health professional, financial advisor or close surgical colleague should be the first port of call. The EDSA is not a substitute for any of those personal advisors/ mentors. However, the EDSA can sometimes help by serving Standard Registration Fee $440 / Trainee/Medical Student $220 as a sounding board – to hear the problem and the proposed course of action and to offer advice or comment. ARER Radiology Pathology In some situations the EDSA may be able to help mediate a Correlation Series path for parties to a dispute, to navigate College or regulatory REGISTER ONLINE NOW: authority systems, or to connect Fellows with appropriate Ideal for Registrar training! sources of help in the health sector. Sometimes the EDSA www.tinyurl.com/CMES2014 Great refresher or introduction course for medical professionals! becomes involved in issues relating to the cognitive impairment Develop a deeper understanding of radiology and pathology, and the clinical relationship of a Fellow, often unrecognised by the surgeon themselves. between the two specialties. Approved for CME/CPD by RANZCR and RACS The College is keen to know how it can help Fellows in need. In the future you should expect a Fellowship survey question 22nd March 2014 on this subject, but before then please write to either EDSA on Thoracic Oncology the kinds of help you see as appropriate, and how the College Further Information: 5th April 2014 can be the “first port of call in a storm”. RACS Conferences and Events Management Gastrointestinal Oncology The College maintains the ‘Support for Surgeons’ web page accessed via the Member Services footer of the www. Royal Australasian College of Surgeons PLUS 4 brand new seminars surgeons.org web site. This page is predominantly focused on coming in 2014 (dates TBA): 250-290 Spring Street, East Melbourne VIC 3002 health issues impacting surgeons including self-care, support Soft Tissue & Bone Tumours networks and surgical friends, encouragement to regularly visit T: +61 3 9249 1260 Hepatobiliary Oncology a general practitioner and peer support networks. E: [email protected] Head & Neck Masses We are reviewing this page to see that it has the resources required by Fellows in need. Again your suggestions in this Genitourinary Oncology field are encouraged. Please contact either EDSA – Dr John Quinn (Australia) or Registration & Enquiries: Macquarie University Mr Allan Panting (New Zealand) – on any Fellows in need W www.arer.org.au North Ryde, Sydney E [email protected] NSW 2109 matter. Email [email protected] or allan.panting@ P 02 8705 8329 surgeons.org Photo Credit: Tourism Victoria; David Hannah Photo credit: Tourism Victoria; Mark Chew

34 Surgical News january / february 2014 Surgical News january / february 2014 35 From the audits of Surgical Archives Mortality

there was a great need for the development of expert ‘firms’, specialised units to deal with specific fields like vascular, thoracic Evaluating the and gastroenterological surgery. In order to accumulate experience, to innovate, to undertake research and value and impact to teach, the time has come for the development of university hospitals: “Post-graduate surgical training has been The Victorian Audit of Surgical Mortality (VASM) virtually non-existent in Australia. All but two of the Professors of Surgery are under the direction of the Australian and New foreign graduates and it is not possible Zealand Audit of Surgical Mortality (ANZASM) for a young surgeon to complete his seeks to review all deaths associated with training in Australia ... there was too surgical care. VASM outlined its commitment to much emphasis on examination and not sufficient on training in the present the audit in the October issue of the ANZ Journal Australian system. of Surgery 2013. The following is the abstract. “Most general practitioners who prac- tise surgery maintain that they confine themselves to simple operations; to been achieved and stakeholders tonsils, appendices and minor repairs. It Barry Beiles Clinical Director, VASM were generally satisfied with the Surgery in is doubtful, of course, whether there is quality of feedback. Suggestions for such a thing as ‘simple surgery’.” Asks one improvement were provided by some Australia Macquarie Street surgeon: “What hap- ince the Victorian Audit of surgeons and hospitals. pens if a GP opens you up for an appen- Surgical Mortality commenced The findings of the external review dix and finds a carcinoma of the bowel?” in 2007, 95 per cent of Victorian of VASM processes and procedures The Australian surgeon in times past S The defenders of the honorary system Fellows have agreed to participate confirmed that the audit was believe that staff positions would mean and have provided data on the deaths operating effectively with robust the first foot in the door towards allowing of patients receiving surgical care. All quality control and achieving the trust experience, either technical or in the field Peter F Burke the nationalisation of medicine and public and the majority of private of stakeholders. The educational value Specialty Editor-Surgical History, ANZ JSurg. of pre-operative or post-operative care, would not attract the best surgeons. hospitals involved in the delivery of of the audit to the surgical community there is no reason, argument or excuse The tradition of “having a go” at a surgical services in Victoria have been was acknowledged and areas for for doing it. Surgery is difficult and “bit of surgery” runs very deep in the submitting data on deaths associated future improvement were identified. he cover story of ‘The Bulletin’ on just about every removable organ, dangerous; its practice to a high standard Australian medical profession and is one with surgery. De-identified reports on Karthikesalingam and P.J. Holt in magazine in May 1965 was, an appendix will fetch £22.10s ... the of excellence requires the diligence and of its deepest, although rarely discussed, this data are distributed in regular a letter to the editor of the Journal T“Surgery in Australia”. Sam Lipski human being has about £300 worth of discipline of whole-time activity”. divisive influences. annual reports and case note review recommended that a detailed study wrote, “Who wields the Scalpel? The dispensable tissue,” one conjectured. Professor Dudley believed that both the Geographically, the argument for booklets. of the relationships between VASM passing of the God-surgeon. In 1963 Sir Theodore Fox, Editor of public attitude, which does not demand allowing GPs to continue to perform Although informal feedback on participation and risk-adjusted “The day of the scalpel virtuoso the ‘The Lancet’, wrote of “The Antipodes, specialist care, and the lure of the cash surgery, is the strongest. the perceived value of the audit surgical mortality, emergency ‘God-surgeon’, so beloved of novelists Private Practice Publicly Supported,” register conspire. One eminent surgeon of world was encouraging, a formal review readmission rates, re-intervention and so unloved by hospital staff has quoting a cynic, “round here, the He pointed out that any tighter post- standing in his field had strong doubts, of all aspects of the audit was rates, post-operative complication gone. For a start the most distinctive indication for hysterectomy is any woman graduate training program in surgery pointing out that there were very few felt important. Consequently, an rates, mortality after complications feature of surgery in Australia is that over 40 who still has her uterus”. would mean many changes: “A sterner places in Victoria or New South Wales, for independent formal appraisal of (“failure-to-rescue”) and length of not much is done by surgeons with The Australian scheme paid the same accreditation for hospitals, with insistence instance, that are so isolated that patients VASM governance, documentation, hospital stay should be still evaluated higher qualifications but by general subsidy for an operation whether the on the maintenance of standards of record cannot be brought to major surgical datasets and data analysis was to underpin the value and impact of practitioners: some put the figure at operator was an internationally famous keeping, seminars and clinicopathological centres or surgeons brought to them. performed, in addition to a survey of the VASM. higher than 50 per cent. specialist or a recently qualified man in conferences, the grouping of hospitals both Queensland has set a lead here with the 257 individuals (surgeons and other VASM acknowledges that the “More surgeons and indeed the whole general practice. metropolitan and country so that such a flying surgeon who works as a consultant stakeholders) on the perceived impact external independent audit has medical profession must try to grapple With the ‘retrospectroscope’, we can standard can be maintained, staff can all to the general practitioner. of VASM. highlighted that VASM has reached with the answers to the fundamental now evaluate the opinions expressed then participate in training and more patients One specialist, recently returned from The external review recognised the stage where ongoing monitoring question – is the Australian patient and compare them with current practice. can become available for training pur- overseas, noted: “Besides, I am worried increasing participation and of the audit value and impact can getting the best surgery possible? The Foundation Professor of Surgery poses; willingness of practitioners to yield when I have to spend most of my day acceptance by surgeons since the be implemented and some of the answer seems to be that at its best it is at Monash University, Hugh Dudley, their surgical cases to those whose bent in my car instead of seeing patients; inception of the project. Governance recommendations made to the editor very good, that much of it is fair to good, observed, “Because in 90, 95 or 99 per and training is in surgery.” more concentration of patients, better mechanisms were found to be within the scope of the mortality and some is inexcusably bad. cent of cases it is possible to get away Professor John Dunphy, then President of postgraduate teaching, more research, less effective and acknowledged by audit will be taken into consideration “Critics of the NHS place the blame with an operation of varying degrees of the American College of Surgeons, con- timidity in getting off our backsides within stakeholders and collaborators. during future VASM evaluation and on the way the Government ‘puts a price’ magnitude when one lacks wide surgical sidered the standards quite high; however, the profession – that’s what we need.” Robust participation rates have analysis processes.

36 Surgical News january / february 2014 Surgical News january / february 2014 37 Successful Education Scholar & Training

translated to humans and has not been used before to investigate this condition. Dr Vather’s “Previous methods of gastrointestinal career highlights interrogation, either barometry or Low Why social That gut Resolution Manometry, have been > 18 peer-reviewed publications encumbered by bulky recording devices > 17 refereed conference proceedings which are logistically difficult to use in > Louis Barnett Prize, NZ Annual Scientific Meeting media matters the peri-operative setting. (2012) feeling > Best General Surgical Presentation, RACS Annual “However, HRM uses a fibre-optic Scientific Congress (2013) College support drives state-of-the-art trials catheter that quantifies pressure changes > Runner-up Travel Award, RACS Surgical Research in real-time at 1cm intervals. When placed Society Meeting (2013) within the gut lumen, it can provide > Best Oral Presentation, NZ Society of detailed information on pressure wave Gastroenterology Annual Meeting (2013) amplitude, direction, velocity and extent. > $100K project-related funding raised “At this time we still don’t know if A view from an actively tweeting Trainee the clinical symptoms which herald gut dysfunction are underpinned by intestinal Helen Freeborn dysmotility, hypomotility or the complete collecting information for a risk stratification Urology SET 1, RACSTA QLD representative absence of motility. We hope that by database. developing an appreciation of changes in “Approximately 90 peri-operative variables are peri-operative gut contractility, we may being recorded for each patient undergoing elective s a Urology SET 1 who has been placed in a General improve pathophysiologic understanding colorectal resection at Auckland City Hospital with Surgery position with no specific urological services of this condition. all patients subsequently being independently and Aaccessible in the hospital, social media (a.k.a. SoMe) has “This knowledge may serve as a uniformly assessed for the occurrence of an ileus. played a large and often underappreciated role in keeping me platform for identifying new therapeutic “We are also currently undertaking a double- motivated and connected to the wider world of Urology. targets and treatments.” blind randomised controlled trial investigating SoMe, in particular Twitter, has enabled an avenue of Dr Vather is using HRM as part of gastrografin versus placebo for the therapeutic communication and knowledge expansion via a connectivity Dr Ryash Vather on holiday in Tanzania a two-armed in vivo study: the first management of prolonged POI,” he said. that has yet to be cemented in my medical life to date. By investigating the effects of healed distal Dr Vather said that if this randomised trial following multiple Trainees, consultants and journals, my colorectal anastomoses on motility was positive, its findings would first need to be knowledge and understanding of Urology is kept current. and absence of bowel movements – have and the second looking at changes in validated by other centres in other populations Twitter also creates an environment for posing questions and With Karen Murphy been shown to slow patient recovery and colorectal motility before, during and before gastrografin could be used clinically for this queries about various aspects of Urology and current evidence increase the risk of developing post- after colectomy. condition. enables answering from consultants and Trainees worldwide. esearch now being conducted at operative complications, with the cost of He said research on the first cohort of “In this specialty we see a small but significant To date, the most useful element of SoMe has been the Auckland City Hospital could its management estimated at $1.5 billion patients has already been completed at group of patients who suffer enormously because of creation of an International Urology Journal Club. Not too Reventually allow surgeons across in the US alone. Auckland City Hospital, with the study post-operative gut dysfunction,” he said. dissimilar to a regular hospital based journal club, once a a range of specialties to better predict the He said that while POI may be attrib- showing for the first time evidence of “If we can better understand its pathophysiology month a recent urological article is selected by the International likelihood and manage the occurrence uted to three cardinal factors – handling of anastomotic nerve regeneration and and risk factors, we’ll be much closer to being able Urology Journal Club #urojc and a time frame is allocated of gut dysfunction following abdominal the gut during surgery, use of narcotic an- a preserved meal response in humans to prevent and hopefully treat it.” for questions and discussions on this article. Merit on the surgery. algesia and derangements in neurohormo- following anterior resection. Dr Vather’s research has been supported by methodology, outcomes and if or why a change in clinical General Surgical Trainee Dr Ryash nal activity – much remained unknown. He said that the second arm of the the College through the Foundation for Surgery practice are considered. Vather is conducting PhD research into Dr Vather’s research incorporates the study is underway with hopes of reaching Scholarship for 2012 and 2013 and is being The international flavour of Twitter provides brilliant the pathophysiology and management use of sophisticated High Resolution the proposed recruitment target by the conducted under the supervision of Associate networking with fellow Urology Trainees and specialists from of Post-Operative Ileus (POI) via use of Manometry (HRM) technology, creation middle of this year. Professor Ian Bissett from the University of around the world. At an upcoming international Urology state-of-the-art fibre optic technology of a purpose-built risk stratification He also said that recruitment for Auckland. meeting, due to engaging with the Urology Twitter community, and the performance of a randomised database for patients undergoing elective the risk stratification database and He said he has greatly enjoyed his time an invitation was forthcoming for a select group of the controlled trial respectively. colorectal resection, and performance of a randomised trial are progressing well. conducting scientific research and that the support ‘twitterati’ to attend a networking event. An opportunity that Dr Vather said that while most randomised trial. “We know that increasing age, of the College had been invaluable in lending would not have transpired without an involvement on SoMe. patients undergoing abdominal surgery “I chose to investigate post-operative male gender, peri-operative narcotic credibility to research objectives and hypotheses. I am pleased to be a part of an innovative specialty, which experienced some degree of post- gut dysfunction because it is an aspect consumption and intra-operative blood “I am grateful for the unfaltering support, counsel values the role of SoMe in educating and developing its operative gut dysfunction, particularly of surgical care which has not been well loss have all been associated with the and encouragement provided by Associate Professor members worldwide. There is a number of other email following bowel resection, up to 25 per characterised – from pathophysiology to occurrence of POI,” he said. Bissett throughout my research,” Dr Vather said. or internet based surgical discussion groups across many cent suffer from a ‘prolonged’ ileus with risk factors to therapeutic management – “However, these findings are based “I am also fortunate to have received academic specialities. These forums are particularly useful for Trainees symptoms lasting up to a week or longer. perhaps a reflection of the ambiguity with on retrospective studies with varying guidance from Dr Tarik Sammour, Dr Arman and surgeons alike who are isolated by geography, but equally He said prolonged POI – which which it is defined and reported,” he said. definitions of ileus. Kahokehr and Dr Greg O’Grady, all College can also connect a group of Trainees across the same city. includes symptoms of nausea and “It is also exciting science because “We are working to more accurately Trainees who have completed doctoral research at I would recommend to all my SET colleagues in a similar vomiting, inability to tolerate a solid diet HRM is a new technology only recently identify relevant factors by prospectively the University of Auckland.” position to sign onto Twitter and join in the discussion.

38 Surgical News january / february 2014 Surgical News january / february 2014 39 Professional Development

educator. Educational activities The 4th Conjoint Medical The Academy of Surgical Educators include the Academy Forum, National Education Seminar on Academy of Simulation Health Educator Training ‘Revalidation’ will be held on welcomes its 500th member program, the Graduate Programs in Friday, March 14, at Hilton Mr Kareem Marwan FRACS Surgical Education, Supervisors and on the Park, Melbourne. It General and Colorectal Surgeon Surgical Educators Trainers for Surgical Education and will be hosted by the Royal What a year it has been! Training, Keeping Trainees on Track, Australasian College of Surgeons, Surgical Education and Training Royal Australasian College of Firstly, congratulations on Why is Selection Interviewer Training, Non- Physicians and Royal College becoming the Academy’s 500th surgical Technical Skills for Surgeons, Surgical of Physicians and Surgeons member. Could you please give education Teachers Course and the Educator of Canada and will involve us a short introduction about important Studio Sessions. The Academy is international and domestic yourself? to you? supported by an eLearning platform presenters including Sir Peter I am a consultant general surgeon with While overseas as a surgical Fellow, I that houses recorded presentations, Rubin, Dr John Adams, Mr Barry a specialist interest in colorectal (lower came to realise that our surgical training podcasts, journal articles, calendar Beiles, Dr Craig Campbell, Dr gastrointestinal) and laparoscopic is second to none. This was not just a of events, discussion forum and Linda Snell, Dr Joanna Flynn, surgery. Currently I have a public personal impression, but also based on eNewsletters. Prof Liz Farmer, Dr Jocelyn hospital appointment at Eastern feedback from British trained surgeons In 2014 the Academy will initiate Lockyer and Dr William Pope. Health and a specialist surgical practice who have had some form of surgical its reward and recognition program The joint Graduate Programs based at Knox Private Hospital (in training in Australia. Maintaining and address its primary purpose of in Surgical Education offered Victoria). excellence in surgical training and thanking the educators that tirelessly by the University of Melbourne I obtained my FRACS in General Sur- education is becoming more challenging support the College. These include the and the College offer a suite gery in February 2012 after training at St with more Trainees, economic pressures, awards of Supervisor or Mentor of the of programs that address the Vincent’s, the Alfred and Monash Medical increasing hospital safety regulations and Year, Instructor of the Year, Examiner of specialised needs of teaching and Centre. I spent 18 months in Colchester, the need to comply with safe working the Year, Training Hospital of the Year learning in a modern surgical UK where I undertook a Fellowship fol- hours directives. and the Sir Alan Newton Education environment. lowed by a consultant post in colorectal Certainly, in that respect, the UK may Award. There will also be recognition The Academy is supported by and advanced laparoscopic surgery. be seen as our crystal ball to the future for commitment with lapel pins and an interactive online learning of training. Few would argue that the certificates awarded to supervisors, community where members What is your background in factors aforementioned have not impacted mentors and instructors after three, six can gather ideas, share interests surgical education? negatively on the quality of surgical and nine years. and research, find resources and I had a five year honorary appointment training. In order to avoid this happening The Academy hosted its inaugural keep abreast of upcoming events. as a lecturer with Monash University, to us; we need to be innovative in our Forum in Adelaide last year with The environment is supportive, contributing to undergraduate teaching use of exciting resources such as digital presentations from renowned medical collaborative and fosters and research. Overseas I was part of simulation, webinars and online training educators. This year it will include the enthusiasm in surgical education. a team of trainers at the state-of-the- videos to increase efficiency of time presentation of the Academy Awards. It includes: a discussion forum, art, purpose built ICENI centre in and place. Of equal importance is our The Educator Studio Sessions resources, links to articles, Colchester, UK. As a training hub, the training culture. showcase presentations from renowned eNewsletters, grant information ICENI centre holds various surgical medical educators on topics of interest and research opportunities, training courses aimed both at Trainee Do you think it is important to to members. The next session is on listings of workshops and and trainer. This includes Masters have a supportive community of Tuesday, March 11, in Melbourne with courses, pathways to become courses in minimal invasive surgery, practice in surgical education and Julian Smith Assoc Prof Victoria Brazil, Academic trainers and supervisors and training the trainers and many others. why? Chair, Professional Development, Chair, Academy of Surgical Educators Stephen Tobin Lead for integrated Clinical Practice, award information. Those who have the interest and natural Dean of Education Faculty of Health Sciences and How did you get involved? ability to train need to be sought, trained Medicine, Bond University, on ‘A Health Upon my return to Australia, I decided and empowered to form a cohesive and Service’s Approach to Education and to continue my role as a surgical trainer creative team which will guarantee the hat a great year 2013 has educators within the College. Since its Training’. Membership of the Academy is open to and educator alongside building future of our surgical training. I believe all Fellows and Trainees and external been for the Academy of inception it has evolved into an active ‘The National Health Education and my clinical practice. I am privileged this is what the Academy of Surgical medical educators who have strong Surgical Educators (ASE) community of practice and this year Training in Simulation’ is a program for educational interests and expertise. to be accepted as a member of the Educators stands for. with the establishment will start to reward and recognise the surgical educators who use or intend For more information on getting ASE; this involvement was suggested I am passionate about ‘smart surgical Wof a membership base of more than contributions of its members. to use simulation as an educational and supported by my colleague training’, and helping Australian surgeons involved in Academy activities or how 500 people and around 900 attendees The Academy offers a range of method to support the education and to become a member please contact Fellow Roger Wale, who acted as my reach the fine balance required of the participating in our activities and courses. educational activities, resources and training of surgeons. The Academy ran Kyleigh Smith on +61 3 9249 1212 mentor during my training years and surgeon/trainer role. My aspiration for The Academy was established to recognition to its members in order to four courses in 2013 and has three more or [email protected] continued on as an important source our surgical training is to be exemplary, support, enhance and recognise surgical support them in their role as a surgical scheduled this year. of valuable advice. and I am confident we will get there.

40 Surgical News january / february 2014 Surgical News january / february 2014 41 From the Archives

Henry Newland with patients at the Queens Hospital, Sidcup enlisted in late 1914 and was posted as a Major with the 1st Australian Stationary Digs La Touche, Fay Maclure and Daryl Lindsay Henry Simpson Hospital (1ASH). After a brief stay in Egypt, his unit was sent to establish a 200 Newland and the bed hospital at Lemnos. Newland’s first task was to survey the site for the hospital and in company road to Sidcup with General Birdwood, he spent a night aboard a naval cruiser. By the end of July Despite his career as a General Surgeon, Newland 1915, the 1ASH had expanded to 1,000 was important in advancing plastic surgery beds and in October, it was decided to move the hospital to Gallipoli. Once again, Major Newland was sent to survey Elizabeth Milford Archivist the site. “We then went to Anzac and were there during the famous storm [torrential rain which flooded the trenches, then snow and extreme cold which caused the ground to Captain Charles Bean freeze]. I went all around the lines with the man who wrote the Australian history of the war, CEW Bean ...” Newland was sent to France in 1917 and he says, “It was a beautiful spring and we went up to Rouen and from there to Estaires. We were there for some months, and then went to the Somme and Passchendaele.” Working as a surgeon with the 3rd Australian Casualty Clearing Station based at Grévillers and later Brandhoek, Newland specialised in abdominal cases. However, the slaughter during the Ypres campaign meant that this “first class surgeon who was towards establishing plastic surgery Lindsay produced at Sidcup and X-Rays, After representing the AAMC at the as strong as a horse” gained experience in as a specialty”. Consisting of sections diagrams, black and white photographs Inter-Allied Surgical Conferences in Paris all kinds of military surgery. from Britain, Australia, New Zealand are in the College Archive. in 1918, Newland left Sidcup in the middle He also encountered Charles Bean and Canada, the hospital specialised in On the advice of his brother-in-law, of 1919. Prior to his departure, his friend again and there is an intriguing image facial and jaw injuries. Will Dyson, Daryl Lindsay promoted George Bell wrote: “Went down to Sidcup in Newland’s photograph album in the After a period spent observing himself as a war artist and probably met and saw Colonel Newland do a bone College Archive which shows Harry the work of the British section, Henry Newland in early 1917. At some graft of a jaw. Technique excellent.” And Gullett, John Masefield, Will Dyson and Newland was able to report that he stage Newland gave his World War a contemporary account stated that: “… Charles Bean peering over a ridge at a had performed his first operation in 1 photograph album to Lindsay who many a man whom would have dreaded Lindsay in studio desolate, treeless battlefield. Perhaps this January, 1918. He also said that “One subsequently donated it to the College. to look in the mirror owes the fact that liaison with two war correspondents, a sees a great number of fractured The album combines photographs from he can shave himself without a suicidal n 1964, College President Kenneth surgical specialties, Newland was a poet and an artist was in what Newland’s jaws and the work is very interesting the Western front with a record of the shudder to the Adelaide surgeon who Starr commented on Sir Henry general surgeon. In 1901 his postgraduate friend, George Bell described as a “quiet and promises to give great scope to staff, patients and surrounds of Sidcup. goes about his work so quietly”. Newland’s contribution to the facio- studies found him at the ‘Septic Block’ period”. He says that during an occasional originality.” Pictures of patients in their Sidcup But although Newland is remembered maxillary section of the ‘Official of the London Hospital which gave him respite from the operating tent, Newland The work at Sidcup was undoubtedly (blue and red) uniforms vie with a rare for his work at Sidcup, he was not HistoryI of the Australian Army Medical experience in the treatment of infected “took plenty of exercise and even took part very innovative and the hospital image of Daryl Lindsay with his artist destined to practice as a plastic surgeon. Services 1914-1918’, saying that it “reads wounds. In the same year, following visits in a cricket match in which I remember he employed a variety of staff ranging sister Ruby Lind who succumbed to Despite the advances made at Sidcup, the like a modern textbook on plastic and to Dr Theodor Kocher in Switzerland and bowled very good length balls”. from surgeons, dentists and technicians the influenza epidemic in 1919. Another fledgling specialty had no following in reconstructive surgery”. Dr George Crile at the Cleveland Clinic, At the end of 1917 Lieutenant-Colonel to war artists such as Daryl Lindsay in photograph shows Lindsay working Australia. Thus, Newland enriched by Born in 1873 and educated at St Peter’s he became interested in new techniques Newland was appointed as commander the Australian, and Henry Tonks in the in his ‘studio’, surrounded by images his experiences during the war, returned College and the University of Adelaide, of thyroid surgery. And a later visit to of the Australian section at the Queen British, section. of damaged faces and plaster casts. home to work as a general surgeon at Sir Henry Newland’s encounter with Europe and America, led to an enduring Mary’s Hospital at Sidcup in Kent. Set in In order to create a comprehensive Newland is captured hard at work in the Adelaide Hospital and the Adelaide plastic surgery was brief, influential and fascination with neurosurgery. the idyllic grounds of Frognal House – picture of individual patients, everything his office and posing with patients and Children’s Hospital. He was knighted determined by the exigencies of the 1914- However, like so many others, once the home of Viscount Sydney – the was meticulously documented. And Lindsay is shown with surgeons, Alfred in 1928 and was very active in the early 1918 war. Newland’s surgical career was put ‘on hospital had been established by Harold much of this significant material Fay Maclure and William Digges College, firstly as a Founder then as As was common in an era before hold’ by the outbreak of World War 1. He Gillies who “did more than any other man including the watercolour sketches La Touche. President from 1929-1934.

42 Surgical News january / february 2014 Surgical News january / february 2014 43 Surgical Sketches and Silhouettes

Yet in the public system, the less privileged are not always so fortunate. Sir Benjamin and Lady Only recently, a major US health Rank at one of his final fund, conscious of spiralling costs, set dinner engagements at the rebate fee for any form of breast Victoria Barrackes 1993 reconstruction at $2000 regardless of the Letters procedural details. Cost containment MUNCHAUSEN invades the surgical decision-making SYNDROME process, which is wrong, but they control from the purse strings. Consequently surgeons have reverted back to traditional implants and flap reconstructions unless the Heidelberg patient pays the difference. K Where do we sit in Australia? Most are Y cognisant of the fees charged in private Reflections with Don Marshall on M practice. The young surgical Trainee is Benny Rank and the evolution of C Factitiousexposed to this and the MBS scheduledisorders Plastic Surgery in Australia. numbers as well, so costs (and therefore income) are not hidden, perhaps creating

Plate: Musings about Munchausen Syndrome, are there three types? the expectation of a substantial income once their training is finished. Don quotes the story of the late Barry Milroy in Sydney, who was asked by his academic mentor, “Now you are going into practice, Barry – are you goinglater to become that evening an academic discharged herself. This clin- As we know musing is gazing meditatively surgeonical or history a merchant stimulated me to recount the story and refl ectively in a literary context. This led surgeon?” OpusOPXIII XXX of some of my other Munchausen experiences me to ponder the Munchausen syndrome. Someover surgeons the last three and a half decades, and three Whether by proxy or direct involvement the plastic surgical group Felix Behan embarkcases on inelaborate particular and spring to mind – I wonder in the public or the private sectors, this that all such procedures Victorian Fellow expensiveif this microvascular is the statistical average (one every ten psychiatric disorder is classifi ed as a facti-are best separated from the How did you arrive at it?” reconstructionsyears and I whenwould simpler welcome other comments). tious sequence of clinical episodes - fancied, MBS schedule to prevent Felix Behan marginalisation, which we see “Quite simply,” the surgeon said.n a recent theatre list I had an inter-alternativesThe may second be available. case makes an interesting feigned or self-infl icted-. It is interesting how Victorian Fellow happening now. How does “That’s all they had.” esting clinical experience even Neverat narrative, forget Occam’s in the 1980’s.razor In those days the medi- this eponym arose: Richard Asher in 1951 was one determine the quality of We are all aware of Aesop’s fablemy of age. the In the Anaesthetic roomprinciple a cal administrator – simplicity is allowed often us to transfer insur- the fi rst to describe such self-harm, recall-

listair Cooke’s weekly radio discussions. This led Don to recall the goose Date:that 27-SEP-2009 lays the goldenO egg; and health best. At a recent International surgery to match the price? patient was awaiting surgery. My registrar was ance patients to the private domain. Over a two ing Baron Munchausen in an article in the program ‘Letter from America’ story of a well known British surgical Microsurgical meeting, some Complications inevitably funds are not a bottomlessnot there pit, to with quote me to present the details on his month period a general surgeon and I operated Lancet. He mentioned how the Baron had a described personalities figure, a Lord, consulting a patient in the Brendan Coventry of Adelaide. As we have of the cases presented caused will occur, as reflected in the line of management. He had mentioned before- on this young man a number of times. He had list of fantastic stories, beyond belief, refl ect- and events over 58 years Home Counties by train from London. seen in the press recently, the Medicare one attendee to state to me, Marsden adage, “Only liars don’t hand that this lady had presented for removal sustained abdominal injuries in a motor vehi- ing daring exploits, quite unbelievable. In his Aof broadcasting. Similarly my weekly He was pre-eminent on the London system is under increasing pressure “Some were just reinventing get complications.” of something off her leg. cle accident, a perfectly credible story until I obituary in the British Medical Journal, it was conversations with Don Marshall led me scene, reflecting the adage ... “successful financially, with GP proceduralists costing the wheel” – and possibly Any patient who has paid a When I addressed the patient in this later questioned the multitudinous mature mentioned how Asher respectfully dedicated to reflect on his pearls of wisdom, over a surgeons have a low complication rate the system up to $20 billion, quoting gilding the lily. high fee has high expectations context, my question was “now what am I abdominal wall scars – another warning sign. Donthis alsosyndrome in attendance to the Baron career in surgery which is really a tapestry and their opinions are highly valued”. Professor Brooks in the Age. What must Our discussions in the of success and conversely similar removing today?” She said “I have a scar on the (like the Bayeux) of his surgical life. He saw the patient, organised his the figure be for specialists? Age touched on our duty of pre-operatively in the anaesthetic bay levels of redress when things Yes, Don recalls Benny Rank (BKR) management and caught the train back to This is unsustainableleg with at a an skin ageing graft site and I was told you couldcare and“As service one to patients of my for optimalmentors and and reviewing later the surgicalcolleagues proposals, saidgo wrong. Recently in London a seven- often, who lived in Heidelberg and was Paddington that evening. The following population and fewer taxpayers.possibly fiIt x begs it”. Previous attempts at serial scaroutcome. In both the public and private problems may be solved before they figure sum was paid to a prominent a hard taskmaster. Once he criticised a day discussing this with his surgical team, the question, “What hasrevision this to dohad with been unsuccessful. People knewsystems years we are nowago burdened “Plastic with surgeonscommence. are In the sometimes public system this describedbusinesswoman following a facelift speaker from Sydney at an early College his regular anaesthetist, cautiously and surgery?” Nothing! However,I have financialsuccessfully closed similar defects thein legalas necessities psychiatrists of reams of paper with knives”process breaks – but down notwhen non-clinicallyalways.” complicated by division of a branch of the meeting when the presentation did not even tentatively, inquired: “What would management reflectingmelanoma costs affects patients us all. with the usual keystoneand umpteen signatures as the basis qualified administrators fill vacant lists facial nerve. Imagine the personal strain meet BKR’s level of excellence, commenting one charge for such a consultation?” At one extreme, a microvasculartechnique. breast of Informed Consent to cover legal for operating surgeons without the benefit inherent in such legal processes going on publicly, “If this is the standard we are Without hesitation (in the days when fees reconstruction for a little underLike aany five-figure experienced surgeon, I exposedliabilities. Three days before discharge he askedof pre-operative a The outpatient Baron served consultation. in the Russianfor years,mili- enough to lift the linings of your going to adopt for future (College) were quoted in guineas), he responded sum creates the platinumthe card whole level lower of sur limb- to examine it and found,On young reflection nurse it foris apparent$15 so that that his clothes Withoutcould taryprior forces knowledge, against the the surgical Ottoman Empirecoronaries and or your gastric mucosa. meetings, we are doomed to failure.” “£21 -17s -7½d”. His anaesthetist replied, gical elegance and perhaps,to my one horror, hopes, she total had a donor site dressing onby spendingbe dry-cleaned. a little extra I asked time the in young lady decisionsome acquiredmay be inappropriate. a reputation for witty and exagger-Following settlement, the MBAs at Surgical fees surface repetitively in our “That’s a somewhat unusual amount. patient satisfaction. Othersher doupper it for thigh. less. On further questioning, consultationit months withlater thewhether patient, she repeatedhad ever received Inher aesthetic ated tales surgery, and Bennybecame warned the subject of numerousthe next board meeting of the insurance u Page: 40 transpired, this had been there for six months. money. She was never paid. texts published in 1862 by Gustav Doré, from 44 Surgical News january / february 2014 I then glanced at her notes on the anaesthetic Some years later, I was doing Monday balloon fl ights, to taming wolves to shootingSurgical News january / february 2014 45 bench. There were fi ve volumes, each about fi ve morning rounds when I encountered the fl ocks of ducks and being mauled by bears (en. inches thick – “a warning sign”. At this stage the same individual, recently admitted again wikipedia.org). alarm bells were ringing and I asked her “why with abdominal trauma. Needless to say he However the idea occurred to me that have you been in hospital so often?” suspect- signed himself out within the hour when I this recollection had a similar ring to another ing some major clinical catastrophe like neph- confronted him. particular person who also wrote about rotic syndrome. She gave a history of repeat A further story relates to a nursing aide fi ctional and fanciful adventures. He was far overdose needing ICU admission. It transpired who burnt her fi nger on a steriliser. The regis- more readable and he became the second most she was seen in our unit six months earlier and trar in the Emergency Department referred translated author of all time, (second only to it was found that she has been putting oven her to me for grafting (which failed), which Agatha Christie). Having written Journey to cleaner on the skin graft donor site. was repeated and failed a second time before the Centre of the Earth in 1864, then 20,000 I took her into theatre and manually debri- doing a cross fi nger fl ap. The resultant stiff Leagues Under the Sea in 1869, and Around the ded the wound under general anaesthesia and fi nger years later resulted in a ray amputation World in 80 days in 1873 – none other than the dressed it with the usual donor site techniques, of the middle fi nger, by another specialist, as great Jules Gabriel Verne (1828-1905) reinforced with soft topical non-removable I discovered when she came back to me for a He lived along the Loire Valley. At the Pub: CMC TOTS dressings, and signed it “not to be removed medico legal report seeking compensation for school of St Donation College, one of his without my permission”. I heard that she had this work related injury. tutors in drawing and mathematics was possi-

SURGICAL NEWS P40 / Vol:10 No:8 September 2009 Surgical Sketches and Silhouettes 2015 Rowan Nicks Pacific Islands Scholarship & 2015 Rowan Nicks International Scholarship 2015 Rowan Nicks Australia & New Zealand Exchange Fellowship

The Royal Australasian College of Surgeons invites suitable applicants for the 2015 Rowan Nicks Scholarships and Fellowships. These are the most prestigious of the College’s International Awards and are directed at qualified surgeons who are destined to become leaders in their home countries.

The Rowan Nicks International and Pacific Islands The Rowan Nicks Australia and New Zealand company divide this settlement cost thing for a patient is to be in the hands Scholarships provide opportunities for surgeons to develop their Fellowship is intended to promote international surgical amongst the members, raising premiums of a man engaged in clinical teaching. management, leadership, teaching, research and clinical skills interchange at the levels of practice and research, raise – yes, we pay for our mistakes. Be aware of In order to be a teacher, the doctor must through clinical attachments in selected hospitals in Australia, and maintain the profile of surgery in Australia and New the Pareto principle (1906) that, “80 per always be a student.” New Zealand and South-East Asia. Zealand and increase interaction between Australian cent of the effects come from 20 per cent of I note 2014 is the 150th anniversary of The goal of these Scholarships is to improve the health outcomes and New Zealand surgical communities. causes” including costs and complications. the establishment of the Mayo clinic in for disadvantaged communities in the region, by providing training The Fellowship provides funding to assist a New There are regular offenders in surgical Rochester, Minnesota, where the best opportunities to promising individuals who will contribute to the Zealander to work in an Australian unit judged by the medico-legal settings. for the patient and the best available development of the long-term surgical capacity in their country. College to be of national excellence for a period of up to Never forget the patient ‘is always right’, expertise, using the most modern one year, or an Australian to work in a New Zealand unit the principle adopted by César Ritz, the methods are all considered paramount. Application Criteria: using the same criteria. King of Hoteliers in Paris and London Incidentally Munificence with Beneficence Applicants for the both the Rowan Nicks International and Pacific years ago. He came to Paris in 1867 for the can sustain the Ailing (my clinical ‘MBA’). Islands Scholarships must: Application Criteria: Universal Exhibition, working at a high Don also recalls his brother Bob’s famous – commit to return to their home country on completion of their Applicants must: class restaurant ‘Voisin’, waiting on the likes statement, “If you are sick overseas, go to Scholarship; – have gained Fellowship of the RACS within – meet the English Language Requirement for medical registration the previous ten years on the closing date for of Gautier, Alexandre Dumas and even the University Department’s second-in- in Australia or New Zealand (equivalent to an IELTS score of applications. Emil Zola (we are enjoying the series ‘The charge (who does all the emergencies) to 7.0 in Australia or 7.5 in New Zealand, in every category); – provide evidence that they have passed the final exit Paradise’ on television at the moment). get the best possible outcome.” – be under 45 years of age at the closing date for applications. exam to allow them to obtain a Fellowship of the His code of excellence embraced Oliver Wendell Homes I have mentioned principles of life in Royal Australasian College of Surgeons by the time the following: seeing without looking, clinical practice from Osler to Mayo to In addition, applicants for the International Scholarship must: selection takes place. hearing without listening and anticipating Hospital, the idea of doing an MBA Wendell Holmes. No biography of these – hold a relevant post-graduate qualification in Surgery; without being presumptuous. He believed crossed my mind. My interest waned gentlemen or their peers ever reflects – be a citizen of Bangladesh, Bhutan, Cambodia, Indonesia*, Selection Criteria: the contract with the service provider when I discovered the time taken would financial rewards, i.e, without any arrière Laos, Mongolia, Myanmar, Nepal or Vietnam – The Committee will consider the potential of the detract from my clinical teaching and applicant to become a surgical leader and ability to was where the provider must always be pensée. Adoption of a teaching ethic brings *With preference given to Indonesian applicants from outside the provide a particular service that may be deficient in subservient to the paying customer, a publication (a Companion volume to the a harmonious balance to professional major capital cities of Jakarta and Surabaya who will return to their chosen surgical discipline. concept relevant to patient management. Keystone text is coming out with Elsevier practice. Another Benny statement was, practice in regional areas. And another story about fees. A in March 2014). Thus treating a patient, no “To operate as a surgeon is a fulfilling and – assess the applicants in the areas of surgical ability, ethical integrity, scholarship and leadership. Director of Surgical Services was matter what their social status, goes hand satisfying existence, amply rewarded, and Applicants for the Pacific Islands Scholarship must: The Fellowship is not available for the purpose of in hand with a teaching commitment – be a citizen of the Cook Islands, Fiji, Kiribati, Federated States contacted by an Adelaide patient even puts fruit on the sideboard.” extending a candidate’s current position in Australia or as every patient teaches us something of Micronesia, Marshall Islands, Nauru, Papua New Guinea, regarding a lipectomy to be done by a If I had not heard these tales and more New Zealand. local plastic surgeon, checking on the equating to experience. from Don (acting as his amanuensis), Samoa, Solomon Islands, Tonga, Tuvalu or Vanuatu; – hold a Masters of Medicine in Surgery (or equivalent). However, surgeon’s qualifications and standing. often quoting Benny, many would have Value: Up to $50,000 for a 12 month attachment, consideration will be given to applicants who have completed She was reassured of the surgeon’s been lost to history. Benny taught us the depending on the funding situation of the candidate and Time for reflection local general post-graduate surgical training, where appropriate importance of a commitment to a public provided sufficient funds are available, plus one return competency to do a Pitanguy lipectomy, In the 1890s, Oliver Wendell Homes to the needs of their home country. but as a closing comment was asked said, “A good clinical teacher is himself hospital practice, including teaching. economy airfare between Australia and New Zealand about the price. Without hesitation, a medical school.” Osler’s epitaph reads, If a patient cannot afford a procedure, Selection Criteria and support to attend the Annual Scientific Congress of the College, if the Scholar is in country at the time of the embarrassment or equivocation, she “I desire nothing else. I taught medical the public system should be the – The Committee will consider the potential of the applicant to Congress. quoted a sum of $8,000. The response was students in the wards and I regard this alternative. Benny invited Don into become a surgical leader in the country of origin, and/or to “That’s interesting. You know you can get as the most important and useful work partnership to become, in turn, the supply a much-needed service in a particular surgical discipline. Tenure: 3 - 12 months a heart transplant for $4,000.” I have been called upon to do.” Similarly reflective voice of plastic surgery in – The Committee must be convinced that the applicant is of When I was Director of Surgical Charlie Mayo in the Proceedings from Australia (if not its conscience), as etched high calibre in surgical ability, ethical integrity and qualities of leadership. Services with Bob Thomas at the Western Mayo Staff Clinic (1927) said, “The safest in these redacted vignettes. Application forms and instructions are available – Selection will primarily be based on merit, with applicants providing an essential service in remote areas, without from the College website: opportunities for institutional support or educational facilities, www.surgeons.org being given earnest consideration. Closing date: Monday 2 June, 2014. Applicants will be notified of the outcome of their Surgical News Please write to The Editor, Surgical News, Value: Up to $50,000 for a 12 month attachment, depending application by 30 October 2014. Royal Australasian College of Surgeons, on the funding situation of the candidate and provided sufficient Please contact: Secretariat, Rowan Nicks Committee, always welcomes funds are available, plus one return economy airfare from home Royal Australasian College of Surgeons 250-290 Spring St, East Melbourne. Victoria 3002 country and support to attend the Annual Scientific Congress of the 250 - 290 Spring Street, East Melbourne VIC 3002 letters from readers. College, if the Scholar is in country at the time of the Congress. Email: [email protected] or email: [email protected] Phone: + 61 3 9249 1211 Fax: + 61 3 9276 7431 Tenure: 3 - 12 months

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48 Surgical News january / february 2014 Surgical News january / february 2014 49 The Royal Australasian College of Surgeons Member Advantage Benefit Program

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Card Holder’s Name - block letters Card Holder’s Signature Date Mr James Roberts-Thomson Mr Robert Sillar OAM Mr Michael Taplin Mr Unis Unis Mr Kwok-Kee Wong Dr David Anderson Mr Harvey Coates AO Mr Kwai Fung Dr Paul Jarman Mr Douglas McManamny Dr Daniel Robinson Mr Paul Simcock Dr Susan Taylor Mr Rene van den Bosch Mr Robert Wood Your skill. I would like my donation to help support: Dr Bee Ang Assoc. Prof. Andrew Cochrane AM Assoc. Prof. Jonathan Gani Mr Michael Jay Dr Michael McMeniman Mr Myron Rogers Mr David Simons Mr Christopher Taylor Dr Melinda Van Oosterum Mr Alexander Wood Your legacy. General Foundation Programs InternationalMr D Stephenevelopment Archer Prog rams Mr Ian Colledge Mr Jeremy Gathercole Dr Suren Jayaweera Mr Stuart McNicoll Assoc. Prof. Peter Royce Mr Adam Skidmore Mr Charles Teo AM Mr Nicholas Vertzyas Mr Peter Woodland Scholarship and Fellowship Programs IndigenousAssoc. Health Prof. Programs Leigh Atkinson AO Dr Philip Colman Mr Anthony Geddes Dr Rosalind Jeffree Mr Stuart McNicoll Dr Alex Rutherford Mr Stewart Skinner Dr Leana Teston Mr Subramaniam Vigna-Rajah Assoc. Prof. Peter Woodruff AM I have a potential contribution to the Cultural Gifts ProgMrram Noel Atkinson Dr Scott Coman Dr Simone Geere Mr Anthony Jeffries Miss Philippa Mercer Mr Brendan Ryan Mr Denis Smart Mr James Thomas Mr Vijith Vijayasekaran Mr Kevin Woods I do not give permission for acknowledgement of my giftMr inJohn any AvramovicCollege publication Mr Andrew Comley Mr Midhat Ghali Mr John John Mr Arend Merrie Your Mr Nihal Samaraweera Professor Julian Smith Mr Andrew Thompson Mr Timothy Wagner Mr Timothy Wright Please send your donation to: Mr Michael Baldwin Mr Hugh Cooke Dr Katherine Gibson Mr Michael Johnson Mr Ian Michell Mr Richard Sarre Mr David Stabler Mr Ian Thomson Mr William Walker OAM Mr William Wright AUSTRALIA & OTHER COUNTRIES NEW ZEALAND Mr Simon Banting Dr Catherine Cord-Udy Mr John Giles Ms Mary Johnson Mr Campbell Miles Foundation. 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52 Surgical News january / february 2014 Surgical News january / february 2014 53 Register online at www.racsanzca2014.com ROYAL AUSTRALASIAN COLLEGE OF SURGEONS

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