FIVE YEAR REVIEW 2009-2014

Department of Surgery, Faculty of Medicine 149 College Street, 5th Floor Toronto, Ontario, Canada M5T 1P5 Tel +1 416-978-2623 • Fax +1 416-978-3928 [email protected] • www.surgery.utoronto.ca 2 Five Year Review 2009-2014 This report is respectfully submitted by:

Dr. James T. Rutka RS McLaughlin Professor and Chair of Surgery www.surgery.utoronto.ca

TABLE OF CONTENTS

1. Executive Summary ...... 7 5. Organizational and 2. Introduction ...... 9 Financial Structure ...... 34 3. Key Findings of the 2007 Review ...... 11 6. Resources and Infrastructure ...... 40 4. Chair’s Statement ...... 13 7. Education ...... 41 a) Historical Perspective ...... 13 8. Research ...... 48 b) Developing the Brand ...... 14 9. Quality and Best Practices ...... 51 c) Strategic Plan ...... 15 10. Faculty Development ...... 53 i. Education ...... 15 11. Continuing Professional ii. Research ...... 16 Development ...... 54 iii. Quality and Best Practices ...... 17 12. Global Health ...... 55 iv. Faculty Development and Mentoring ...... 18 13. Surgical Skills Centre ...... 58 v. Integration/Global Outreach ...... 19 14. Report of Faculty Members ...... 62 d) Communications ...... 20 15. Report of Learners ...... 64 e) Academic Performance 16. Division Reports ...... 81 and Metrics ...... 20 17. Hospital Reports ...... 137 f) Chairs and Chairholders ...... 21 g) Promotions ...... 23 18. Conclusion ...... 221 h) Appointments ...... 23 19. Appendix A & B available electronically i. New Faculty ...... 23 ii. University Division Chairs ...... 24 iii. Surgeon-in-Chiefs ...... 25 iv. Other Leadership Appointments ...... 25 i) Continuing Appointment Reviews ...... 25 j) Retention ...... 26 k) Transition ...... 26 l) Education ...... 26 m) Research ...... 26 n) Major Award Recipients ...... 27 o) Advancement ...... 28 p) Departmental Firsts ...... 30 q) Strengths and Challenges ...... 31 r) Future Directions ...... 32 MAIN ABBREVIATIONS USED:

AAP: Annual assessment of productivity LInC: Longitudinal integrated curriculum

AEF: Academic enrichment fund MAM: Medical academy of Mississauga

AFP: Alternated funding plan MOHLTC: Ministry of health and longterm

BPiGS: Best practices in general surgery care

CACMS: Committee on accreditation of MOU: Memorandum of understanding Canadian medical schools NBME: National board of medical examiners CAR: Continuing appointment review NEAL: New and emerging leaders CaRMS: Canadian resident matching service PCC: Patient centred care CBC: Competency based curriculum PGME: Postgraduate medical education CGQ: Canadian graduate questionnaire Q/BP: Quality and best practices CPD: Continuing professional development RCPSC: Royal college of physicians and CRC: Canada research chair surgeons

FEAC: Fellowship education advisory SEAD: Surgery exploration and discovery committee SIC: Surgeon-in-Chief IDEAS: Improving and driving excellence across sectors SLUE: Surgical leader of undergraduate education LCME: Liason committee on medical education SSTP: Surgeon scientist training program

LHIN: Local health integration network TES: Teaching effectiveness score

6 Five Year Review 2009-2014 1. EXECUTIVE SUMMARY:

The Department of Surgery is steeped in a than 1,000 peer-reviewed publications per year, rich tradition of surgical innovations which have and receive numerous prestigious national and had enormous impact on the health of mankind. international awards. Contemporary innovations in surgical education Funding for the Department is derived including the development of the Surgeon from multiple sources including: Base funds Scientist Training Program (SSTP), the Surgical from the University and the Ministry of Health Skills Centre (SSC), and a Competency Based and Longterm Care (MOHLTC); revenue from Curriculum (CBC) have further solidifed the Continuing Professional Development (CPD) Department’s global reputation. courses; advancement funds; and endowment The Department is the largest across Canada funds. Advancement efforts within the with 275 full-time faculty members, 250 residents, Department of Surgery, the University Divisions 200 clinical fellows, and 40 scientists. There are and the Hospitals have led to the creation of 7 direct entry Royal College of Physicians and a myriad of endowed chairs held by surgeons Surgeons training programs (Cardiac Surgery, totaling over $150 Million per year of funds General Surgery, Neurosurgery, Orthopaedics, that are used to support the academic mission. Plastic and Reconstructive Surgery, Urology, The Department also lays claim to 10 Canada Vascular Surgery) and 4 sub-specialty programs Research Chair holders. (Pediatric General Surgery, Colorectal Surgery, The Department has developed an ambitious Surgical Oncology, and Thoracic Surgery). Strategic Plan entitled: “Transforming Surgery: Interestingly, the Division of Anatomy is Beyond the Cutting Edge”. Within this plan, housed within the Department of Surgery in a there are 5 well-defned planks of activity relationship that has been mutually productive including: 1) Education; 2) Research; 3) Best and benefcial for over a Members of the faculty practices/Quality; 4) Faculty Development; and are distributed at 6 major teaching hospitals: 5) Integration/Global impact. Progress that St Michael’s Hospital, Mount Sinai Hospital, has been made along each plank is described Sunnybrook Health Sciences Centre, Women’s in detail within the body of this 5 year report. College Hospital, University Health Network, The plan and its component parts align well and the Hospital for Sick Children. Part time with the Faculty of Medicine’s Strategic Plan – and adjunct faculty members are found in an Integration, Innovation, Impact. ever expanding array of community-affliated From 2009-14, the Department has hospitals in and around the Greater Toronto Area recruited 63 new faculty members, appointed (GTA). Residents, fellows and medical students 5 new University Division Chairs, and on surgical rotations receive excellent surgical supported the appointments of 7 new program instruction in particular at North York General directors, and 4 new Surgeons-in-Chief at Hospital, Toronto East General Hospital, St the various hospitals. There were 62 faculty Joseph’s Hospital, and Trillium Health Partners. who successfully completed their Continuing The Department is a research-intensive, Appointment Reviews (CARs). And fnally, the and academically productive unit in which the Department celebrated in the promotion of 95 faculty generate approximately $35-45 Million faculty members to higher academic ranks. per annum in research funding, publish more

Five Year Review 2009-2014 7 KEY MESSAGE

In the past 5 years, some notable “frsts” for the Department include: • Establishment of the Surgical Exploration • Establishment of the University of Toronto and Discovery (SEAD) Course City-Wide Brain Tumour Banking initiative • Creation of Faculty Development Day to • Creation of a Resident course in Practice assist faculty in need of improving their Management and Financial Planning teaching, research, and creative professional • Establishment of three new Departmental activity scores Lectureships • Producing and funding the Department of • Hiring of a Departmental Strategic Planning Surgery “Prep Camp” for all PGY1 residents Implementation Co-ordinator held at the SSC. • Hiring of a Departmental Communications • Establishment of the Best Practices in Co-Ordinator SurgeryWorkgroup • These and several other notable frsts • Writing of the “Late Career Transition outlined in the pages of this 5 year report Guidelines” serve to illustrate the new directions taken • Establishment of the Surgeon: Global within the Department based on its strategic SurgeryAcademic Role and job description priorities. • Harmonization of Departmental Academic Salaries according to Academic Role and Job Description • Competency Based Curriculum initiated in the Division of Orthopaedics, and now being applied incrementally to other specialties in Surgery

8 Five Year Review 2009-2014 I am most proud of the commitment to Committee working synchronously with the academic excellence which is demonstrated University Division Chairs and Program Directors, consistently by all members of the Department. Surgeons-in-Chief, and Hospital Division Heads, Academic excellence is fostered within a ensures that adequate infrastructure and support supportive environment that is provided by the can be provided to the exceptionally talented University, hospitals, and research institutes in members of the Department to maintain its prized which the faculty conduct their clinical practice ranking in Canadian surgery, and beyond, and and research efforts, and in which learners are to provide leadership in academic surgery with educated. The organization of the Department global impact. with its Executive Committee and Senior Advisory

2. INTRODUCTION

The Department of Surgery is comprised published annually by Departmental members, of a strong network of faculty and learners, and the annual grant capture ranges from $35-45 and traverses six fully-affliated hospitals and Million in external funding from peer reviewed an expanding number of community-affliated regional, provincial, and national agencies. The hospitals. The Department is home to 275 full- Surgeon Scientist Training Program (SSTP) time faculty, 40 part-time faculty, 75 adjunct is a unique element of the research training for faculty and 40 research scientists. The Department residents in the Department, and has been a highly is responsible for surgical teaching of 225 medical successful program in training the next generation students throughout the four years of their of Surgeon Scientists. The range of scholarly undergraduate curriculum, and for overseeing work has been wide including formal training the welfare of eleven residency programs with in fundamental biology, clinical epidemiology, a total enrollment of over 250 resident trainees. medical education, business administration and The Department’s clinical fellowship program is ethics. the largest across Canada with over 200 fellows From an educational perspective, in the from 40 countries around the globe coming each past 5 years, the Department has contributed year to learn highly specialized surgical care and to the successful accreditations of the medical techniques from our surgeons. school in the Faculty of Medicine in 2012, The Department is a research-intensive and the Royal College of Physicians and enterprise which is academically productive and Surgeons review of the various residency well funded. Over 1,000 peer reviewed papers are training programs. The University of Toronto

Five Year Review 2009-2014 9 Surgical Skills Centre at Mount Sinai Hospital provides a laboratory setting where basic and complex surgical procedures can be learned and practiced in a simulated, non-threatening environment. The Centre’s continued use by the University community underscores the increasing recognition of the value and need for technical skills training outside the clinical setting. In addition, it serves as a platform for skills related research. Finally, the Department The Department of Surgery works in offers a myriad of Continuing Professional close collaboration with the Faculty of Medicine, Development (CPD) programs annually, and the hospitals and their research institutes, the these are embedded within all Divisions and various Divisions of Surgery and their practice beneft medical students, residents, clinical plans, and in many instances, the Ministry of fellows and faculty alike. Health and Longterm Care (MOHLTC). The The Department’s new Strategic Plan for Chair of the Department of Surgery exerts 2012-17 – Transforming Surgery: Beyond the infuence through the building of interactive Cutting Edge – is a bold blueprint for taking networks with the Dean of the Faculty of the Department to a higher station. Signifcant Medicine, Vice Deans, Surgeons-in-Chief, progress has been made along each of the Research Institute Directors, University Division Strategic Directions which have taken the Chairs, Hospital Division Heads, hospital VP’s Department into wholly new areas previously of Medical Affairs, Chief Executive Offcers, unexplored. These directions are identifed as and individual faculty members. While such follows: dependency on agreement with others may 1. Foster excellence in teaching through seem unwieldly in some environments, this new program development spirit of cooperativity and collaboration works 2. Create and translate novel research quite well for the Department of Surgery in fndings into surgical practice the Faculty of Medicine at the University of 3. Drive quality and best practices across Toronto, as it is hoped the pages of this fve year all surgical divisions review document will clearly illustrate. 4. Engage and value the contributions of the faculty 5. Consolidate our expertise for global impact Enabling and supporting strategies for the plan include enhancing the supporting infrastructure; strengthening communications; and establishing inspiring advancement initiatives.

10 Five Year Review 2009-2014 3. KEY FINDINGS FROM THE 2007 EXTERNAL REVIEW:

The previous review of the Department Response: of Surgery was undertaken in 2007 while The Department has continued to refne the Professor Richard Reznick was Chair of the structure and content of the “crash course” for Department of Surgery. On balance, the review medical students. The Mississauga Academy by Professor Jonathan Meekins and Garth has graduated its frst pool of medical students, Warnock was highly laudatory of Dr Reznick’s and the staff surgeon teachers are engaged more leadership, and the quality of the programs in than ever before. Special emphasis is now being the Department of Surgery. There were several placed on recognizing outstanding resident key suggestions made to improve the operations teachers at the end of each academic year. of the Department of Surgery in all of its facets. These can be broken down into the following Postgraduate Medical Education: component parts: The Reviewers noted the innovation occurring in postgraduate medical education (PGME) in the Undergraduate Medical Education: Department and commented on the development Some concern was raised over the exposure of of the Competency Based Curriculum (CBC) in students to specialty and subspecialty focus over Orthopaedics, a frst of its kind in North America. a broader range of relevant community surgery. Concern was expressed over the diverse array The “crash course” was considered an innovative of rotation assignments in some Divisions, and educational offering to students, but the standard the lack of preparedness for community based of teaching was variable depending on resident practice. The diffculties with establishing a and fellow availability during the rotations. “case log” system were noted. Mention was Concern was raised over the addition of the made of the fragmentation of surgical simulation Mississauga Academy to student education. training across the different hospital sites, even It was recommended that the Department of though it was recognized that the Surgical Skills Surgery increase the preparation of residents Centre at Mt Sinai Hospital remained a most towards their interactions with students during impressive facility. Residents were concerned formal course offerings, such as the “resident as about their interactions with the numerous a teacher” course; that the expansion of medical fellows on service at any given time, and what student teaching to additional campuses, such their roles were regarding operative cases in as the Mississauga Academy, will require particular, and service work in general. considerable Departmental oversight; and that the Department work closely with the Faculty of Response: Medicine Undergraduate Education Committee The Department has continued to support the to focus on innovative pathways to preserve laudable efforts of the CBC in Orthopaedics surgical teaching and exposure to surgical which has gone on to receive full Royal College specialists. approval in 2015. Now, the Royal College is requesting that all residency programs follow

Five Year Review 2009-2014 11 a competency based assessment program, and was aided by having the Vice Dean of CPD at the Department is already well established in the University, Professor Dimitri Anastakis, as this area. Residents continue to evaluate their one of surgeons on the Departmental faculty. rotations. Rotations with minimal educational value are now eliminated from the pool of Research: assigned rotations. Many Divisions now are The Reviewers acknowledged the strong offering community-based rotations in surgery research tradition in the Department, and were so that they can acquire the experience of a impressed with the support of the Surgeon community based practice before taking their Scientist Training Program (SSTP), and the Royal College Examinations. A case log system research accomplishments of the Surgeon- has now been implemented thanks to the efforts Scientists and –Investigators at all levels of the PGME offce and the Department of of appointment. That said, the Reviewers Surgery. The Department is examining ways recommended: 1) Increased funding to sustain in which it can support the integration of all the SSTP; 2) Restructuring of the academic surgical simulation sites at the different hospitals point system to recognize the accomplishments with a burgeoning Faculty of Medicine task of mid-career investigators; 3) Establishment of force which is set to improve this feature. And greater support for the Department’s scientists fnally, the interaction of residents with fellows on hospital research institutes: 4) Improve the continues to be carefully monitored. Faculty and tracking of attributions of grants derived from residents know that the primary mandate of the the Department’s faculty in the University’s Department is to support resident education. research service database; and 5) New hirings to the Division of Anatomy to off-set the intense Continuing Professional Development teaching load of faculty, and to protect time for (CPD): anatomists performing investigative work. The Reviewers recommended the expansion of Departmental CPD to foster research Response: development in knowledge translation through The Department has enhanced its support of continued efforts to provide education offerings the SSTP on an annual basis. That said, this is a to learners at all levels, including community- costly undertaking for the Department at a time based surgical practitioners. when resident research fellowship applications are not reaching funding level status. The Response: academic point system has been restructured The number of CPD offerings in the to take into account the relative contributions Department has increased substantially since of Surgeon-Scientists, -Investigators, and – the Review in 2007. Virtually all Divisions now Teachers to the academic mission. The issue of have annual CPD courses which are targeted at a greater voice at the hospital research institute residents, fellows, faculty, and the community. committees is a diffcult one that the Department Surplus funds from these CPD courses are is continuing to troubleshoot. The Department shared with the Divisions. The Departmental Chair has been meeting with the hospital CEO’s aliquot of surplus funds is used to support the and the Research Institute Directors on a routine academic mission, and the strategic plan. In basis to try to accomplish this. The Faculty of recent times, the Departmental CPD program Medicine’s Vice Dean of Research has worked

12 Five Year Review 2009-2014 hard these past several years to improve the search process continues to be refned, but is attribution of Surgeon’s grant capture in their recognized by all to be extremely important for database. And fnally, the Division of Anatomy all new faculty hirings. The Department has has hired new faculty members as teachers recently produced guidelines for Late Career primarily to balance the requirement for teaching Transitioning of surgeons which are in the versus investigative inquiry. process of being implemented.

Morale: Organizational Structure: The Reviewers commented that in general The Reviewers recommended improving morale was at a high level in the Department. the Departmental relationship with the Surgeons Processes such as the provision of Critical in Chief at all hospitals. It was suggested Illness Insurance, and Day Care allowances that support for teaching be also extended to have helped engender this high regard for the community-based hospitals. The Reviewers Department. The mandatory search process was commented that the Department could leverage considered a transparent and effective tool to opportunities of funding surgical services bring on new faculty. It was noted that there was through the Local Health Integration Networks a considerable bolus of new faculty recruitments (LHINs). in the past 5 years such that a highly developed mentoring program was recommended. In Response: addition, in the absence of an age restriction The Department Chair meets with the for retirement, it was recommended that the Surgeons-in-Chiefs on an ongoing basis Department examine new ways to help transition quarterly to discuss management and operational faculty to new roles in the Department at the late issues. Teaching support has been extended career vantage point. now to community-based hospitals, including the Mississauga Academic. Several surgeons in Response: leadership positions, including the Department The Critical Illness Insurance, Day Care Chair, have had opportunities to interface with allowances, and Life Insurance policy options the LHINs over resource allocation policies continue for new faculty recruits. The mandatory which have beneftted the Department.

4. CHAIR’S STATEMENT:

a) Historical Perspective: Professors of the Department of Surgery surgery The Department of Surgery at the beginning with Dr W.E. Gallie (1929 – 1947), University is steeped in a rich tradition of Dr Robert Janes (1947 – 1957), Dr Frederick academic excellence and innovation dating back Kergin (1957 – 1966), and Dr William Drucker to 1843. Dr. Clarence L. Starr became the frst (1966 – 1972). In more recent times, Dr Donald full-time Professor of Surgery in 1921, which L. Wilson, (Chair from 1972 – 82), helped to was the frst appointment of its kind in Canada. establish the RS McLaughlin Chair in Surgery Following Dr. Starr there were several luminary in 1978, the frst endowed Chair in Surgery in

Five Year Review 2009-2014 13 Canada. Dr Bernard Langer (1982-92) developed Toronto General Hospital, The Toronto Bariatric the guidelines for surgical practice plans in the Collaborative, and the Competency Based Department of Surgery, and established the Curriculum in Orthopaedics. Upon Dr Reznick’s Surgeon Scientist Training Program. Dr John departure from the University of Toronto to Wedge served as Chair from 1992-2002 and become Dean of Medicine at Queen’s University, established the Surgical Skills Centre at Mount David Latter was installed as interim Chair from Sinai Hospital in 1998. Dr. Richard Reznick served 2010-11, before James Rutka was announced as as Chair from 2002 – 2010, and was instrumental the RS McLaughlin Chair of Surgery in April 2011. in creating the Wilson Centre for Education at the

Chairs from left to right: James Rutka, Richard Reznick, Donald Wilson, John Wedge, Bernard Langer, David Latter

b) Developing the Brand: on our surgeon scientist training program, As part of the which dates back to Dr William Gallie’s tenure new Strategic Plan as Chairman. for the Department of In this image, you will see two suture needles Surgery, it was strongly that are slightly offset, one to the other, in space. recommended by former The suture needles represent our emphasis and Dean Catharine Whiteside to begin branding focus on the art and practice of surgery. The the Department in ways which would enhance suture threads are actually depicted by a double our visibility on the global stage, increase our helix of double stranded deoxyribonucleic acid ranking on the continent, and promote our ability (DNA) with appropriate nucelotide base pair for advancement across all of our Divisions. cross - linking strands. The DNA represents In creating a new image for the Department our focus on surgical science and includes our of Surgery, efforts were made to underscore research work from molecule to man. our core values which are: 1) Surgery in all of its facets including technical innovation, and As we created the logo in its fnal form, education; and 2) Science, given our rich history it did not escape our notice that the colours of of accomplishments amongst our faculty, and the DNA strands, red and blue, were connected the emphasis that has traditionally been placed by cross linking bands that were white, making

14 Five Year Review 2009-2014 the logo highly reminiscent of the colours of the its focus on education with advanced programs archetypal “barber pole” from antiquity where in undergraduate, postgraduate, fellowship and blue represented the veins, red represented the graduate education. arteries, and white was the background that Faculty Lead accentuated the spiral of the red and blue stripes. David Latter Signifcant Developmental c) Strategic Plan: Milestones in Education: The Department of Surgery embarked • We have strengthened the recruitment, on a strategic planning process in October 2011, development, and support of surgeon teachers with the aim of developing a robust roadmap and by increasing offerings in faculty development well defned priorities to guide the Department’s for teachers, identifying and nurturing surgical efforts over the next fve years. The planning educations in undergraduate and postgraduate process was timely given the recent release of education, providing stipendiary support the new Faculty of Medicine Strategic Academic for teachers with leadership positions, and Plan. Our new Strategic Plan for 2012 to 2017 consistently acknowledging the importance of – Transforming Surgery: Beyond the Cutting teaching in annual assessments of productivity Edge -- acknowledges the Department’s position (AAP), and giving awards to teachers at the as one of Canada’s leading Departments of Departmental/Divisional/Hospital/Faculty of Surgery and one of the top tier Departments Medicine levels. in the world (http://surgery.utoronto.ca/about/ • We have refned the core undergraduate surgery strategic-plan.htm). This plan builds on a curriculum to outline the essential learning strong history of excellence in patient care and elements for surgery clerkship, and expanded surgical innovation. It challenges us to push the range of learning sites. A “crash course” in to new frontiers in surgical practice, education surgery has been developed for clinical clerks, and research. There are fve major goals of the together with a well defned compendium of Department’s Strategic Plan as follows: essential surgical information for students. • We have expanded novel teaching approaches and methods, and capitalized on communications technologies and advances in simulation. With the assistance of the Postgraduate Medical Education (PGME) offce, our residents are now required to log all operative cases they are involved in on a mobile app program. Learners at all levels can now beneft from simulation centre experience at the Surgical Skills Centre at Mt Sinai Hospital, the Li Ka Shing Knowledge Centre at St Michael’s Hospital, the centre for Surgical Simulation at Sunnybrook Health Sciences Centre, the Temerty-Chang i) Education: To foster excellence in teaching Simulation Centre at the Toronto Western through new program development. Hospital, and the Hospital For Sick Children. The Department of Surgery is heavily invested in Simulated surgical skills are now assessed

Five Year Review 2009-2014 15 routinely for laparoscopic cholecystectomy, in a highly advantageous and benefcial way. fracture fxation, spinal fusion, uro- and neuro- • We have provided a robust array of continuing endoscopy, among many other skills. professional development (CPD) opportunities • We have pioneered the use of a completely in Surgery for residents, fellows, and faculty. competency-based curriculum (CBC) for Virtually every Division hosts specifc CPD residency training in Orthopaedics; and we courses for learners, faculty, and visitors are embarking on extending competency- who beneft enormously from the teaching of based assessment programs for all residency our talented faculty. This has all been aided programs, in part mandated by the Royal by Dimitri Anastakis, Professor, Division of College of Physicians and Surgeons. The CBC Plastic and Reconstructive Surgery, and Vice in Orthopaedics was the frst of its kind across Dean CPD, who has helped to make these North America, and has garnered tremendous offerings as informative and as proftable as attention and accolades by virtue of its ability to possible. The full report on CPD can be found demonstrate that orthopedists could be trained on page 86 of the 5 year review. in a shorter period of time while undergoing the CBC than while pursuing a conventional ii. Research: Create and translate novel fndings orthopedics residency curriculum. This novel into surgical practice. program was supported by the Ministry of Health and Longterm Care in the Province of Faculty Lead Michael Fehlings Ontario. • We have enhanced career development for Signifcant Developmental residents, and have provided needed career Milestones: assistance to graduates. Dr Barry Rubin, • We have pursued stable funding for research Vascular Surgery, teaches the residents a through the identifcation of new sources of course on “Practice management and fnancial revenue. In collaboration with the Offce of planning” complete with information on hiring Advancement at the University of Toronto, staff, performing accurate billings, practice donations to the Department of Surgery have incorporation, and fnding the best job. Across averaged close to $3 Million/year to support the all Divisions, the University Division Chair and academic mission. These monies have been in Program Director meet with their graduating the form of alumni gifts, industry support, and residents routinely to navigate the job market philanthropic donations. Numerous University/ Hospital Chair funds have also helped to support key research leaders in the Department of Surgery. A major gift to the Department of Surgery came from Amira and Michael Dan ($2 Million in 2013) to support the creation of a university-wide brain tumour bio bank in which all hospitals where neurosurgery is performed add patient data and specimens (tumour, blood, DNA, RNA, protein, stem cells) to a centralized data base (http://surgery.

16 Five Year Review 2009-2014 utoronto.ca/research/University_of_Toronto_ development of No No Inc with the production Brain_Tumour_Bank.htm). of a drug for stroke prevention, and Victor • We have instituted new policies to support Yang in the design of a new surgical navigation the success of scientists in the Department of platform based on real time imaging. Surgery. These include fnancial support for • We are becoming a world leader in surgical new recruits from the Department of Surgery, innovation across all Divisions. Further Hospitals, Divisions, and Research Institutes, information in surgical innovation and the creation of the Roscoe Graham Reid knowledge translation is found in the Surgical Scholarship as salary support for scientists Innovation prospectus at: http://surgery. within their frst 5 years of practice, an internal utoronto.ca/news/groups.htm review of grants program, a mentorship program, and a biennial retreat of scientists iii) Quality and Best Practices: To drive quality within the Department of Surgery. and best practices across surgical practice and • We have sustained and enhanced the training of education. residents within the Surgeon Scientist Training Faculty Lead Program (SSTP). The SSTP is the fagship Robin McLeod program of the Department’s postgraduate Signifcant Developmental training program (see research report). It Milestones: costs approximately $1.5 Million/year of • We have instituted a robust quality and best Departmental funds to ensure that all residents practice (Q/BP) program across all Divisions of enrolled in the SSTP can receive funding at the Department of Surgery. A Departmental Q/ their appropriate PGY-level, and can have their BP Committee has formed with representation tuition covered (approximately $8 K/year). In from all Divisions, and Chaired by Robin 2014, there were 33 residents enrolled in the McLeod. This Q/BP individual also sits on all SSTP across all the Divisions in Surgery. Divisional Executive Committees. One of the • We have pursued greater integration of frst projects tackled by the Departmental Q/BP research across disciplines, sites, and types of Committee is the readmission rates following researchers. This can be demonstrated by the index surgical procedures across all Divisions formation of the Toronto Aortic Collaborative, (e.g. CABG, pulmonary lobectomy, colectomy, the Cardiac database, the Trauma program, knee and hip arthroplasty). It is hoped that the Spine program, the Hand program, and the information from such a project, among others, Brain Tumour Bio-banking initiative, as some will inform the Hospitals how to prevent such examples. readmissions, and will lead to information of • We have enhanced knowledge translation beneft to the province, and MOHLTC at large. and commercialization of surgical inventions We have just embarked on a unique Person through important relationships with key (Patient) Centered Care (PCC) initiative to partners at the Medical and Related Sciences increase patient experience and satisfaction, as (MaRS) Discovery Site, Techna, and the well as reduce health care costs. University of Toronto Research Offce. • We have built capacity to advance the science of Faculty who have demonstrated high level IP Q/BP in the Department of Surgery. • Funding and knowledge translation projects include has been received from all UofT Hospitals to Shaf Keshavjee and the EX VIVO organ support the Best Practices in General Surgery repair initiative, Michael Tymianski and the

Five Year Review 2009-2014 17 (BPiGS) program. Dr Rutka and Dr McLeod success of faculty members who receive formal are meeting with all Hospital CEO’s and VP mentoring from senior colleagues, our program Medical Affairs in all units to foster support is designed to ensure transparency around job of the newly formed Best Practices in Surgery descriptions and expectations, supports career (BPS) program. Several faculty have taken advancement, and strengthens camaraderie advantage of the Improving and Driving across the Department. Mentors are now named Excellence Across Sectors (IDEAS) program for both clinical and research domains on a from the Institute of Health Policy, Management new faculty member’s Letter of Appointment and Evaluation (IHPME). IDEAS is a (LOA), and the mentor is invited to attend the comprehensive, and province-wide initiative to Continuing Appointment Review (CAR) of the enhance Ontario’s health system performance faculty member at 3-5 years. We plan to track by increasing quality improvement, leadership, the success of this mentoring program annually and change management capacity across all and longitudinally. Mentoring awards are health sectors (http://www.ideasontario.ca/ being established in the Department of Surgery about-ideas/). to recognize outstanding mentors who have • We have begun to integrate quality across the supported newly recruited faculty members. educational programs in the Department of • We have fostered and developed the nurturing Surgery. Najib Safeddine, Tim Jackson, and of leaders across the Department of Surgery. Giuseppe Papia have worked with the Center Several faculty members have been funded for Quality Improvement and Patient Safety to through the Department of Surgery to attend develop a Q/BP curriculum for all residents in the New and Emerging Leaders (NEAL) course the Department of Surgery at the PGY1-2 levels in the Centre for Faculty Development (https:// in the Foundations Course. At the Annual cfd.utoronto.ca/neal). Faculty Development Day in November, Q/BP • We have strengthened the Department’s lectures and seminars are provided to faculty processes for academic support, appointment throughout the one day course. reviews, assessments of academic performance and promotions. Through the efforts of Ori iv) Faculty Development and Mentoring: To Rotstein, the CARs have become a robust review engage and value the contributions of the faculty effort which tracks faculty achievements and in the Department of Surgery. accomplishments in the frst 3-5 years of practice. Faculty Lead Faculty passing their CARs are acknowledged Ori Rotstein in the Department of Surgery e-newsletters, the Signifcant Developmental Spotlight, and the Annual Address. For Annual Milestones: Assessments of Academic Productivity (AAPs), • We have established a mentoring program in the scores are sought and entered by the University Department of Surgery through the efforts of Department and Division Chairs, The Hospital Ori Rotstein and Paul Grieg (http://utoronto.ca/ Head, the Surgeon in Chief, and the Vice Chairs faculty/Mentoring_Program.htm). They have of Education and Research. The scores are then worked closely with the Faculty of Medicine’s averaged by the Department Chair, and the total Centre for Faculty Development (https:// score is used to inform the practice plans for cfd.utoronto.ca). As the literature continues redistribution of Academic Enrichment Fund to illustrate the increased productivity and (AEF) and Alternate Funding Plan (AFP) monies.

18 Five Year Review 2009-2014 in which the University Division Chairs of Vascular and Cardiac Surgery have come together to establish a clinical, research and fellowship program to provide state-of-the-art care for patients with mid to upper complex aortic pathologies. • We have built on existing collaboratives to strengthen infrastructure required for great success. Examples include collaboratives with the Spine, Hand, Surgical Oncology, Trauma, • In the absence of a defned retirement age, Burn and Sports Medicine Programs which the Department of Surgery has developed have all grown stronger through increasing Guidelines for Late Career Transition. These infrastructure and priority to each. An example guidelines state that Department members of a developing program is the Breast Surgery should develop a transition plan as they Program which involves surgeons and health approach the end of their surgical careers; care workers at Sunnybrook Health Sciences they should consult with the Surgeon-in- Centre, St Michael’s Hospital, and Princess Chief, Hospital Division Head, and University Margaret Hospitals. Division Chair in establishing such a plan; they • We have built on our international outreach should be encouraged to seek other academic program, and strengthen partnerships with opportunities such as teaching and mentoring health care systems regionally, national junior colleagues during this phase of their and globally. Examples of our outreach to careers; and they should move forward with distant regions include a cleft lip and palate plans for transition as they come off the active care program with “Operation Smile” (Greg on-call roster at the hospital. Borschel, David Fisher, Ronald Zuker); burn treatment in Bangladesh (Toni Zhong), and in v) Integration and Outreach: We will Kenya (Leila Kasrai); and a Ukraine pediatric consolidate our expertise in global impact. neurosurgical fellowship program (James Faculty Lead Rutka and Mark Bernstein). Avery Nathens • Examples of capacity building in different regions include Georges Azzie and lapascopic Signifcant Developmental simulation training in Botswana; Peter Chu Milestones: and surgeon training in Niger; Ted Gerstle • We have empowered University Division and educational development in Addis Ababa; Chairs to promote integration across their Mojgan Hodaie and neurosurgical online hospital sites. An example of this initiative is education in Ghana and Iran; and John Hagen the cross-credentialing effort of members of the and laparoscopic training in China. Division of Vascular Surgery in which vascular • Thanks to the generosity of Mr. Ash Prakash, surgeons will be able to share expertise readily we have established annual Prakash Foundation across the different vascular units by being fellowships for surgeons from low income credentialed across all hospitals. Another countries who come to the University of example is the development of the Toronto Toronto to take part in active clinical surgical Aortic Collaborative and fellowship initiative

Five Year Review 2009-2014 19 a monthly e-newsletter of communications (known as Excelsior); to engage the Department in social media including Facebook pages and a Twitter feed; and to prepare a rapid e-news communication vehicle (known as e-clips). Accordingly, Ms Stephanie Neilson was assigned to these communications tasks which have truly assisted in our ability to reach out to faculty and to maintain their engagement with the Department of Surgery. To engage faculty and alumni further, fellowships. Some of the countries where we have added dimensions to the “Surgical fellows have previously come from include Spotlight”, a bi-annual print newsletter started Nigeria, Indonesia, and Ethiopia. by Dr Richard Reznick which is mailed to all • Finally, we have established a new academic present and former members of the Department. role in the Department of Surgery entitled: The Surgical Spotlight is a highly newsworthy “Surgeon: Global Health”. A job description newsletter which includes information on has been prepared for this academic role, and new faculty recruits, achievements by faculty the frst surgical faculty have entered this newly members, columns from the Editor-in-Chief, designated academic stream. Martin McKneally and Chair James Rutka.

As mentioned, we are well along the way with our goals in the Department of Surgery Strategic Plan. Enabling and supporting strategies include advancement and fundraising; building on the supporting infrastructure; and delivering rapid and timely communications to all constitutents. The Executive Committee of the Department of Surgery provides the implementation oversight and guidance for the plan, and has developed measures and key performance indicators for all pillars of the plan. We have been very fortunate to have hired a full-time strategic planning implementation coordinator in Joanna Giddens who has helped us stay on course with the plan. e) Academic Performance: d) Communications: The Department of Surgery lays claim In 2011, a full-time communications to hundreds of publications and grant awards – expert was hired in the Department to prepare too numerous to mention here – and these can and send out timely information to all faculty, be found in the Supplementary Materials of this residents, fellows and students; to maintain 5 year review (page 321-336). Suffce it to say our website in an up-to-date fashion; to create that the Department of Surgery publishes on

20 Five Year Review 2009-2014 Several faculty members have communicated their expertise to the world via the popular “Ted Talk” series found on You-Tube. Examples of faculty who have delivered Ted Talks include: a) Dr Shaf Keshavjee on in vivo lung repair and regeneration https://www.youtube.com/watch?v=T2EmuyHoMAI b) Dr Andres Lozano on deep brain stimulation for depression and Alzheimer’s Disease http://www.ted.com/talks/andres_lozano_parkinson_s_depression_and_the_switch_that_ might_turn_them_off?language=en c) Dr Ori Rotstein on multiorgan trauma and resuscitation https://www.youtube.com/watch?v=wlAoykZBA_g ; and d) Dr James Rutka for his research work on pediatric brain tumours https://www.youtube.com/watch?v=P21CeQGlB1w

average 1,400 papers in peer reviewed journals f) Chairs and Chairholders: each year, with a total of 7,000 papers from 2009 The Department of Surgery is well – 14. While the vast majority occur in good to endowed with Chairs that have been established excellent specialty journals in surgery, there are at the University, at the various fully affliated numerous examples of faculty members who hospitals, and jointly between the two. On average, have published as frst or senior author in high each endowed chair is valued at $3 Million, and impact journals such as Nature, New England supports the academic efforts of the chairholder Journal of Medicine, Cell, Science Translational towards enhanced research, teaching, creative Medicine, Lancet, and JAMA. professional activity, and surgical innovation. Grant capture in the Department of There are currently 3 endowed University Surgery has averaged $43,117,754.56/year with a Chairs (Langer Chair, General Surgery; Dan total of $215,588,772.78 million from 2009 – 14. Family Chair, Neurosurgery; and Barkin Chair, Grants have been earned by faculty from major Urology). There are 4 Joint University – Hospital peer review funding agencies such as CIHR, Chairs; 36 Hospital – University Affliated NSERC, Heart and Stroke, Canadian Cancer Chairs; and 20 Hospital Chairs, making a total of Society, and Canadian Foundation for Innovation. 63 endowed Chair position for members of the Department of Surgery, for a total value of over $150 Million to support the Academic Mission in the Department. The distribution of the various Chair positions across all the Divisions is shown in Table 1.

Five Year Review 2009-2014 21 Table 1. Endowed Chairs by Position Endowed Chairs by Division

Needless to say, the establishment of The Department of Surgery has 10 Canada these Chair positions becomes a very positive Research Chairholders (CRC’s) (Table 2). and strong recruitment and retention strategy CRCs are highly competitive research support within the Department, and enables devotion to mechanisms to ensure that faculty surgeons can research and innovation which otherwise would have suffcient protected time for their research. not be possible. Table 2. Canada Research Chairs

22 Five Year Review 2009-2014 g) Promotions: worthy of promotion are then forwarded to the Academic promotion remains a cornerstone Decanal Committee in the Faculty of Medicine institution in the Department of Surgery in the for adjudication. Faculty of Medicine at the University of Toronto, We have indeed been fortunate with and all faculty members strive to be promoted those members of the Department who have up the ranks towards full professor status. The successfully gone forward for promotion. From Department of Surgery’s Promotions Committee 2009-14, we have had 77 successful applications has stakeholder membership across all Divisions, and 4 unsuccessful applications. The distribution and reviews applications for promotion in the fall of faculty members who were promoted in the of each academic year. The applications of those Department across the Divisions over all years surgeons whose accomplishments are deemed can be found in Table 3. Table 3. Promotions by Division 2009-2014

Promotons by Division 2009 - 2014

h) Appointments: process is deemed fair and transparent by all. i) Recruitment New Faculty: The composition of such Search Committees Unlike many of the Clinical Departments typically includes the Department Chair, in the Faculty of Medicine, the Department of University Division Chair, Hospital Division Surgery is one of the few which mandates that all Head, Divisional Faculty Members, Vice new recruits to the Department are the productive Chair Research, Hospital Research Institute of active, open, and external, search processes. representative, Hospital Vice President Medical While this can pose some logistical issues in Affairs, and Surgeon-in-Chief (see Appendix A– terms of gathering all relevant stakeholders (page 316) Personnel on Search Committees). together at search committee meetings, the

Five Year Review 2009-2014 23 From 2009-14, there were 63 new recruits Table 4. New Full-time Recruits to the Department of Surgery. Of these, 53 were by Year 2009-2014 frst time faculty appointments in the different University Divisions. Ten were appointees at mid- to senior levels. The number of new recruits as a function of year is shown in Table 4; the distribution of new recruits over time across the different Divisions is shown in Table 5.

Table 5. New Full-time Recruits by Division 2009-2014

A concern which has been expressed regard, we are in the process of developing best in the Review of the School of Medicine practices in the conduction of Search Committee Accreditation document from 2012 (Committee Processes to include defnitions of diversity on Accreditation of Canadian Medical Schools and implementation of strategies to ensure that and the Liason Committee on Medical adequate diversity is achieved in such searches. Education (LCME) in the US ) (https://www. afmc.ca/accreditation/committee-accreditation- ii) Appointment of University Division canadian-medical-schools-cacms) is the Chairs: incomplete degree of diversity noted amongst As is customary in the Clinical Departments the faculty in many of the Clinical and Basic at the University of Toronto, University Division Science Departments. While the Department Chairs in the Department of Surgery serve at of Surgery has not been singled out in this the discretion of the Department Chair for a

24 Five Year Review 2009-2014 period of 5 years, renewable upon successful was appointed SIC at St Joseph’s Hospital in completion of a 5 year term, for an additional 2013; 5 years. Under exceptional circumstances, a University Division Chair who has completed iv) Other Leadership Appointments: two 5 year terms may be asked to remain in the Oleg Safr was appointed as Director position for an additional year or two, or for of the Surgical Skills Centre (2012); George another term depending on circumstances. The Christakis as Director of Undergraduate Medical Department Chair leads all University Division Education; Sender Herschorn as Director of Chair searches, with broad representation across the Departmental Promotions Committee; the Division serving on the Committee. Andrew Pierre, Program Director of Thoracic From 2009-14, external searches were held Surgery; Abhaya Kulkarni, Program Director for 13 number of University Chair positions. of Neurosurgery; George Oreopoulos, Program Andres Lozano was appointed as Chair of the Director of Vascular Surgery; Helen MacRae, Division of Neurosurgery in 2009; Tom Waddell Program Director, Colorectal Surgery; Bob Bell, was appointed as Chair of Thoracic Surgery in Deputy Minister of Health, Ministry of Health 2010; Neil Fleshner was appointed as Chair of and Longterm Care; Andy Smith, VP medical Urology in 2012; Tom Forbes was appointed as affairs, Sunnybrook Health Sciences Centre; Chair of Vascular Surgery, 2014; Peter Ferguson Mauric Blitz was appointed as the Director of was appointed as Chair of Orthopaedics, 2014; the Surgical Foundations Course, 2013; Michael and Carol Swallow was appointed as Chair of Fehlings was appointed as the Vice-Chair General Surgery, 2014. Research in the Department of Surgery, 2014.

i) Continuing Appointment Reviews: iii) Appointment of Hospital Surgeon-in- While too numerous by name here, Chiefs: many faculty appointees underwent their The appointment of Surgeon-in-Chiefs Continuing Appointment Reviews (CARs) in (SICs) at the Hospitals is a process conducted the Department of Surgery from 2009-14. The by the Vice President of Medical Affairs at each CAR is considered an equivalent to tenure at of the hospitals with input from a large hospital- the University for clinical faculty. The CAR is based stakeholder group, and representation by typically performed in years 3 – 5 following a the University by the Department of Surgery faculty appointment. Failure to pass the CAR Chair. As with the University Division Chair could lead to grounds for dismissal from the appointments, the SICs are typically appointed Hospital, and from the University. Thankfully, for a 5 year term, renewable once upon this has not been an issue over the past 5 years. satisfactory review for another 5 years. From 2009-14, there were 70 who From 2009-2014, the following SIC successfully underwent their CARs. The appointments occurred: Shaf Keshajee was distribution across the various specialty sections appointed as SIC of the University Health of Surgery is found in table 6. Special thanks Network (2010); Carmine Simone was appointed are given to Ori Rotstein, Associate Chair as SIC at Toronto East General Hospital (TEGH) Surgery, who adjudicated over all CARs in the 2012; Avery Nathens was appointed as SIC at St Department of Surgery. Michael’s Hospital (SMH) 2012; Chris Compeau

Five Year Review 2009-2014 25 Table 6. Successful CARs by Division the Surgeon in Chief, and the Hospital Division Head. The Department is generating new ways in which its Late Career Faculty can become engaged in Hospital/Departmental activities that are both meaningful and productive to all parties.

l) Education: In the past 5 years, the Department of Surgery has participated in the accreditation cycles of the Medical School by the LMCE/CACMS for undergraduate medical education in May 2012, and the Royal College of Physicians and Surgeons accreditation of residency programs in April 2013. Both accreditations were successful for the Department. For the accreditation of the Medical School, the Department worked diligently with the Faculty of Medicine to ensure that the core curriculum in surgery, and student j) Retention: evaluations were at the highest level possible. At any given time, the Department faces For the Royal College Review, all programs in the challenges of losing distinguished and Surgery were accredited, with General Surgery accomplished faculty to other jurisdictions. and Urology requiring mandated external Where appropriate, the Department Chair works reviews in September-October 2015. assiduously with the University Division Chair, The Department is grateful to the time, the Surgeon-in-Chief, the Hospital Division energy and effort expended by David Latter, Head, and the hospital research institute to Departmental Vice-Chair of Education, Ronald produce a “retention package” for highly valued Levine, Director of PGME, and George surgeons. This approach has been used on several Christakis, Direct of UME. Their detailed occasions in the past 5 years to the great beneft reports are found on page 60 of this 5 year review of the Department. Given the Department’s document. evanescing budget, however, contributions from the Department may wane unless further m) Research: strategies are employed to increase the amount One of the main goals of the Department of funding available. since 2011 was to work towards a ranking within the top 5 of all Departments of Surgery k) Transition: worldwide as measured by peer-reviewed The Department has now developed publications, grant capture, and exemplary guidelines for Late Career Transition planning clinical practice. The Department has worked for all surgeons. Ideally, the conversation begins steadily towards this goal. Special thanks is many years before retirement. The dialogue is given to Michael Fehlings current Vice Chair of initiated with the University Division Chair, Research, and Benjamin Alman, past Vice Chair

26 Five Year Review 2009-2014 of Research for all they have done to support the The Surgeon Scientist Training Program Departmental mission for accomplishment in (SSTP) remains the signature initiative within research. the Department that continues to train residents An analysis in scholarly research and towards higher degrees of the publications each year. It is remarkable that since its inception within the Faculty in 1983, the SSTP has trained over 350 residents of Medicine in of whom almost 100 have enrolled in doctoral the University programs. The SSTP requires almost $1.5 of Toronto Million annually of support to run effectively. between 2010 – Sources of support are being actively sought 2014 revealed each year. a total number More than 200 faculty are engaged in of publications research at some level in the Department. of 35,705 (data Since 2009, more than 7,000 publications have courtesy Elizabeth emanated from the hands and hard work of Perill, Executive Publisher, Surgery, STM Departmental members engaged in research. Journals, Elsevier, New York, and SciVal and Over the past 5 years, research funding has Scopus). The “Surgery” journal category accounts grown from $38.7 Million in 2009, to $43.2 for approximately 5% (2,447 publications) of the million in 2014. entire University’s publication output. The Field Department of Surgery members celebrate Weighted Citation Impact for Surgery output is their research accomplishments each year at 1.54. The world average citation impact is 1. Gallie Day during which faculty, residents, If an institute’s citation impact output is below fellows, scientists, and trainees present their 1 the institute is performing below the world work. average. If an institute’s citation impact output The full report of Research from the is above 1 the institute is performing above the Department of Surgery can be found on pg. 74. world average. Of the top 50 most prolifc authors/ n) Major Awards Recipients: investigators in the Faculty of Medicine at the Each year, Department of Surgery Faculty, University of Toronto, 10 (20%) are within the Residents and Fellows distinguish themselves Department of Surgery. When ranked against by receiving numerous awards which bring some of the other major institutions in North credit to the standing of the Department within America, the Department of Surgery at the the University, Provincially, and across Canada. University of Toronto compares favourably with The Department gives out several awards Harvard Medical College, Duke University, annually at Gallie Day. The Departmental faculty University of Washington, UCSF, and University receives awards from the Faculty of Medicine, of Pittsburgh. Postgraduate Medical Education Offce, The Department is engaged in all areas of Undergraduate Medical Education Offce, and research endeavor including translationaally the University of Toronto. In addition, there oriented basic and pre-clinical science, clinical are numerous Divisional awards for education, epidemiology, health outcomes and policy research, and exemplary clinical practice. research, and research into state-of-the-art educational initiatives.

Five Year Review 2009-2014 27 Department of Surgery Faculty are worthy recipients of some of Ontario’s and Canada’s top awards and honours such as Canada Research Chairs, Induction into the Canadian Medical Hall of Fame, Royal College of Physicians and Surgeons, Canadian Institutes of Health Research, Order of Ontario, Order of Canada, Canadian Cancer Society, and Heart and Stroke Foundation. A listing of the major awards recipients from 2009-14 can be found in the supplementary information at: http:// surgery.utoronto.ca/about/Gallie_Day_Award_ Recipients.htm

o) Advancement: The Department of Surgery employs a full-time Senior Development Offcer (SDO) from the Faculty of Medicine who assists the Department Chair, and Divisions Chairs, among others with fundraising strategic goals. Ms. Darina Landa was the appointed SDO from 2009-14, and with her help, and assistance from the University Division Chairs, a total of $16.1 Million was raised in the Department of Surgery. Advancement funds take the form of direct donations, alumni appeals, support from Industry, fellowship funds, support of endowed Chairs, and others. The Department has built lasting relationships with donors, volunteers and alumni.

28 Five Year Review 2009-2014 Table 7. Advancement Funding for 2009-2014

In 2011, the Department spearheaded what The Department has been focused on has now become an annual alumni mailing, strengthening relationships with our fully which has strengthened relationships with alumni affliated hospitals; ensuring Departmental around the world and to date has raised a total of priorities are strategically supported, while $200,000, increasing and elevating advancement creating a foundation of collaboration on which activities for the Department. Furthermore, the productive fundraising activity can take place. Department has led a concerted effort to more Examples of this activity include: 1) Support meaningfully engage with the Department’s for the Surgical Skills Centre, for which an alumni by reviving and re-invigorated the updated MOU with Mt Sinai Hospital and joint- Surgical Alumni Committee, and recruiting a fundraising agreement with the University of new Chair to this position. Toronto and Mt. Sinai Hospital Foundation was As part of the $2 Billion Boundless campaign created; and 2) The at the University of Toronto, the Department creation of the city- supported the creation of a campaign video and wide Brain Tumour case for support (https://www.youtube.com/ Bank Network, which watch?v=qDnpgizz3Oo), which were not only led to developing extremely effective fundraising tools, and the partnerships between frst of their kind for any Department within the four hospitals and Faculty of Medicine, but also an inspiration and securing a $2 million model for other Departments to create similar philanthropic donation marketing and campaign fundraising tools. for this project.

Five Year Review 2009-2014 29 p) Departmental Firsts: From 2009-14, several new initiatives were put into place within the Department of Surgery to help support its vision and mission, and to reach its strategic goals. Some of the more important and interesting ones are enumerated here as follows:

30 Five Year Review 2009-2014 q) Strengths and Challenges: Faculty Development, there is the annual Faculty Strengths: Development Day and the Mentoring Program; The Department of Surgery is the largest and in Integration, there is the establishment of of its kind across Canada when one considers the the Surgeon:Global Surgery Academic Role. numbers of medical students, residents, fellows, With size and demonstrated strengths, there are and faculty who are a part of its programs. By defnitely challenges that are faced. virtue of its size and talent pool, the Department lays claim annually to an enormous number of Challenges: high impact peer reviewed publications, grants, Given the size and the complexity of honours and awards. Innovation is evident at a the Department of Surgery, Departmental high level in virtually all pillars of the strategic organization continues to be a challenge. The plan. For Education, an example is the highly Chair works in synchrony with the Executive touted CBC in Orthopaedics; for Research, there Committee and the Senior Advisory Committee is the highly successful and sought after SSTP; to ensure that the Department remains operational for Quality and Best Practices, there are the and synergistic. achievements of the Best Practices in General Learners are fearful of the dire job market Surgery (BPiGs) collaborative across the city; for in General Surgery and all surgical specialties.

Five Year Review 2009-2014 31 This has prevented talented medical students continue to offer and run this program which has from considering career paths in surgery, and has been so successful for the Department. created signifcant angst for residents who are Ongoing fnancial constraints present about to enter the job market. In 2013, the Royal signifcant challenges for the Department. At College of Physicians and Surgeons produced a this time, the Department of Surgery is the only report which has examined employment issues Clinical Department that pays a stipend to all in specialties across Canada (http://www. full-time faculty, a practice that was based on royalcollege.ca/portal/page/portal/rc/common/ “historic hard dollars” which were allocated documents/policy/employment_report_2013_e. to individual faculty members many years ago pdf). It was noted that employment issues without signifcant accountabilities. Given the are most pronounced for resource-intensive large number of new recruits to the faculty in the specialists such as surgeons. Perhaps as part Department, the various retention packages that of the perception that there may be too many have been offered to valued faculty members, underemployed specialists in Ontario, the the health care benefts that have been offered to MOHLTC is reducing the number of residency faculty, the expenses associated with successfully positions in surgery over the next 5 – 10 years. implementing the goals of the strategic plan, and While not an immediate challenge, the impact of the reduction in the support from the Faculty of these reductions will be felt within a few years. Medicine, the Department will need to contrive Because the Department has traditionally an alternate means of business modeling to stay been a highly academic enterprise that values fnancially solvent over the next 5 years. and supports surgeons conducting research and who are academically productive, there is r) Future Directions: a concern and perception that the role of the Despite the fscal concerns that face all Surgeon:Teacher may be under-appreciated or academic Departments at the University of devalued. Restoring the importance and value in Toronto, and perhaps across all Universities in the large cohort of educators in the Department, Canada, the future of the Department continues to and providing them with support they need look bright and promising given the tremendous to be successful will be a core mission of the talent pool and academic achievements of Department. individual faculty members, and the programs Recent changes in health research funding that are in existence, and ones that continue to has created risks for all surgeons and scientists evolve. in their careers. The creation of alternate There is no question that identifcation of funding streams and mechanisms will thus be an alternate revenue streams will be an extremely important goal for the Department in the years important future direction of the Department ahead. to support research endeavours, such as the The SSTP is currently in risk of being SSTP, education, faculty development, and inadequately funded. This is in part due to the BP/Q initiatives. Some of these revenue numbers of residents who are enrolled in the streams will come from additional efforts in program, and the reality that a higher percentage advancement directed by the Department and of residents are not receiving externally funded by the various Divisions; some will come from awards as they did in the past. Here again, industry partnerships in the form of unrestricted alternate revenue streams will be essential to educational gifts; and some will be derived from

32 Five Year Review 2009-2014 the offering of new CPD courses by the Divisions There can be no question that based on its under a new business model for CPD. major investment in competency based training, It also seems clear that a new model for the Department can be a leader in assisting all providing stipendiary support for faculty in Divisions in Surgery and other Departments the Department will need to be developed. in achieving a competency based assessment The practice of providing historic hard dollars curriculum. The work already established in the to all faculty members irrespective of their Division of Orthopaedics heralds considerable contributions to Departmental activities now excitement across the country. seems antiquated and untenable, especially The Department is eager to implement its when one considers that the Department of “Late Career Transition” Guidelines as part of Surgery is the only Department to do this in the its efforts in Faculty Development. There have Faculty of Medicine. Rather, a system of “pay for already been some good examples of “graceful” performance” within or “pay for contributions” to transitions to retirement in several Divisions. Department of Surgery seems more appropriate. To accomplish such successful transitions Such a system could be devised by the Finance will require an early dialogue with all faculty Committee of the Department with stakeholder members, and with clear cut expectations approvement across the various institutions. about planning for exiting clinical practice by There is an opportunity for the Department increasing teaching or research or mentoring to be a leader in future simulation efforts in opportunities while one’s clinical practice is the Faculty of Medicine. With the assistance diminishing by design. of the Dean, and with collaboration of other The Department will continue to explore Departments (e.g. Anesthesiology, Medicine, the use of communications and social media Obstetrics/Gynecology), the Department has opportunities to advance its global outreach and much to give to this effort with ongoing projects impact. Promulgation of the Department’s core at the Surgical Skills Centre, the Li Ka Shing values through the activities and accomplishments Knowledge Institute, Sunnybrook Health of its talented faculty members has already Sciences Centre, Sick Kids, and UHN.

Five Year Review 2009-2014 33 begun, and will be continued. The hiring of a Finally, the Department will continue to Medial Artist has recently been accomplished to leverage its proximity to Queen’s Park and the assist with Departmental branding, packaging Ministry of Health and Longterm Care to help of content, and providing professionalism to all set the agenda for surgical care of Ontarians communications. through adherence to Q/BP initiatives that have been led by Departmental Faculty members.

5. ORGANIZATION AND FINANCIAL STRUCTURE:

1. Organization Vascular Surgery) and 4 sub-specialty entry The Department of Surgery is comprised programs (Pediatric General Surgery, Colorectal of a strong network of faculty and learners,and Surgery, Surgical Oncology, and Thoracic traverses six fully-affliated hospitals and an Surgery) with a total enrollment of 204 trainees. expanding number of community-affliated The Department of Surgery has the largest hospitals. We have 268 full-time clinical fellowship training program across Canada with faculty, 100 part-time clinical faculty, 170 adjunct 250 fellows from over 15 countries coming each clinical faculty, 7 anatomists and 42 research year to learn the nuances of specialty surgery. scientists. We are responsible for the surgical There are more surgical fellows who train in teaching of our 225 medical students throughout Toronto than collectively are trained across the four years of the undergraduate curriculum. the rest of Canada (Table 8). Interestingly, We oversee eleven residency programs including the Division of Anatomy is housed within the 7 CaRMS entry Royal College of Physicians and Department of Surgery in a relationship that has Surgeons (RCPSC) programs (Cardiac Surgery, been mutually productive and benefcial for over General Surgery, Neurosurgery, Orthopaedics, a decade. Plastic and Reconstructive Surgery, Urology, Table 8. Number of Clinical Fellowships vs. Other Universities 2009-2010

34 Five Year Review 2009-2014 Clinical faculty members in the Department Chair, and determines the distribution of time of Surgery hold concurrent appointments in between clinical care, education, research either fully-affliated or community-affliated and administration. At present, there are four hospitals. The faculty are also organized into academic roles from which faculty members can choose. They include: Surgeon-Scientist eight Department-wide specialties (Cardiac (55 faculty); Surgeon-Investigator (115 faculty); Surgery, General Surgery, Neurosurgery, Surgeon-Teacher (96 faculty); and Surgeon- Orthopaedics, Plastic and Reconstructive Global Surgery (2 faculty). Surgery, Thoracic Surgery, Urology, and Each year, the full-time clinical faculty are Vascular Surgery). There is a close working reviewed and assigned an academic score based relationship between the University Department on their activities for the calendar year in review. of Surgery and the Hospital Departments of The domains in which surgeons score points Surgery. Faculty members are accountable to include research, teaching, creative professional their University Division Chair and Department activity, administration, academic rank, and citizenship. Each category is assessed on a point Chair for their academic activities and to their scale of 0-3, as per Table 9 below, with the Hospital Division Head and Surgeon-in-Chief exception of the citizenship category. This score for their clinical activities. Each full-time is then weighted in a variable fashion in each clinical faculty member is assigned an academic category depending on an individual’s academic role with a corresponding job description. The role. For example, a Surgeon-Scientist will be job description is developed jointly by the given a score in research and that score will be Surgeon-in-Chief, Hospital Division Head, multiplied by a factor of 3, whereas his/her score University Division Chair and Department in teaching will be multiplied by a factor of 1.

Table 9. Academic Point System

Five Year Review 2009-2014 35 Table 10. Department of Surgery Organizational Chart

36 Five Year Review 2009-2014 With such a large Department including The Department administrative staff multiple hospitals and large numbers of faculty consists of 10 full-time employees of the and students, the governance structure that University. These individuals oversee the has evolved is one of a matrix authority. The following areas of administration: Finance, Department leadership consists of the Chair; human resources, academic appointments, Associate Chair; Vice-Chairs of Research, faculty promotions, postgraduate education, Education, Clinical, Innovation, Global Outreach/ Integration and Quality/Best Practices; Chairs of undergraduate education, communications, and all nine divisions (including Anatomy); Directors strategic initiatives. The administrative staff is of Undergraduate, Postgraduate and Continuing located in the Stewart Building at 149 College Professional Development; Surgeons-in-Chief; Street West, 5th foor, along with the senior and Hospital Heads (Table 10, previous page). academic administrative leaders.

All major decisions made in the Department 2. Financial Structure stem from broad consultation across our leadership team. To assist with the implementation of a fairly The Department’s operating budget consists fat hierarchical organization, the Department has developed several organizational structures. of University base funds specifcally earmarked These include a number of main committees: for Departmental expenditures and the Division an Executive Committee consisting of the of Anatomy; T&R (teaching and rehabilitation) Chair, Associate Chair and Vice-Chairs; a funds received from the Ministry of Health and Senior Advisory Committee consisting of Long Term Care (MOHLTC); and postgraduate approximately 25 individuals in key leadership expansion funds (Pool A), international medical positions in the Department of Surgery (Table graduates (IMG’s) (Pool B), and funds received 11); a Finance Committee and a Departmental for Visa-sponsored trainees (Pool C). These Appointments Committee. In addition to these funds are used to administer the operational committees, every four months, the Chair meets individually with each of the 25 members of the expenses and for academic stipends paid to full- senior leadership team. time clinical faculty with specifc academic job descriptions. Table 11. Senior Advisory Committee In 2013-14, the budget for the Department of Surgery, considering all sources of revenue, was $5.8 million. Please note that unlike other Departments of Surgery in other jurisdictions, at the University of Toronto, the Department of Surgery does not tax practice plan/clinical earnings in any of its Divisions. Stipendiary support is provided to all members of the Executive Committee for their efforts in steering the strategic directions of the Department; in addition, leaders in Surgical Education and Research, University Division Chairs, Surgeons-in-Chief and Hospital Division Heads receive stipends commensurate with the

Five Year Review 2009-2014 37 time commitment involved with their positions. based on an individual’s academic role. The The amount of funding going to Senior decision to do this was suggested and approved Leadership, Hospital Heads and Educational by the Departmental Finance Committee and Leads is shown in Table 12 (next page). was based on an opportunity to harmonize Departmental salaries, and to offset signifcant Table 12. Stipendiary Support budget decreases. 2014-2015 The realignment of funds allows the Department to implement programs and initiatives according to our strategic plan. The Department continues to invest efforts in increasing endowment funding, working collaboratively and appropriately with industry, and identifying new philanthropic donor pools of funding. At this time, the Department of Surgery is the only clinical Department in the Faculty of Medicine which provides a salary stipend to all full-time faculty members which is based on historic salary allocations. These stipends are paid to faculty according to their academic role. Notwithstanding the diminution in base Surgeon-Scientists receive $20,000 for the frst budget funding each year, the Department has 5 years, after which they receive $14,000/year; used these funds to: Surgeon-Investigators receive $15,000/year for 1. Strengthen, support and renew faculty the frst 4 years, after which they receive $7,000/ development year; and Surgeon-Teachers receive $2,000/ 2. Enhance teaching and enrich the student year on an ongoing basis. Table 13 (next page) experience outlines the distribution of funding by academic 3. Enhance productivity and impact of research role. 4. Promote innovation in research, teaching and Table 13. Remuneration by Academic clinical practice Role 2014-2015 5. Build international outreach and strengthen partnerships nationally and globally 6. Integrate best practices and quality across departmental programs 7. Explore and establish alternative sources of revenue

To achieve this, funds are re-allocated from within the Departmental budget on an annual basis to refect the above priorities. For example, in July 2014, all academic stipends paid to clinical faculty were re-allocated according to a compensation formula which was

38 Five Year Review 2009-2014 While the Department of Surgery has had, full-time faculty member in the Department of and continues to have a carryforward amount Surgery must belong to a conforming practice at the end of each fscal year (see Table 14), it plan of one of the fully-affliated hospitals can be seen that this amount is being reduced and approved by the Department Chair. All annually. The reasons for the reduction in annual funding fowing through the practice plans at the carryforward is multifactorial, but include the hospitals are taxed by the hospital based practice following: 1) recent high level recruitment plan. It is the practice plan that provides the base packages for new faculty; 2) expenditures for salary support for members of the Department new strategic goals and directions; 3) fuctuations of Surgery. The purpose of these practice plan in funding for the Surgeon Scientist Training agreements is to ensure transfer of funding to Program; 4) annual increases in administrative an Academic Enrichment Fund (AEF) to offset staff salaries; 5) retention packages for key the clinical income loss for those surgeons Department of Surgery faculty members; 6) who are actively participating in research and increased cost of benefts to faculty members teaching roles in the Department of Surgery. (e.g. critical care insurance, day care subsidy To help support the educational mission in and health care); and 7) reduced central budget the Department of Surgery, the practice plans allocation from the Faculty of Medicine. annually receive funding from the MOHLTC Practice plans are instrumental to the Alternate Funding Plan arrangement. viability of the academic surgical mission. Every

Table 14. Budget Carryforward

Five Year Review 2009-2014 39 6. RESOURCES AND INFRASTRUCTURE

In 2013, the administrative offces of the Department of Surgery were relocated to the Stewart Building (149 College Street) after having been in the Banting Institute (100 College Street) for over 80 years. Renovation and refurbishing of the space was generously provided by the Faculty of Medicine who also provides funding to pay for the rental fees on an annual basis. The Chair, the Departmental administrative staff, the University Divisional offces for General Surgery, Orthopaedics, Plastic and Reconstructive Surgery and Urology, along with the Educational Directors are located on the 5th foor of the Stewart Building. The offce space is comprised of 4,210 square feet that is primarily open-concept for the administrative staff, with enclosed offces for the Chair, Business Manager, and Divisional In 2011, with the appointment of Dr. Rutka Offces. Semi-private work-modules exist for as Chair of the Department, a decision was the Education and Research leads. made to convert all computer workstations to A state-of-the-art conference room has Macintosh products. As these computers are been fully equipped for telephone and video- nearing the end of their life-cycle, they will need conferencing, and is the location for all Executive to be replaced in the next 1-2 years. and Senior Advisory Committee Meetings, along As the Department continues to grow, we with meetings for Continuing Appointment will require more space for offces and document Reviews, Departmental Searches, and Strategic storage. Planning Committee among several others. The Department is constantly reviewing All Divisions in the Department of Surgery their fnancial structure in order to deal with the have access to booking the conference room as signifcant budget reductions each year. required for their activities.

40 Five Year Review 2009-2014 7. EDUCATION

Report Provided by David Latter, Vice-Chair Education; George Christakis, Director, Undergraduate Education; and Ronald Levine, Director, Postgraduate Education

Education and educating learners remain a core career path that several faculty members pursue business of the Department of Surgery. Each in order to be promoted to higher academic year, members of the Department, including ranks. The goals of the Educational pillar of faculty, residents and fellow, garner a signifcant the 2012-2017 Strategic Plan – Transforming number of teaching awards across the Faculty Surgery Beyond the Cutting Edge – include the of Medicine. Educational scholarship remains a following:

With these goals in mind, the Department Undergraduate Education is headed by the has advanced its curriculum and training across Director of Undergraduate Education and is the spectrum of learners. supported by a full-time coordinator as well as Report on Undergraduate Medical several other hospital site administrative staff. Education: The Undergraduate Education Committee has The Department of Surgery’s representation across the various Divisions and Undergraduate Education Offce oversees and welcomes participation of medical students. coordinates various surgery-related programs, In addition, the offce is complemented by the initiatives and courses over the University of Director of Pre-clerkship as well as faculty Toronto’s 4-year MD/Ph.D. program as well support at various levels. as to medical students from within Canada and various parts of the world. The Offce of

Five Year Review 2009-2014 41 Undergraduate Education is an important 8-week experience. and integral part of the Department of Surgery’s • The implementation of a combined Medicine- Education portfolio and looks to provide Surgery OSCE, run centrally by the Faculty of the highest levels of surgical instruction and Medicine. exposure to the brightest minds that make up the medical students within Canada and across the • The elimination of phase I and phase II world. rotations with completion of all rotations, by Education is an exciting and dynamic feld all students, prior to the CaRMS period. The that needs to change along with the needs of society, latter portion of the fourth medical school year new learning techniques and teaching styles as is used to focus on synthesis of information and well as constant advancements in technology. performance of “selectives.” From 2009-14, a number of innovations and 3) A surgical clerkship was initiated in 2011 in new programs have been introduced into the which the 8-week clerkship begins with a week curriculum, and Undergraduate education in the long ‘Crash Course in Surgery,’ a series Department refects these changes. of seminars and hands-on technical skills In May 2012, the Department of Surgery sessions, designed to provide students with participated in the accreditation cycle of the an overview of the surgical specialities Medical School by the LMCE/CACMS for and an opportunity to learn fundamental undergraduate medical education in May procedures. Following the Crash Course, 2012. Prior to the review, it was clear that students complete three sub-rotations. One the Department had issues in undergraduate two-week rotation followed by another medical education which potentially threatened two-week rotation and end with a three- a successful accreditation of the Medical week rotation. Students have input into their School. The Department worked diligently choice of rotation and the Surgical Education with the Faculty of Medicine to ensure that the offces do their best to accommodate. curriculum and training in surgical education Additionally, General Surgery was mandated was met with strong evaluations by the students. as a mandatory rotation. It was the opinion of This indeed proved to be the case, and some of the Undergraduate Education Committee that the reasons why the Department contributed to there are certain experiences that the General the successful review of the Medical School can Surgery rotation most reliably provides. be enumerated as follows: 4) Evaluation of the new clerkship changed in 2011 1) In 2010, the surgery clerkship course expanded to include a performance-based examination; to include St. Joseph’s Health Centre and observed directed history and physical Humber River Hospital. The inclusion examination; three structured oral questions; of these two community affliated sites and the written NBME shelf examination provided third year students with valuable to serve as the equivalent to the “MCQ” “community” experiences. exam. Here, UofT students excelled on the 2) The implementation of a new clerkship surgical questions when compared against curriculum commenced in September of international benchmarks for this exam. 2010. These curricular changes included: 5) A mini retreat for undergraduate education • A reduction in the length of the Surgical headed by Drs. Rutka and Latter took place in Clerkship from two 6-week rotations to a single late September 2011. Information provided

42 Five Year Review 2009-2014 by the student questionnaire in preparation 8) Recognizing the important role of residents for the medical school accreditation in May in educating medical students, in 2012 the 2012, was helpful in creating new ideas as “Resident Leaders of Undergraduate well as promoting the goals and objectives Education” role was establishing in the for education in surgery. The conclusions Department. With the help of the Director, from the mini retreat were that undergraduate Postgraduate Education and the Program surgical education will continue to be valued Directors, a core cadre of committed and as an important contributor to the Department enthusiastic teacher residents has been of Surgery and will be recognized through identifed to form the ‘Resident Leaders promotions, practice plan points as well as in Undergraduate Education.’ Their fnancial reimbursement. The strength of responsibilities will include, formalizing a this support for undergraduate education handbook on how to teach clerks as well as was further reinforced in the Department’s taking responsibility for education of their Strategic Plan meeting in Jan 2012. resident colleagues in the methodology and 6) T-Res was introduced at the Undergraduate organizational aspects of teaching clerks. Two Education offce as an electronic submission representatives from this group are also part system that students use to track the various of the Undergraduate Education Committee. case logs of clinical activity that they are 9) In 2013, The Surgery Clerkship website required to perform. If a lapse or lack of (portal) was comprehensively reorganized and progress is observed, actions are instituted revamped. Content for the crash course to ensure that the student is offered the sessions were updated and organized with opportunity to achieve these mandatory relevant readings posted for students to experiences. There has been 100% compliance review in preparation for each session. in the completion of T-Res requirements in Several other learning resources, including the Department. videos and access to relevant library materials are included. A mobile app was also 7) The Undergraduate Education Committee was created to enable students to access relevant expanded by 75% in order to allow for more information “on-the-go.” site representation. The Committee also 10) In 2013, several clinical clerks completed created a larger committee for undergraduate their rotations at the Medical Academy of education known as the Surgical Leaders of Mississauga (MAM). Student feedback has Undergraduate Education (SLUEs). Each been extremely encouraging. surgical division has appointed a divisional 11) To further the goal of delivering consistent director for undergraduate education who will and cohesive undergraduate education collaborate with other SLUEs in their division. across all sites, in 2014 the position There is now a SLUE from every division of Division Director in Undergraduate at every hospital. In this way there will be Education was established. This person is a facilitator for undergraduate education the spokesperson and Division lead on all representing every division at every hospital things related to Undergraduate Education. site. These committed and enthusiastic This person is responsible for undergraduate surgeon/ educators will facilitate every clerk’s teaching activities, teaching assignments, sub-rotation. and education-related communication

Five Year Review 2009-2014 43 within their Division, as well as to bring There is no question that Undergraduate Medical all the Surgical Leaders in Undergraduate Education in the Department will continue to Education (SLUE) in the Division for evolve and improve. The vision is to continue to regular meetings. provide students with quality of education and 12) The Longitudinal Integrated Curriculum instruction that is among the best in the world. (LInC) project was initiated in clerkship in the Report on Postgraduate Medical Education: Department of Surgery in 2014. The Dr. Richard Reznick stepped down as purpose of LInC is to provide a select group chairman after 8 years to become the Dean at of students an opportunity to remain on a Queen’s University in 2010. Dr. David Latter particular service for an extended period was the interim chairman for approximately of time throughout the year to enable them one year until our current chairman, Dr. James to gain experience in one discipline, build Rutka, assumed the role in April 2011. Dr. Rutka relationships with team members, and to has been an excellent leader for all postgraduate follow patients through their journey in activities in both time and fnancial support for hospitals from admission, to work up, to new initiatives. surgery, to recovery. The Department of Surgery at the 13) From 2009-14, the Undergraduate Education postgraduate level is the largest in Canada with Committee continued to provide oversight approximately 280 residents in total. There to several highly successful pre-clerkship are 11 surgical programs; 7 CaRMS entry and programs including the Surgical Education 4 sub-specialty programs. The backbone of the And Discovery (SEAD) program for frst 11 surgical programs is the dedicated Program year medical students (http://surgery. Directors and their administrative assistants. utoronto.ca/education/undergraduate/ Our surgical positions for all of our CaRMS SEAD_Program.htm), the Surgical entry specialty programs are sought after by Longitudinal Experience (SurgicLE), medical students from across Canada. All Student Surgical Skills Development (S3D) CaRMS entry surgical positions have been flled and the activities of the Surgical Interest in the frst iteration between 2009 to 2014 and Groups (SiG), to name a few. most residents matched to our programs are the top-ranked applicants. Many of the surgical specialties also take international medical graduates (IMGs) and visa trainees from around the world. Over the 5 years there have been several search committees and appointment of new chairpersons. These search committees have all been chaired and organized by Dr. Rutka. These newly appoint chairs have all been excellent and taken the Department of Surgery to the next level: Dr. Carol Swallow - General Surgery Dr. Christopher Forrest - Plastic and Reconstructive Surgery

44 Five Year Review 2009-2014 Dr. Tom Forbes - Vascular Surgery All of the PGY1 residents attend a surgical Dr. Peter Ferguson - Orthopaedic skills course in the fall. Each of the surgical Surgery specialties also runs their own courses where Dr. Agostino Pierro - Paediatric surgical skills specifc to their specialty are General Surgery taught. Lisa Satterthwaite is the Senior Manager Dr. Neil Fleshner - Urology of this unique lab and Dr. Oleg Safr took over The Program Directors and their as the Director of the Surgical Skills Lab from administrative assistant coordinate the everyday Dr. Helen MacRae and he has brought many running of the different specialties. There new changes to the lab. Our surgical skills lab is have been a number of changes to the Program one of the largest in Canada (see Surgical Skills Directors over the past 5 years: Centre page 95). Dr. George Oreopoulos - Vascular There have been a number of new Surgery academic initiatives over the past 5 years that Dr. Markku Nousiainen - Orthopaedic have continued to improve the delivery of Surgery an outstanding curriculum to residents in the Dr. Abhaya Kulkarni - Neurosurgery Department. They include: Dr. Gideon Cohen - Cardiac Surgery 1) The Department of Surgery Prep Camp was Dr. Frances Wright - Surgical Oncology introduced in July 2013 that was hugely Dr. Helen MacRae - Colorectal Surgery successful. This Prep Camp is mandatory for Dr. Andrew Pierre - Thoracic Surgery all PGY1 surgical residents and runs for the frst two weeks in July. It is an intense program The frst two years of training in surgery of didactic lectures and learning fundamental is known as Surgical Foundations. Besides surgical skills. There is an exam at the end of attending the specialty-specifc academic Prep Camp. Several of the surgical specialties endeavors, the Surgical Foundations residents have their own Prep Camp after the surgical attend a series of didactic lectures to prepare Prep Camp. them for Royal College Surgical Foundations The introduction of Competency Based exam and to make them better surgeons overall. Teaching and Assessment within all Divisions These didactic lectures are every Tuesday in the Department of Surgery. A retreat between 7:30am – 9:00am. In September 2013 was held in the Department of Surgery in the organization of these lectures was taken over January 2012 where one of the priorities by Dr. Maurice Blitz. There have been a number for Postgraduate surgery was to introduce of initiatives in Surgical Foundations. The Competency Based Teaching and Assessment. didactic lecture series has been changed from a There were several educational meetings 2-year program to a one-year program. Dr. Blitz on how to introduce competency-based has developed a national in-service exam for teaching for all program directors. We have Surgical Foundations and this exam is written by now initiated competency based teaching all residents across Canada. There are also three and assessment for all specialties and in the competencies that each resident has to achieve to future will coordinate this with “Competency pass Surgical Foundations: 1) 75% attendance by Design” as it is rolled out by the Royal at the didactic lectures; 2) passing the in-service College. exam; and 3) passing the Prep Camp.

Five Year Review 2009-2014 45 The offering of a number of didactic seminars, mandatory for all PGY1 and PGY2 residents journal clubs, M&M rounds, professor rounds and all 8 modules must be completed by the and teaching courses at the Surgical Skills Lab end of the PGY2 year. Each module takes 4 within each of the Divisions in the Department. – 5 hours to complete and there is an exam at the end of each module. The results of the The “Surgeon in Society” Course taught exam are provided to the resident, Program each July to the PGY1’s and 2’s in which Director and the Director of Postgraduate medicolegal issues are discussed. This is run Education. by Dr. John Bohnen and Dr. Ron Levine. The Resident as Teacher Day for the PGY1 and PGY3 residents taught by Dr John Murnaghan, which is a workshop to teach residents how to be better teachers. A Resident Orientation Day organized by Dr. Ronald Levine for all of our new frst year residents. ATLS training which is mandated for all frst year residents and coordinated by Dr. Jameel Ali at St. Michael’s hospital.

The establishment of a “Women in Surgery” All teachers in the De partment of Surgery group which was started in order to attract are evaluated by the residents on POWER and a female medical students into the surgical teaching effectiveness score (TES) is generated. specialties. This has been led by Dr. Carol- These scores are released to the faculty, Program Anne Moulton and has now become a balance Directors, Chairperson, Surgeons-in-Chief at and lifestyle group called “Life in Surgery” the specifc hospital, Director of Postgraduate which meets several times a year to deal with Surgery and the Chairman of the Department of the balance and lifestyle issues in surgery. It is Surgery. Faculty with chronically poor scores open to all medical students, residents, fellows meet with the Departmental Chair and PGME and faculty. Director to discuss strategies to improve teaching performance. Case log tracking on POWER is now A Faculty Development Day was introduced mandatory for all surgical residents. The in 2011 and it is held annually in the spring. It Program Directors can monitor the operating is directed by Dr. David Latter and all faculty experience of the resident at each hospital and with low TES scores are highly encouraged to can compare the experience from one hospital attend. Faculty Development Day is open for all to another using the data from POWER case other faculty members that wish to attend as the logging. purpose is to improve the teaching skills of the Postgraduate Core Education (PGCoreEd) surgical faculty. is a series of interactive modules based on The University of Toronto, Royal College the CanMEDS roles. There are 8 modules of Physicians and Surgeons and the Ministry including end of life care. These modules are of Health have all mandated an increased

46 Five Year Review 2009-2014 community experience for our residents. This The Department has developed its own mandate is known as Distributed Medical website of information on Clinical Fellowships Education and the Department of Surgery has (http://surgery.utoronto.ca/education/ been very supportive of this initiative. To meet fellowships.htm). Links to all Divisions which this mandate, the Department of Surgery has offer Clinical Fellowships are found on this site. increased the number of residents going to our Survey data from 2014 are available from community hospital affliates. The feedback Clinical Fellows within the Department. There from residents rotating through these community were 105 Respondents to the Survey (40%). hospitals has been excellent. Several challenges were faced by Clinical There are many awards in Postgraduate Fellows applying to Surgical Programs. These teaching to recognize excellence in surgical included diffculties with licensing, credentialing, teaching. There is an awards committee chaired and registration, levels of fellowship funding, by Dr. Robin Richards that meets regularly fnding suitable access to primary care, and to nominate surgeons for different awards. fnding affordable housing. The majority of Specifcally in postgraduate teaching there are fellows received between $50-75K per annum the Bruce Tovee Award for excellence in teaching as remuneration. The majority of clinical fellows by an attending and the D.R. Wilson Award for ranked their educational experience as above excellence in teaching by a resident. expectation or outstanding in the felds of mix and diversity of cases, quality of patient care Report on Clinical Fellows Education: experiences, quality of teaching, and availability The Department offers training to over 250 of procedures. When asked why they considered clinical fellows each year across all different a Clinical Fellowship in the Department, the specialty areas in Surgery. The Department majority stated that it was a unique training is indeed fortunate to have David Latter lead opportunity; that the clinical experience would efforts in clinical fellowship training, as he help them gain employment advantage; and that is also the Chair of the Fellowship Education they received highly advanced clinical training. Advisory Committee (FEAC) within the Faculty Naturally, the Clinical Fellowship Medicine at the University of Toronto (http:// experience is both Hospital and Mentor www.pgme.utoronto.ca/content/fellowship- dependent as the survey data indicated. The education-advisory-committee). Under Dr relationship between Residents and Clinical Latter’s leadership of FEAC, clinical fellowship Fellows is one that is constantly being monitored training goals and objectives have advanced by the Department. Data from the most recent enormously. The different Clinical Departments Royal College accreditation in 2013 suggested have adapted the policies espoused by FEAC that on balance this relationship was a healthy on such important topics as the Guidelines one, although at times the two groups can for Educational Responsibilities in Clinical come into areas of confict. The Department Fellowships; Evaluations of Clinical Fellows; is continuing to improve all aspects of Clinical Remuneration of Clinical Fellows; Offer Letters Fellowship training, and is pleased to work with to Clinical Fellows; Access to Primary Care for FEAC to ensure that standards are maintained New Clinical Fellows; and Workplace Safety and across all Clinical Departments. Insurance Board Coverage for Clinical Fellows.

Five Year Review 2009-2014 47 8. RESEARCH REPORT

Prepared by Michael G. Fehlings MD PhD FRCSC FACS FRSC FCAHS, Vice Chair Research, Department of Surgery Research is a key cornerstone which 352 residents of whom 98 have been enrolled in contributes to the excellence in the Department doctoral programs. The current enrollment in the of Surgery at the University of Toronto (http:// SSTP is 32 of whom 24 are enrolled in Master surgery.utoronto.ca/research.htm). The degree programs and 8 are pursuing a PhD. The achievements in research contributes to the SSTP is closely linked with the Royal College of international impact that this Department and Physicians and Surgeons Clinician Investigator the Faculty of Medicine have achieved. Areas Program. Resident trainees take time out of their of research focus in the Department of Surgery clinical training to pursue at least two (2) years include translationally oriented basic and pre- of thesis-based research training. The salary clinical science, clinical epidemiology and support for members of the SSTP is close to $1.5 clinical trials research, health outcomes and million per year. This is fnanced through salary policy research and research into cutting edge support scholarships which are topped up by educational initiatives. the Department to enable residents to continue The Surgeon Scientist Training Program receiving funding at the appropriate PGY level. (SSTP) in the Department of Surgery is arguably Of the over 350 graduates of the SSTP from 1983- the jewel in the crown of our research portfolio. 2014, roughly 70% of surgeons are in academic Since its inception in 1983, the SSTP has positions and over 60% have continued research facilitated formal graduate research training for commitment.

Table 14. Surgeon Scientist Training Program 2002-2014

48 Five Year Review 2009-2014 Despite the successes of the SSTP we are In the future, it is likely that these areas of faced with a number of challenges. Having a academic activity will continue; however, it is dedicated endowed source of funding to support also expected that a number of surgeons and the SSTP is a major challenge. This has been surgical trainees will consider the option of identifed as a high priority for fundraising efforts enrolling in new graduate training programs in which are being undertaken in collaboration translational research which are being offered at with the Faculty of Medicine’s Advancement the University. Offce. In addition, it is increasingly recognized A key to the success of research efforts in that the career path for surgeon scientists can the Department of Surgery lies in the excellence be challenging. Recently, the Department of of the faculty. Currently, over 200 faculty in Surgery Research Committee at the University the Department include research as a major of Toronto undertook a research retreat in area of priority focus. These faculty include which the opportunities and challenges related 117 surgeon investigators, 56 surgeon scientists to the developmental path of a surgeon scientist and 48 full-time faculty scientists. Collectively, (from initiating the residency program through these faculty truly represent a translational completion of the SSTP to the initial faculty powerhouse in research. The importance appointment and subsequent promotion to mid- of full-time scientists in the Department of career level) was discussed in detail. Several Surgery who do not engage in clinical activity initiatives from this research retreat will has been formally recognized in several ways. arise. These include a formal linkage with the These initiatives include the appointment of an mentoring program which has been initiated Associate Vice Chair of Research who is a full- through the Department of Surgery. Another time scientist not engaged in clinical activities. initiative will be the establishment of a career In addition, full-time scientists and their trainees counseling night for surgeon scientist trainees are now an active part of the Annual Gallie Day. nearing completion of their research training. In The research excellence in the Department the fall of 2014, the Department inaugurated an of Surgery is refected by a prolifc level of annual “Town Hall” meeting for the PGY1 and productivity related to peer-reviewed research PGY2 surgical residents to introduce them to the publications. Since February 2010, surgeon opportunities of research training and a career in scientists and surgeon investigators in the research in the Department of Surgery. Department of Surgery have published over As a complement to the SSTP, the 7,000 peer-reviewed papers – many of which are Department of Surgery has also established a in the highest impact journals. Scholarship in Surgery Program (SIS). The The impact of research in the Department Department has recognized that academic of Surgery is further refected by the levels of scholarship can occur in heterogeneous ways. external funding which faculty attract. Faculty Accordingly, there is an increasing need for in the Department of Surgery have increased alternatives to thesis-based research training as the level of external funding support from $38.7 embodied by the SSTP. The SIS Program thus million in 2009 to $43.2 million in 2014. supports graduate training in academic areas which do not involve thesis-based programs. In the past, trainees in this program have focused on various aspects of business or public health.

Five Year Review 2009-2014 49 Table 15A. Grant Funding by Division 2009-2014

Table 15B. Grant Funding Total Gallie Day. Gallie Day refects the excellence 2009-2014 of the surgeon scientist trainees, graduate students, postdoctoral fellows and full-time faculty scientists. Annually, over 80 research presentations are presented in either podium or poster format. The 2014 Gallie Day Symposium and Gordon Murray Lecture focused on innovation and commercial translation of research. The translation of cutting-edge research into practical applications to beneft patients and society is truly at the heart of excellence in the Department of Surgery. This increase in external funding is largely In summary, research is a key cornerstone refected by an increase in competitive external of excellence in the Department of Surgery. peer-reviewed grants from the Canadian The commitment by the Department to research Institutes of Health Research (CIHR). CIHR activities is very strong and is refected by funding by Departmental investigators increased the excellence of faculty and trainees in the from $18.8 million in 2009 to $23.4 million in Department. A major challenge and opportunity 2014. This is a remarkable accomplishment for the future will be to fundraise to achieve given the increasing challenges and complexity a substantial endowment to support research in landing external peer-reviewed grant support. training and innovative translational research The academic research excellence in the into the future. Department of Surgery is celebrated annually at

50 Five Year Review 2009-2014 9. QUALITY AND BEST PRACTICES

Prepared by Robin McLeod, MD, FRCSC, Vice Chair Quality and Best Practices The Department of Surgery’s Quality review of the remaining procedures. While the and Best Practices (Q/BP) committee has committee will look at the readmission and ER made signifcant progress over the past several rates, it is hoped that each Division will further years. Below you will fnd an in-depth look analyze the data to understand the reasons why at these milestones in the domains of quality patients return to the ER or are readmitted improvement and best practices. and develop initiatives to decrease ER visits and readmissions. We will look at the data by Unplanned Readmissions and Emergency hospital and if there are differences amongst the Room Visits various hospital divisions, hopefully it will lead The Q/BP committee decided to to collaboration and learning from each other. undertake a quality initiative that would be pertinent to all Divisions in our Department. We Guideline Development thus, decided that we would analyze unplanned The Division of General Surgery initiated readmissions and emergency department visits Best Practice in General Surgery (BPIGS) in following surgery for a common index procedure 2006 and it has been very successful in developing performed in each Division. We now have data guidelines and other quality initiatives which for coronary artery bypass grafts, and will soon have had good uptake at all of the hospital have data on pulmonary lobectomy, colectomy divisions. In addition, BPIGS has been supported and knee arthroplasty. We will then complete the by most of the hospitals and we have also been

Five Year Review 2009-2014 51 able to receive external funding. Our proposal is curriculum for our residents. This will be a small- to transition BPIGS to Best Practice in Surgery group seminar based course that will launch this (BPS) and develop guidelines and initiatives that coming academic year (2015-2016). All PGY- are relevant to a larger audience. While there are 1 residents in the various divisions within the some guidelines and protocols that have been Department of Surgery will participate. Residents developed at the hospital level, we have found will be expected to identify an area where there that BPIGS has been well received because of is a gap in care and as a team, develop a quality the clinician engagement and the collaborations initiative to address it. The program will extend we have developed with other stakeholders. over the year and each small group will be We also see that there is an opportunity to mentored by one of our surgical faculty. At the promote the University of Toronto Department end of the year, we will try to organize a forum of Surgery in the quality sphere. The Canadian where the protocols can be presented. Patient and Safety Institute (CPSI) recently asked us to share our guidelines and partner with Faculty Development Day them in developing surgical safety initiatives. Each year the Departments of Anaesthesia and Surgery sponsor Faculty Development Person (Patient) Centered Care (PCC) workshops. This year, there will be a combined Initiative event. David Latter has asked us to do one of the Engaging patients in their care has been breakout groups focused on quality initiatives. shown to increase patient experience and We are planning to have a session of interest to satisfaction as well as reduce health care costs. both surgeons and anesthesiologists focused on We have formed a subcommittee of individuals quality initiatives in the perioperative period (ie: who have an interest in PCC to develop a PCC pain control, fuid management etc). This will be strategy for our Department. As a frst initiative, led by Stuart McCluskey from Anaesthesia and we have planned a workshop where we will bring Robin McLeod. surgeons, residents, nurses and patients together to understand what is important to patients, IDEAS Program prioritize these initiatives and develop strategies This year, faculty members Graham Nagle on how these can be implemented. Roche, Tim Jackson and Najib Safeddine and one of our residents (Reilley Musselman) completed Resident Curriculum The IDEAs program. This program is offered by Faculty members Najib Safeddine, Tim HPME and provides training in developing and Jackson and Joe Pappia have been working implementing a quality improvement initiative. in partnership with the Centre for Quality Improvement and Patient Safety to develop a QI

52 Five Year Review 2009-2014 10. FACULTY DEVELOPMENT

“ENGAGE AND VALUE CONTRIBUTIONS OF THE FACULTY” As Prepared by: Dr. Ori D. Rotstein, Associate Chair of the Department of Surgery This pillar focuses on developing a culture in which all faculty members have equal opportunity to achieve their academic potential. Performance measures and accomplishments since 2012 include the following: Leadership training: The Vice Chair and a faculty lead have introduced the basic structure for a Leadership Training Program in which formal mentoring will be provided to those on a leadership track in Mentoring: The frst year of the mentoring their careers. Chair support has allowed for the program will require attentive monitoring in opportunity to partner with the Rotman School order to make the necessary adjustments for an of Business and a major fnancial institution for effective program. Chair funding will allow for assistance in program design. ongoing training sessions and access to valuable teaching resources, as well as an online portal Mentorship: in which mentors and mentees can communicate Chair support of a surgery-specifc and log their career goal progression. It is the mentoring program has allowed for the selection Strategic Plan’s expectation that the Department of a career-specifc mentor in addition to the may be able to utilize the data from its evaluations academic mentor specifed in the Memorandums to contribute to the academic literature on of Agreement, for the inclusion of this mentor surgical mentoring. in the MOA, and for the design of a new clause Later-career transitioning program: An altogether. It has also granted four sessions with identifed faculty member will be collaborating the Centre of Faculty Development in which with the Vice Chair to develop a program for mentors and mentees received hands-on skills facilitating later-career opportunities. The training for mediating effective mentoring program will include seminars, workshops, relationships. The Vice Chair and mentoring and informative lectures, all of which will rely committee have completed the program’s offcial on Chair support for their implementation. infrastructure, mentor-mentee pairings, and the development of mechanisms for monitoring the relationships throughout the year.

Looking Ahead Leadership training program: Program development will continue, with expected implementation in the upcoming year with select individuals in a pilot program.

Five Year Review 2009-2014 53 11. CONTINUING PROFESSIONAL DEVELOPMENT

Report prepared by Terry Axelrod MD MSc, Director, CPD

Status report, July 1, 2009- June 30, 2014 • Many faculty members involved as Chair and faculty in CPD events nationally and Overall CPD Goals internationally outside of the CE jurisdiction • Promote best practices in continuing education and professional development (including New Model for the relationship between the Faculty University CE Offce and the Department of Development, CE, and Professional Surgery: Development) • The Department of Surgery has been selected by • Foster scholarship and research in continuing the Vice Dean for Continuing Education to be education the Test Department for the implementation of a • Broaden the scope and inclusiveness of new model outlining a partnership between the continuing education (including international, CPD offce at the University and the Department interprofessional) for promotion of and full management of our • Work closely with CPD offce in the Faculty CPD events. This is an exciting development of Medicine at the University of Toronto that should rapidly expand many aspects to implement a new model of partnership, involved in CPD, including promotion of including funding and advertising of CE events, expanding target audiences, fnancial programmes modeling, and innovation in other areas such as Web based education, simulation and hands 2009-2014 Activities on programmes. • 120 CPD events in the Department run through

the CPD offce at the University, with 85 fully Objectives for the next 5 years: managed, the remainder with sponsorship for • Encourage all Divisions to run or accredit accreditation only courses through CPD offce. • Approximately 75% are live meetings, 20% • Catalogue the National and International CPD faculty development, 5% Web based that is done outside of the CPD offce • Superb success with enrollment in the hundreds • Continue to encourage the development of for several of the annual courses, such as more Web based programmes. the Update in General Surgery 2013 (435 • Promote the value of CPD to the Faculty of participants), 2014 (381 participants); Urology Medicine vis a vis promotion and advancement Update 2012 (222 participants), 2013 (192 of faculty through partnership with the Vice participants) Dean of Continuing Professional Development • New programmes including the First Annual • Establish a working committee within the Pediatric Wound Care Symposium, 2014 (Joel Department for CPD, to promote events, Fish and Irene Lara-Corrales) and the Hand and explore various opportunities and to reach into Upper Extremity Update 2014 (Steve McCabe) Web based educational events

54 Five Year Review 2009-2014 12. GLOBAL SURGERY

Report prepared by Andrew Howard, MD, FRCSC, Director Offce of International Surgery Overview: and a business plan for major philanthropic The University of Toronto was ahead of support is under way. its time in establishing an Offce of International During these fve years two major Surgery in 1999. The mandate of the Offce is philanthropic donations are notable. First is the to support and promote scholarly work aimed establishment at Toronto Western Hospital of at reducing the morbidity and mortality from the Greg Wilkins Barrick chair in international surgical diseases in low and middle income neurosurgery. Professor Mark Bernstein is the countries. inaugural holder of this key chair. Second is By 2009, International Surgery or Global the establishment of the Prakash Foundation Surgery had become formally established scholarships in 2013. These scholarships open in academic departments of surgery across up fellowship training at U of T to surgeons from Canada. The Bethune Round Table, an annual low income countries who otherwise may not meeting initiated by University of Toronto, was have an opportunity to receive subspecialized instrumental in creating such other departments clinical, scientifc, and educational training. as it moved from city to city in Canada. Strong north-south collaborations have been initiated Specifc Projects: and fostered through this academic meeting. Bethune Round Table on International In 2014, Global Surgery is receiving Surgery increasing attention particularly due to fndings This national meeting is now in its 15th of the Lancet Commission on Global Surgery. year and has become a fxture in the Canadian The best estimates to date show 3.6 billion to 5 surgical calendar. 150 to 200 delegates discuss billion people effectively lack access to surgical and advance the feld of international surgery. care. Correcting this would relieve 30% of A unique feature of the meeting is that travel the worlds burden of morbidity and mortality. scholarships are offered to low income country An ambitious plan envisioned by the Lancet delegates whose abstracts are accepted. The commission would see surgical care for all by meeting was held in Calgary in 2010, Montreal 2030. in 2011, Toronto in 2012, Vancouver in 2013, The current departmental strategic plan and Hamilton in 2014. Toronto has hosted 8 of envisions a bold transformation of the way the 14 meetings so far. In 2012 we raised money University of Toronto engages in International to support 13 scholarship recipients, and we Surgery during the next fve years. The success welcomed 150 delegates to discuss the theme that our department has enjoyed as a world “Filling the Gap” in health human resources. class centre for surgical research and surgical For the frst time, our residents ran their own education sets a high standard for attainment of post meeting workshop, focused on developing this transformation. A broad approach engaging skills to be a social entrepreneur. The Bethune and enabling faculty, residents and medical Meeting will return to Toronto in 2017, after students is being designed and implemented. Calgary 2015 and Halifax 2016. Andrew People, projects, and partnerships need Howard is a permanent member of the oversight substantial support to have substantial impact, committee for this meeting.

Five Year Review 2009-2014 55 Ptolemy Project The recent Surgery in Africa series on Surgeons training or practicing in low critical care for surgeons has been published as a income countries can register for online full text standalone electronic and print book edited by Dr. access to the University of Toronto library. This Fanus Dreyer of Scotland and Dr. Abebe Bekele project has continually operated for 15 years and of Ethiopia. This book is the text for a critical has served millions of downloads. The project is care course which is taught twice annually in now managed by Sandra Kendall and colleagues Africa as a collaboration between COSECSA at the Sidney Liswood library at Mount Sinai and UK. hospital. Bi-annual workshops continue to be held in Africa to aid new participants in Prakash Foundation Fellowships maximizing their use of this complex but Since 2013 we have awarded $70,000 valuable resource. scholarships to low income country applicants accepted for fellowship training by a surgical Surgery in Africa division in Toronto. Many countries cannot This project provides online educational provide clinical training for this type of materials created specifcally for surgical surgeon but Canada can. This has allowed us trainees in East Africa. Our new editor, Tara to attract stellar applicants who will be future Aird, who is a doctor with an MPH in Global leaders in their countries of origin. So far we Health, has completely revamped the project in have hosted Faith Mchemwe, a plastic surgeon 2015. We are now running a ten module fully from Zimbabwe; James Balogun, neurosurgery interactive online journal club for COSECSA from Nigeria; Tihituena and Hanna Getachew, trainees using a Moodle platform within the paediatric general surgeons from Ethiopia; COSECSA website. Collaborators include the and Samuel Hailu, an orthopaedic surgeon Royal College of Surgeons of Ireland, and Dr. from Ethiopia. We anticipate continuing and Brian Cameron from McMaster University. expanding this program indefnitely. Early response has been encouraging with over 70 active participants. Content creators have Bethune Fellowships been enlisted from Canada, the UK, and Africa Our inaugural Bethune Fellow, Maryse thanks to the energy and connections of our new Bouchard, received funding to complete her editor. surgical scientist training program Master’s degree in 2010 2011. She studied availability of surgical implants in Uganda using a framework established by supervisor Jillian Kohler of pharmacy who is an expert in international trade law and policy surrounding pharmaceutical availability. Maryse has now completed clinical training in paediatric orthopaedics and is pursuing an academic career in the United States.

Greg Wilkins Barrick Scholarships Toronto medical students are supported fnancially with up to $5000 bursaries allowing

56 Five Year Review 2009-2014 them to travel to low income countries and Howard (Orthopaedics, Sickkids) is establishing experience surgery in a resource constrained resident curricula and a fellowship training setting. These experiences are supervised by program in paediatric orthopaedics at CURE University of Toronto faculty and often reinforce Hospital and Black Lion Hospital in Ethiopia, existing inter-institutional relationships. and is examining for COSECSA annually. Allan Okrainec (GenSurg, TWH) leads innovative Global Health Education Initiative training techniques, particularly laparoscopic A module on international surgery, skills, for surgeons overseas through the use of anaesthesia, burden of injury and surgical telesimulation. His work has allowed for the workforce is taught annually as a three seminar development of curriculums and assessment tools series. Core faculty include Dr. Andrew Howard, in remote regions of South America, Africa, Asia, Dr. Greg Silverman, and Dr. Mark Bernstein. and Eastern Europe. Peter Chu (GenSurg, SHSC) annually travels to the Galmi Hospital in Niger Faculty Led Activities to train African surgeons, while simultaneously Numerous U of T surgical faculty lead or supervising elective residents from Canada participate in clinical educational projects in who wish to pursue globally-focused surgical every continent. careers. Mojgan Hodaie (NeuroSurg, TWH) has Mark Bernstein and James Rutka are pioneered neurosurgical education in developing teaching neurosurgical techniques in Lviv, countries, focusing on structured online learning. Ukraine. Leila Kasrai teaches about burn Her efforts are well underway in Ghana and are prevention and treatment in Ethiopia, Kenya, currently expanding within Africa. She is also an and Nepal. Toni Zhong (Plastics, TGH) is a Affliated Global Faculty for www.BIHE.org, an dedicated member of Women for Women (WFW) online university created in response to the lack and the Emirates Floating Hotel, which provides of available post-secondary education in Bahrain, essential medical care to the residents of Chilmari, Iran. Christine Novak (Plastics, TWH) utilizes Bangladesh. Christopher Forrest (Plastics, her clinical practices as a physical therapist and HSC) and a team from SickKids were invited rehabilitation scientist through her work with the by Transforming Faces Worldwide to oversee Guatemala Healing Hands Foundation. John an extensive needs assessment of the provision Hagen (GenSurg, HRRH) travels to China to of cleft lip care in Ethiopia. Several faculty provide laparoscopic surgical care, followed by members are also involved with cleft lip and interactive learning sessions with the Chinese palate care through Operation Smile, including surgeons. He also travels to remote areas in the Gregory Borschel (Plastics, HSC), David mountains Guatemala with HELPS International Fisher (Plastics, HSC), Ron Zuker (Plastics, with a team of surgeons and volunteers to provide HSC), and Howard Clarke (Plastics, HSC). primary surgical care to locals in need. Georges Azzie (GenSurg, SickKids) annually travels to Botswana to train local specialists in Future Plans: laparoscopic simulation, as well as to establish Transformation of our approach to contextualized training programs. Ted Gerstle international/global surgery is integral to the (GenSurg, SickKids) focuses on capacity- second half of our current strategic plan. Key building in healthcare providers in Ethiopia, steps include: through his partnerships with Tikur Anbessa • Formalizing evaluation of international surgery Hospital and Addis Ababa University. Andrew activity for career progression

Five Year Review 2009-2014 57 • Recruiting faculty whose academic career is and donor agencies to forward mutual goals dedicated to global surgery • Obtaining major philanthropic support Achieving universal access to surgical • Enabling and Engaging faculty, fellows, care by 2030 as envisioned by the Lancet residents and medical students in projects of commission is an ambitious vision. It will likely their own design fail. However, the payoff of partial progress is • Financially supporting time devoted to enormous and the human cost of ignoring the international surgery within divisional practice problem is completely unacceptable. Achieving plans universal access is an important unsolved • Increasing the number of low income country problem that will require creative academic fellows training in Toronto input in a collegial network of institutions. The • Increasing the number of U of T faculty University of Toronto can and will emerge as supporting in-country formal training programs a world leader in this important effort over the • Strategically partnering with Universities, NGOs, next fve years. 13. SURGICAL SKILLS CENTRE REPORT 2009-15

As Prepared by Oleg Safr, Director. Lisa Satterthwaite, Manager, Surgical Skills Centre Mount Sinai Hospital, Department of Surgery, University of Toronto Since 2009 the University of Toronto camp. This program was developed for all Surgical Skills Centre at Mount Sinai Hospital incoming PYG1 surgical residents from the (http://sites.utoronto.ca/ssc/) has continued departments of surgery, OHNS, Obstetrics and to grow and thrive under the umbrella of the Gynecology and the Northern Ontario School University Of Toronto Department Of Surgery. of Medicine (NOSM). In 2013 our inaugural The centre continues to play an integral role program was delivered to 54 residents moving to in simulation education, training and research a total of 64 residents in our 2015 program. The for surgical and medical students, residents program included basic skills acquisition as per and faculty as well as a wide array of health required topics from the Royal College Surgical care affliates. Currently the centre supports Foundations outline and a full lecture series on more than 10,000 clients per year that include variable topics such as Electro surgery Anatomy focused training events, continuing professional of the Suture, Diffcult Communications ect development courses, U of T departmental that concluded with a fnal MCQ test. The 2 programs, international meetings, outreach week program was stringently evaluated and sessions and a wide collection of visitors concluded with overall favorable comments from around the world who are interested in by residents and program directors. Of note developing a centre similar to ours as a result of within the evaluations were comments on the our international reputation for both innovative comradery developed amongst residence many and quality driven programming and assessment. of whom were new to Toronto as well as the In July 2015 we celebrated our 3rd iteration opportunity to learn pearls of wisdom from peers of the U of T Department of Surgery PREP teaching the sessions. In the end, PREP camp

58 Five Year Review 2009-2014 demonstrated the need for a focused program throughout the academic year with focused at the start of surgical residency as opposed to technical skill courses for all levels of PGY our original delivery of a 2 hr weekly distributed residents. program over the academic year. In year 2 We now enter year 6 of our award winning (2014) of the PREP camp a pre OSATS exam Toronto Orthopedic Boot Camp (TOBC) and was introduced to the program to fnd out what Orthopedic Competency Based Program. In 2013 residents baseline knowledge in technical skills the TOBC was the frst recipient of the Excellence were as well as to help drive the training program in Innovations Award given by The Association in those areas of need as demonstrated by exam for Surgical Education. The competency based results. The OSATS exam was then repeated program remains a highly recognized program at the end of the program for comparisons. As throughout the international surgical community predicted residents technical skills exam results attracting educators, administrators, and faculty moved from a lower than expected outcome to to learn about the delivery and maintenance nearly perfect scores within the 2 week PREP of this new educational delivery model. The camp training period. This same learning trend program began with only 3 residents in increasing was once again apparent in our 2015 PREP camp to the full complement of approximately 12 exam results. Each fall PREP camp is followed residents by year 3. Developed within the up with a 10 week distributed Phase II program. program was the notion of the Exit Exam and The 2 hour sessions enhance skills learned during Defciency Day. The Exit Exam combines all summer PREP camp by using higher fdelity of the TOBC modules into a continuum exam models, faculty educators and introducing more testing residents on their ability to develop” focused technical skills such as laparoscopic and start to end” surgical technical skill and decision microsurgical training. making processes. The exam is followed by a In order to attain the most effective teacher Defciency Day program that reviews results / student ratio required for PREP camp, a from the Exit Exam allowing residents to correct Residents as Educators program was developed errors and demonstrate competency through in conjunction with the Post Graduate Medical active dialogue and feedback from faculty and Education offce. This evening workshop senior resident mentors. allowed volunteer residents from all PGY levels Programs for our medical undergraduate to learn about the art of teaching through pre groups continue at the skills lab and include readings, didactic session, focus group discussion and full class dialogue. The program enhanced, motivated and prepared resident educators to deliver exceptional teaching sessions as refected in our post course evaluations. In conjunction with the PREP camp a yearly increase in the number of divisional specifc summer boot camps have been developed that include neurosurgery, vascular, plastics, ortho spine, and the general surgery Fundamentals of Laparoscopic Surgery program. Many of these divisional and departmental programs continue

Five Year Review 2009-2014 59 the General Surgery Crash Course, Emergency Medicine Longitudinal Program and SEAD – Surgical Exploration and Discovery Program for year 1 medical students interested in pursuing careers in surgery. SEAD which is a “taste of surgery” has increased in popularity each year moving from 20 to 30 medical students attending a variety of select intro to surgery sessions that include vascular anastomosis, craniotomies, casting, bone fxation and cardiac surgery. It is hoped that this opportunity allows students in their early medical career years to make informed decisions on the surgical direction that they may choose to pursue. Those students unequivocally decided in a surgical career fnd this early introductory program highly motivating. As part of our commitment to educational research, we have been deeply involved for the past 3 years with the development and The September 2012 COSATS exam was held delivery of the Colorectal Objective Structured in Chicago at Northwestern University, with Assessment of Technical Skills (COSATS). a total of 40 surgeons being examined over 2 The COSATS was developed by the Surgical days. The exam was repeated for a 3rd time in Skills Centre in conjunction with the American September 2014 in Chicago with a compliment Society of Colon and Rectal Surgeons (ASCRS) of 70 colorectal fellows. Statistical analysis of and the American Board of Colon and Rectal the project is now underway with submissions to Surgery (ABCRS). It is a performance based major journals in progress. technical skills exam, with the hope and purpose Allied health care programs continue of the COSATS becoming the new standard to thrive within the centre and include for colorectal board certifcation. The project comprehensive training programs for cardiology, was led by Drs Helen MacRae and Sandra de nephrology, respirology, family medicine and Montbrun, with the model design and creation emerg med. Development of these programs is being heavily the responsibility of the skills very synergistic with those for the department of centre staff. The inaugural COSATS exam surgery and encourages interdisciplinary training took place in June of 2011, with 20 residents and education. from the United States taking part. The initial The Departments of OHNS, Obstetrics and project demonstrated that this specifc method Gynecology remain a solid fxture at the Surgical of testing was reliable in discriminating between Skills Centre and include core curriculum graduating colorectal residents and graduating programs as well as major CPD events. Spring general surgery residents. In September 2012, 2012 was our inaugural endoscopic ear program a second ACRS funded study. This 2nd study for the Department of OHNS led by Dr. Pothier compared the COSATS results of newly and has continued annually since then gaining graduated colorectal surgeons to the results international recognition as a premier training from their colorectal surgery examinations. program.

60 Five Year Review 2009-2014 In June 2012 a 24 hour practice room was the Surgical Skills lab 15th anniversary since developed with in the Surgical Skills Centre to inception. In this time period the lab has grown allow residents the opportunity to rehearse and exponentially doubling in size, staff, programs or enhance surgical technical skills in their off and usage. We are proud to continue on this hours. This independent practice room has been journey continually challenging our abilities and extremely popular with residents especially dedication to surgical and medical education and in the areas of microsurgery and laparoscopic research. surgery training. Our weekly sign in average for Under the Direct leadership of our D.H. the room is 15 residents. Future plans include Gales Director, Dr. Oleg Safr the lab has been expansion of the space to be able to support an able to continue its journey of excellence but even more diverse array of skill training. would be remiss if recognition was not given In December 2015 we will continue our to the our dedicated staff, volunteers, faculty, accreditation application with the American students and residents who continue to make our College of Surgeons. Our frst accreditation took journey so worthwhile. place in 2006 and continues to be an integral part of our grounding within the Accredited Educational Institutes globally. 2013 marked

Five Year Review 2009-2014 61 14. REPORT OF FACULTY MEMBERS:

Report by James T Rutka, RS McLaughlin Chair, Department of Surgery

The Department performed a survey of Surgery over the next 5 years, the following faculty members in 2011 in conjunction with its answers were given: strategic planning process, and received input • Job shortage for surgeons from faculty that was both highly informative • Integration of academic activity between and interesting in terms of faculty satisfaction hospitals levels and expectations. The survey was sent to • Faculty recruitment and retention all active faculty members, and the response rate • Knowledge translation, and translational was 48%. research The majority of faculty thought that • Education at all levels emphasis in the Department should be placed • Global Surgery on Postgraduate education (68.4%), Fellowship Education (57.3%), Surgical Simulation (56.4%), • Retirement planning Surgical Innovation (64.1%) and Best Practices • Surgical Innovation (65%). Just less than the majority replied that • Career planning for residents Undergraduate Medical Education (47.9%), • Support of Surgeon Scientists the Surgeon Scientist Training Program (47%), • Advancement (Fundraising) and Faculty Development (45.3%) should be considered as top priorities. Survey of Faculty in First 5 years of When the faculty were asked if they would Appointment: value a well organized faculty mentoring program, In order for faculty members in the 80.5% indicated that they would. In response to Department to retain their University appointments the question about the beneft of a competitive longterm, they must successfully undergo and pass pension plan if offered by the Department of a Continuing Appointment Review (CAR) within the frst 3-5 years of their initial appointment. Surgery, 59.8% of faculty stated yes. This interview-based process is an integral part When asked about the positive value of the of faculty development. Accordingly, under the new positions in the Department of Surgery, the auspices of Ori Rotstein, Associate Chair of the following affrmative responses were given: Department, in 2014, a survey was taken of all Webmaster for website assistance (34.7%); surgeons who have undertaken their CAR in the Editorial Assistant for manuscript preparation past 5 years. There were 30 respondents. All (44.9%); Medical Illustrator (37.8%). respondents successfully completed their CAR. In determining a surgeon’s ability to When asked if they had anxiety about the CAR participate in collaborative clinical trials across process, 20.7% were extremely anxious, 62.1% all hospitals, the ability to take part in these trials were somewhat anxious. All respondents had was graded as follows: Not diffcult (9.7%); undergone formal 1 and 2 year reviews, and Somewhat diffcult (24.8%); Very diffcult felt reasonably well prepared for their CAR, as (29.2%); and Unknown (36.3%). it prepared them for the benchmarks they were When asked about the single most important required to meet, and it reinforced their tracking issue to be considered in the Department of towards a successful CAR.

62 Five Year Review 2009-2014 The table below shows the responses to a education and teaching, work life balance, and question about satisfaction with clinical practice, support.

Table 16. Faculty Survey Response

If there were unmet needs in the frst 3-5 Clinical partners, or mentors to help sort out the years, junior faculty knew that they could gaps in support. approach their Surgeon-in-Chief, Division Head,

In response to the question, “Do you feel your Continuing Appointment Review comes at too early a time in your development as an academic surgeon?”

In response to the question, “Are you getting adequate personal time for yourself and family?”

Five Year Review 2009-2014 63 Qualitative Data on Faculty Satisfaction: research productivity, teaching responsibilities, Each year, each faculty member is likely and creative professional activities. to have at least one or more interviews with Letters from these interviews are kept the Surgeon-in-Chief, the Hospital Division within faculty fles in the Department of Surgery, Head, the University Division Chair, or the and reviewed by the Department Chair. Issues Department Chair. During these interviews, that arise during these interviews are managed the satisfaction of faculty is gauged regarding in a multitude of ways, both within the hospital, their clinical practices, fnancial remuneration, and the Department as the case requires. 15. REPORT OF LEARNERS

Prepared by David Latter, Vice-Chair Education; George Christakis, Director Undergraduate Medical Education; and Ronal Levine, Director Postgraduate Medical Education Undergraduate Medical Education: The Reasons for the drop in scores from 2013 Results from the Canadian Graduate to 2014 are likely multifactorial, but the Offces Questionnaire (CGQ 2009-14) were used to of Evaluations in the Faculty of Medicine have generate this report in part. It should be noted performed an indepth analysis of some of the that the CGQ only specifes general surgery, so questions asked in the CGQ, and compared the the results may not refect experiences obtained results between these two years. Interestingly, on the specialty clerkship rotations in the for some questions, scores were higher in 2013 Department. In general, the overall percentage than 2014. For example, “Rate the quality of your acceptable ratings by the medical students of the educational experience” 2013 (80% acceptable) surgical rotations ranged between 73 – 80% from vs 2014 (73% acceptable); and “My time spent 2010 – 14. There was a trend towards increasing in the operating room was benefcial” 2013 (66% percentage acceptable ratings until 2014 at which acceptable) vs 2014 (63% acceptable). Whereas time the scores dropped from 80% to 73%. for other questions, the 2014 scores were higher than 2013. For example, “A faculty member Table 17. Overall Percentage observed me taking a patient history and gave Acceptable Ratings General Surgery me feedback” 2014 (59%) vs 2013 (43%); 2010-14 and “I received mid-rotation feedback on my performance”, 2014 (66%) vs 2013 (64%). It is interesting that there is considerable variability in the percentage acceptable scoring from one Academy to another at the different Hospitals. The Department is currently performing an indepth analysis of these data.

64 Five Year Review 2009-2014 Analysis of some of the qualitative data between 2013 and 2014 has revealed some themes which are worth showing here:

Table 18. Qualitative data analysis of questions from 2013 and 2014 CGQ:

When compared against other clerkship courses in other Departments from 2010-14, the Department does not fare as well, although the mean results have not deteriorated in a signifcant manner from one year to another.

Five Year Review 2009-2014 65 Table 19. Comparison of General Surgery ratings (0 -5) with other Departments, 2010-14

Several themes emerge in the qualitative • Community sites should be utilized as much data that may be useful in developing strategies as feasible to reduce the effects of learner to improve student satisfaction. crowding and to expose students to procedures that they may have a more prominent role in • More faculty need to be encouraged to be Interestingly, internal data from the Faculty more directly involved in teaching students of Medicine reveal that the Surgeon Teachers are and providing them with a positive learning scoring relatively well on the evaluations by the environment medical students. These data have been fairly • The learning needs of students may be better consistent on an annual basis, and are somewhat met doing consultations in the Emergency at odds with the overall results of the CGQ. Department and in the ambulatory clinics

Table 20. Internal Evaluation Data of Teaching Scores in Clinical Clerkship 2013-2014 (0 – 5)

66 Five Year Review 2009-2014 Some of the comments of the medical students during clerkship provide additional qualitative data which are useful for the Department to base decisions on. These can be divided into both perceived strengths and weaknesses as follows: Strengths: Weaknesses: • Access to highly specialized procedures • I did not get a chance to scrub in much as • Enthusiastic teachers, on call was there were a lot of residents and fellows reasonable, saw lots of trauma cases • Too much time in the OR for a student not • Excellent teaching from faculty, and junior interested in surgery and senior residents • A somewhat tense/unfriendly general • Excellent experience at a community surgery culture hospital site in general surgery • A lot of scut work, and very little • I had a lot of opportunity to assist in surgical responsibility procedures • Poor teaching by faculty who often did not • Exceptional variety and breadth. Surgeons show up for lectures cared about teaching • I felt lost sometimes during my general • High volume centre, residents are great surgery rotation; no expectations were given teachers, staff accessible and friendly, at the start of the rotation surgical skills lab in frst week of rotation • The surgical procedures were too specialized very useful with little to gain from knowing about them • I felt like an important part of the team. I • The NBME exam is irrelevant got to scrub in on cases and assist with • Not enough ambulatory care patient surgery. experience • I felt that I was part of the team with enough • Patient management on the ward was responsibilities rushed, and not a good learning environment • The procedural skills lab was very good • I saw Whipple’s procedures from a distance, but no appendectomies

Clearly, the clerkship experience between a high priority. The Department considers the different hospitals and between medical graduates of its residency programs to be among students is uneven. The Department has been the best in Canada in terms of being masters of working progressively to “smoothen out” the the CanMEDS roles. That said, it is extremely experience by assigning Division Directors important for the Department to learn from for Undergraduate Medical Education in each the residency experience. Accordingly, the surgical specialty. This is a work in progress, following is an analysis of the resident learning but the Department is committed to improving experience upon exiting their specifc training the clerkship experience for all medical students programs. The Department thanks the PGME at all levels of training. offce for providing these data for this 5 year report. Postgraduate Medical Education (PGME): The Department prides itself with excellent residency training programs where resident education and research experience are given

Five Year Review 2009-2014 67 EXITING RESIDENTS IN SURGERY: What do they have to say?

July 1, 2009 - June 30, 2014 Resident Exit Survey

A Detailed Review of Surgery Exiting Residents

Prepared by the Policy and Analysis Unit PGME Offce, University of Toronto August 2015

CONTENTS Education Ratings ...... 90 Education Experience ...... 90 Program Director ...... 90 Work Environment ...... 91 Learning Environment ...... 92 CanMEDS ...... 92 Preparing for Certifcation ...... 93

Preparing for Practice ...... 93

Wellness ...... 94 Professional or Personal Well-being (New in 2010-11) ...... 94 Offce of Resident Wellness Services Awareness (New in 2010-11) ...... 95

Intimidation/Harassment ...... 95

Future Plans ...... 95 Post-Residency Plans (New in 2011-12) ...... 95 Concerns About Securing a Position ...... 96 PGME and Healthforce Ontario’s Marketing & Recruitment Agency Partnership: ...... 96

68 Five Year Review 2009-2014 The Postgraduate Medical Education This report examines residents’ (PGME) offce at the University of Toronto responses from the Department of Surgery conducts a yearly survey of exiting residents. The and compares them to responses from all survey measures exiting residents’ satisfaction departments for the fve academic years with education quality, resident well-being, between July 1, 2009 and June 30, 2014. intimidation and harassment, their readiness for practice and future plans. EDUCATION RATINGS Education Experience: Overall, Surgery residents seem to be with other areas of their educational experience satisfed with their education experience. A large such as the amount of protected educational time majority rate their mix and diversity of cases and they receive and the availability of time to attend quality of patient care experiences ‘very good’ professional meetings and elective educational or ‘excellent’ over the fve years. A smaller activities. proportion of surgery residents seem as satisfed

Figure 1: % of those who rated their education experience ‘very good’ or ‘excellent’ (4 or 5 out of 5)

2009-10 2010-11 2011-12 2012-13 2013-14 Please rate your EDUCATION Surg. All Surg. All Surg. All Surg. All Surg. All experience in your program: n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Amount of protected educa- 52 67 33 75 56 73 74 79 50 70 tional time Amount of service work* 61 70 39 75 56 73 Balance of cases/procedures 74 60 40 53 with Fellows** Availability of procedures 93 58 78 61 88 59 96 56 84 53 Availability of time to attend professional meetings and 68 72 33 71 71 79 65 81 72 76 elective educational activities Clarity of educational objec- 84 81 61 77 85 82 74 83 78 80 tives Graduated professional 82 83 78 89 82 86 78 84 75 82 responsibility Mix and diversity of cases 100 88 89 87 97 88 100 90 94 85 Quality of patient care experi- 98 91 89 91 94 92 96 90 94 85 ences Quality of teaching 89 82 61 83 88 87 83 87 84 36 OVERALL EDUCATIONAL 95 87 72 87 88 88 83 90 75 82 EXPERIENCE

*question asked 2009-10 to 2011-12 **new question in 2012-13

Five Year Review 2009-2014 69 Program Director: Surgery residents also rate their Program satisfed with the counselling/guidance they Directors favourably. A large majority say their receive from their PDs. PDs are an advocate for their program and they’re available to residents. A smaller proportion is Figure 2: % of those who rated their Program Director ‘very good’ or ‘excellent’ (4 or 5 out of 5)

2009-10 2010-11 2011-12 2012-13 2013-14 Please rate your PROGRAM DIRECTOR regarding the Surg. All Surg. All Surg. All Surg. All Surg. All following characteristics: n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Advocate for program 80 82 67 84 79 81 91 87 77 77 Advocate for residents 68 77 67 81 68 74 87 82 73 72 Availability to resident 82 85 83 88 76 84 96 87 80 81 Counselling/Guidance 68 72 56 74 68 71 83 76 53 69 Effectiveness of program leadership 75 76 67 80 79 79 87 79 73 75 Organization of program 77 78 61 80 79 78 91 80 73 75 PROGRAM DIRECTOR 77 80 67 81 76 80 91 83 77 76 OVERALL PERFORMANCE

Work Environment: Ratings of ‘very good’ and ‘excellent’ for Ratings from 2010-11 are consistently lower, overall work environment has fuctuated over but due to the low number of responses (n=18), the fve years for Surgery residents. Most years, caution should be exercised when interpreting Surgery residents rate their work environment less responses from this year. favourably than residents from all departments. Figure 3: % of those who rated their work environment ‘very good’ or ‘excellent’ (4 or 5 out of 5)

2009-10 2010-11 2011-12 2012-13 2013-14 Please rate the QUALITY OF YOUR WORK ENVIRONMENT Surg. All Surg. All Surg. All Surg. All Surg. All THROUGHOUT YOUR RESI- DENCY: n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Adequacy of call facilities 45 54 61 61 50 57 39 63 48 57 Amount of “’scut” service work 48 50 33 64 44 59 48 60 35 55 Availability of information technology (computers, 73 78 72 82 59 77 61 82 69 78 internet library) Educational clinical workload 77 81 61 82 82 82 87 84 68 75 Quality of dedicated room/lounge for residents 40 44 28 56 41 55 35 59 38 59 Safety and security 81 85 72 87 88 89 87 89 93 86 Your call schedule 59 69 56 73 59 72 61 73 45 69 OVERALL WORK 64 73 50 76 76 79 74 82 55 76 ENVIRONMENT

70 Five Year Review 2009-2014 Learning Environment: Overall ratings of learning environment from all departments, rate their overall learning for Surgery residents vary over the fve years. environment ‘very good’ or ‘excellent’. With the exception of 2009-10, a smaller proportion of Surgery residents than residents Figure 4: % of those who rated their learning environment ‘very good’ or ‘excellent’ (4 or 5 out of 5)

2009-10 2010-11 2011-12 2012-13 2013-14 Please rate the QUALITY OF YOUR LEARNING ENVIRON- Surg. All Surg. All Surg. All Surg. All Surg. All MENT THROUGHOUT YOUR RESIDENCY: n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Face to face time with teach- ers/supervisors and senior 86 81 72 82 68 86 78 84 68 79 residents Interactions with mentors 76 71 61 73 65 75 70 72 65 71 Personal Support For Stress 63 60 28 65 60 67 61 69 52 66 Resident Morale 64 63 33 67 65 71 52 69 35 61 Supportive environment 61 69 39 77 68 75 57 74 55 71 University Protection Against Intimidation and Harassment 92 63 50 75 77 77 81 80 87 77 Your ability to balance resi- dency and life commitments 57 63 33 66 71 72 57 74 45 59

Your ability to Manage Finan- cial Issues 60 61 39 64 67 72 52 66 31 64 OVERALL LEARNING EN- VIRONMENT THROUGH- 89 77 39 77 74 82 74 81 68 74 OUT RESIDENCY

Five Year Review 2009-2014 71 CanMEDS: A large majority of Surgery residents say the residents from all departments appear satisfed adequacy of their education in preparing them for with their preparation with respect to the Scholar practice in terms of the CanMEDS Roles is ‘very and Manager Roles in particular. high’ or ‘excellent’. In most of the fve years, a larger proportion of Surgery residents than

Figure 5: % of those who rated their preparation with respect to CanMEDS Roles ‘very good’ or ‘excellent’ (4 or 5 out of 5)

2009-10 2010-11 2011-12 2012-13 2013-14 Please rate the adequacy of your education in preparing Surg. All Surg. All Surg. All Surg. All Surg. All you for practice with respect to each of the CanMEDS Roles n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Collaborator 80 79 83 84 88 82 87 84 87 79 Communicator 82 82 72 83 88 82 87 85 80 82 Health Advocate 75 74 83 69 79 70 77 78 77 71 Manager 82 69 72 68 82 68 70 72 77 67 Medical Expert 89 85 72 81 85 83 96 87 83 80 Professional 86 85 83 85 88 86 91 86 90 81 Scholar 89 82 67 73 88 80 96 82 87 75

Preparing for Certifcation: With the exception of 2013-14 (and 2010- residents than residents from all departments rate 11 which seems to be an anomaly year with few their preparation for certifcation ‘very good’ or respondents), a larger proportion of Surgery ‘excellent’. Figure 6: % of those who rated their preparation for certifcation ‘very good’ or ‘excellent’ (4 or 5 out of 5)

2009-10 2010-11 2011-12 2012-13 2013-14 Please rate your experience in your residency program in Surg. All Surg. All Surg. All Surg. All Surg. All relation to PREPARING FOR CERTIFICATION: n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Coaching and Mentorship 71 59 39 57 60 53 52 56 52 54 Practice oral/clinical exam 80 74 78 78 74 77 74 77 68 75 Practice written exam 40 48 39 60 63 62 62 61 52 61 Study groups 80 59 63 57 85 61 70 66 83 59 OVERALL PREPARATION 77 66 28 65 74 66 78 68 58 63 FOR CERTIFICATION

72 Five Year Review 2009-2014 Preparing for Practice: Over the years, residents from all departments. Surgery residents are least satisfed departments rate their preparation for practice with the assistance they receive in fnding lower than other aspects of their training. With employment and support for preparation for the exception of 2011-12, Surgery residents obtaining IP license and billing number. rate this area lower than residents from all

Figure 7: % of those who rated their preparation for practice ‘very good’ or ‘excellent’ (4 or 5 out of 5)

2009-10 2010-11 2011-12 2012-13 2013-14 Please rate your experience in your residency program in Surg. All Surg. All Surg. All Surg. All Surg. All relation to PREPARING FOR PRACTICE: n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Assistance in finding employ- ment 8 22 29 37 18 35 19 36 21 32 Bioethics 53 40 39 47 54 48 33 52 33 47 Career guidance 39 40 28 49 41 47 48 46 23 41 Communication Skills 59 68 33 69 77 71 57 75 67 71 Critical appraisal and re- search skills 75 65 56 64 79 67 83 69 57 63 Information on Continuing Medical Education 50 46 33 51 37 49 48 47 32 41 Legal Issues 23 31 25 47 50 44 30 51 20 43 Practice management sem- inar 35 45 33 53 50 44 53 50 35 47 Resource utilization 48 55 39 57 54 50 43 62 47 56 Support for preparation for obtaining IP license and 8 27 30 37 25 56 30 64 15 56 billing number Managing challenges to your wellbeing throughout your 34 42 19 54 33 35 48 41 27 33 career OVERALL PREPARATION 32 40 28 45 44 44 35 49 23 44 FOR PRACTICE Wellness

Professional or Personal Well-being (New in 2010-11): Figure 7: % of those who said were given formal training for maintaining professional and/or personal well-being

2010-11 2011-12 2012-13 2013-14 During your residency training were you given formal instruction Surg. All Surg. All Surg. All Surg. All or coaching on effective coping skills for maintaining professional n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 and/or personal well-being? Yes 83 46 65 51 52 56 50 57

Five Year Review 2009-2014 73 Offce of Resident Wellness Services Awareness (New in 2010-2011): Figure 8: % of those who said they are aware of the services offered by the Offce or Resident Wellness

2010-11 2011-12 2012-13 2013-14 Are you aware of the services offered to residents and fellows by Surg. All Surg. All Surg. All Surg. All the Office of Resident Wellness? n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Yes 89 80 74 80 83 79 80 82

Intimidation/Harassment Figure 9: % of those who said are aware of policy on intimidation/harassment and who said were harassed/intimidated during their residency

2009-10 2010-11 2011-12 2012-13 2013-14 Surg. All Surg. All Surg. All Surg. All Surg. All n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Aware of policy on intimida- tion/harassment 91 82 83 75 88 81 78 83 80 83 Harassed or intimidated during residency 25 21 28 12 44 20 30 18 30 22

Future Plans

Post-Residency Plans (New in 2011-12): Figure 10: Plans after residency (%)

2011-12 2012-13 2013-14 What are your plans when you’ve completed your residency? Surg. All Surg. All Surg. All n=34 n=282 n=23 n=304 n=32 n=352 Join or set up a permanent practice 15 40 9 30 17 39 Locum 12 57 13 60 17 69 Clinical or Research Fellowship 71 14 74 24 59 12 Subspecialty training as a PGY (accredited training) 18 27 13 19 17 20 Clinical Associate/ Contract Posi- tion 3 7 4 7 10 8 Graduate Studies 9 1 9 7 14 8 Don’t know 0 13 9 16 0 8

74 Five Year Review 2009-2014 Concerns about Securing a Position: Concern about securing a position is consistently higher among Surgery residents. Concern peaked in 2011-12 with 88% of surgery residents saying they’re concerned.

Figure 12: % who says they have concerns about securing a position in their chosen specialty

Do you have concerns about 2009-10 2010-11 2011-12 2012-13 2013-14 securing a position in your Surg. All Surg. All Surg. All Surg. All Surg. All chosen specialty? n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Yes 75 35 67 26 88 34 83 40 87 35

PGME and Healthforce Ontario Marketing & Recruitment Agency Figure 13: % who are aware of Healthforce Ontario services and have used or intend to use their services

2009-10 2010-11 2011-12 2012-13 2013-14 Surg. All Surg. All Surg. All Surg. All Surg. All n=44 n=227 n=18 n=215 n=34 n=282 n=23 n=304 n=32 n=352 Aware of career plan- ning services offered by PGME in partnership with 45 45 61 53 56 69 48 65 63 60 Healthforce Ontario Have used or intend to use these services 50 54 36 58 47 63 64 67 74 63

What have we learned from these data from the exit survey?

In comparison to other Departments in the Faculty of Medicine: • residents are generally satisfed with their • residents are somewhat more concerned about educational experience fnding employment after residency • residents are generally satisfed with the support • there were no major concerns about resident received from the Program Directors wellness programs, harassment or intimidation • the work environment (e.g. amount of “scut”, call room quality, call schedule) likely needs some attention • residents are very satisfed with their instruction of the CanMEDS roles • residents are very satisfed with their preparation for the Royal College Examination • residents are somewhat less satisfed for their preparation for independent practice after residency

Five Year Review 2009-2014 75 In addition, in debriefng with the Director Fellows: of PGME for the Department who interviews all Survey data from 2014 are available from residents throughout their years of training, the Clinical Fellows within the Department. There following points were made clear: were 105 Respondents to the Survey (40%). Several challenges were faced by Clinical Job situation: Fellows applying to Surgical Programs. These Overall this is the major concern of the included diffculties with licensing, credentialing, graduating residents. There are not all that many and registration, levels of fellowship funding, jobs and because of this the majority of residents, fnding suitable access to primary care, and almost 100%, are doing fellowships. They are fnding affordable housing. The majority of doing fellowships whether they are doing an fellows received between $50-75K per annum academic career or a community career. They as remuneration. The majority of clinical fellows are very frustrated by this and they do not know ranked their educational experience as above if the situation is going to improve. The group expectation or outstanding in the felds of mix of residents that are being interviewed have all and diversity of cases, quality of patient care setup their fellowships and are at least 18 months experiences, quality of teaching, and availability from trying to fnd a job. of procedures. When asked why they considered a Clinical Fellowship in the Department, the Protected Downtime: majority stated that it was a unique training All of the surgical specialties have opportunity; that the clinical experience would protected downtime. This is indeed protected help them gain employment advantage; and that and residents are freed up and allowed to attend they received highly advanced clinical training. their sessions. There is almost 100% attendance Information regarding the Clinical and this has not come up as an issue. All of these Fellowship Experience was received from the protected downtimes are in the morning and University, and the survey information is found very in length and how often they are carried on the accompanying pages: out. The residents fnd these sessions extremely benefcial and the sessions are well organized. Report from the PGME Offce on Clinical Fellows: Operating Experience: The Postgraduate Medical Education All of these residents are in their last year and (PGME) offce at the University of Toronto they have done 5 – 6 years of operating. Overall conducts a survey every two years of Clinical they feel that their operating experience has been Fellows. Respondents are asked about their very good and they feel they have covered the interaction with residents only once in this full spectrum of their specialty. survey with respect to education experience. Fellows are asked to rate the balance of available Interaction with Fellows: cases and/or procedures with residents and other This comes up as a concern occasionally. The learners. When comparing the top two ratings majority of the graduating residents see the (Outstanding or Above Expectations), Surgery fellows as value-adding. Occasionally it is is Fellows’ ratings are similar to those of Fellows brought up that there is an issue with fellows from all departments (40% - 43%) in 2012 and taking cases but this has not been brought up as 2014, and are slightly lower in 2010 (26% vs. a major concern.

76 Five Year Review 2009-2014 34%). However, a larger proportion of Surgery ‘Below Expectations’ all three years. Fellows rate the balance ‘Unsatisfactory’ or

Figure 1: Please rate your EDUCATION experience in your program by selecting one response for each of the 8 items. All responses (%)

2010 2012 2014 Balance of available cases/pro- cedures with residents and other Surg. All Surg. All Surg. All learners (%) n=87 n=558 n=92 n=514 n=112 n=540 Outstanding 9 10 17 16 17 14 Above Expectations 17 24 26 27 23 29 Meets Expectations 49 51 32 45 40 43 Below Expectations 20 12 15 10 15 12 Unsatisfactory 5 4 10 3 5 2

Figure 2: Please rate your EDUCATION experience in your program by selecting one response for each of the 8 items. Top 2 and Bottom 2 responses (%)

2010 2012 2014 Balance of available cases/pro- cedures with residents and other Surg. All Surg. All Surg. All learners (%) n=87 n=558 n=92 n=514 n=112 n=540 Top two ratings (Outstanding or Above Expectations 26 34 43 43 40 43 Bottom two ratings (Unsatisfactory or Below Expectations) 25 16 25 13 20 14

Although they weren’t specifcally asked colleagues? Explain below” and “Please tell us about the relationship with residents in other any additional information that you feel would sections of the survey, some Surgery respondents be useful for us to know about your fellowship discussed this topic in their responses to experience at the University of Toronto” that two open-ended questions. Surgery fellows’ mention residents are included below. responses to “Would you recommend fellowship training at the University of Toronto to your

Five Year Review 2009-2014 77 Would you recommend fellowship training at the University of Toronto to your colleagues? Explain below.

2010 Survey “I think the fellowship programme is not like I expect: in the hospital :where I do my fellowship they are caring of residents more than fellows especially in OR , Ii feel my hands getting stiff. Yes I am good observers (seeing more than doing) it’s like an observership not clinical fellowship I am feeling lose my skills,just less than one case per week?????? Imagine we should set the clear goals for fellowship (like number of cases, type of cases ) I am feeling below the resident while I suppose above him thanks”

“Many fellowships give specialist training. Residents do the majority of basic procedures - not a place to learn basic skills.”

2012 Survey “Has to know that priority is given to residents”

“Surgery wise the chief residents operate and fellows are second assistants - very disappointing”

“The remuneration is unnecessarily low for fellows who are eligible to bill. On my service, fellows are required to do in-hospital frst call whereas senior residents on the same service do not do frst call and only have to do second call. There will therefore be times when an FRCSC fellow or equivalent is being “backed up” by a resident who has not passed his or her fellowship exam. This has also led to some fellows being forced to do staff call and frst call during the same on-call shift.”

“Every case was given to the resident to perform and I assisted. I was only the primary surgeon when the resident was away, or incapable of performing the operation, or the case was bilateral so I got to do one side. This was highly unsatisfactory to me, not at all what I expected and absolutely not how Fellows are treated in other parts of the world so while I saw a large number of cases, I would add a very strong warning to any future Fellow that they will be playing second fddle to the resident for their entire time. I felt this was completely unacceptable.”

“lack of operating when resident available”

2014 Survey “The hands-on experience of the fellowship is a little less than expected because most of the cases seem to be performed by the residents. However, the opportunity to teach residents and guide them through the surgery is great.”

“All the procedures in operating room were done by staff or residents, I as a fellow were not considered at all, even though I had my residency training in Canada, program is totally biased toward residency, no sharing of surgical cases with fellow, they treat fellow like they are observers and only remember them when there is scut work, only department in Canada that force fellows to do junior calls.”

“Awareness that residents take priority to be trained over fellows”

78 Five Year Review 2009-2014 Please tell us any additional information that you feel would be useful for us to know about your fellowship experience at the University of Toronto.

2012 Survey “The X division at X hospital has to fgure out how to divide operations between fellows and residents in a way that will insure that future fellows can recommend this fellowship to future prospective fellows.”

“Currently since staff evaluation by residents is the main goal for staff, all priorities and ORs just going to residents. Not enough OR exposure for fellows is what can be described for UofT surgical Fellowships.”

2014 Survey “There should be a clear goal /agenda for fellows as regards to number of surgeries per week/ month/3months etc. If that criteria isn’t met, changes should be done to the fellow’s exposure from time to time. The balance between a resident and fellow training should be nicely managed and I feel that balance at the U of T is tilted towards residents much more than it should have been.” “Fellow should have their own log book at the end of rotation. This contains minimum required operations numbers and types. It is the responsibility of the supervisor to give the opportunity to fellows to complete this log book and to sign it. It is his role to give them the opportunity to operate according to minimum requirement and then can turn the wheel toward the residents as they are supervisor responsibility too.”

Five Year Review 2009-2014 79 80 Five Year Review 2009-2014 DIVISION REPORTS

Five Year Review 2009-2014 81 DIVISION OF ANATOMY

Department of Surgery, University of Toronto As Prepared by Dr Cindi Morshead, Professor of Surgery July 1, 2009 – June 30, 2014

Anne Agur, Professor Barbara Ann Ballyk, Sr. Lecturer Judi Laprade, Sr.Lecturer Paulo D. Koeberle, Associate Professor Cindi M. Morshead, Professor Hong-Shuo Sun, Assistant Professor Mike Wiley, Professor Ian Taylor, Professor

This past fve year saw a number of Our Division faculty has been incredibly important changes that have moved the Division successful at acquiring external funding for forward and set the stage for future years. Dr. research and academic endeavours. Collectively, Michael Wiley completed his term as Division four research programs in the Division have Chair in January 2011. His outstanding garnered over $9,000,000 in funding to support leadership and commitment to the division their research and trainees. Our faculty are throughout his 10 years as Chair were highly highly collaborative and attract award winning regarded by all. Dr. Cindi Morshead was trainees to their respective research teams. recruited as the Chair of the Anatomy Division. Professor Morshead completed her Ph.D. in The Division has maintained and excelled the Department of Anatomy and Cell Biology meeting the diverse educational needs of students at the University of Toronto in 1994 and after from many programs across numerous faculties postdoctoral training in Toronto and Calgary, including Medicine, Residents, Dentistry, she joined the Division of Anatomy in 2003. Her Physical Therapy, Occupational Therapy, expertise is in neural stem cell biology, and she Speech and Language Pathology, Pharmacy, continues has an active research program in the Physicians Assistant Program, Biomedical feld of neuroregenerative medicine. Communications, School of Graduate studies, Kinesiology and Physical Education, and Arts We were pleased to have Dr. Hong-Shuo & Science. We have continued to develop Sun join the Division in July 2010 in the capacity innovative approaches to teaching, launching of Assistant Professor (tenure stream). Dr. Sun an online Anatomy course in collaboration with received his MD from Sun Yat-Sen University the Department of Physiology and developing and his PhD from the University of Calgary, and online teaching tools for the Physicians Assistant followed this with postdoctoral training under Program. We have integrated substantial the supervision of Michael Tymianski and John revisions to the undergraduate medical MacDonald at the Toronto Western Hospital curriculum which continues to be a challenge Research Institute. Since his appointment Dr. as we attempt to meet the growing demands of Sun has developed an active research group with increased class sizes across all faculties with no complementary focus to the research programs room for expansion of the facilities. Each year within Anatomy, looking at neuroprotection and the faculty teach and train the over 2500 students regeneration in models of stroke. that are enrolled in courses provided by the

82 Five Year Review 2009-2014 Division. We have seen an enormous demand Trainees and Awards on the Division resources and recognize a very The Division faculty have had more than real challenge for medical training in the future. 50 trainees in the past 5 years including graduate Most notable is the increasing demand for students, postdoctoral fellows, undergraduate cadaveric material. The University of Toronto is research students, lab technicians, visiting the largest willed body programs in Canada. The scientists and research associates. Our graduates Division receives over 200 body donations each and award winning trainees are highlighted year yet we are still not able to keep up with the below: demand for cadaveric specimens. The donated bodies are used for teaching of undergraduate and graduate students as well as for surgical and Graduates: resident training and research. The generosity of Christine Bae (Sun, supervisor) MSc the donors is not a limiting factor but instead, we face the challenge that there is a need to expand Nadia Sachewsky (Morshead, supervisor) PhD the capacity of the Division in order to allow Awards: CIHR-TPRM scholarship us to accept more donations. We need to look Travel Award to the International at ways to expand our capacity to ensure that Society for Stem Cell Research we can continue to excel in the education and Philip Donofrio (Agur&Koeberle, co- training of students and researchers. At this time supervisors) MSc the Division is preparing for some big changes as the undergraduate medical curriculum is being Shoeb Ahsan (Morshead, Supervisor) MSc redesigned. The proposed changes will impact Awards: IMS Entrance Scholarship all aspects of our facilities and we are continuing to work closely with the curriculum directors, Deans and facilities management. Undoubtedly Graduates: these changes will have a positive impact on medical training. Dave Piccin (Morshead, supervisor) PhD Awards: Eureka’s 4th Annual Promotions: International Certifcate Program Alan Wu award at IMS Research 2012 Dr. Paulo Koeberle was awarded tenure Day and promoted to Associate Professor. CIHR PhD Fellowship (4 years)

2013 Dr. Judi Laprade was promoted to Senior Andrew Chow (Morshead, supervisor) MSc Lecturer. Dr. Laprade is the course director for Awards: Ontario Graduate Scholarship anatomy in the Faculty of Physical Education and IMS entrance scholarship. Kinesiology and the Faculty of Dentistry. She also contributes to the undergraduate medical curriculum. Her signifcant contribution to these Trainees: programs is well received and appreciated by Wenjun Xu (Morshead, supervisor) PhD students and faculty alike. candidate Awards: James H. Richardson Fellowship 2013 Dr. Cindi Morshead was promoted to the in Anatomy; rank of full Professor. Carlton and Marguerite Smith Medical Research Fellowship

Five Year Review 2009-2014 83 Robert Babona-Pilipos (Morshead, supervisor) Faculty Research: PhD candidate Awards: NSERC-CREATE CARE Patents fled studentship. P Koeberle – Novel Peptides and methods and Kristina Wakimoto (Anne Agur, Supervisor) uses thereof for preventing retinal disorders PhD candidate Awards: SIRF grant from Humber CM Morshead and 2 others – Inducing Directed College ($7,032) Migration (Translocation) of Neural Precursor Opportunities to Innovate, Cells Using Assymetric Balanced Biphasic Higher Education Quality Electric Fields Council of Ontario ($8,323)

Parvati Dadwal (Morshead, supervisor) MSc Faculty Awards candidate Awards: CIHR Training Program Dr. Anne Agur: in Regenerative Medicine Longstanding Academic Contribution and Fellowship (2 years) Collaboration from an External Partner Award. IMS entrance Scholarship. Division of Physiatry, Department of Medicine, Till and McCulloch abstract Faculty of Medicine, University of Toronto. competition – First Place (>400 Excellence in Teaching Award, Department abstracts) of Occupational Science and Occupational Heart and Stroke Foundation Therapy training fellowship Excellence in Undergraduate Life Sciences Teaching Awards, Faculty of Medicine, Labeeba Nusrat (Morshead, supervisor) MSc University of Toronto. candidate Awards: Ontario Graduate Student Dr. Barbara Ballyk: Fellowship. Excellence in Undergraduate Teaching in Life Sciences, Faculty of Medicine, University of Ashkan Azimi (Morshead, supervisor) Summer Toronto. Fellowship Aikens Award, Faculty of Medicine’s, Award: Undergraduate Summer University of Toronto Research Fellowships Dr. Mike Wiley: E. Mary Hollington Excellence in Pre-Clinical Kate Sauks (Anne Agur, supervisor) PhD Teaching Award. candidate Harry Whittaker Memorial Teaching Award, Awards: Carlton and Marguerite Smith Faculty of Medicine Medical Research Fellowship. Aikins Award for Large Group Teaching , Faculty of Medicine Ekaterina Turlova (Sun, supervisor) PhD President’s Teaching Award, University of candidate Toronto Awards: CIHR MSc trainee award. Ontario Council of University Faculty Associations Teaching Award, Province of Ontario

84 Five Year Review 2009-2014 Dr. Ian Taylor: Faculty Appointments: E. Mary Hollington Excellent in Pre-clinical Anne Agur was appointed President of the Teaching Award, Faculty of Medicine (13th American Association of Clinical Anatomists. time)) Hong Sun was Guest Editor for Acta Dr. Hong Sun: Pharmacologica Sinica on Special Topic of Outstanding Professional Alumni Award from Stroke. Sun Yet-Sen Univ ZhongShan Med School. Cindi Morshead (Anatomy Chair) was appointed Graduate Coordinator in the Institute of Medical Science

Cindi Morshead (Anatomy Chair) was appointed University of Toronto delegate to the CIHR.

Five Year Review 2009-2014 85 DIVISION OF CARDIAC SURGERY

Department of Surgery, University of Toronto As Prepared by Dr Christopher Caldarone, Professor of Surgery July 1, 2009 – June 30, 2014 At the Toronto General Hospital, Tirone David continues to lead in his mastery of mitral Overview repair and complex aortomitral reconstructions. The Division of Cardiac Surgery continues to thrive in its international presence of high- Vivek Rao, Terry Yao, and RJ Cusimano quality clinical care, research, and teaching. are developing innovative therapies for heart The Division has established itself as a clinical failure using stem cells. innovator in mechanical support/heart failure, complex aortic reconstruction, mitral valve At Sunnybrook, Gideon Cohen and Steve repair, and congenital heart surgery. Research Fremes developed a high-volume Transcatheter programs focus on translational research Aortic Valve Implantation (TAVI) program. with direct clinical application, and are lead Gideon Cohen also developed expertise in by investigators at St. Michael’s Hospital, deploying MitraClip technology. Sunnybrook Health Sciences Center, and the Hospital for Sick Children. Trillium Health George Christakis has developed expertise Center has also become an important leader in in rapid deployment Percival aortic valves. the teaching of cardiac surgery residents. Glen Van Arsdell continues to lead the Divisional Activity Congenital Heart Surgery Program at the Labatt Family Heart Center. The program has reduced Clinical Activity mortality for single ventricle management to top- tier levels in comparison to other programs. The With over 4000 cases per year, the Division program is also developing ventricle management of Cardiac Surgery continues to provide clinical techniques pulmonary vein stenosis. excellence with one of the highest case volumes in North America, making strong advances in - Surgeons at the Hospital for Sick Children the development of new surgical strategies. lead the Adult Congenital Heart Disease (ACHD) program at the Toronto General Hospital, one of Mark Peterson and Maral Ouzounian the largest of its kinds in North America. have led Division-wide initiatives to improve complex aortic pathology care. Mark Peterson assembled a multi-disciplinary team at St. Research Activity Michael’s Hospital to perform hybrid procedures and high complex aortic reconstructions. The The Division continues to enjoy a high team implanted a novel transcatheter mitral level of research productivity at all participating valve through a left ventricular apical incision, hospitals thanks to external peer-reviewed which was the frst implantation of this device in funding, journal publication, and notable leaders. North America. At the Toronto General Hospital, Maral Ouzounian leads in the development of In the past fve years, the Division has complex aortic surgery. achieved funding of 143 grants, with funding totaling over $9.5 M in the 2013-14 academic

86 Five Year Review 2009-2014 year, publication of 378 articles, and a journal Cardiovascular Data Management Center impact factor of 1792.045. In 2011, the Division created the Cardiovascular Data Management Center Ren-Ke Li and Richard Wiesel (Toronto (CVDMC) in order to encourage university-wide General Hospital) maintain lab funding and integration of quality improvement and clinical support for residents during their enrichment research activities. Housed at the Hospital programs. for Sick Children and managed by a team of statistical and publication support personnel, the Steve Fremes (Sunnybrook) maintains CVDMC aggregates all clinical data on patients funding for multiple prospective trials. with cardiovascular disease into a single linkage- rich environment through the removal of clinical Terry Yao and Vivek Rao lead investigations and translational research barriers. The ongoing into cell-based therapies for heart failure. sharing agreement across the four hospitals is a frst in the history of the University of Toronto Tirone David produces a high volume of for a freestanding data management entity. clinical outcomes research and analyses. The Heart & Stroke Richard Leward Centre of Excellence in Cardiovascular Research, as well Subodh Verma (St. Michael’s Hospital) as operational funds and the recent large gift has received many CIHR and Heart & Stroke from the Rogers family generously funds the Foundations, and holds a Tier 2 Canada Research CVDMC. Chair in Atherosclerosis that was renewed in 2012. He led the creation of the CARDIOLINK Toronto Aortic Collaborative platform, which serves as a critical hub for In 2011, the Toronto Aortic Collaborative developing and executing surgical trials by (TAC) was formed as a group dedicated to connecting the broader Canadian cardiac surgical the provision of excellence in the clinical care community. of patients with complex aortic pathology, as well as promoting research and education in At the Hospital for Sick Children, Richard aortic diseases. The TAC has established a data Weisel was also formally appointed as the module within the CVDMC by developing a Research Guide for the entire group in order biobank of aortic tissues, housed at the Toronto to promote the strategic pursuit of funding General Hospital. Another major achievement proposals. His leadership has led to outcomes such of the TAC has been the TAC-Call Initiative as CIHR funding for Christopher Caldarone led by the Division’s Maral Ouzounian and the development of a collaborative program and Mark Peterson, and Vascular Surgery’s for promoting tissues engineering in congenital Andrew Dueck. The initiative is working to heart surgery in conjunction with the University’s create a no-refusal and single point of access for Institute of Biomaterials and Biomechanical CritiCall referrals for patients with acute aortic Engineering, Glen Van Arsdell and Edward syndromes. Looking ahead, the TAC plans to Hickey’s innovative work in the identifcation establish regular and effective citywide Aortic and characterization of errors during congenital Disease Rounds as a mechanism for a shared surgery, and Osami Hanjo’s transplant and clinical decision-making model. mechanical support programs.

The Division also co-hosts the annual Teaching and Training International Heart Valve Summit. The Division of Cardiac Surgery participates in teaching for medical students, cardiac surgery residents, and cardiac surgery fellows. George

Five Year Review 2009-2014 87 Christakis serves as Director of Undergraduate forceps, and pocket simulators. The Divisional Education for the Department of Surgery at the Wet Lab and purchase of two Chamberlain heart University of Toronto, Gideon Cohen serves as model simulators ensures that residents have the Program Director for Residency Training, opportunities to practice at any time. Residents and Stephanie Brister served as Director of also attend an annual CPB simulator course at Fellowship training for the Division of Cardiac the Michener Institute and a catheter-based skills Surgery. simulator course held by Medtronic Canada. To promote exposure to new ideas outside the In response to the growing need for University of Toronto, the Division hosts annual counseling, a mentoring program was established named lectures, supported the Terrence Donnelly in 2011 for personal and professional guidance. Day at St. Michael’s Hospital, and supports An Academic Enrichment Committee was also numerous additional lectureships. These include established in an effort to prepare residents with the Bigelow Lectures, the Heimbecker Lectures, guidance for research endeavors. and several visiting professors. Unfortunately, To complement the improved training, the Terrence Donnelly Day was discontinued in improved evaluation methods were also 2014 after 17 years. introduced. Over the past fve years, several new evaluation tools have been developed including a Residency Training Clinical Encounter tool, an Academic Encounter tool, a NOTTS evaluation tool, a STACER tool, The Division’s residency training program has and a 360-feedback tool. Residents also undergo undergone many changes over the past fve years. structured technical skills evaluations in the The position of Program Director was taken over wet lab and operating theater, as well as oral by Gideon Cohen in 2010-2011, after previously exams with a written (TSDA) exam. Finally, in being held by David Latter. During this time, the advance of the development of a competency- Division successfully underwent an internal review based curriculum model, competency-based in 2011 and an external review in 2013. evaluations have been recently adopted with a In 2011, a resident coordinator position at focus on the annual examination process that UHN was introduced to ensure continuity across will ultimately facilitate the promotions process teaching sites. Extra efforts were made to ensure from one PGY year to the next. that rotating residents were only exposed to those The Division of Cardiac Surgery introduced with an affnity for teaching, which was refected two new and fully funded awards over the past in the improved feedback of residents rotating fve years, including the Shafe Fazel Outstanding through the UHN sites. To further advance the Resident Award and the Heimbecker Award. quality of teaching, the Division introduced Four additional Divisional awards were also alternate training sites at Trillium Health established in order to incentivize quality Sciences Center for cardiac rotations, as well as teaching and recognize the top faculty teachers St. Joseph’s, Humber, Toronto East General, and at each of the four academic sites. Credit Valley Hospital for thoracic rotations. To this end, affliate memberships are now granted to various institution members at the University level Fellowship Training and a permanent position was made available at The 2010-2011 introduction of the post the RPC for a surgeon member to represent the of Fellowship Director with Stephanie Brister Trillium group in 2011. was valuable in the improvement of quality Training continues to improve not only in the fellowships at the four hospitals. Teaching operating theater, but outside as well. Simulation Effectiveness Scores (TES) have been in the training has been signifcantly enhanced over the excellent range (> 4.0) over the last six years, past fve years in several aspects. Residents now with an average TES of 4.55 for clinical fellows receive starter sets of castro needle drivers, fne in 2013-2014.

88 Five Year Review 2009-2014 Recruitment Payment Review Board at the Ministry of Health Osami Hanjo was recruited as staff (2011-12). He was appointed as Head of the cardiovascular surgeon at the Hospital for Sick Division of Cardiac Surgery at University Health Children (2010-11). Network (2011-12). Fuad Moussa was recruited as staff George Christakis was appointed as Director of cardiovascular surgeon at Sunnybrook Health Undergraduate Medical Education for Surgery at Sciences (2010-11). the University of Toronto (2011-12). Edward Hickey was recruited as staff cardiovascular surgeon at the Hospital for Sick Edward Hickey was appointed as Director of Children (2011-12). Undergraduate Education for the Division of Maral Ouzounian was recruited as staff Cardiac Surgery at the University of Toronto cardiovascular surgeon at the Toronto General (2011-12). Hospital (2012-13). Fuad Moussa was promoted to Assistant William Stansfeld was recruited as staff Professor at the Department of Surgery, as well cardiovascular surgeon at the Toronto General as Director of Undergraduate Surgical Education Hospital (2012-13). at Sunnybrook Hospital (2012-13). Mitesh Badiwala was recruited as staff cardiovascular surgeon at the Toronto General Lee Errett was appointed as the Wilfred G. Hospital (2012-13). Bigelow Professor of Cardiac Surgery (2013- 14). Promotions Subodh Verma was promoted Full Professor at Osman Al-Radi was promoted to Assistant the Department of Surgery, and was appointed Professor at the Department of Surgery (2009-10). as Co-chair of the Toronto Acute Coronary Syndrome Summit and the State of the Heart Christopher Caldarone was promoted to Symposium (2013-14). Professor at the Department of Surgery (2009- 10) and as Senior Associate Scientist at the Visiting Professors Hospital for Sick Children Research Institute (2010-11). The Bigelow Lecture is an annual lectureship in which the Division has been fortunate to host Gideon Cohen was promoted to Associate many exceptional lecturers, including Matthew Professor as well as Program Director for the Howard (Chief of the Division of Neurosurgery Cardiac Surgery Residency Program at the at the University of Iowa) in 2009-10, Gregory Department of Surgery (2009-10). Hirsch (Cardiovascular Surgery, Queen Osami Honjo was promoted to Associate Elizabeth II Health Sciences Centre, Dalhousie Scientist at the Hospital for Sick Children University) in 2010-11, Sidney Levitsky (Beth Research Institute (2010-11). Israel Deaconess Medical Center) in 2011-12, David Latter was appointed as Chief of the and Kenneth W. Kizer (Former Director of the Division of Cardiovascular Surgery at St. US Department of Veterans Affairs and founding Michael’s Hospital (2010-11). President and CEO of the National Quality Forum) in 2013-14. Vivek Rao was appointed as Director of the Cardiovascular Business Unit at the Peter Munk Keith Horvath (Director of Cardiothoracic Cardiac Center/UHN and Chair of the Physician Surgery Research at the National Heart, Lung and Blood Institute and Chief of Cardiothoracic

Five Year Review 2009-2014 89 Surgery at the National Institutes of Health Heart Mitesh Badiwala: Inaugural Shafe S. Fazel Centre) was a University Rounds lecturer (2009- Outstanding Resident Surgeon and Investigator 10). Other distinguished visiting professors have Award, University of Toronto (2010-11); included Eugene Blackstone (Director, Clinical Second prize in the Gallie-Bateman Competition Investigations Cleveland Clinic’s Heart and (2010-11), Royal College Detweiler Travelling Vascular Institute) in 2009-10, John Ikonomidis Fellowship (2012-13) (Associate Professor, Medical University of South Carolina) in 2011-12, Phillipe Menasche Mitesh Badiwala & Vivek Rao: Vivien Thomas (Professor, University of Paris Descartes) in Young Investigator Award, American Heart 2011-12, David Adams (Mount Sinai Hospital, Association (2010-11) New York) and Michael Borger (University of Saswata Deb: Sopman Humanitarian Award, Leipzig) in 2012-13. University Health Network (2010-11), Vanier Canada Scholar (2011-12, 2012-13), Heimbecker Terrence Donnelly Day lecturers have Award for Surgical Research (2013-14) included Ivan Rebyka (Professor, University of Alberta) and Marc Ruel (Professor, University Edward Hickey: Zane Cohen Clinical of Ottawa Heart Institute) in 2010-11, and Fellowship Achievement Award, University Nimesh Desai in 2011-12. of Toronto (2010-11); Postgraduate Medical Trainee Leadership Award, University of Toronto Heibecker Lecturers have included (2010-11) James Cox (Washington University School of Medicine) in 2011-12, and Joseph Dearani Daniel Lodge: Harrison Award, Sunnybrook (Chief of Cardiovascular Surgery at the Mayo Health Sciences Centre (2010-11) Clinic) in 2013-14. Praphulla Shukla: Vivian Thomas Young Resident & Fellow Honours Investigator Finalist (2010-11, 2011-12) and Awards Rachel Vanderlaan: Congenital Heart Surgery Over the course of the past fve years, Resident Research Prize, American Association cardiac surgery residents received a total of 22 for Thoracic Surgery (2012-13), Banting awards and honours for their achievements. Postdoctoral Fellowship, Canadian Institutes of Some notable awards include: Health Research (2013-14)

Krishan Singh: Vivien Thomas Young Faculty Honours and Awards Investigators Award, American Heart Association (2009-10). Over the course of the past fve years, staff surgeons received a total of 69 awards Gilbert Tang: Trainee Excellence in Education and honours for their achievements. Award, Canadian Cardiovascular Society (2009- 10).

Bobby Yanagawa: AATS Lillihei Research Award (2010-11), Heimbecker Award, University of Toronto (2010-11), Resident Research Award, Physician’s Services Incorporated Foundation (2012-13)

90 Five Year Review 2009-2014 DIVISION OF GENERAL SURGERY

Department of Surgery, University of Toronto As Prepared by Dr Carol Swallow, Professor of Surgery July 1, 2009 – June 30, 2014 that augment the educational experience of the Divisional Activity various rotations in the hospitals.

The Division of General Surgery continues The One Day Master Program was widely to excel in its major contributions to the embraced by the Division faculty, as well as the University of Toronto and citywide healthcare 101 frst-year students who had the opportunity system. In addition to delivering excellent care to gain exposure to General Surgery by being to patients and their families, individuals and positioned in the operating rooms with active teams across the division are having a major faculty (2009-10). system impact within the context of the rapidly changing healthcare system. In addition to The wide array of continuing education standard metrics such as papers and grants, there courses offered through the division is is signifcant tangible evidence of the Division’s noteworthy. Courses, both large and small, positive impact. increasingly reach across the entire city and beyond in their impact. For example, John Education Hagen and the MIS surgeons in Toronto have Darlene Fenech assumed the role of Course developed well attended recurring courses; Director for the new second-year medical school monthly City-Wide MIS rounds and Bariatric course ‘Mechanisms, Manifestations, and rounds approximately six times per year. The Management of Disease” (2009-19). Update Course in General Surgery celebrated its 50th anniversary in April 2010 with a record of Jaime Escallon was appointed citywide Divisional 530 registrants. Director of the Surgical Clerkship (2011-12). Other academic highlights include the Nancy Baxter was appointed as Division Chief publication of the U of T Surgical Oncology at St. Michael’s Hospital (2012-13). Manual, led by France Wright and colleagues (2011-2012). Nancy Downs became the Division Chief at North York General Hospital (2012-13). Finally, a highly notable change in the Department is the departure of Dr. Richard General Surgery currently boasts eight Reznick who proudly hailed from the Division of formal fellowships. Under the leadership of Paul General Surgery. Dr. Reznick went on to become Greig, there has been an increase in coordination the Dean at Queen’s University on July 1, 2010. and integration of fellowship leaders and their programs across various sites. Najma Ahmed Integration and her team have done an outstanding job The 2010-11 academic year saw the of continually reviewing the structure of realization of the Ontario Peritoneal-Based the residency and increasing the rigor of the Malignancy Program (PBMP), a collaborative, component parts of the training program. inter-institutional, interdisciplinary program Much of this has involved adding modules based at the Mt. Sinai Hospital.

Five Year Review 2009-2014 91 A further example of the Division’s implementation of the guidelines throughout the integration efforts includes is the connection city through the BPiGS initiative. Led by Robin that continues to evolve between minimally McLeod, an enlarging and increasingly varied invasive surgery (MIS) experts across the city. inter-professional BPiGS team continues to Dr. Allan Okrainec has energetically led the bring focus to core areas of clinical importance MIS Fellowship as this program continues to including surgical site infection, mechanical become increasingly competitive and attracts bowel preparation, thrombo-prophylaxis, superb applicants from around the world. Most intra-abdominal infection, enhanced recovery importantly, the training program was recently after surgery (ERAS) and peri-operative pain assessed and received full accreditation by the management. Particularly noteworthy for 11-12 Fellowship Council. Other U of T leaders such as was the willingness of the University of Toronto Dr. John Hagen have worked in a steadfast manner hospitals to target money from their base budgets to increase the profle of minimally invasive to support BPiGS evolution and thus sponsor the surgery through the development of citywide development of a single Toronto-wide approach MIS and obesity rounds and, by extension, to patient management. Additionally, BPiGS knitted together a citywide community. continued to catalyze awareness, agreement and adoption beyond Toronto as a result of outreach 2011-12 was notable for the continued activities such as the BPiGS listserv and our U of momentum of the U of T Trauma Program, T General Surgery Update Course. a collaborative between St Michael’s Hospital, Sick Kids and Sunnybrook Health Science Recruitment Centre to integrate trauma related activities in the areas of education, quality, and research. The Timothy Jackson was recruited as staff surgeon UofT Trauma Program features collaborative at the Toronto General Hospital and bolstered the fellowship training; the newly designed ranks of the minimally invasive surgery (MIS) Trauma & ACS fellowship will have fellows program at UHN (2009-10). receive training from St. Michael’s Hospital Jean Francois Boileau joined the breast cancer and Sunnybrook Health Sciences Centre. team at Sunnybrook Health Sciences Center Additionally, UofT Trauma Guidelines seek to (2009-10). unify standards of care for trauma patients in Toronto and to have these readily available in an Shiva Jayaraman joined Richard Hart at St. app. Joseph’s Health Center to form the third unit of a Center for Excellence in hepatobiliary surgery in Finally, Trauma Triage Transfer Criteria Toronto (2009-10). are improving the coordination efforts of EMS triage and the transfer criteria from community Peter Dauphinee (Royal Victoria Hospital), hospitals to a trauma centre. Norm Hill, Don Munnings, Mark Pope, Joe Wen (Trillium Health Centre) and Mark The success of the Trauma Program is but Taylor (Lakeridge Health Centre) received one example in an increasing number of ways adjunct faculty appointment (2009-10). Such the individual hospitals’ surgeons are linked in a community-hospital appointments are crucial systematic way. for the Faculty of Medicine’s development of integrated medical education. BPIGS Mary Chen was appointed as the University of Toronto Trauma Care Program Advisory General Surgery continued to lead in the Committee Research Manager (2010-11). creation of evidence-based guidelines and the

92 Five Year Review 2009-2014 Anand Govindarajan was recruited as staff Julie Hallet was recruited as staff surgeon at surgeon at Mount Sinai Hospital. He will Sunnybrook Hospital, joining the HPB surgical contribute to ongoing PBMP and GI surgical oncology team (2013-14). oncology at MSH and the Princess Margaret Hospital (2010-11). Jory Simpson was recruited as staff surgeon at St. Michael’s, joining the breast surgical Paul Karanicolas was recruited as a oncology team (2013-14). hepatobiliary surgeon at Sunnybrook and the Odette Cancer Program (2010-11). Promotion

Shady Ashamalla was recruited as staff Najma Ahmed, SMH, was promoted to surgeon at Sunnybrook. He will contribute to Associate Professor (2009-10). MIS oncology and curriculum development in simulation (2011-12). Andrea McCart, Mount Sinai Hospital, was Sandra de Montbrun was recruited as staff promoted to Associate Professor (2009-10). surgeon at St. Michael’s Hospital, specializing in colorectal surgery and surgical education Ian McGilvray, UHN-TGH, was promoted to research. Associate Professor (2009-10).

Karen Devon was recruited as staff surgeon John Hagen, Humber River Regional Hospital, at Women’s College Hospital, specializing in was promoted to the rank of Assistant Professor endocrine surgery and surgical bioethics (2011- (2009-10). 12). David Urbach, UHN, was promoted to Full Fayez Quereshy was recruited as staff surgeon Professor (2010-11). at UHN. He will contribute to MIS oncology and healthcare economics (2011-12). Andy Smith, Sunnybrook, was promoted to Full Professor (2010-11). Joseph Tan was recruited as staff surgeon at Humber River Regional Hospital. He will Georges Azzie, SickKids, was promoted to contribute to MIS oncology and surgical Associate Professor (2010-11). education (2011-12). Anna Gagliardi, UHN, was promoted to Agostino Pierro was recruited as Division Associate Professor (2010-11). Chief at the Hospital for Sick Children (2012- 13). Teodor Grantcharov, SMH, was promoted to Associate Professor (2010-11). Joao Rezende-Neto was recruited as staff surgeon at St. Michael’s (2012-13). Michael Reedijk, UHN, was promoted to Barto Nasciemento was recruited to the new Associate Professor (2010-11). role of academic hospitalist (2012-13). Todd Penner, UHN-TWH, was promoted to Nicole Look Hong was recruited staff surgeon Assistant Professor (2011-12). at Sunnybrook Hospital, joining the breast Carol Anne Moulton, UHN, was promoted to surgical oncology team (2013-14). Associate Professor (2011-12).

Five Year Review 2009-2014 93 Homer Tien, Sunnybrook, was promoted to Sean Cleary, UHN, was promoted to Associate Associate Professor (2011-12). Professor (2013-14)

Natalie Coburn, Sunnybrook, was promoted to Tom Harmantas, St. Joseph’s Health Centre, Associate Professor (2011-12). was promoted to Associate Professor (2013-14).

Sandro Rizzoli, SMH, was promoted to Full Erin Kennedy, MSH, was promoted to Associate Professor (2011-12). Professor (2013-14).

Helen Macrae, Mount Sinai, was promoted to Calvin Law, Sunnybrook, was promoted to Full Full Professor (2011-12). Professor (2013-14).

Allan Okrainec, UHN-TWH, was promoted to Associate Professor (2012-13).

Alice Wei, UHN-TGH, was promoted to Associate Professor (2012-13).

94 Five Year Review 2009-2014 DIVISION OF NEUROSURGERY

Department of Surgery, University of Toronto As Prepared by Dr Andres Lozano, Dan Family Chair, Division of Neurosurgery July 1, 2009 – June 30, 2014 neurosurgical resident awards in the country, in Overview addition to garnering other highly competitive awards and fellowships. Our clinical fellows The Division of Neurosurgery continued program was bolstered by the establishment in in its tradition of strong performance in the 2011 of the “Michael and Amira Dan Fellowships academic, research, clinical and teaching domains in Neurosurgery at the University of Toronto”. as it underwent a change in leadership in 2010. These ten new training positions over fve years Dr. James Rutka was succeeded as Chair by Dr. are an invaluable addition to our academic Andres Lozano, who after a competitive search, mission. In 2013 we launched a new city-wide selected Dr. Abhaya Kulkarni as Residency Brain Tumor Bank at the University of Toronto, Program Director. Approximately 6,000 cases thanks to the generous support of the Dan Family. were performed each year across our four main We remain extremely grateful for their strong teaching hospitals. Over the fve-year period, ongoing commitment to neurosurgical education Neurosurgery faculty and residents published and excellence in Toronto. 1,392 papers in top-tier journals including Nature, Nature Genetics, New England Journal of Under the leadership of Dr. Kulkarni, our Medicine, Lancet, Lancet Neurology and Science Neurosurgery Residency Program successfully Translational Medicine. Our neurosurgeons and completed its six-year review by the Royal affliated neuroscientists captured over $116.3M College of Physicians and Surgeons of Canada in in research grant funding, and 3 new endowed 2012, and although slightly out of the reporting chairs were established for a total of 13 endowed period, our Division passed its external review chairs in the Division (as of June 30, 2014; now held in early 2015. We continue to be regarded 15 chairs). a premiere program with special stature globally, one that the world looks to for leadership on Neurosurgery Faculty members received clinical, research, teaching and leadership fronts. some of the most prestigious distinctions and appointments in our discipline, with highlights Recruitment including the Royal Society of Canada (Drs. 2010 Rutka and Lozano), Canadian Academy of Sunit Das, St. Michael’s Hospital Health Sciences (Dr. Michael Fehlings and Dr. Nicholas Phan, Sunnybrook Health Lozano), Order of Ontario (Dr. Rutka), CPSO Sciences Centre Council Award (Drs. Fred Gentili and Charles Tator), SNS Winn Prize (Drs. Fehlings and 2012 Lozano), AANS Humanitarian Award (Dr. Mark Paul Kongkham, Mohammed Shamji, Ivan Bernstein), ASIA Lifetime Achievement Award Radovanovic, Toronto Western Hospital (Dr. Tator), PAIRO Resident Advocate Award Victor Yang, Sunnybrook Hospital (Dr. Gelareh Zadeh) and Editorship of the Mark Erwin (Affliate Neuroscientist), Journal of Neurosurgery (Dr. Rutka). Each year Toronto Western Hospital our residents were awarded McKenzie Prizes in Neuroscience Research, the most prestigious

Five Year Review 2009-2014 95 2013 head injury and prevention, movement disorders, Suneil Kalia, Toronto Western Hospital neuromodulation, neurooncology, pain, regenerative medicine and spinal cord injury. Promotions Clinical trials funded in this period include those in the areas of Alzheimer’s disease, depression, 2009 eating disorders, Parkinson’s disease, spinal cord Eric Massicotte, to Associate Professor injury, stem cells and stroke. Michael Taylor, to Associate Professor William Tucker, to Full Professor Residents and Fellows Honours/ 2010 Awards/Positions Held James Eubanks (Affliate Neuroscientist), In each year from 2009 to 2014, our to Full Professor residents were awarded McKenzie Prizes in Mojgan Hodaie, to Associate Professor Neuroscience Research, the most prestigious Gelareh Zadeh, to Assistant Professor neurosurgical resident awards in the country. The prize winners are listed below. Toronto 2012 Neurosurgery continued its historically strong Clement Hamani (Affliate Neuroscientist), performance in this competition, having won to Associate Professor 22 of the 37 McKenzie Prizes (59.5%) awarded Michael Taylor, to Full Professor since 2000 (as of June 20, 2014).

2009 New Endowed Chairs Ratan Bhardwaj Clinical Neuroscience Research 2011: Greg-Wilkins Barrick Chair in International Surgery - Mark Bernstein 2010 2013: The Garron Family Chair in Childhood Scellig Stone Cancer Research - Michael Taylor Basic Neuroscience Research, 1st place 2013: The Garron Family Chair in Childhood Cancer Research – Peter Dirks 2011 Adrian Laxton Clinical Research Grants Neuroscience Research, 1st place Our neurosurgeons and affliated Douglas J. Cook neuroscientists captured over $116.3M in Basic Neuroscience Research, 1st place research grant funding over this 5 year period, Gregory Hawryluk from agencies including the Canadian Institutes Basic Neuroscience Research, 2nd place of Health Research (CIHR), Canada Foundation for Innovation (CFI), Natural Sciences and 2012 Engineering Research Council (NSERC) and Jeff Wilson National Institutes of Health (NIH), among Clinical Neuroscience Research, 1st many other granting agencies and philanthropic place organizations. 2013 These funds have been used to support David Cadotte research programs in the areas of advanced Clinical Neuroscience Research optic and imaging modalities, biomarkers, Nir Lipsman cerebrovascular disease, epilepsy, gene therapy, Clinical Neuroscience Research

96 Five Year Review 2009-2014 In addition, our residents have been Berris Award for postgraduate education. successful in winning other highly competitive Andres Lozano received the Winn Prize awards and fellowships, selected highlights from the Society of Neurological Surgeons. of which include the prestigious Starr Medal, Charles Tator was the recipient of the UHN New York Academy of Medicine Lewis Rudin 2011 Global Impact Award. Glaucoma Award, Royal College Fellowship, American Academy of Neurosurgery Resident Michael Taylor received the George Award, New Investigator Award at the American Armstrong-Peters Prize for outstanding Institute of Ultrasound, Synthes Award for achievements in research by a surgical Resident Research on Brain and Craniofacial faculty at the early stages of their career. Injury, CIHR Fellowship Grant, A.W. Harrison Resident Teaching Award, CIHR Bisby Prize, 2011 PSI Resident Research Award and NREF James Drake was appointed as Director of Research Fellowship. the Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI). Faculty Honours/Awards/Positions Held Fred Gentili and Charles Tator received the The remarkable talents and achievements of Council Awards for 2011 from the College our faculty have been recognized by the receipt of Physicians and Surgeons of Ontario. of numerous awards and honors from 2009 to 2014. Highlights include appointments to the Michael Fehlings was appointed as Royal Society of Canada and Order of Ontario; President of the Cervical Spine Research induction to the Canadian Academy of Health Society (CSRS). Sciences; receipt of two prestigious Winn Prizes from the Society of Neurological Surgeons; and Charles Tator and Michael Fehlings were creation of an honorary named lecture by the co-recipients of the Reeve-Irvine Research American Association of Neurological Surgeons/ Medal. Congress of Neurological Surgeons. James Rutka was inducted as a Fellow of 2009 the Royal Society of Canada. Michael Fehlings received the Olivecrona Andres Lozano was the recipient of a Award and Medal from the Karolinska Pioneer in Medicine Award from the Society Institute. for Brain Mapping and Therapeutics. Andres Lozano was elected to the Royal Charles Tator was the recipient of the Society of Canada. American Spinal Injury Association (ASIA) Lifetime Achievement Award, for Michael Taylor received the Gold Medal his contributions to the world of spinal cord Award in Surgery from the Royal College. injury care. 2010 James Rutka was elected to the Canadian James Rutka served as the President of Academy of Health Sciences. the American Association of Neurological Surgeons (AANS). Charles Tator had a lecture named in his honor by the American Association Mojgan Hodaie was awarded the Wightman- of Neurological Surgeons/Congress of

Five Year Review 2009-2014 97 Neurological Surgeons (AANS/CNS) James Rutka was appointed as the Section on Neurotrauma and Critical Care. seventh Editor-in-Chief of the Journal of Gelareh Zadeh on her receipt of the 2012 Neurosurgery. Lois H Ross Resident Advocate award from PAIRO. 2013 James Rutka was elected to the Order of Ontario, the Province’s highest honour. 2012 American Academy of Neurological Michael Fehlings was appointed as Vice Surgery (AAcNS) President James Rutka Chair Research in the Department of delivered the 2012 AAcNS Presidential Surgery at the University of Toronto. Address. Andres Lozano received the 2013 Margolese Charles Tator was selected as the 2012 National Prize in Brain Disorders, awarded Gallie Surgical Lecturer by The Royal to a Canadian who has transformed care in College of Physicians and Surgeons. heart or brain diseases. Michael Fehlings was awarded the Winn Prize from the Society of Neurological Gelareh Zadeh won 2014 Bernard Langer Surgeons. Surgeon-Scientist Award, presented annually to an outstanding graduate of the Mark Bernstein received the 2013 Surgeon-Scientist Training Program in Humanitarian Award from the American the Department of Surgery who shows the Association of Neurological Surgeons. greatest promise for a career in academic surgery. James Rutka received the inaugural 2012 Abhijit Guha Award from the Society for Todd Mainprize received the Marvin Tile NeuroOncology and the Section on Tumors Distinguished Service Award at Sunnybrook of the AANS/CNS. Hospital.

Andres Lozano received the Olivecrona Michael Fehlings was elected to the Award and Medal from the Karolinska Canadian Academy of Health Sciences. Institute.

Todd Mainprize received the Peters-Boyd Visiting Professors Academy Mentorship Award. E. Harry Botterell Visiting Professorship in Neurosurgery Michael Fehlings won the Queen Elizabeth Daniel Barrow, Emory University, 2009 II Diamond Jubilee Medal. Matthew Howard III, University of Iowa College of Medicine, 2010 Andres Lozano was the inaugural recipient Jacques Morcos, University of Miami, 2011 of the quadrennial Tasker Award from Kim J. Burchiel, Oregon Health and Science the World Society for Stereotactic and University, 2012 Functional Neurosurgery. Not held due to Celebration of 90 Years of Neurosurgery at the University of Toronto, Michael Fehlings received the 2012 Jonas 2013 Salk Award.

98 Five Year Review 2009-2014 E. Bruce Hendrick Visiting Professorship in Los Angeles, 2010 Pediatric Neurosurgery Armin Curt, University of Zurich, 2011 William Harkness, Great Ormond Street Susan J. Harkema, University of Louisville, Hospital, 2009 2012 Richard Ellenbogen, University of Washington, Multiple guest speakers, 2013 2011 P. David Adelson, Barrow Neurological University of Toronto Spine Program Institute, 2012 Visiting Professorship John Kestle, University of British Columbia, Ed Benzel, Cleveland Clinic, 2009 2013 Charles Johnston, Texas Scottish Rite Hospital for Children, 2010 William S. Keith Visiting Professorship in Jens Chapman, University of Washington, 2011 Neurosurgery Jean F. Dubousset, St. Vincent de Paul Hospital, Anil Nanda, LSU Health Sciences Centre, 2009 2012 Nelson Oyesiku, Emory University, 2011 Alexander Vaccaro, Thomas Jefferson Christopher Shaffrey, University of Virginia, University Hospital, 2013 2012 Duke Samson, University of Virginia, 2013

Division Firsts Arthur and Sonia Labatt Brain Tumor Research Centre Annual Academic 2010 Lectureship In a new tradition for our Division, our Joe Costello, University of California at San annual William S. Keith Professorship dinner Francisco, 2009 was combined with a graduation ceremony for Waldemar Debinski, Wake Forest University, our PGY6 residents, who were presented with 2010 mounted photographs taken with their mentors. Kenneth Aldape, MD Anderson Cancer Centre, 2011 2011 Inder Verma, The Salk Institute, 2012 1st Division of Neurosurgery Annual Fred Lang MD Anderson Cancer Centre, 2013 General Meeting Brian Marshall Lectureship Launch of a monthly “Faculty Focus” Michael Avidan, Washington University in St. profle series on the Division website Louis, 2009 Establishment of the Michael and Amira Andrew Maas, University Hospital Anwterp, Dan Fellowships in Neurosurgery 2011 (Host, Neurosurgery) 2012 Thomas Bleck, Rush Medical College, 2012 (Host, Anesthesiology) Launch of a new PGY4-PGY1 mentorship Not held due to Celebration of 90 Years of program. We thank our PGY4 residents for Neurosurgery at the University of Toronto, their outstanding job in service to their junior 2013 colleagues.

Charles H. Tator-Barbara Turnbull 2013 Lectureship Series in Spinal Cord Injury First Skype broadcast by the University James Fawcett, Cambridge University Centre of Toronto Brain School to the Neurosurgery for Brain Repair, 2009 Program in Kijabe, Kenya, as part of International V. Reggie Edgerton, University of California Surgery Rounds.

Five Year Review 2009-2014 99 Our Division’s frst Cerebrovascular Royal College Fellowships Neurosurgery Soiree was held on Feb. 24, 2009: Hussein Al-Ahmadi, Merdas Al-Otaibi 2014 with Faculty presenting developments in and Ratan Bhardwaj clinical, research and teaching work at their sites, 2010: Ryan DeMarchi, Zul Kaderali, Paul and discussing opportunities for new synergies Kongkham and Adrian Laxton across the University-wide program. The event 2011: Douglas Cook, Suneil Kalia, Demitre was followed by Soirees for Neurooncology, Serletis and Victor Yang Spine and Gamma Knife Surgery. 2012: Soha Al-Omar, Michael Ellis, Gregory Hawryluk, Scellig Stone and Adrienne Weeks Leadership Changes/Progressions 2013: Julius Ebinu, Aria Fallah, Carlo Michael Tymianski, Head, Division of Santaguida, Mehdi Shahideh and Sunjay Sharma Neurosurgery, Toronto Western Hospital, effective June 1, 2012 Todd Mainprize, Interim Head, Division of Neurosurgery at Sunnybrook Hospital, effective July 1, 2013

100 Five Year Review 2009-2014 DIVISION OF ORTHOPAEDICS

Department of Surgery, University of Toronto As Prepared by Peter Ferguson, MD, FRCSC, AR Latner Chair, Division of Orthopaedics July 1, 2009 – June 30, 2014

The past 5 years have seen tremendous an intensive skills course during the frst month growth and accomplishment in the Division of of training, (2) maximizing effciency in training, Orthopaedic Surgery. Long considered a world (3) a rigorous and intensive assessment program leader in the pillars of orthopaedic clinical and (4) progression through the program based care, research and education, our division has on demonstration of competence rather than a continued to reinvent itself in these areas of fxed time. Educational leadership changed in academic practice. Dr. Benjamin Alman held January 2011 when Dr. Peter Ferguson took over the position of Albert and Temmy Latner Chair as Program Director and Dr. Markku Nousiainen of Orthopaedic Surgery from 2009 to June 30 assumed the role of Associate Program 2013 before departing to become the Chair Director with a focus on the Competency of the Department of Orthopaedic Surgery Based Curriculum. Initially 3 residents per year at Duke University. During his tenure the enrolled in the pilot for 4 years and then, based Division developed the world’s frst completely on its success, in July 2013 the entire class of Competency-Based Surgical training curriculum, 12 new residents entered this program which continued novel and innovative translational has now become the standard curriculum in and clinical research and established various our program. The metrics for success of this University-wide clinical programs to improve new curriculum include the fact that the initial and streamline patient care. Judging from these intensive skills course is a part of curriculum achievements and the number of new faculty for all surgical trainees at the University of recruits, promotions and awards, Dr. Alman Toronto and in fact is being mimicked by other left the Division in fantastic shape. Dr. Peter orthopaedic training programs including Harvard Ferguson served as Interim Chair from 2013- University. The entire curriculum has generated 2014 before being named the Albert and Temmy signifcant interest at the level of the Royal Latner Chair effective July 1 2014. College of Physicians and Surgeons of Canada with other orthopaedic programs across the country likely following suit. Furthermore other Education surgical programs around the world are looking to incorporate various components including our Our Division has developed the world’s frst assessment tools into their programs. Thus far the completely Competency Based surgical training new curriculum has been reviewed by the Royal curriculum. This was done through the immense College and has received full accreditation status contributions of a number of committed and without major weaknesses. The frst 5 trainees dedicated members of our faculty who served have successfully passed their Royal College as educational leaders. Initially designed by Dr. specialty exams on the frst attempt, 4 of them Bill Kraemer Program Director and Dr. Peter after 4 years of training. Ferguson Associate Program Director, the frst 3 residents in this pilot stream entered the program Dr. Jeremy Hall has held the position of July 1 2009. This novel curriculum emphasizes undergraduate supervisor in the Division and has (1) early technical skills training by institution of done a stellar job of incorporating orthopaedic

Five Year Review 2009-2014 101 education into the undergraduate curriculum at across the broad University of Toronto and the University. Our faculty regularly ranks highly its affliated hospitals community, it has two in their undergraduate teaching evaluations nodes at Sunnybrook Hospital and Mount Sinai and we have continued to recruit high quality Hospital. The centre focuses on developing residents into our program because of our initiatives to help translating research from undergraduate education endeavours. the bench to the bedside to the backyard. Several trainees working with members of Dr. Albert Yee has served as fellowship our division received salary support for their supervisor and has implemented a Division-wide interdisciplinary translational research. The fellowship committee to oversee fellowship centre developed a new collaborative graduate education and research issues. Our Division has education program, helping with the recruitment the largest fellowship program in the Department of new MSK researchers to Toronto. Its ultimate of Surgery and one of the largest in the world goal is to develop new and improved methods at over 60 fellows annually. Development of a of treating patients with orthopaedic and other Division-wide Fellowship Research Day has musculoskeletal conditions. Our division been met with much success, providing fellows members will be able to use the centre a forum to present their research to their peers. infrastructure to develop multi centre research and to help develop new interdisciplinary work. Research The past several years have seen the Our academic footprint is a measure of development of new technologies and research how we impact orthopaedics internationally. It paradigms that have improved the quality and is a measure of the impact of our publications, clinical applicability of our research work. These the number of our trainees who have develop developments are associated with growth in the successful academic careers outside of Toronto, size of the biomedical research community and and how our work improves the outcome for the the expense of undertaking high quality research patients we treat. We have one of the world’s studies. Indeed there has been tremendous largest academic footprints, having ranked third growth in the Toronto research community over in the world in peer reviewed publications several the past decade. Unfortunately, national research years consecutively, and this accomplishment funding has not kept pace with the increased is in no small part due to our strong focus of costs associated with undertaking this high research. quality research. Despite these challenges, we continue to maintain research funding at a high Our Divisional research committee has level, with annual funding frequently totaling been co-chaired by Drs. Cari Whyne and Sevan more than $6 million dollars. Hopyan. A key component of this essential job is overseeing and mentoring the residents who enter their integrated research and clinical year. Their Clinical Care participation in this novel combined clinical and The six core academic teaching hospitals are research training program has facilitated the quaternary referral centres for most subspecialties in ability of our trainees to participate in high level orthopaedics. We also have 5 affliated community research, resulting in an overall increase in our hospitals within our division. Our clinical volumes research productivity. and breadth of complex surgical cases far surpasses any centre in Canada and rivals most large centres The Toronto Musculoskeletal Centre (a in the US. As part of our initiative to develop a university wide extra-departmental unit) was broader competency based program, we have initiated during Dr. Alman’s tenure. While the organized some aspects of education, research, and center crosses all institutions and departments clinical care along specialties rather than sites.

102 Five Year Review 2009-2014 Dr. Albert Yee, along with Dr. Michael Fehlings in teaching and research. On a broader scale, (Neurosurgery) we appointed as co-directors of the members of our division have won numerous U of T Spine Program, and have done a fabulous Departmental awards within Surgery including job working to integrate spine care, education and research achievements at Gallie Day, the D.R. research across orthopaedics but also between Wilson Award for best resident teacher in the orthopaedics, neurosurgery and other disciplines Department (twice), the Tovee Postgraduate treating the spine. Dr. Tim Daniels, as the head Award for faculty (twice), the Charles Tator of our foot and ankle program has developed a Surgeon-Scientist Mentor Award (twice) and Toronto wide foot and ankle education program the Surgical Skills Centre Distinguished Teacher (including a city wide fellowship program), and Award. We have also won numerous awards is helping to coordinate care between foot and across the entire Faculty of Medicine including ankle specialists in the GTA, and to encourage the W.T. Aikins Award for best performance in new research in this feld. Dr. Darrell Ogilvie small group undergraduate teaching, the Dean Harris was appointed the inaugural interim head L. Chute Award for all-around contributions to of our sports program. This program united undergraduate medicine, and the Excellence in clinicians from several of our hospitals and Postgraduate Education Award (Development developed shared clinical resources for outpatient and Innovation) – an award open to all members care at Women’s College Hospital towards the of the Faculty of Medicine that has been won development of an innovative comprehensive by members of the Division of Orthopaedics 5 sports clinical, education, and research program. years in a row. Finally, our members have won The program has developed a fully integrated numerous national and international awards education module for residents and fellows. at the Canadian Orthopaedic Association, the American Academy of Orthopaedic Surgeons, We continue to rejuvenate our faculty by the Orthopaedic Trauma Association and the recruiting outstanding young surgeons. These American Orthopaedic Foot and Ankle Society, individuals are able to deliver the highest quality to name a few. Our faculty members have served clinical care using modern technology and in national and international leadership roles surgical techniques. In the past 5 years we have as we continue to demonstrate our outstanding recruited 10 new faculty with a wide range of reputation at the forefront of academic clinical and academic expertise. We have also had orthopaedics in the world. very few faculty depart our division. This group of young surgeons is poised to capitalize on the mentorship of our senior membership to lead us into the next era of academic orthopaedics.

Promotions, Awards The academic accomplishments of the members of our division are signifcant, as signifed by the large number of awards and academic promotions that have been obtained. Ten members of our faculty have been successful in their promotion applications – 3 to Assistant Professor, 4 to Associate Professor and 3 to Full Professor. Our Divisional awards are always competitive and high quality individuals are rewarded for their achievements

Five Year Review 2009-2014 103 DIVISION OF PLASTIC AND RECONSTRUCTIVE SURGERY

As Prepared for Christopher Forrest, MD, MSc, FRCSC Division Chair, Plastic and Reconstructive Surgery July 1, 2010 – June 30, 2015

The Division of Plastic and Reconstructive representation from all teaching faculty as well as Surgery at the University of Toronto is the largest from the residents. The committee is responsible group of academic surgeons in North America for the effective delivery of the goals and comprising a consolidated group of 49 surgeons, objectives of plastic surgery residency training, 3 senior scientists, 26 residents and 25 fellows as set out by the Royal College of Physicians and working at 12 units in 10 teaching hospitals in Surgeons of Canada. It is also responsible for the the greater Toronto area all under the University selection of new residents through the Canadian of Toronto academic mission. Our division Resident Matching Service. has expertise in the entire breadth and depth of Plastic and Reconstructive Surgery in the The University of Toronto training program arenas of pediatric surgery, cleft, craniofacial, is 5 years in duration. The frst two years include burns, microsurgery, facial reanimation, upper training in Foundations of Surgery. Residents extremity, breast, aesthetic and oncologic receive training in plastic surgery as well as surgery providing state of the art in patient care. in several complementary specialties. These Our program and its members are recognized two years provide the basic knowledge and across the globe and we attract a large number foundation on which the resident will eventually of medical observers who travel to visit and see become a specialist in plastic surgery. The three frsthand the innovative techniques developed senior years occur entirely within the division. here. We train the largest number of residents Residents typically rotate on 9 rotations and fellows in the country including tomorrow’s of four month duration, covering all of the generation of surgeon-scientists. The past 5 years “subspecialties” in plastic surgery. Our academic have seen leadership change, divisional growth program is diverse and includes an extremely and enhanced profle in the arenas of education, detailed seminar series delivered through the research, clinical innovation and global outreach. weekly plastic surgery school curriculum. Other www.uoftplasticsurgery.ca activities include: morbidity and mortality rounds, journal club, professor’s rounds, multiple symposia, research day and the annual Residency Training visiting professor. Research is a very important component of our program and residents have The vision of our training program is to an opportunity to be involved in both clinical produce outstanding plastic surgeons who will and basic science research throughout their become leaders within our feld and contribute training. Residents who desire a committed to the ongoing development of our specialty in period of focus in research are encouraged to both an academic and a community setting. This access the Surgeon Scientist Program within occurs through a combination of excellence in the Department of Surgery. The division trains education, world class research and committed approximately 4 new residents each year. mentorship. The training program is run by the residency program committee. This committee is chaired by the program director and includes

104 Five Year Review 2009-2014 Research Whilst many of our training program graduates become community Plastic and Research within the Division of Plastic Reconstructive Surgeons, our philosophy and Reconstructive Surgery at the University to emphasize the importance of research of Toronto has always remained a cornerstone methodology in all of our trainees is a necessary of our Division. Our humble start in the 1960’s skill set regardless of the designation of your with former Chair, Dr. W. K. Lindsay’s fexor practice. Awareness of research methodology tendon injury models in chickens has blossomed and the importance of recognizing good science to include the full spectrum of laboratory-based is necessary when dealing with industry who research, epidemiology, surgical education and are introducing new products or understanding health care delivery. We have faculty that are the literature promoting an innovative surgical “contributors “to our profession as we embrace technique. All our trainees contribute to the body research questions and the projects that follow. of scientifc literature by completing a minimum Many of our academic staff are graduates of the of 2 research projects leading to peer-review innovative Surgeon-Scientist program that was publication during their residency. Our division established at the University of Toronto well is very supportive of the enhancing research over 25 years ago and fourishes to this day. profle of all trainees and the majority of staff Each year, the division supports trainees with will mentor summer students, medical students, an interest in an academic surgery to enter this residents and fellows to initiate and complete a program to complete a MSc or PhD and help research project. defne the future of our specialty. The Division of Plastic and Reconstructive Plastic surgery does not own a major Surgery is fortunate in being surrounded by highly organ system but we face reconstruction in all productive and collaborative surgical divisions anatomic arenas thereby allowing us the unique at the University of Toronto. Our research opportunity to collaborate with all medical trainees have worked with Divisions of Thoracic and surgical subspecialties. As such, we are Surgery, Cardiac Surgery, Neurosurgery, called on to help address problems in the broad Medical Bioengineering, Orthopedic Surgery areas of wound healing, tissue engineering, and General Surgery. transplantation, limb replacement, breast reconstruction, peripheral nerve repair, skin Research is a necessary component of replacement, surgical simulation and robotics to faculty development and all new staff recruits name but a few. The depth and breadth of our to the University of Toronto are encouraged specialty is vast and this allows us to pursue to pursue a research focus as an important an equally broad base of research interests and component of their academic career. Innovative problems. opportunities have led to the development of internationally recognized leaders within the The Division of Plastic and Reconstructive Division of Plastic and Reconstructive Surgery Surgery at the University of Toronto has always in the areas of outcomes research, epidemiology, had a tremendous interest in training tomorrow’s surgical education and simulation, health care leaders and surgeon scientists. Of the 49 surgeons delivery and economics, basic science research, on staff in our division, the vast majority of us quality of life and patient reported outcomes. hold higher degrees in research, either through

the Surgeon-Scientist Program or other graduate Our division mission statement stresses the programs. importance of research for our division and for the growth of Plastic and Reconstructive Surgery as a specialty.

Five Year Review 2009-2014 105 Recruitment Manuel Dibildox: Lecturer, Ross Tilley Burn Centre, Sunnybrook Health Science The Division has expanded over the past 5 Centre (2011) years with new staff at 4 teaching hospitals and Joan Lipa: Associate Professor, the inclusion of a new community partner at the Sunnybrook Health Science Centre (2011) Trillium Centre as part of the Mississauga Medical Christine Novak: Associate School Academy. Professor and Senior Scientist at the Toronto Rehabilitation Institute and Marc Jeschke: Director, Ross Tilley Burn Research Associate, The Hand Program - Centre, Sunnybrook Health Science Centre Toronto Western Hospital) (2011) (2009) Steven McCabe: Associate Professor, Greg Borschel: Associate Professor, The Director of the Hand Program at the Hospital for Sick Children (2009) Toronto Western Hospital, University Tessa Gordon: Senior Scientist, The Health Network (2012) Hospital for Sick Children (2009) Anne O’Neill: Assistant Professor at the Michael Weinberg: Lecturer, Trillium Toronto General Hospital, University Health Health Science Centre (2009) Network and Mt. Sinai Hospital (2013) Cory Goldberg: Lecturer, Trillium Health Karen Wong: Assistant Professor, The Science Centre (2009) Hospital for Sick Children (2013) Zvi Margaliot: Lecturer, Trillium Health Karen Cross: Clinical Associate, St. Science Centre (2009) Michael’s Hospital (2014) Morris Rebot: Lecturer, Trillium Health Bryan Cheung: Clinical Associate, Hand Science Centre (2009) Program at the Toronto Western Hospital, Frank Lista: Lecturer, Trillium Health University Health Network (2014) Science Centre (2009) Alan Rogers: Lecturer, Ross Tilley Burn Atul Kesarwani: Lecturer, Toronto East Centre, Sunnybrook Health Science Centre General Hospital (2010) (2015) Laura Snell: Assistant Professor, Kristen Davidge: Locum, The Hospital for Sunnybrook Health Science Centre (2010) Sick Children (2015) Jamil Ahmed: Lecturer, Trillium Health Science Centre and TWH-UHN, (2010)

106 Five Year Review 2009-2014 Promotions Manuel Dibildox (relocated to Mayo Clinic residency program in Plastic and David Fisher (The Hospital for Sick Reconstructive Surgery) (June 2015) Children) Associate Professor (2010) Oleh Antonyshyn (Sunnybrook Health Ralph Manktelow former Chair and Science Centre) Professor (2011) Professor of the Division of Plastic and Dimitri Anastakis (TWH – UHN): Reconstructive Surgery (TWH-UHN) and Professor (2011) world expert in facial reanimation retired Toni Zhong (TGH – UHN) Assistant from the division in 2009. Professor (2011) Jeff Fialkov (Sunnybrook Health Science Manuel Gomez (Sunnybrook Health Centre): Associate Professor (2012) Sciences Centre), Director of Research for Greg Borschel (Hospital for Sick Children) St. John’s Rehabilitation Unit retired in Associate Professor (2013) March 2015. Stefan Hofer (TGH - UHN) Professor (2013) Cho Y. Pang, Senior Scientist at the Hospital Marc Jeschke (Ross Tilley Burn Centre, for Sick Children and supervisor for many Sunnybrook Health Science Centre) surgeon scientist trainees at the University Professor (2013) of Toronto retired and transitioned into Manuel Gomez (Sunnybrook Health Professor Emeritus role in March 2015. Sciences Centre) Associate Professor (2014) Toni Zhong (TGH - UHN) Associate Ronald M. Zuker, former Chief of the Professor (2014) Division of Plastic and Reconstructive Surgery at the Hospital for Sick Children Departures and Transitions retired from active clinical practice in June In general, turnover of staff in the Division 2015. of Plastic and Reconstructive Surgery has been low indicating a high level of job satisfaction. In Memorium Hugh G. Thomson, MD, MSc, FRCS(C) Dimitri Anastakis stepped down as the Chair (1930 – 2012) was Professor Emeritus in of the Division of Plastic and Reconstructive the Division of Plastic and Reconstructive Surgery to assume an appointment as Vice- Surgery, University of Toronto and staff Dean, Offce of Continuing Education surgeon at the Hospital for Sick Children for & Professional Development Faculty 43 years (1960 – 2003). of Medicine, University of Toronto in September 2011, WRN Lindsay, MD, FRCS(C) (1926 – 2013) former Chief of the Division of Plastic Christopher Forrest was appointed and Reconstructive Surgery at the Wellesley the Interim Chair in October 2011 and Hospital, established the Burn Unit at the commenced as Chair in July 2013. Wellesley Hospital (transitioning into the Ross Tilley Burn Unit at Sunnybrook Health Linda Dvali was appointed as the new Science Centre), actively participated in Division Head to the Toronto East General gender reassignment surgery and established Hospital as of April, 2011. the UoT Annual Aesthetic Plastic Surgery Symposium in 1970 which held its 45th annual meeting this year.

Five Year Review 2009-2014 107 Robert J. Knowlton MD, FRCS(C) (1934 Peter MacDougall MD, FRCS(C) (1932 – 2014) former Chief of the Division of – 2011) former Chief of Plastic Surgery, Plastic and Reconstructive Surgery, St. St. Michael’s Hospital and Past President, Joseph’s Health Sciences Centre. Canadian Society of Plastic Surgeons

Engagement

Under the supervision of Dr. Forrest, the Engagement of alumni has become a priority division has been active in generating engagement and Dr. Ron Zuker was recently appointed as at all levels using the schemata below. A major Director of Alumni Relations for the division. renovation of the divisional website was carried UoT Alumni and Friends receptions have been out in 2014 and was integral to success in this established at the annual Canadian Society of area. Plastic Surgeons, ASAPS and ASPS meetings. Highlights of enhanced communication Response has been very favourable in all have included an active email-based system these areas of development. of regular announcements (WGO’s – What’s going on), Chair’s comments, “Snapshot: 33 questions”, “Where are they now?”, annual newsletter, division FaceBook and Twitter accounts. An active social program has been established that focuses on staff-resident-fellow interaction in non-clinical settings such as Bowling Night, Cooking Class, Wine Appreciation Night, Career Night and the Gala Graduation event at the end of the academic year. Continuing Medical Education

108 Five Year Review 2009-2014 The Division of Plastic and Reconstructive recognition that can be bestowed by the Surgery has an active program in CME. Yearly Department of Surgery on a young surgeon. CME events consist of the following: This prize was given to members of the Division of Plastic and Reconstructive Surgery two years Tau Omicron Hoyle Campbell Visiting in a row: Dr. Marc Jeschke (Ross Tilley Burn Professor- Resident Research Day Centre, Sunnybrook Health Science Centre in Lindsay-Thomson Pediatric Plastic 2013) and Dr. Greg Borschel (SickKids in 2014). Surgery Symposium Vale Pediatric Craniofacial Lecture Plastic Surgery School was implemented in Upper Extremity Update September 2010 as the Division’s frst Academic UoT Aesthetic Plastic Surgery Half Day for the Senior Residents. Academic Symposium sessions are considered mandatory protected Toronto Breast Symposium time for the residents. Most of these sessions Ralph Manktelow Upper Extremity Day are designed for senior residents, however some Canadian Burn Symposium of the sessions are designed for both senior and Biannual Pediatric Upper Extremity junior residents. Plastic Surgery school takes Symposium place on Mondays from 8:00-11:00 a.m. and Pediatric Wound Care Symposium includes Resident Seminars, Ethic sessions, Dupuytren’s Day Surgical Skills sessions, and CanMEDS seminars/workshops. Each of these sessions, Other CME events include: as well as all academic activities, have been KLS Martin Craniofacial Lectureships formally evaluated, with feedback sent directly Obstetrical Brachial Plexus Palsy to the facilitators to use to create change where Symposium necessary as it relates to improved teaching Advanced Craniomaxillofacial methods. Conference: Adult and Pediatric Wharton Lectureships Site Specifc Goals and Objectives and GTA Lecture Series Site Specifc ITERS have been generated and Professors Rounds instituted for all junior and senior resident M&M Rounds rotations for off-service and on-service experiences.

Divisional Firsts The division is a large and biologically CanMEDS Workshop diverse organization, covering all aspects of the Several faculty have assigned roles for feld of Plastic and Reconstructive Surgery – implementing and incorporating the teaching of academic frsts and achievements in the areas of each of the seven CanMEDS roles. Seminars/ clinical work, research and education are briefy lectures/assignments have been implemented summarized below: into the training program for each of these roles.

George Armstrong Peters Prize: This Global Outreach is a major focus of many is awarded to a young investigator who has of the division members and activity has been shown outstanding productivity during his/her focused through several NGO’s (Operation initial period as an independent investigator Smile, Operation Rainbow, Transforming Faces as evidenced by research publications in peer Worldwide, African Medical Research and reviewed journals, grants held, and students Foundation) in several low and middle income trained and represents the highest level of countries around the world including India,

Five Year Review 2009-2014 109 Bangladesh, Uganda, Middle East, Ethiopia, Composite Vascularized Transplantation Kenya to mention a few. Program: Drs. Ronald Zuker and Greg Borschel from the Hospital for Sick Children obtained Clinical innovations: approval for their protocol for the Pediatric Dr. David M. Fisher (SickKids): Cleft lip Composite Vascularized Allotransplantation repair and ear reconstruction Protocol from the Ministry of Health and Long Term Care in 2013. This is the frst approved Dr. Marc Jeschke (RTBC – Sunnybrook protocol in the pediatric world and opens Health Science Centre): opportunities reconstructive world to include Skin bioengineering and 3D printing allotransplantation for limb loss and severe Dr. Greg Borschel and Dr. Ron Zuker facial disfgurements. (SickKids): Corneal re-innervation Each year, the Annual Breast Reconstruction Dr. Ron Zuker (SickKids): Facial Awareness Day (BRA Day) is held for the reanimation purpose of educating women about breast Dr. Craig Fielding (St. Joseph’s Health reconstructive surgery post-mastectomy and was Science Centre): Gynecomastia repair the brain-child of Dr. Mitch Brown (Women’s Dr. Oleh Antonyshyn (Sunnybrook Health College Hospital). This was initiated in 2010 and Science Centre): Craniofacial imaging is now internationally recognized in almost 30 Dr. Jim Mahoney (St. Michael’s Hospital): countries and is open to the public each year. Wound Care Centre The Pediatric Burn Care Program at the Dr. Steve McCabe (Toronto Western Hospital for Sick Children was the frst program Hospital – UHN): Upper extremity surgery in Canada to receive approval from the American Dr. Joel Fish (SickKids): Pediatric Burn Burn Association in 2013 under the supervision Care of Dr. Joel Fish. The Ross Tilley Burn Program Drs. Christopher Forrest and John Phillips at Sunnybrook Health Science Centre also has (SickKids): Use of CAD-CAM ABA approval. technology in pediatric craniomaxillofacial surgery

110 Five Year Review 2009-2014 DIVISION OF THORACIC SURGERY

As Prepared by Thomas K. Waddell Pearson-Ginsberg Chair in Thoracic Surgery July 1, 2009 – June 30, 2014

The academic years 2009-2014 have seen and narrow band imaging as well as endoscopic tremendous growth and successes in Division surgery. In 2011, the UHN site opened the of Thoracic Surgery and cemented the position LungMets Program to allow patients with of the University of Toronto program as the pre- malignancy metastatic to the lung to be evaluated eminent Division in the world. It continues to by both Thoracic Surgeons and Radiation have the largest clinical activity of any thoracic Oncologists. In October 2011, a program in program in Canada. A fourth site has been added Robotic Thoracic Surgery was initiated by Dr. (2011) and an important collaborative effort Yasufuku and he performed the frst robotic established with McMaster University (2010). lobectomy in Canada shortly thereafter. The The Toronto sites now include Toronto General University of Toronto-McMaster Joint Program Hospital (TGH) and the community hospitals, in Thoracic Surgery took another step forward St. Joseph’s Healthcare Centre-Toronto (SJ- with the frst interchange of a clinical fellow, Dr. T), Toronto East General Hospital (TEGH) Nir Golan, who spent a portion of his training and the Mississauga hospitals (Trillium and both in Toronto and Hamilton. In 2012-13, a new Credit Valley). Residents have long enjoyed the program initiated by the Division of Thoracic community surgery experience at St. Joseph’s Surgery at TGH was the Joint Program in Benign Hospital but over the past 5 years both residents Esophageal Disease, led by Dr. Gail Darling as a and fellows now rotate to both SJ-T and TEGH. combined monthly clinic with GI Medicine and The Mississauga program will be an increasingly General Surgery. This program also features important site for undergraduate education. monthly rounds for interesting case discussion. The Toronto General site continues to serve Dr. Darling has also led the rejuvenation of the as the primary tertiary referral centre for most Esophageal Multidisciplinary Cancer Conference of Ontario and a quaternary referral centre for to focus more attention on this important area of Canada. The Toronto Lung Transplant Program, Thoracic Surgery. In 2013, Dr. Marc de Perrot, under the leadership of Dr. Shaf Keshavjee, along with radiation oncology colleague, Dr. has become the undisputed leader in lung John Cho, have reported on their pioneering use transplantation, as the largest clinical program of neoadjuvant radiation in mesothelioma prior bolstered with a huge program of clinical and to extrapleural pneumonectomy. laboratory research.

Recruitment Division Firsts The University of Toronto Division of 2010 marked the opening of the Menkes Thoracic Surgery successfully recruited several Family Interventional Thoracic Surgery Suite at candidates over the last 5 years. Dr. Michael Ko TGH for early diagnosis, staging and treatment was recruited to SJ-T (2010-graduate of the U of of patients with lung and esophageal cancer. T residency), Dr. Najib Safeddine was recruited This includes modalities such as endobronchial to TEGH (2010- graduate of the U of T residency, ultrasound (EBUS), endoesophageal ultrasound fellowship at Cedars-Sinai), Dr. Marcelo Cypel (EUS), photodynamic therapy, autofuorescence was recruited to TGH(2011- graduate of Porto

Five Year Review 2009-2014 111 Alegre, Brazil and U of T fellowship) while Dr. Dr. Najib Safeddine was appointed as Sameena Uddin was recruited to the Mississauga Division Lead, Quality Improvement in 2014. Hospital (2011- graduate of the U of T residency). All of them are now very successful Dr. Maurice Blitz assumed Leadership of and established in their respective centres. the Foundations Course for the Department of Surgery in 2014, after serving in support of the Our partners at McMaster University Integrated Medical Education portfolio. recruited Dr. Yaron Shargal (2010-recruited from SJ-T), Dr. Christian Finley (2010-graduate Royal College Fellowships of the U of T residency), Dr. Colin Schieman (2011-graduate of University of Calgary and Over the last 5 years, our graduates have fellowship at the Mayo Clinic), and Dr. Wael done well at the Royal College. Successful Hanna (2013-graduate of the U of T residency). graduates included Drs. Finley, Smith, and Ko in 2010, Drs. Privitera and Uddin in 2011 Dr. Hanna in 2013.

Promotions Beginning in 2013, our training program Dr. Waddell was promoted to Full Professor has developed increasing recognition south of in 2010, on the basis of research activity. In 2011 the border, beginning with the Massachusetts Drs. Robert Zeldin and Andrew Pierre were General Hospital, who sent two outstanding promoted to Associate Professor, acknowledging residents to us for 4-month rotations as part their contributions to education. Dr. Yasufuku of their US residency training requirements. was promoted to Associate Professor at the Additional residents have since joined us from University of Toronto in 2013. Dr. Carmine the University of Colorado, and the University Simone was promoted to Assistant Professor in of Maryland, with two more scheduled for 2015 2014. from MD Anderson and Memorial.

Leadership Changes Fellows graduating from our program in 2010 included Dr. Masaki Anraku (Assistant Dr. Keshavjee was appointed Surgeon-in- Professor, Keio University, Japan), Dr. Masaaki Chief at University Health Network in 2010. Sato (Assistant Professor, University of Kyoto, Dr. Carmine Simone was appointed Surgeon- Japan), and Dr. Eero Sihvo (Deputy-Chief, in-Chief at TEGH in 2012. Dr. Compeau was Thoracic Surgery, University of Helsinki, appointed Surgeon-in-Chief at St. Joseph’s Finland). In 2011, Drs. Dr. Isabelle Schmitt- Toronto in 2013. Opitz (Assistant Professor, University of Zurich, Switzerland), Dr. Gustavo Fortunato (Assistant In 2011, after more than 10 years of Professor, University of , Brazil), Dr. Nona stewardship, Dr. Gail Darling passed the reins Zeitlin (Assistant Professor, University of Haifa, of the Thoracic Surgery Residency Program Israel) all completed their training in Toronto. Directorship to Dr. Andrew Pierre while Dr. Clinical Fellows completing additional training Maurice Blitz has assumed the important role in the 2011-2012 academic year included Tetsuzo of Associate Director, Undergraduate Education Tagawa (Kyushu Medical School), Drs. Henrique for Integrated Medical Education. Nietmann (Serra dos Orgaos Foundation Medical School, Brazil), Tetsu Yamada (Kyoto Dr. Abdollah Behzadi has assumed University), and Bill Lynch (University of Iowa). leadership of Undergraduate Education for the Dr. Lianne Castle broke new ground as the frst Division of Thoracic Surgery. fellow to complete advanced training with Dr.

112 Five Year Review 2009-2014 Yasufuku in Interventional Bronchology as a Thoracic Surgery Club. She was appointed CCO respirologist. In 2012-13, Dr. Golan (pour frst Clinical Liason for Lung Cancer in 2014, with joint fellow with McMaster) returned to Israel as responsibilities for all aspects of care including Assistant Professor and other fellows completing radiation and systemic therapy. She was elected training included Drs. Donna Eaton (Assistant to membership in the AATS in 2010 and to the Professor, Dublin), Nicolo Daddi (Associate American Surgical Association in 2013. She Professor, University of Perugia), and Andrea won the GE Darling Award for Excellence in Mariscal (Assistant Profesoor, Barcelona). In Undergraduate Teaching in 2010, 2012,and 2013-14 we had an incredibly busy year for 2013. fellows, including several visiting faculty already well established as mid-career surgeons. Dr. De Perrot was elected to membership in These included Drs Amir Khan (ITSS fellow, the AATS in 2010. pulmonologist, Baylor, Houston), Mauricio Pipkin (Assistant Professor, Porto Alegre, Dr. Keshavjee’s leadership and contributions Brazil), Felippe Undurraga (Assistant Professor, have received numerous recognitions over the Santiago, Chile) Olaf Mercier (Associate past 5 years. For example, he was elected to Professor, Marie Lannelongue, Paris), Stephane the Council of the American Association for Collaud (Graham Fellow of the AATS, Zurich), Thoracic Surgery in 2010. Several national and Virginia Linacre (Assistant Professor, Santiago, international special recognition awards were Chile), Thorsten Krueger (associate Professor, received by Dr. Keshavjee in recognition of Lausanne), Michele de Waele (Joint Fellow the transformative impact that Ex Vivo Lung with McMaster, Assistant Professor, Antwerp), Perfusion (and organ repair in general) is having Edouard Sage (Associate Professor, Hopital on the feld of organ transplantation. These Foch, Paris), and Tiago Machuca (Assistant were the Zellers Senior Scientist Award (Cystic Professor, Gainesville, Florida) Fibrosis Canada), the Distinguished Lecturer in Respiratory Science Award (CIHR Institute of Faculty Honours and Awards Circulatory & Respirology Health & Canadian Thoracic Surgery) and the Roche Award for Dr. Chris Compeau won the Outstanding Excellence in Science (The Transplantation Surgical Teacher at St. Joseph’s Hospital in 2011. Society), all in 2011. In 2013, Dr. Shaf Keshavjee was awarded a Queen Elizabeth II Diamond The American Association for Thoracic Jubilee Award and was named to the Order of Surgery awarded Dr. Cypel with the prestigious Ontario recognizing his many contributions Michael DeBakey Research Scholarship as the in lung transplantation, thoracic surgery, and most promising young faculty member in North surgical leadership. In 2014, he was named a America. In 2013, Dr. Cypel was awarded a Companion of the Order of Canada, and received Canada Research Chair in Lung Transplantation. honorary degrees from Ryerson and Queen’s In 2014, Dr. Marcelo Cypel was awarded a Universities. He received the RJ Ginsberg Award Premier’s Early Research Award. for Best Postgraduate Teacher in 2010. Dr. Gail Darling has accepted major roles in important Thoracic Surgery organizations. In 2011, Dr. Andrew Pierre received both She is now Chair of the Thoracic Surgery the RJ Ginsberg Award for Best Postgraduate Specialty Committee of the Royal College and Teacher and the GE Darling Award for Excellence Chair, Board of Regents for the International in Under-graduate Teaching. Association for the Study of Lung Cancer. She is a member of the Executive Committees of Lung In 2010, Dr. Waddell was renewed for Site Committee for National Cancer Institute of a second term as R. Fraser Elliott Chair in Canada Clinical Trials Group, and the General

Five Year Review 2009-2014 113 Transplantation Research and was awarded the won a Astral Media Fellow Award from McGill newly created Heather and Richard Thomson University. Dr. Siba Haykal, a Plastic Surgery Chair in Translational Research. He was resident working in the laboratory of Dr. Waddell admitted to the American Association for had an outstanding academic year in 2011-2012. Thoracic Surgery that same year. In 2012, he was She won the Best Basic Science Research Award appointed Chair of the American Association for at the Canadian Society of Plastic Surgeons, was Thoracic Surgery Research Committee and was a fnalist in the Alan Wu Poster Competition inducted into the American Surgical Association at the Institute of Medical Science Research in 2013. In 2014, Dr. Waddell was appointed to Day. She was the recipient of several Post- the Council of the newly inaugurated Ontario Graduate Medical Education Awards, such as Institute of Regenerative Medicine, the Chair the William S. Fenwick Research Fellowship, of the Research Committee of the Thoracic the Edward Christie Stevens Fellowship in Surgery Foundation for Research and Education. Medicine and the Joseph M. West Family In recognition of contribution to teaching, Dr. Memorial Fund Award. She also received the Waddell won the RJ Ginsberg Award for Post- extremely competitive Vanier Canada Graduate Graduate Teaching in 2012 and 2014, and the Scholarship from CIHR. Dr. Jon Yeung won Ross Fleming Surgical Educator Award (UHN) frst place in the Gallie-Bateman competition for in 2013. his research undertaken under Dr. Keshavjee’s supervision. Dr. Stephane Collaud, a clinical Dr. Kazuhiro Yasufuku won the Best fellow from Zurich Switzerland was selected for Referenced Paper Award (Japanese Association the very prestigious Evarts A Graham Travelling for Thoracic Surgery) in 2012. Dr. Yasufuku also Fellowship from the American Association for was recognized at the American Association of Thoracic Surgery. Dr. Kasia Czarnecka received Bronchology and Interventional Pulmonology, the Cameron Gray Fellowship in 2012 to pursue Fall Scientifc Symposium, 2013 in Chicago her training with Dr. Yasufuku in interventional where he received the Geoffrey McLennan bronchology. In 2013, Dr. Wael Hanna won the Memorial Award, and had a paper receive the Shafe Fazel Award, Dr. Siba Haykal (Supervisor “Most Intriguing” Award. He was elected to T. Waddell) won the Gallie Bateman Prize for membership in the American Association for Resident Research. Thoracic Surgery in 2013. That same year he won the Robert J. Ginsberg Award for Excellence Research Grants in Postgraduate Teaching. Over the last 5 years, several faculty have held major peer reviewed grants as PI and as Co- Resident/Fellows Honours and Awards Investigators on several large team grants. For The FG Pearson Award honours the Best example, in 2009, Dr. Waddell held grants from Resident/Fellow Teacher of junior residents and CIHR, Cystic Fibrosis Canada and the Heart and medical students. Over the past 5 years it was Stroke Foundation totaling 300K per year as PI awarded to: Drs. Michael Ko (2010), Sameena and was Co-Investigator on Team and other grants Uddin (2011), Yaqoob Al-Sawaf (2012), Wael comprising a total of 5M/year. Dr. Keshavjee has Hanna (2013) and Pedro Reck dos Santos (2014). maintained robust grant funding every year from 2009 to 2014 from both CIHR and Cystic Fibrosis Major highlights for 2010-2011 included the Canada. In 2010, our Division entered a new Young Investigator Award, from the American phase of grant capture, with the frst major Team College of Chest Physicians going to Dr. grant awarded to Drs. Keshavjee and Liu from Takahiro Nakajima for his work on molecular Genome Canada for 1.75M over 5 years. This assessment of lung cancer (supervisor, Dr. K same year was also notable for Dr. Ysufuku’s Yasufuku). In 2011-12, Dr. Wael Hanna, has frst success as a PI for an OICR research grant.

114 Five Year Review 2009-2014 In 2011-12, several faculty were successful in Visiting Professors grant capture: Dr. Keshavjee (Canadian Cystic Over the last 5 years, we have maintained Fibrosis Foundation. Tissue Remodelling and indeed increased an active program of and the Immune Response in Obliterative Visiting Professors. For 2009-10 Dr. Hiroshi Bronchiolitis After Lung Transplantation. PI Dr. Date (Kyoto University). For 2010-11, Drs Shaf Keshavjee $331,501), Dr. Yasufuku (CIHR. Paul van Schil (Antwerp, Belgium) and Blair Porphysome nanoparticle-enabled minimally Marshall (Georgetown, Washington). For 2011- invasive transbronchial photothermal ablation 12, Drs. Sean Grondin (University of Calgary), of lung cancer, Co-investigator, Project Lead, Malcolm Brock, (Johns Hopkins), and David Dr. Kazuhiro Yasufuku $756,699 and NSERC Sugarbaker, (Brigham and Women’s Hospital) -CIHR Collaborative Health Research Program. who attended as the Kergin Lecturer for the Non-linear multimodal microendoscopy for lung Department of Surgery. Visiting Professors for cancer pathology. Co-I Dr. Kazuhiro Yasufuku 2012-13 academic year were: Drs. Alessandro $531,0000). In 2012-13 Drs. Cypel, Liu, and Brunelli (University of Ancona, Italy), Brian Keshavjee received a 5 year CIHR grant entitled Louie (Swedish Cancer Center, Seattle), and “Advanced therapeutic strategies for ex vivo Dr. Ara Vaporciyan (MD Anderson Cancer repair of lungs for transplantation”. Dr. Cypel Center, Houston). Visiting Professors for 2013- also received funding from the Canadian Cancer 14 academic year were: Benjamin Kozower Society Research Institute for an Innovation (University of Virginia, Charlottesville, Virginia) Grant entitled “Development of isolated lung and Dr Gunda Leschber (Berlin Chest Hospital, perfusion for the treatment of cancer metastases Germany). to the lungs”. Dr. Mingyao Liu received CIHR

funding for his grant “Signal cross talk in lung A highlight of the academic year is the injury and repair”. Dr. Waddell received funding highly successful Toronto Thoracic Surgery from the Roche Organ Transplant Research Refresher Course held each year in June. Over Foundation for “Lung Progenitor Cell Profling the past years some stellar faculty have visited in the Development of Bronchiolitis Obliterans Toronto including, 2010 – Drs. Doug Mathisen Syndrome”. He also received funding from the (MGH, Boston), David Jones (University of Centre for Commercialization of Regenerative Virginia, Charlottesville) and Mark DeGroot Medicine (CCRM) for “Expansion of patient- (University of Capetown, South Africa), specifc Cystic Fibrosis epithelial cells for 2011 – Drs. Jean Deslauriers (Laval), Sudhir drug screening through transient partial Sundaresan (Ottawa), Jim Luketich (Pittsburgh), reprogramming”. To help commercialize this and Walter Weder (Zurich), 2012 – Drs. Robert technology, Dr. Waddell also received funding to Cerfolio (Alabama), Drew Bethune (Halifax), support the patent application for “ Methods and Nasser Altorki (New York) and Eugenio Pompeo Compositions for Producing Induced Airway (Rome), 2013 – Drs. Phillippe Dartevelle (Marie- Tissue Progenitor Cells.” from the Stem Cell Lannelongue, Paris), Scott Swanson (Brigham, Network. Dr. Waddell also received funding for Boston), Wayne Hofstetter (MD Anderson, a Catalyst Grant from the Transplantation and Houston) and Lorenzo Ferri (McGill, Montreal), Regenerative Medicine Centre, Hospital for Sick 2014 – Drs. Paul De Leyn (University Hospital, Children, entitled “Targeting Rejection: Reversal Leuven, Belgium), Thierry Le Chevalier and Prevention of Allograft fbrosis by direct (Institute Gustav Roussy, Paris, France), Steve reprogramming of Activated Myofbroblasts.”. Cassivi (Mayo Clinic, Rochester, Minnesota), In total, just for laboratory research, only and Michael Humer (Kelowna General Hospital, including grants where faculty surgeons were the Kelown, BC). Principal Investigators, funding for the Division exceeded 1.3 M annually in 2014.

Five Year Review 2009-2014 115 The academic year of the University of Eric Vallieres (Swedish Cancer Center, Seattle), Toronto Division o f Thoracic Surgery concludes Richard Finley (UBC, Vancouver) and Bryan with Pearson Day, an annual celebration of Meyers (Washington University, St. Louis). clinical and laboratory research by trainees in our Division. The Pearson Day Visiting Professors over the past 5 years have been Drs. Alec Patterson (Washington University, St. Louis), Valerie Rusch (Memorial, New York),

116 Five Year Review 2009-2014 DIVISION OF UROLOGY

As Prepared by Neil Fleshner, MD, FRCSC, Martin Barkin Chair, Division of Urology July 1, 2009 – June 30, 2014

The Division of Urology has continued to The following promotions occurred this be productive over the past fve years, to the year: Dr. Ron Kodama was promoted to point where we currently consist of 28 full time Professor. Drs. Lesley Carr, Tony Finelli, Kirk faculty as well as 3 full-time PhD scientists Lo, Vasu Venkateswaran & Jack Barkin were spanned over 6 fully affliated University-based promoted to Associate Professor. hospitals. During this time we have trained over 24 residents and 18 fellows. The following are This year Dr. Ron Kodama was appointed some highlights of this period: site Chief at Sunnybrook Health Science Centre, taking over from Dr. Laurence Klotz and Dr. Ken During the 2009-10 academic year, Drs. Pace commenced as site Chief at St. Michael’s John Honey, Darius Bagli and Magdy Hassouna Hospital, taking over from Dr. John Honey. In were promoted to Professor. Dr. Kenneth Pace addition, Dr. Jason Lee commenced his frst was promoted to Associate Professor. year in practice engaged in education-based research and minimally invasive surgery. He Some faculty awards and other appointments will also assume a major role in core curriculum during this period were: Dr. Ken Pace was added development for undergraduate education. to the Leadership Program of the American Urology Association; Dr. Robert Stewart was 2011-12 was a steady but somewhat quiet awarded the BruceTovee Award for excellence in year. This year Dr. Alex Zlotta was recognized undergraduate teaching; Dr. Sender Herschorn by the European Association of Urology with was given the Lifetime Achievement Award two Best Poster awards and a Platinum Award from the Society of Urodynamics and Dr. Ron for his presentation at their annual meeting that Kodama won the Faculty of Medicine Aikin year. We note that Dr. Tony Finelli won the Award for excellence in undergraduate teaching. Best Poster distinction at the American Urology Association meeting and Dr. Ken Pace received Throughout the 2010-11 year the awards the Best Reviewer Award from the Journal of received by faculty included: Dr. Sender Endourology. Finally Dr. Laurence Klotz was Herschorn was elected Secretary of the recognized by the Journal of Clinical Oncology International Continence Society; Dr. Ron for one of the 50 most cited publications in that Kodama & Dr. Rob Stewart both won Faculty journal. Postgraduate Teaching Awards; Dr. Robert Nam was awarded the Ajmera Chair in Urologic Dr. Darius Bagli won 3rd Prize for his work Oncology; Dr. Vasu Venkateswaran assumed from the European Society for Pediatric Urology the Graduate Coordinator role at the Institute and Dr. Walid Farhat organized and directed the of Medical Sciences; Queen’s Diamond Jubilee 6th Annual North American Pediatric Fellows Medals were received by Drs. Trachtenberg, Laparoscopy Course. Dr. Armando Lorenzo was Jewett, Klotz, and Fleshner and Dr. Tony Finelli given an Award of Distinction from the European won the Bernard Langer Surgeon Scientist Association of Urology for his work with the Award. International Exchange Program.

Five Year Review 2009-2014 117 2012-13 was a banner year in terms of peer- Bharti Bapat, Darius Bagli, Keith Jarvi, who reviewed grant capture. The following faculty served as PI’s or CO-PI’s on peer-reviewed served as PI’s or Co- PI’s on peer-reviewed grants. grants totaling over 3 million dollars: Michael Jewett, Antonio Finelli, Magdy Hassouna, Neil Drs. Dean Elterman & Michael Ordon Fleshner, Robert Hamilton, Girish Kulkarni, joined our faculty at the TWH and SMH sites Andrew Matthew, Bharti Bapat, Darius Bagli, respectively. Dr. Walid Farhat was promoted Keith Jarvi. to Full Professor and Drs. Robert Stewart & Armando Lorenzo were promoted to Associate Dr. Robert Nam was promoted to Full Professor Professor and Dr. Rajiv Singal was promoted to Assistant Professor. We are proud to report that Dr. Bimal Bhindi (PGY3) won an award from the Health This year saw Dr. Neil Fleshner being Policy Management and Evaluation (HPME) named to the GU Surgeons and elected as Chair Department as the most promising researcher of the Canadian Urological Oncology Group. & Dr. Justin Lee (PGY5) was voted Best Dr. Sender Herschorn was elected General Undergraduate Educator in the Department of Secretary of the International Continence Surgery. Society. Dr. Laurence Klotz continued as Chair of the World Uro-Oncology Federation. Faculty This year, Dr. Laurence Klotz won the teaching awards were received by Drs. Robert Lister Prize at Gallie Day. As well, Dr. John Nam, Girish Kulkarni, Antonio Finelli and Kirk Trachtenberg was awarded an Honorary Lo, Rob Hamilton. Doctorate from University of Guelph.

Two outstanding awards were received by fellows this year. Dr. David Margel was granted 2 awards from the Health Policy Management and Evaluation (HPME) Department including the Claire Bombardier Award for the most promising researcher and Dr. Li Ming Wong won best poster award at the American Urological Association annual meeting.

Two Division “frsts” were, Dr. Girish Kulkarni performed the frst robotic radical cystectomy and Dr. Antonio Finelli chaired and organized the frst “Robotic Surgery in Ontario” symposium. This year saw Dr. Neil Fleshner assuming the Martin Barkin Chair as University Chair and Dr. Martin Koyle taking over as site for the Hospital for Sick Children following a strong term by Dr. Joao Pippi-Salle.

During the 2013-14 year, grant capture totaled over 4 million dollars in part due to the efforts of Michael Jewett, Neil Fleshner, Robert Hamilton, Girish Kulkarni, Andrew Matthew,

118 Five Year Review 2009-2014 DIVISION OF VASCULAR SURGERY

As Prepared by Dr Tom Forbes Chair, Division of Vascular Surgery July 1, 2009 – June 30, 2014

Division Executive Committee Dr. Thomas L. Forbes (Chair) Dr. Mohammed Al-Omran (Division Head, St. Michael’s) Dr. Aaron Beder (Division Head, Humber River) Dr. Andrew Dueck (Division Head, Sunnybrook) Dr. Thomas Lindsay (Division Head, UHN) Dr. Marc Pope (Division Head, Trillium) Dr. George Oreopoulos (Director, Postgraduate Medical Education) Dr. Elisa Greco (Director, Undergraduate Medical Education) Dr. Giuseppe Papia (Quality & Best Practices)

Current Faculty (as of April 2015)

St. Michael’s Hospital Sunnybrook University Health Network Dr. M. Al-Omran Dr. A. Dueck Dr. T. Lindsay (Division Head) (Division Head) (Division Head) Dr. E. Greco Dr. G. Papia Dr. T. Forbes (Division Chair) Dr. T. Moloney Dr. D. Kucey Dr. B. Rubin Dr. M. Wheatcroft Dr. R. Maggisano* Dr. G. Roche-Nagle Dr. W. Tanner Dr. G. Oreopoulos Dr. L. Tse Dr. J. Byrne Dr. K.W. Johnston* Dr. D. Wooster* Humber River Trillium Dr. A. Beder (Division Head) Dr. M. Pope (Division Head) Dr. J. Cardella Dr. C. Werneck Dr. I. Vucemilo Dr. W. Johnson

*Senior, non-operating surgeons

Five Year Review 2009-2014 119 Introduction a number of U of T vascular surgeons on its executive including Drs Forbes (President), The Division of Vascular Surgery was Roche-Nagle (Research Committee Chair), formed as a separate Division at the University Papia (Education Committee Chair) and Cardella of Toronto in 1982 with Dr. K. Wayne Johnston (Member at Large – Central) named the frst Division Chair. Dr. Thomas Lindsay completed his term as University Division Chair in 2014 and the current Chair Administration is Dr. Thomas Forbes (beginning in September The Division Chair has his clinical offce at 2014). Clinical activities are based at three main Toronto General Hospital and runs the Division’s academic hospitals, St. Michael’s, Sunnybrook activities here. At some point an offce in the and University Health Network and two affliate Department of Surgery’s offces and additional sites, Humber River and Trillium. administrative support will be necessary. The Division’s executive committee is chaired by the The Division of Vascular Surgery at the Division Chair and also consists of the Division University of Toronto has a long and established Heads from the 5 hospitals, the Postgraduate track record of clinical excellence, academic Education Coordinator, the Undergraduate productivity, and excellence in education. The Education Coordinator and the Quality & Division has received international acclaim Best Practices representative who also sits on with members having served as Presidents of the Department of Surgery’s Quality & Best major vascular surgery society’s (CSVS: Drs Practices Committee. The Division of Vascular Forbes, Lindsay, Johnston, Wooster, Kucey; Surgery is well represented at the Department PVSS: Dr Lindsay; SVS: Dr Johnston), Editor- level with the Division Chair sitting on the in-Chief of the Journal of Vascular Surgery (Dr Senior Advisory Committee, the Quality & Best Johnston), Associate Editor of the Journal of Practices Committee, the Research Committee Vascular Surgery (Dr Forbes) and Editor of the and the Finance Committee. preeminent textbook in the feld, Rutherfords Vascular Surgery (Dr Johnston), and current The Division’s fnances are run through the Chair (Dr Lindsay) of the Vascular Surgery Division Chair’s offce. There are 2 endowed Specialty Committee of the Royal College of chair positions within the University Division Physicians & Surgeons of Canada (RCPSC). but these are both hospital based (Sunnybrook Division members also continue in health and UHN) and do not support University Wide delivery leadership roles including Dr Rubin Division related initiatives. The University who continues to serve as Chairman and CEO of Division’s operating funds were previously the MSH/UHN AMO and represents all AHSC obtained by tithing Division members. There AFP Governance Organizations in Ontario on was resistance to this and concerns regarding the Academic Medicine Steering Committee. equality and transparency. There was not a tithe He is also Program Medical Director of the for the 2015/15 academic year. Operating funds Peter Munk Cardiac Centre. Dr Forbes chair’s were achieved from industry sponsors and some the Vascular Care Working Group of the small alumni donations. Operating funds for the Cardiac Care Network which is charged with residency training program come from annual reorganizing vascular care for the province of expansion funds from the Faculty of Medicine’s Ontario. Other U of T vascular surgeons who Post Graduate Medical Education Offce, which sit on this committee are Drs Johnston, Lindsay, became available at the time Vascular Surgery Dueck and Pope. became a direct entry program. The Department Chair has been very supportive of the Division’s Our national specialty society, the Canadian residency program in annual discussions with Society for Vascular Surgery, currently has

120 Five Year Review 2009-2014 the Division Chair regarding funding levels. responsibilities. The University Division Fellowship salaries come from a combination Chair has full clinical role including call of individual hospital contributions and from responsibilities. individual hospital Division’s practice plans. Clinical Services Human Resources In 2005 and 2006 two Centres of Excellence Trillium – 4 vascular surgeons work at Trillium, were created at UHN and SMH as well as an 3 of which were U of T graduates. Their HR alternative payment plan for surgeons at these needs are stable. They offer the full range of open hospitals. Currently, UHN and SMH remain and interventional vascular procedures, short of the primary hospitals for senior resident and advanced aortic work, and offer residency and fellow training. CritiCall coverage for the fellowship training opportunities. GTA and surrounding areas are met through an alternating call arrangement between the two Humber River - 2 vascular surgeons work hospitals. Clinical volumes are signifcant with at Humber River, but Dr Cardella has been a large volume of endovascular aortic repairs recruited to Yale beginning this summer and a including advanced aortic work performed in new surgeon from McMaster University will be collaboration with interventional radiology replacing him. This group will be moving to a colleagues. Peripheral interventions have been new hospital in the fall of 2015 and will likely be adopted by the vascular surgeons allowing recruiting at least one more surgeon. They also suffcient exposure for trainees. Both UHN provide residency and fellowship rotations. and SMH Divisions are supported by close collaborations with other colleagues in cardiac Sunnybrook – 4 surgeons work at Sunnybrook, surgery and interventional radiology at the Peter with one senior surgeon not operating. HR is Munk Cardiac Centre at UHN and the Heart & stable at this site and recruitment in the near Vascular portfolio at SMH. Such collaboration future is not likely. provides many academic, educational and clinical opportunities. St. Michael’s – 6 surgeons currently work at St. Michael’s. Over the last number of years this site Sunnybrook Health Sciences has a has been a major challenge to stabilize human complement of 4 vascular surgeons who are resources. However, with the recruitment of Dr. a primary training site for vascular surgery Al-Omran has Division Head and the Dr. Greco residents and fellows as well. Previously this as a new surgeon, this has stabilized. However group had been disadvantaged by the failure with the return to Ireland of Dr. Moloney and the to integrate, and to be integrated, into this city- impending retirement of Dr. Tanner there is the wide system following the designation of the immediate need for one and eventually two new two Centres of Excellence at the downtown surgeons. hospitals. As a consequence this group initially did not receive Ministry of Health funding for University Health Network – 9 surgeons endovascular stent grafts, did not agree to adopt currently work at Toronto General Hospital, 2 the Alternative Payment Plan, nor did it become of which are senior non-operating surgeons. Of involved in the provision of CritiCall coverage. the remaining 7, 2 also have signifcant clinical A somewhat divisive relationship and a feeling responsibilities in interventional radiology, 1 is of resentment persisted on both sides between a newly recruited Surgeon-Scientist with only Sunnybrook and the downtown hospitals (UHN a 25% clinical responsibility and 1 has a major and SMH) for some time. This has changed administrative role as Medical Director of the recently but still requires attention. Peter Munk Cardiac Centre and less clinical

Five Year Review 2009-2014 121 As with the SMH and UHN surgeons, Chair, sit on the Department of Surgery’s Sunnybrook’s vascular surgeons provide Quality & Best Practices Committee, chaired excellent care in all aspects of vascular surgery by Dr Robin McLeod, and are looking at such including extensive involvement in peripheral quality measures as readmission rates across the interventions by vascular surgeons. They also Division’s hospitals. Dr. Roche Nagle is also have a long history of open thoracoabdominal enrolled in the IDEAS program. Alignment and aortic work and more recently advanced aortic coordination of our Division’s CQI initiative is work as well as support of the busy trauma a priority. service at Sunnybrook. Education Trillium Healthcare and Humber River Regional Hospital have been included in the Dr Oreopoulos was appointed Program Division’s functions at the educational level. Both Director in 2011 and is widely regarded as groups are populated by surgeons predominantly providing excellent leadership for the residency trained at University of Toronto. They are eager program. With vascular surgery now being a to be further involved in educational, academic Royal College direct entry primary specialty, the and clinical initiatives. They are involved Division now offers direct entry as well as the in administrative responsibilities within the traditional 5+2 route to RCPSC certifcation in educational program including Dr Wernick who vascular surgery. A Fellowship program is also organizes the residents’ academic half days and offered at the main academic teaching hospitals. Dr Cardella who successfully organized the frst endovascular skills course last summer The residency program underwent a for all trainees across the country. Both groups RCPSC mandated internal review earlier this have successfully incorporated peripheral year and although only a draft document has interventions into their everyday vascular been reviewed by the Program Director and practice and certainly provide an attractive Division Chair, the review was favorable with educational exposure for both junior and senior no large concerns. level vascular surgery residents. Several initiatives have been instituted by Around the GTA more and more hospitals the Program Director and surgical faculty and are performing vascular surgery, although not are examples of innovative teaching initiatives all are providing 24/7 coverage. There is some aligning well with Departments educational concern that that elective referrals are decreasing program under Dr Levine. The vascular surgery at the University affliated hospitals but that after academic half-day is organized by Dr Werneck hours emergent work and complicated work are and although still predominately sited at TGH not. This is an area requiring attention going does rotate around the city occasionally. The forward. curriculum has been adjusted to meet the needs of the residents as refected by the results of the recent VSITE examination, a US administered Quality & Best Practices in-training examination. In addition a vascular UHN and St. Michael’s are the only two surgery boot camp was added as an extension to Canadian sites participating in the Society for the surgery boot camp that all PGY1 residents Vascular Surgery’s Vascular Quality Initiative. attend. This was very well received and should Optimally all sites would enroll patients in continue. Dr Cardella supervised the Canadian the same CQI database, but some sites use the Endovascular Skills Summit at the Li Kai Shing American College of Surgeons’ NSQIP. Two Learning Centre at SMH and the hope is that this members of our Division, including the Division will continue to be a local and national resource.

122 Five Year Review 2009-2014 This was originally funded partially by the Canada, graduates of the SSP will be well-suited Canadian Society for Vascular Surgery with one- for the increasingly competitive job market in time funding. Additionally, Dr Oreopoulos is academic vascular surgery. The Division has two planning on instituting several novel initiatives residents currently enrolled in this program and including in-training OSCE’s and competency an additional one, at least, starting in the coming based evaluation and promotion tools and year. In addition Dr. Roche-Nagle serves as the metrics for the residents. residency director of research.

Residents currently rotate through vascular A well attended resident research day surgery rotations at the 5 hospitals although occurs yearly in June where resident research is senior level residents in both Royal College highlighted and a visiting professor (K. Wayne pathways are concentrated at TGH, SB and Johnston Visiting Lecturer) is invited. SMH with the other 2 hospitals receiving junior The Division continues to offer clinical level vascular surgery residents predominately. fellowships for international surgeons at TGH, There has been a general decline in the number SB and SMH which are at least partially funded of off service residents rotating through vascular by the hospitals. Generally these surgeons are surgery rotations which is causing some diffculty seen to augment the residency training program in coverage. and to fll clinical needs when the residents are away at their academic half-day. However the Excellent education for the residents is potential does exist for confict as the residents being offered at all 5 sites. Trillium Healthcare and fellows compete for adequate exposure with and Humber River Regional Hospital have some procedures (advanced aortic cases are one recently begun to offer junior vascular surgery example). Dr Mark Wheatcroft is transitioning rotations. These have been very well received by into the role of Fellowship Director. the residents. The residency training program currently The Division as a whole provides an has a half FTE administrator which will abundant opportunity for training in both likely require augmentation once the recently open and endovascular vascular surgery. completed internal review is considered. Endovascular aortic surgery is offered at all 5 sites with advanced work performed at TGH, Academic Productivity SMH, and Sunnybrook. The endovascular aortic The Division is involved in a number of exposure is seen as suffcient by the residents. academic and research initiatives. Division Peripheral interventions (PI) are offered at members have been quite successful in obtaining all 5 sites in a variety of clinical areas and by awards from the Canadian Society for Vascular different providers. PI experience is obtained by Surgery as well as small research grants. Dr. the residents as either a separate rotation (TGH, Roche-Nagle has been particularly productive SMH) or as part of their general vascular surgery at the CSVS annual meetings and has recently rotation (SB, THC, HRRH). been appointed as Chair of the CSVS Research Committee. The Surgeon Scientist Program (SSP) is well-established at the University of Toronto With respect to academic productivity, in the and trains surgeon researchers for an academic past, the number of peer reviewed publications career. The Division of Vascular Surgery is well by the Division has been relatively modest for positioned to take advantage of this opportunity. a Division of this size and capabilities. During As vascular surgery continues to be centralized 2011-2014, over the last 3 academic years the in larger University affliated hospitals, at least in Division published 31 papers in peer reviewed

Five Year Review 2009-2014 123 journals with Division members being primary or Cardiac Centre at UHN as well as the Surgical senior responsible author on 19 of these 26 papers. Scientist Program. Increased academic productivity measured by Clinical research productivity would be grants, publications, citations and bibliometrics is facilitated through a research database. The UHN a priority. and SMH group has adopted the Vascular Quality Initiatives (VQI) database from the Society for Grant funding has been modest outside of Vascular Surgery and this has major quality some CIHR and PSI research grants for the basic assurance capabilities with the ability to compare science research laboratories. Otherwise there are with other hospitals and jurisdictions. Division a fair number of small Society funded and internal members are also involved in the creation of research grants supporting the academic mission a provincial vascular surgery database being of the Division. created with colleagues from other centres and the Cardiac Care Network. However, neither The University of Toronto Division of of these databases are true research databases. Vascular Surgery has long been envied as the only A hurdle to clinical research is the lack of a Canadian division with basic science expertise University Institutional Review Board (IRB). and productivity. This has been through Dr. A centralized IRB would facilitate integrated Rubin’s and Dr. Lindsay’s laboratories which Division wide research initiatives and make the have received multiyear CIHR and PSI funding, Division an attractive site for industry and non- until recently. This unique aspect of the Division industry funded research and clinical trials. is at risk with Dr Lindsay having to close his lab because of increasing administrative, clinical and academic responsibilities and with Dr Rubin External Review having to spend less time in the lab because of increased responsibilities as Head of the Peter Nearing the conclusion of Dr. Lindsay’s Munk Cardiac Centre. Dr. Byrne has been term as Division Chair, an external review of recruited to UHN as a Surgeon-Scientist and the Division was performed by Dr. Forbes (then is pursuing a small animal research model in Professor & Chair at the University of Western th aneurysm pathogenesis in collaboration with Ontario) on November 14 , 2013. The summary Clint Robbins. of that review follows:

There are several areas of expertise in clinical I. Strengths & Weaknesses research and applied research within the Division. These include Dr. Tse’s biomedical engineering a. Strengths work, Dr Dueck’s CIHR funded imaging research i. Strong leadership by Dr. Lindsay during a as well as education related research where there tumultuous period brought relative stability to is some expertise and academic productivity with the Division. Dr Oreopoulos’ and Dr Wooster’s work. Clinical outcomes research is another opportunity for ii. International profle through leadership growth and is a priority of the Division. Several positions in societies and editorial positions hospital-based research facilities such as the on journals and textbooks. La Ki Shing Research Institute at St. Michael’s Hospital provide an opportunity for this. In iii. Cooperation between UHN and SMH to meet addition academic opportunities at some sites emergency clinical demands (via CritiCall). (namely UHN and SMH) are enabled by hospital iv. Successful integration of Trillium and administration and organizational structures, Humber River into the residency training ie Heart and Vascular at SMH and Peter Munk program.

124 Five Year Review 2009-2014 v. Signifcant clinical exposure to all aspects of II. Recommendations vascular surgery, including advanced aortic endovascular procedures. 1. A strategic planning exercise is required to:

vi. Successful adoption of peripheral a. Integrate SB with the downtown hospitals and interventions by vascular surgeons at all 5 develop a city wide clinical services delivery hospitals. model for both emergent and elective care.

vii. Successful adoption of direct entry residency b. Develop a model of residency training program and continuation of 5 + 2 training that ensures suffcient coverage of clinical program. Strong Program Director (Dr teaching units at all hospitals and results in a Oreopoulos) with successful formal teaching more equitable allocation of junior and senior program (led by Dr Werneck). residents.

viii. Attractive fellowship positions for c. Review opportunities to align and share international surgeons at SMH and UHN, fnancial resources to achieve shared academic funded at least partially by the hospitals. goals.

ix. Surgeon Scientist Program at University of d. Develop and facilitate Division-wide research Toronto provides strong research training for priorities which can have a unifying effect. residents. Fully explore resident research opportunities in, and outside, the SSP to make trainees more x. A history of continuously funded basic science competitive for academic positions and to research laboratories (Drs Lindsay and Rubin). augment the Division’s academic productivity.

xi. Several areas of clinical research potential e. Align the addition of new recruits with clinical including clinical trials, device development needs and specifc academic and research (Dr Tse), education, imaging. priorities.

a. Weaknesses 2. In preparation for the next RCPSC review of the residency program: i. Lack of clinical integration and coordination between SB and the downtown hospitals, UHN a. Pay specifc attention to service-education and SMH. balance and ensure more equitable distribution of residents across the clinical teaching units. ii. Inequality in the allocation of senior residents The SB site following the RCPSC review among the hospitals. of the General Surgery program requires immediate attention. iii. Some potential friction between residents and fellows as they compete for clinical exposure b. Consider appointing a separate Program as well as with other health care providers (ie Director for fellows so that the concerns IR). of residents and fellows can be separately represented. iv. Declining basic science research footprint. c. Explore opportunities for developing (or v. Modest clinical research productivity (peer sharing) a fellow position at Sunnybrook with reviewed publications and grants). hospital support (as at UHN and SMH). vi. Lack of a coordinated Division-wide research d. Ensure suffcient EVAR clinical case exposure plan and priorities. at UHN for residents and minimize confict with fellows and IR trainees.

Five Year Review 2009-2014 125 3. In some areas Faculty and career are valuable clinicians with potential for development require attention: academic productivity now that SMH is closer to a suffcient number of surgeons. a. New recruits require expectations of academic deliverables and productivity and c. Dr Tse’s research program needs additional the resources, protected time, and support support in terms of protected time from from Division members to ensure success. the Division and in terms of recognition of its importance at both the Division and b. Because of extenuating clinical Department level. circumstances beyond their control the 3 year review period for Drs Wheatcroft and Moloney should be extended. These

Strategic Planning (2015-2020) – DRAFT The Division of Vascular Surgery recently (February 2015) underwent a strategic planning exercise and the following represents a DRAFT document.

The Vision, Mission & Values of the Division of Vascular Surgery

126 Five Year Review 2009-2014 Strategic Directions

Strategic Directions 2015 – 2020 within our Division and with physicians STRATEGIC DIRECTION 1 – from other specialties. These initiatives CLINICAL EXCELLENCE will align with those of the Cardiac Centres and Heart & Vascular Institutes We will ensure that our surgical practice at our individual hospitals. results in the best outcomes for patients while facilitating world class research and teaching. This will be supported Objective 3 – Clinical Sub-specialties by the alignment of privileges, stronger partnerships and linkages, development The Division will continue the process of sub-specialties, consolidating best of developing Vascular Surgery sub- practices, coordinated outreach to specialties, including complex aortic university and community hospitals and surgery, complex limb salvage, coordination of urgent and non-urgent wound and diabetes management and services. hemodialysis, among others. These subspecialty interests and expertise Objective 1 – Privileges will drive clinical coordination within the University Division and result in In order to promote collaborative collaborative and multidisciplinary clinical exercises within our hospitals academic and educational initiatives. and centres, surgeons at each academic hospital will have courtesy privileges Objective 4 – Best Practices & Quality at the other academic hospitals in the Improvement Division. In order to lead in the development of Objective 2 – Partnerships in the Coordination vascular surgery best practices, we will of Clinical Activities carefully collect data on all surgical interventions. All vascular surgery Clinical excellence will be improved procedures will eventually be included by developing strong partnerships, in CQI database (s) with appropriate for example, with medical imaging, risk adjustment, reporting and outcome cardiac surgery and other groups of measurement. This will assist in best healthcare providers. In addition, we practices and guideline development and will strengthen external linkages with provide benchmarks for performance referring physicians to improve clinical improvement. coordination and collaboration. We will develop “virtual centres of excellence”

Five Year Review 2009-2014 127 Objective 5 – Outreach steps will be taken to appoint a Vice- Chair, Research. Taking the lead for our We will coordinate outreach efforts with overall research strategy, the Vice-Chair university affliated and community will engage members of the Division hospitals. In addition, we will develop in developing a research agenda and initiatives to optimize the delivery of needed resources to encourage research urgent and elective vascular surgery and innovation collaboration across the provision through equitable and fair various hospitals. processes. Objective 3 – Research Database

STRATEGIC DIRECTION 2 – The Division will develop a Research INCREASE DISCOVERY & INNOVATION Database. As a frst step, we will amass an inventory of research, innovation To become a global leader in our feld, activities and interests of Division we will expand discovery and innovation members to develop a research agenda. initiatives increasing Division wide Next, we will take steps to collect and resources and capabilities; appointing a assemble data in order to build a usable Division of Vascular Surgery Vice-Chair Divisional Research Database accessible Research; building a research database; to all members. increasing joint grant-writing and the output of peer reviewed publications; Objective 4 – Increase Academic Productivity build capacity in clinical outcomes research; integrating pure scientists with Over the next fve years, we will aim to clinical teams, and explore investments in increase the number of grants for research basic science. and double the output of peer reviewed publications. Objective bibliometrics, such as number of citations and h-factor, Objective 1 – Fund Raising, Endowed Chair(s) will be used as measurements of academic productivity at the Division and Currently the University Division’s individual surgeon levels. In addition, ability to fnancially support protected we will encourage Division members to time, centralized research resources get involved in professional conferences and academic salary support is limited. and societies and make presentations on Fundraising, philanthropy and endowed topical issues in vascular surgery. To Chair(s) positions are vital instruments achieve this, the Division will increase to promote Division wide academic joint grant-writing, and develop statistical productivity. Centralized research needs, and research resources in support of such as grant writing and statistical members. support, as well as individual investigator support would be supported with these Objective 5 – Clinical Outcomes Research positions. An important objective for the Division will be fnding sources of funding We are committed to pursuing a signifcant for these positions from foundations, increase in clinical outcomes research. To corporations and grateful patients. the end, the Division will recruit a clinical trials specialist to champion this objective. Objective 2 – Division Vice-Chair, Research Centralized research resources will also be developed so we take advantage of In view of the importance the Division the breadth of clinical activity within our places on Discovery and Innovation, Division’s individual hospital groups.

128 Five Year Review 2009-2014 Also, the eventual coordination of hospital Training Program will be increased so based Ethics Review Boards will allow as many trainees as possible receive more city wide clinical trials with our the research training necessary for a University Division being a prime site for successful academic career. industry and non-industry funded clinical trials. Objective 2 – Innovative Education Initiatives

Objective 6 – Integrate Pure Scientists with We will take steps to continue and expand Clinical Teams innovative education initiative such as the Vascular Surgery Boot Camp, Vascular We will explore the opportunities of Surgery Half-Days and the Canadian integrating pure scientists with clinical Endovascular Skills Summit with a view teams to enhance discovery and clinical to making them available throughout outcomes. Recruitment of pure scientists the Division and beyond. We will seek will be an objective in 2016/17. to invest in simulation labs and other innovative technology that will keep us at Objective 7 – Investment in Basic Science the leading edge of vascular education. In addition, we will offer to pilot competency To deepen our understanding of the based, learner focused education and mechanisms involved in vascular disease, evaluation of trainees. Collaborative the Division will seek funding for fellowship programs will be developed opportunities to support basic science to align with clinical sub-specialties research in areas of interest to members. and “virtual centres of excellence” (see Objective 1.2)

STRATEGIC DIRECTION 3 – Objective 3 – Career Planning DELIVER SUPERIOR EDUCATION & DEVELOPMENT We will design and introduce a process to assist trainees in obtaining suitable The Division will continue to provide employment upon graduation as well as excellent education of academic surgeons longer range career planning. Milestones and the next generation of leaders in for knowledge, skills, attitudes and vascular surgery taking steps to improve performance will be established with innovative education initiatives and support systems to assist graduates with technology; faculty development including career development. Leadership training career planning for trainees; a mentoring will begin at the resident level. program for new faculty while aligning and balancing clinical, research and Objective 4 – Faculty Development: Early, Mid academic priorities, respectful retirement and Later Career Stages planning, and a fair process for faculty review. We will provide support to faculty at the early, mid and later stages of career. For Objective 1 – Train Tomorrow’s Leaders in new faculty, we will establish a strong Academic Vascular Surgery mentoring program for drawing on the expertise of older faculty members. Steps Our Division will build on our tradition will be taken to align and balance clinical, of leadership and academic excellence research and academic priorities for all by selecting residents and fellows who new faculty. The Division will create a are best suited for an academic career. Collaborative Leadership Development Enrollment in the Surgeon Scientist Program for mid-career faculty

Five Year Review 2009-2014 129 including education skills workshops, Objective 2 – Division Annual Meeting and advanced education programs and Social Events inter-professional education programs. Leadership will focus on “being” (who The Division will hold an Annual Meeting you are as a professional) and “doing” to engage members in discussion about (what you do as an educator). To ensure key issues and accomplishments. We respectful retirement for later career will also plan social events at suitable faculty, we will align with DOS policy times to bring members and their families on end of career surgeons which is being together for celebration. developed. Objective 3 – Conduct Annual Survey of Objective 5 – Faculty Review Division members

We will work to develop a “fair In order to assess the state of the Division, process” for faculty review that aligns a survey of members will be conducted the expectations of the Division, the annually with the results shared in the Department and the hospital. Teaching, Newsletter. academic productivity and clinical service will be cornerstones of faculty Objective 4 – Build the “Brand” review. However, we need a transparent process that takes into account many other We will take steps to build the “brand” of important factors including innovation, the Division ensuring that it is seen as the community service, mentoring, best place to train and work. We will ask collegiality and external recognition for key stakeholders to assess our “brand” example. identity, achievements and reputation. Members of the Division have had many STRATEGIC DIRECTION 4 – EMBED A accomplishments over the years. We CULTURE OF RESPECT, RECOGNITION will celebrate our history of leadership & COLLABORATION by interviewing, video-recording and publishing the experiences of retired We will strive to nurture and build a faculty. We will celebrate their teaching, culture of respect, recognition and research and clinical accomplishments in collaboration among members of the a variety of ways including publishing Division and the partners with whom we their stories in the Newsletter. work. This will be supported through enhanced communications, meetings, Supporting & Enabling Activities surveys, recognition of contributions, and building the Division “brand”. The following activities have been identifed as key activities to support Objective 1 – Communications the implementation of the Strategic Directions. The Vascular Surgery We will strive to enhance communication Division Executive Group will be tasked ensuring that all members, including as the Core Group overseeing the administration and allied health are implementation of the strategic plan. informed in a timely manner of Division In addition, some individuals in the developments and accomplishments. In Division will be asked to participate addition to the Division Newsletter, we in special groups or sub-committees will explore communication initiatives to focus on these and other key aspects using social media such as intranet, of plan implementation. To support Facebook, LinkedIn and a phone app to and enable the Strategic Plan, we will connect all stakeholders.

130 Five Year Review 2009-2014 undertake fundraising activities to to support and enhance the culture of establish a Division Research Chair. respect, recognition & collaboration. A We will establish a central resource communications plan will be created. We centre to support the Division’s will continue to publish the Newsletter research initiatives. We will develop a as a means of updating all members comprehensive communications plan about accomplishments, issues and and a human resources plan to serve the events. We will continue City Rounds, Division. Remote Rounds using IT and Chairman visits to engage all members in ongoing I. Implementing the Strategic Plan developments. We will begin to use Social Media such as Facebook, Twitter The Division Chairman will lead the and Instagram as a means of connecting implementation of the total Strategic regularly on immediate topics of interest Plan. He will appoint various members with members. to lead specifc initiatives as required. Each Strategic Direction will be headed V. Division of Vascular Surgery Human by a Sub-Committee Lead for a 3 to Resources Plan (supporting Strategic 5 year period. Each hospital will be Direction 1, 2 & 3) represented in special groups or sub- committees wherever feasible. We will design a Division Human Resources Plan aligned with other II. Fundraising Initiative (supporting Strategic University of Toronto HR plans that will Direction 2) institute Division-wide mentoring of new faculty; a fair faculty review process; A Fund Raising Sub-Committee will and a faculty leadership development be struck to create a strategy to solicit process. In addition, we will institute the contributions of grateful patients, a plan to equalize the distribution of government funders and foundations in senior residents among the hospitals in order to fund endowed positions within the Division. We will also develop a the University Division. plan and process to assist graduates in obtaining suitable employment. III. Central Resource Centre to Support the Division (supporting Strategic Direction 2)

The Division will create a central resource centre to support all research initiatives. For example, we will collaborate to obtain the services of a grant-writer and a statistician. The Division’s Vice-Chair for Research will be appointed and will also develop an inventory of current and ongoing research initiatives within the Division.

IV. Division of Vascular Surgery Communications Plan (supporting Strategic Direction 4) Implementation Framework We will undertake several new and several ongoing communication initiatives

Five Year Review 2009-2014 131 STRATEGIC ACTION & OUTCOME MECHANISM & DIRECTION IN 5 YEARS START TIMELINE 1 – CLINICAL EXCELLENCE 1.1 Privileges Collaborative clinical exercises Grant privileges to surgeons increase three-fold over 5 years. in academic hospitals by end of 2015. 1.2 Partnerships in Increase opportunities for great- Negotiate agreements 2016. the Coordination er collaboration intra and inter of Clinical hospitals. Activities 1.3 Clinical Increased the volume of complex Identify champions for Sub-Specialities aortic surgery and the develop- sub-specialties 2016. Align ment of multi-hospital, multi-di- with Division’s HR plan. visional and multi-disciplinary training for surgeons. 1.4 Best Practices Collection of data on surgery Continue with current CQI & Quality Im- outcomes to identify promising data collection and best provement and best practices, guideline practices criteria (VQI & development. Our Division to NSQIP). All hospitals to become the Canadian benchmark input data to common CQI for vascular surgery outcomes database by end of 2016.

1.5 Outreach Coordinated outreach efforts with Coordinated outreach plan university affliated and commu- by 2016. nity hospitals and initiative to improve emergency coverage and increase referrals and elective surgery volumes. 2 – DISCOVERY & INNOVATION 2.1 Fundraising, En- Endowed Chair(s) to enable long Seek funding sources 2015 dowed Chair(s) term commitments to academic – 2020. mission. 2.2 Division Vice- Leadership for our overall re- Identify and appoint a Vice Chair, Research search strategy in Vascular Chair by end of 2015. Surgery. Increase in grants and academic publications. 2.3 Research Data- A research database available to Inventory of research, inno- base all members of the Division. vation activities, and inter- ests 2016.

132 Five Year Review 2009-2014 STRATEGIC ACTION & OUTCOME MECHANISM & DIRECTION IN 5 YEARS START TIMELINE 2.4 Academic Publi- Double output of contributions to Publications plan to be led cations peer reviewed publications in 5 by Vice-Chair 2016. Use years. bibliometrics to assess aca- demic productivity by end of 2015. 2.5 Clinical Out- Increased volume of clinical out- Recruit a clinical trials spe- comes Research comes research & clinical trials cialist to lead this direction across the Division. 2017. 2.6 Integrate pure Enhanced discovery and clinical Find opportunities to recruit scientists outcomes. and integrate 2016. 2.7 Investment in Greater understanding of the Seek funding to support Basic Science mechanisms involved in vascular research in basic science disease. 2018. 3 – SUPERIOR EDUCATION 3.1 Train Tomor- Graduates of our training pro- Recruitment of trainees best row’s Leaders in grams will work at academic suited for academic careers Academic Vascu- centers throughout the world. (immediate). Increase en- lar Surgery rollment in SSTP (2016). 3.2 Innovative Edu- Innovative education initiatives Comprehensive plan for cation Initiatives applied throughout the Division educational innovation (simulation, technology and com- 2016/17. petency based evaluation).

3.3 Career Planning All trainees have experienced the Design career plan process career planning process. with milestones 2018.

3.4 Faculty Devel- All new faculty have a mentor Initiate as part of HR plan opment: Early, and balanced priorities. Lead- 2019. Mid and Later ership program and retirement Career Stages plans in place.

3.5 Faculty Review Fair process in place for faculty Design and implement in review. 2016. 4 – CULTURE OF RESPECT, RECOGNITION & COLLABORATION 4.1 Communications All staff are informed in a timely Institute existing and new manner of Division develop- communication mechanisms ments and accomplishments. 2016.

Five Year Review 2009-2014 133 STRATEGIC ACTION & OUTCOME MECHANISM & DIRECTION IN 5 YEARS START TIMELINE 4.2 Annual Meeting Annual meetings are held in Establish a master plan for & Social Events January/February each year with meetings 2015. a State of the Union Address. In- creased number of social events involving family. 4.3 Annual Survey Survey is conducted in January Place in master plan for each year. Division. 4.5 Build the The U of T Division of Vascular Initiate development of a “Brand” Surgery “brand” is known and “brand” strategy 2018 – admired in healthcare. 2019. 5 – SUPPORTING & ENABLING 5.1 Core Group Strategic Priorities are imple- Leads and sub-committees Oversight mented as appropriate on a time- for Strategic Directions ly basis by committed leads and 2015 – 2016. Core Group members. 5.2 Fundraising Endowed Chair(s) Fund Raising Sub-Commit- tee 2015. 5.3 Central Re- Services of a grant-writer and a Fundraise, recruit; plan for source Centre statistician; location of database. database 2016. 5.4 Communications Newsletter; City Rounds; Re- Comprehensive Plan 2016. Plan mote Rounds; Social Media 5.5 Human Resourc- Mentoring; Fair Review Process; HR Plan 2016. es Plan Leadership Development Insti- tute; Employment process for new graduates; plan for distri- bution of residents; retirement process; recruitment plan.

Vascular Surgery Strategy Map

VISION United in a Tradition of Leadership, Discovery & Excellence

MISSION To improve the human condition through clinical excellence, innovation, discovery and the training of tomorrow’s leaders

134 Five Year Review 2009-2014 VALUES Excellence Quality Collaboration Integrity & Recognition Diversity & Responsibility & Respect Inclusiveness

STRATEGIC DIRECTIONS 1. Ensure clinical 1. Expand 1. Deliver 1. Embed a cul- excellence discovery & superior ture of respect, innovation education & recognition & development collaboration We will ensure To become a global The Division will We will nurture and that our surgical leader in our feld, continue to provide build a culture of practice results in we will expand excellent education respect, recognition the best outcomes discovery and in- of academic sur- and collaboration for patients while novation initiatives geons and the next among members of facilitating world increasing Division generation of lead- the Division and the class research and wide resources and ers in vascular sur- partners with whom teaching. This will capabilities; ap- gery taking steps to we work. This will be supported by pointing a Division improve innovative be based on en- the alignment of of Vascular Surgery education initiatives hanced communi- privileges, stronger Vice-Chair Re- and technology; cations, meetings, partnerships and search; building a faculty development surveys, recognition linkages, develop- research database; including career of contributions, ment of sub-spe- increasing joint planning for train- and building the cialties, consolidat- grant-writing and ees; a mentoring Division “brand”. ing best practices, the output of peer program for new coordinated out- reviewed publica- faculty while align- reach to university tions; build capacity ing and balancing and community in clinical outcomes clinical, research hospitals and coor- research; integrat- and academic pri- dination of urgent ing pure scientists orities, respectful and non-urgent with clinical teams, retirement planning, services. and explore in- and a fair process vestments in basic for faculty review. science.

Five Year Review 2009-2014 135 SUPPORTING & ENABLING ACTIVITIES I. II. III. IV. V. Appointment of a Fundraising Central Division Division Core Group Initiatives Resource Centre Communications Human to oversee to Support the Plan Resources Plan implementation of Division the Strategic Plan

136 Five Year Review 2009-2014 HOSPITAL REPORTS

Five Year Review 2009-2014 137 Department of Surgery Mount Sinai Hospital University of Toronto

FIVE YEAR REVIEW

2009-2014 Jay Wonder, M.D. Surgeon-in-Chief, Mount Sinai Hospital University of Toronto

138 Five Year Review 2009-2014 Renew Sinai is Mount Sinai Hospital’s multi- Many members from the hospital’s Sarcoma year capital redevelopment project to create, Program were nominated to work on the Sarcoma expand and modernize its space. To date, six Expert Panel, which developed a working new foors have been added on top of the Murray document for Cancer Care Ontario (CCO) and the Street wing to house the Women’s and Infants’ Ministry of Health on how to improve sarcoma Health Program – the largest academic obstetrical, patient care throughout the province, as well as gynaecological, and neonatal program in Canada. rectify defciencies in case funding, especially Based on continued government support, plans are for limb salvage surgical procedures and sarcoma underway to completely rebuild and modernize chemotherapy, both of which are expensive and several areas of patient care – featuring state-of- poorly remunerated. the-art operating rooms, emergency facilities, and critical care and inpatient units. Thanks to two Finally, Mount Sinai Hospital was generous donors, a Same Day Surgical Admission awarded Ontario’s frst Peritoneal Malignancy Unit adjacent to the Main Operating Rooms was Program under the joint partnership of Mount built and has made a major positive impact for Sinai Hospital, University Health Network, patients and their families on the day of surgery. Sunnybrook Health Sciences Centre and Cancer 2015 developments will include a new neonatal Care Ontario. It has taken a lot of institutional intensive care unit, labour and delivery unit, and cooperation and backroom political intervention antenatal units. An emergency department, 19 leading to the creation of this program. This will new surgical suites, 8 modernized inpatient units, allow patients to receive cytoreductive surgery a 50% increase in ICU beds, and ambulatory with intraperitoneal hyperthermic chemotherapy clinic will follow. locally, without having to be sent abroad to the USA for treatment. Research productivity in Patient safety and access remain major focuses terms of publications, peer reviewed funding, and throughout the hospital, and particularly within invited lectureships remained at an all time high the Department of Surgery. Dr. Jay Wunder led for our department. Some highlights include: the implementation of the Mount Sinai Hospital Surgical Safety Checklist, which was facilitated by holding educational patient safety rounds for Division of General Surgery the entire surgical program. Compliance with the Checklist is now another of the publicly reported Andrea McCart was promoted to Associate safety indicators by the Ministry of Health. Dr. Professor in the Department of Surgery at the Robin McLeod leads the Best Practices in General University of Toronto and appointed as head of Surgery (BPIGS) program, which has brought the new Ontario Peritoneal Malignancy Program together all the University of Toronto teaching (2009-10). hospitals to standardize practice guidelines across general surgery. Robin showed positive results Carol Swallow completed successful terms of improvements in patient outcomes as a direct as President of the Canadian Society of Surgical result of this initiative. Oncology, and Chair of the Royal College Specialty Committee for General Surgical The surgical oncology program and Oncology (2009-10). She was appointed as the arthroplasty groups once again provided Chair of General Surgery in 2014. leadership within the Toronto Central LHIN by successfully increasing surgical volumes beyond Helen MacRae is Chair of the American the hospital’s target and improving patient wait College of Surgeons’ Association of Program times. Directors Committee (2009-10). She was promoted to Professor in 2011.

Five Year Review 2009-2014 139 Robin McLeod holds the Angelo and 31 articles were published in 2010-2011, 52 Alfredo De Gasperis Families Chair in Colorectal published in 2011-2012, 38 published in 2012- Cancer and IBD Research. Robin continues to do 2013, and 48 publications in 2013-2014. an outstanding job as Surgical Lead for Quality Improvement and Knowledge Transfer at Cancer Division of Orthopaedics Care Ontario. Robin was the Gallie Lecturer at the Annual Canadian Association of General Peter Ferguson helped launch the Surgeons Meeting in 2010. In 2011, she became Competency-Based Curriculum (CBC) stream a life member of Colorectal Surgical Society of the Orthopaedic Residency Program while of Australia and New Zealand in 2011 and also serving as the Associate Program Director in received the Best Paper Award from the Canadian 2010. He received the Ivan Silver Award from Society of Colon and Rectal Surgeons. In 2013- the University of Toronto Faculty of Medicine for 14, Robin received the Award of Excellence Excellence in Creative Professional Development from the College of Physicians and Surgeons of related to the new Competency Based Curriculum Ontario, and the Robert Mustard Mentor of the in the Division of Orthopaedic Surgery (2013-14). Year Award from the Division of General Surgery, University of Toronto. Although she closed her Oleg Safr completed his Masters of clinical practice and became a Vice President of Education and was promoted to Assistant Clinical Programs & Quality Initiatives at Cancer Professor in 2009-2010. Oleg is also the co- Care Ontario, she was awarded a CIHR grant Director of the new University of Toronto Young aimed at developing a decision rule for discharge Adult Hip Clinic. He received the 2014 Award for following colorectal surgery. Excellence in Postgraduate Medical Education at the University of Toronto in the category of Dr. Irving Rosen helped facilitate a Development and Innovation for development of philanthropic donation by Mr. Mark Daniels the novel “Surgical Prep Camp” curriculum in the and the Head and Neck Cancer Foundation of Surgical Skills Center. Canada to establish the Rosen-Daniels Visiting Professorship in Surgical Oncology Translational David Backstein served as the Director of Research in 2009-10. The Rosen-Daniels professor Undergraduate Education and Director of the was Dr. Hans de Wilt, a surgical oncologist from Surgical Clerkship for the Department of Surgery, the Netherlands. making signifcant improvements to the medical school’s surgical curriculum (2009-10). He was Anand Govindarajan and Erin Kennedy selected as member of American Association of joined the Division of General Surgery in July Hip and Knee Surgeons in July 2011. 2011, both as Surgeons Investigators, at the rank of Assistant Professor. Erin Kennedy was Jay Wunder became the President of the promoted to Associate Professor at the University Connective Tissue Oncology Society (2011-12). of Toronto, and was elected as the Cancer Care Ontario Gastrointestinal Lead with the Disease Paul Kuzyk joined the Division as Surgeon- Pathway Management Program. Erin was also Investigator, at the rank of Assistant Professor in awarded a $1 Million grant from the Canadian 2011. Partnership Against Cancer to improve care and outcomes for patients with rectal cancer across The Division has been incredibly productive Canada (2013-2014). in terms of publications over the past fve years. 44 articles were published in 2010-11, 78 in 2011- In addition to numerous international talks, 12, 39 in 2012-13, and 62 in 2013-14. the Division has had high research productivity.

140 Five Year Review 2009-2014 Division of Urology Alexandre Zlotta retains his high profle presence in urologic oncology. He remains an Ethan Grober received grants from the Associate Editor for European Urology and is on Medical Council of Canada, The Physicians’ the faculty of the European School of Urology. He Services Incorporated Foundation (PSI), and The received the Basic Science Research Award from Association for Surgical Education (CESERT) to the University of Toronto at the 2011 Charles continue his investigations into the acquisition and J. Robson Research Day; the EAU Platinum evaluation of surgical skills, and particularly to Award, and the Best Poster Award both from determine the correlation between these fndings the European Association of Urology/European and patient outcomes. Urology in Paris, France (2011-2012). Alex was awarded the European Association of Urology’s Kirk Lo was on the program committee for Platinum Award. Alex also received the Basic the Annual Meetings of the American Society of Science Research Award at the Charles J. Robson Reproductive Medicine and the American Society Division of Urology Research Day, and won three of Andrology (2010-2011). He won the A.W. best poster awards at the European Association of Bruce Faculty Undergraduate Teaching Award Urology Meeting. from the Department of Surgery in 2013-14. In addition to giving many international Keith Jarvi received a grant from the lectures, the Division has published many papers Canadian Cancer Society Research Institute, over the past fve years. 18 papers were published a patent for his fndings, and a grant from the in 2010-2011, 77 in 2011-2012, 25 in 2012-2013, MaRS Innovation Proof of Principle Program and 45 in 2013-2014. to develop a test for commercialization. Keith is also on the editorial board of the Canadian Urological Association Journal (CUAJ) and is the secretary of the Society for the Studies in Male Reproduction. He completed his Presidency of the Society for Studies in Male Reproduction. Keith and colleagues published a landmark paper in Science Translational Medicine describing a non-invasive method for diagnosing the cause of male infertility (2013-14).

Five Year Review 2009-2014 141 Department of Surgery St. Joseph’s Hospital University of Toronto

FIVE YEAR REVIEW 2009-2014

Chris Compeau, M.D. Surgeon-in-Chief, St. Joseph’s Hospital University of Toronto

142 Five Year Review 2009-2014 2009-2014 Education

Surgeon-in-Chief Report Recognizing the historical importance of medical education at St. Joseph’s Health Centre, Clinical excellence in surgery as well the senior leadership and board of directors as an outstanding educational experience for established the Department of Medical Education undergraduate, graduate and post-graduate and Scholarship (DMES) in November 2012. trainees has been the hallmark of the Department Under the guidance of Dr. J. Maniate (Director of Surgery at St. Joseph’s Health Centre over of Medical Education) there has been an increase the past fve years. Annual surgical volumes in the number of undergraduate, graduate and have progressively increased in our priority postgraduate medical trainees in our surgery programs (hepatobiliary, thoracic surgery, program. In particular the Fitzgerald Academy bariatrics, arthroplasties). Specifcally we are a in the University of Toronto, Department of provincially recognized Level 1 centre for both Medicine has integrated St. Joe’s into its core thoracic surgery and hepatobiliary surgery and educational stream in Thoracic Surgery. We are a provincial centre of excellence for bariatric acknowledge and celebrate the outstanding surgery. Our surgical manpower has grown with contribution of educators within the department the hiring of fve outstanding clinical surgeons with annual divisional teaching awards which (Dr. Maurice Blitz – thoracic surgery 2009, Dr. are voted on by surgical trainees. Many of Shiva Jayaraman – general/HPB surgery 2010, Dr. our surgeons hold educational administrative Michael Ko – thoracic surgery 2010, Dr. Carlos leadership positions (Dr. Maurice Blitz – Director Lopez – orthopedics/sports medicine 2013, Dr. of Surgical Foundations, Department of Surgery, Dustin Dalgorf – ENT/sinus surgery 2014). U of T; Dr. Ron Levine – Director of Postgraduate Education, Department of Surgery, U of T; Dr. Ian Division Heads Witterick, Chair, Otolaryngology, University of Toronto; Dr. Chris Compeau – Chair, Examination General Surgery Paul Sullivan Committee Thoracic Surgery, Royal College of Thoracic Surgery Maurice Blitz Physicians and Surgeons Orthopedic Surgery Amr El Maraghy Plastic Surgery Craig Fielding ENT Rick Fox Urology Umesh Jain

Five Year Review 2009-2014 143 Department of Surgery St. Michael’s Hospital University of Toronto

FIVE YEAR REVIEW 2009-2014

Ori D. Rotstein, M.D. Surgeon-in-Chief, St. Michael’s Hospital Professor and Associate Chair of Surgery, University of Toronto

144 Five Year Review 2009-2014 Preamble reviewed in 2009. The purpose of this document is to overview the activities in the Department St. Michael’s Hospital (SMH) is a fully- of Surgery at St. Michael’s Hospital from affliated hospital of the University of Toronto. It July 1, 2009 to June 30, 2014, a period which is a downtown hospital with 486 in-patient beds, constitutes my past fve-year term in the position 75,000 emergency room visits per year, in excess of Surgeon-in-Chief. of 15,000 inpatient surgical procedures and an annual hospital budget of approximately $500 With this context, I will try to overview million. The hospital is a Level 1 Trauma Centre. the accomplishments of the Department over The Department has seven Surgical Divisions the past fve years as well as articulate some of with thoracic surgery being represented within the ongoing challenges, both current and in the the Division of General Surgery. The Surgeon- future. in-Chief position and the Department were last

1. Our Faculty The Department of Surgery at SMH had 42 percent of the Departmental members in each full-time active staff (including scientists) as of job descriptions has shifted considerably from June 30, 2009. All full-time active staff at St. 2004 and even from 2009(not shown). Among Michael’s Hospital (SMH) have appointments at the 49 surgeons, there are 12 surgeon-scientists the University of Toronto. In addition to academic (24%), seventeen surgeon-investigators (35%) rank, The University of Toronto Department and 20 surgeon-teachers (41%). Several points of Surgery has defned job descriptions for all are noteworthy in terms of elaborating on the faculty which articulate relative time dedicated recruitment process. All recruitments require a to clinical work, research and teaching. These formal search committee for selection, consisting job descriptions include Surgeon-Teacher of representatives from both the hospital and (20% research), Surgeon-Investigator (40%- the University. As a result, fve of the recruits 60% research), and Surgeon-Scientist (70% were from international sites, including the research). The remaining percentage of activity United States, Brazil, Saudi Arabia, Ireland beyond research consists of clinical care and and England. The Institution provided me with educational activities. During the frst 5 years discretionary recruitment funds to support salary of my term, recruitment signifcantly altered the and research operating funds. The availability academic favour of our Department. On July 1, of these funds allowed me to leverage additional 2004 there were 28 active staff, all of whom had funding from the University, from the Research a job description as a surgeon-teachers except Institute, and from the Divisional Academic four faculty (14%) who had a job description Funds. The fnancial support for new recruits has of a surgeon-investigator. Not surprisingly, the clearly been valuable in that it has allowed these Department was viewed as one which provided individuals freedom from clinical duties thereby strong clinical care and teaching but was permitting protected time for research activities. somewhat limited in its research capabilities, During the past fve years, seven surgeons have and hence its academic productivity. All left the Department. Five surgeons retired (Drs. recruitments require a formal search committee Tucker, Muller, Ameli, Koo and Mustard), and for selection, consisting of representatives three pursued practice opportunities elsewhere from both the hospital and the University. The (Dr. Nathens- Sunnybrook; Dr. Lossing-

Five Year Review 2009-2014 145 Southlake; Dr. Cina-Italy). During the past makeup of the Department to one which has a fve year period, we also recruited two full time better balance of clinical surgeons with a range scientists to bring the total number to six. In of academic job descriptions. summary, the past fve year period has been one characterized by considerable shift in the

2. Governance SMH Programmatic Structure The hospital is divided into Programs for The operating rooms and Pre- and Post- administrative oversight of clinical activities. operative care activities are managed as a Five of the major programs with their alignment separate Service Program called Perioperative with Department of Surgery divisions are: Services (POS), which has its own budget and Mobility: Orthopedic surgery accountability to management. POS has a Trauma/Neurosurgery: Neurosurgery parallel governance with a Medical Director Specialized Complex Care: General and Program Director. Obviously, interests of Surgery the major programs overlap considerably with Diabetes Comprehensive care Program: those of POS. Over much of the past 5 years, Urology, Plastic Surgery the Medical Director of POS has been Dr. James Heart and Vascular: Cardiac surgery and Mahoney, Head of the Division of Plastic Surgery Vascular surgery In the Operating room. As Surgeon-in-Chief, I sit on the Executive Council of POS and therefore Otolaryngology, Ophthamology and am integrally involved in the decision making Obstetrics/Gynecology are separate Surgical around OR activities. The Trauma Program has Departments. dual accountabilities- one to the hospital via the Trauma/Neurosurgery Program and the other to Each of the programs has a Medical the Provincial government. While the Director Director (physician) and Program Director need not necessarily be a Surgeon, a member (administrative) to oversee activities and budget. of our Department has traditionally held this The Medical Director of one of the Programs is position and has continued to do so over the a surgeon (Dr. Earl Bogoch- Mobility), while past 5 years (Dr. Najma Ahmed- 2004-6/ Dr. the remainder come from various other medical Avery Nathens 2006-2012, Dr. Sandro Rizoli specialties. Input from the Surgical Services to 2013-present). the programs comes from surgical representation on each of the Program Councils. The Surgeon- Departmental Committees, Meetings and in-Chief (SIC) does not sit in an offcial position Leadership on the Council of any of the fve major programs, although Surgery is represented by Division Within the Department, we have monthly Heads or their delegates. Issues arising in the department-wide meetings, monthly meetings programs are brought to my attention through of the Division Heads and monthly meetings interactions with Division Heads or the executive of the Education Council consisting of the Vice arm of Senior Management. Chair of Surgery, Dr. David Latter (Cardiac), the Head of Undergraduate Education, Dr. Rob Stewart (Urology) and the Head of Postgraduate

146 Five Year Review 2009-2014 Education, Dr. Timothy Daniels (orthopedics). particularly at the undergraduate (UG) level. The monthly Department meetings have Our surgeons also have various positions precirculated agendas and are minuted in detail at the hospital and at the University of Toronto. (available on request). The primary focus of As noted, Dr. Bogoch is the Medical Director of these meetings is information dissemination. the Mobility Program and Dr. Mahoney is the Each meeting includes an invited presentation on Director of Perioperative Services. Dr. Kenneth a topic of interest to Faculty (e.g. HBAM, clinical Pace is the President of the Medical Staff research infrastructure, Human Resources issues), Association. Dr. Ralph George is the Director an update regarding OR operations and a brief of the CIBC Breast centre and Dr. Rizoli is the overview from the Divisions Heads of each of Director of Trauma. Three of our surgeons are the Division’s activities. The monthly Division Program directors of their University Divisions Heads’ meeting is intended to be higher level (Dr. Latter- cardiac; Dr. Najma Ahmed- General and feature more discussion of broader hospital Surgery; Dr. Robert Stewart-Urology; Dr. and Departmental issues. These meetings have Julian Spears- Associate Program Director precirculated agendas and detailed minutes Neurosurgery). Dr. Latter is the Vice-Chair (available on request). The Education Council of Education in the University department, addresses primarily education issues within the while I am the Associate Chair of Surgery in hospital Department. Dr. Latter is the University our University Department. Finally, Dr. Andras Department of Surgery Vice-Chair of Education Kapus is the Associate Vice Chair of Research at and his involvement in this group adds perspective the University Department. Dr. John Bohnen is to our discussions. This group has spearheaded Vice-Cean of Clinical Affairs at the University a number of initiatives which we feel enhances of Toronto Faculty of Medicine. the delivery of education in the Department,

3. Departmental Clinical Activities Overview (above global hospital budget) to increase case There are 15 Core OR’s and 6 ambulatory activity in specifc areas and hence reduce wait ORs at the Institution. The Department of time. Similarly, General Surgery augmented its Surgery cases comprise approximately 70% of resource, through an increase in the oncology the total cases and hours in the operating room. surgery and in bariatric surgery, both of which Overall there has been a small rise in the total brought new resource through government number of hours from 2009 to present (~2%) and funding. Vascular Surgery experienced an a 5% increase in the total number of cases. This almost complete change in its faculty with the compares to 9% and 3% respectively for the recruitment of new surgeons and the departure period 2004 to 2009. General Surgery, Urologic of one very busy surgeon, as an explanation Surgery, Orthopedic Surgery and Neurosurgery for its reduction. Cardiac surgery experienced have risen over the past fve years, while the a modest reduction, although, in comparison reductions have occurred Cardiac Surgery, to other hospitals in our University system, we Vascular Surgery and Plastic Surgery. The have been able to sustain our numbers. increase in Orthopedic Surgery and Neurosurgery were predominantly related to the development In the following sections, a short summary of the “Wait Times strategy in Ontario” wherein of the key activities of each of the Divisions/ institutions are given incremental funding Programs will be provided.

Five Year Review 2009-2014 147 Cardiac Surgery/Heart and Vascular Program Vascular Surgery/Heart and Vascular During the past fve years, the Division’s Program numbers have been stable. However, this summer, During the past fve years, there has we completed the search for a new cardiac who been signifcant evolution of the members of will join the Faculty next summer. As noted our Division of Vascular Surgery. Through above, case number and hours have diminished. international searches, we have recruited Dr. Concomitant with this reduction, there has Tony Moloney (Ireland), Dr. Mark Wheatcroft been a shift in the case complexity, which now (England) and our Division Head, Dr. Mohammad includes increased numbers in valvular heart Al-Omran (Saudi Arabia). We have also recently disease. This has resulted in increased pressure recruited though a similar search process, Dr. on funding in the OR. There has also been shift Elisa Greco (Toronto) who will offcially join in level of patient comorbidities over this period our faculty in October 2014. The addition of as well. these new surgeons balanced departures due to retirement or relocation (Retired- Dr Michael Specifc initiatives: Ameli; Departed to Southlake Hospital- Dr. Alan 1. The previous recruitment of Dr. Mark Lossing). Obviously, these changes represent a Peterson had profound infuence on divisional considerable fux in the manpower of the division clinical activities, and in particular augmented over the 5 year and not surprisingly, this has been our activity in minimally invasive cardiac surgery stressful particularly for the junior surgeons With Dr. David Latter and in collaboration with who were starting their frst faculty positions. cardiologist Dr. Robert Chisholm, we have With the addition of Dr. Greco, we feel that the developed a percutaneous aortic valve program. Division is right-sized at present. To add to the In the past fscal year (2013-2014), we performed mix, these manpower changes occurred in the 72 of these cases (71 in 12-13). We have also setting of considerable transformation of delivery initiated a program in mitral valve clipping which of Vascular Surgery services in the region. An is in its nascent stages. Funding for these two agreement signed with the government in late programs is partly through government sources 2005 established St. Michael’s Hospital as a (special application for support required) and Centre of Excellence for delivery of vascular partly through our Heart and vascular Program’s surgery care in collaboration with our partner existing resource. The recruitment of Dr. Bobby hospital, University Health Network (UHN). Yanagawa to our Division will bring further This program began formally on February 1, expertise in minimally invasive cardiac surgery 2006 when two surgeons from Toronto East to the Division. General Hospital moved to St. Michael’s Hospital to increase the faculty complement from 2 to Dr. Peterson has also worked closely with 4. As part of this agreement, the four vascular our Division of Vascular Surgery (see below) surgeons entered into an alternative funding in promoting the Endovascular aneurysm repair plan (AFP) with the government wherein base (EVAR) program, particularly advanced activity salary for each surgeon was guaranteed. The such as thoracic EVARs including hybrid hospital was also provided with funding to procedures. increase vascular surgery volumes. The hospital agreed to provide alternate night coverage for vascular surgery emergencies in the Greater Toronto area, to provide additional resource in

148 Five Year Review 2009-2014 the hospital to accommodate increase of volume institution to make a major additional investment by the new vascular surgeons, and fnally to in capital by the construction of a dedicated provide the government regular reporting of angio-operating room. This was offcially activity. University Health Network (UHN) opened on October 20, 2009. and SMH instituted a shared on-call system in January 2006 wherein the surgeons at the two Interventional and Diagnostic Radiology: hospitals alternated 1st Call and if a 2nd Call was As part of the development of this Division, needed the other hospital would provide the our Division members now have the ability to backup. With this system, there were always perform peripheral arterial interventions in the two vascular surgeons on call for vascular Medical Imaging Department. The division emergencies referred through CritiCall Ontario members also have a regular slot in the vascular everyday of the year. This call system lead to laboratory performing diagnostic Doppler a signifcant increase in the number of vascular procedures. The addition of these two activities surgery patients referred and accepted to the two in the past 5 years to the armamentarium of our hospitals through CritiCall each year (increase vascular surgery division members has facilitated ~500%). The on call system also resulted in a care delivery by our Division. 94.8% rate of acceptance of patients referred through this mechanism. The data further The advances in Vascular surgery demonstrated that the Centres of Excellence program over the past fve years was a result of at the two hospitals accommodated patients multiple factors. Two aspects stand out. First, with a high frequency even when the patient s Institutional support for the development of the originated from outside the local region. EVAR program was pivotal. In the early years, this new technology was funded through existing Specifc Initiatives: budget. As the technology evolved, the Heart and Minimally invasive approaches to vascular Vascular program leadership was spearheaded a surgery: successful proposal to the Ministry of Health and Long Term Care (MOHLTC) for new funding Endovascular aortic repair (EVAR): In fscal for this program. Further, the commitment to year 2004/2005, eight EVAR procedures were building a dedicated angio-suite in the operating performed at the institution. This increased room allowed our surgical teams to perform to a total of 123 by fscal year 2008/2009 and these procedures in an optimal setting. Second, from 2009 to 2014, our numbers have fuctuated the close collaborative interaction between between 81 and 117. We perform a mix of both medical imaging and vascular surgery, with “straight forward abdominal” EVAR but also in particular support from the previous Head Dr. more complex thoracic EVAR, branched EVAR Andrew Common and the current Chief, Dr. Tim and fenestrated EVAR. The leveling off of Dowdell, has enhanced the development of this these numbers is likely attributable to a number program . While the evolution of aortic surgery of factors including the change in our faculty toward endovascular approaches has caused a (Dr. Lossing was a key provider) and also the rift in the relations between medical imaging fact that this technology is being increasingly and vascular surgery in many institutions, it adopted at other hospitals across the province. has served to strengthen the relationship at St. The development of this program prompted the Michael’s Hospital and as we move forward, the

Five Year Review 2009-2014 149 medical imaging physicians continue to work in has 4 individuals with acknowledged expertise close collaboration with the vascular surgeons and international profle in the Critical care in the angio-operating room. Included in this Surgery feld (Rizoli, Marshall, de Rezende- collaboration is an agreement between the Neto, and Rotstein). The TACS surgeons Division of Vascular Surgery and Interventional receive referrals from across the province for Radiology for cross training of Vascular Surgery the management of complex intraabdominal fellows. infammatory/infectious problems as well as soft tissue infections. The number of patients referred General Surgery/ Specialized Complex Care to the ACS service through the Emergency The Division of General Surgery has Department and from inpatients services has evolved considerably over the past fve years. progressively increased. This refects the Much of this change has occurred through increasing numbers of patients evaluated in targeted recruitment in a number of areas. The our emergency department and either admitted major strengths in the Division include: Trauma/ directly to the ACS service or to the General Critical Care/ Acute Care Surgery; Cancer care Medical Service. particularly in colorectal and breast surgery; Foregut and Minimally Invasive Surgery St. Michael’s Hospital is a level 1 Provincial including Bariatric Surgery, and Breast. Dr. Trauma Centre sharing trauma call with John Bohnen has an international reputation in Sunnybrook Hospital. The Trauma Program the feld of inguinal hernia repair. Four of the is not formally under the auspices of General surgeons attend in the Intensive Care Unit (either Surgery, but the new recruit to General Surgery, the medical/surgical or trauma/neurosurgical Dr. Sandro Rizoli, is also Trauma Director and ICU) as such, trauma surgery is very much integrated into the General Surgery activity including Specifc Initiatives OR resource, recruitment, allocation of TACS 1. Trauma and Acute Care Surgery Service rotations, sharing of faculty. In 04-05, we (TACS) received 488 Level 1 trauma cases (ISS>16). In 2008, the Division established an Acute This number was 566 in 08-09, and 541 in 13- Care Surgery Service designed to manage 14. urgent/emergent referrals from both outside and inside the institution. Alignment of this program Over the past 5 years, we have strongly with the trauma team has helped to consolidate promoted harmonization of trauma-related clinical care as well as academic foci. During issues with Sunnybrook Hospital. This includes: the past 5 years, there has been some change harmonization of clinical care protocols, sharing in personnel due to departures, retirements and of quality assurance activities, maintenance of focused recruitment. Dr. Nathens departed to a joint fellowship program with a single intake become the Chief of Surgery at the Sunnybrook process, rotation between sites and a common Health Sciences Centre and Dr. Mustard retired. evaluation process, establishment of a joint We were fortunate to recruit Dr. Sandro Rizoli University of Toronto visiting professorship to St. Michael’s Hospital to be Chief of Trauma program. The University of Toronto Trauma and the Head of the TACS service. Dr. Joao de Committee (which includes leadership from Rezende-Neto was recruited from Brazil as a both hospitals) meets quarterly and is committed trauma/critical care surgeon. The Division now to continued efforts to harmonize activity

150 Five Year Review 2009-2014 recruitment of Dr. Sandra deMontbrun in 2012, 2. Promotion of Surgical Oncology we now have three colorectal surgeons on our In the Strategic Plan of 2004, the hospital Faculty, providing both laparoscopic and open recognized Oncology as being a signifcant approaches to surgery. The focus of this care resource user in the Institution and introduced is on the treatment of rectal cancers. Our case the concept of a “Cross Hospital theme” numbers rose from 136 in 2004-2005 to 157 in which would straddle the hospital programs to 09-10 and then remained relatively stable (141 recognize the multidisciplinarity of cancer care. in 13-14). Like breast cancer care, the program Surgical Oncology has become one of the foci has weekly multidisciplinary tumour boards of this theme. This initiative dovetailed with the (including radiation oncology by teleconference initiation of the Provincial Wait Times Strategy. from Princess Margaret Hospital), has Wait In this strategy, the government contracted the times which adhere to the provincial standards, hospital to increase its annual number of cancer and has acceptable pathology turnaround times. cases performed in the area of breast cancer, Dr. Marcus Burnstein has recently inaugurated a colorectal cancer and gastric cancer. The program in Transanal Endoscopic Microsurgery Division has complied well with this initiative (TEMS) using funds received from a donor. and in doing so has crystallized some areas of This should increase the scope of our practice in clinical expertise. In order to facilitate delivery of colorectal surgery. care, we have established a formal arrangement with our neighbouring cancer centre, Princess 3. Gastrointestinal Minimally Invasive Margaret Hospital, to ensure expert and timely surgery including bariatric surgery access to radiation oncology. Over the past fve years, the division has evolved its expertise in advanced. Dr. Breast cancer surgery: Over the past Grantcharov has established himself as a skilled 5 years, under the leadership of Dr. Ralph foregut laparoscopic surgeon and spearhead George, the Director of the CIBC Breast Centre, with Dr. Rotstein the development of our multidisciplinary breast cancer care has evolved bariatric surgery initiative in 2010. St. Michael’s considerably. The Division recruited two fully Hospital is part of the University of Toronto trained surgical oncologists with expertise and Collborative which involves two intake Centres interest in breast cancer. Dr. Jory Simpson and 5 surgical sites. Our surgeons see patients joined the faculty in 2013 and Dr. Adena Scheer through the Toronto Western Hospital intake will begin offcially as active staff on October 1, site and operate on them here at St. Michael’s. 2014. She is also trained in oncoplastic surgery. Patients return to the intake centre for subsequent Breast Cancer cases increased from 263 in 04- care. Our site performs between 150-180 05 to 336 in 08-09 (27% increase) to 402 cases surgical cases per year and is fully active in the in 2013-2014 (20% increase). We comply well collaborative. The collaborative underwent a with the Cancer Care Ontario quality guidelines positive external review in 2012. In addition to in terms of wait times for surgery (Wait time 2), providing high quality patient care, this program pathology turnaround time, and participation in has provide an excellent educational opportunity multidisciplinary tumour boards. especially with respect to developing advanced laparoscopic skills. Colorectal Cancer Surgery: With the

Five Year Review 2009-2014 151 Urologic Service/ Diabetes Comprehensive organ retrieval in our living donor program. Care Program The diminution over the past 5 years has been The Division has expertise in endourology/ primarily related to a reduction in the liver donor stone disease, renal transplantation as well as a program. The Division collaborates fully with lesser focus in genitourinary oncology. There the multi-organ transplant group at the University have been two new recruits in the Division of Health Network and the University of Toronto. Urology over the past 5 years. Dr. Jason Lee has specifc expertise in laparoscopic and robotic Plastic Surgery/ Mobility surgery, while Dr. Ordon is a broadly trained This is our smallest Division with three general/laparoscopic urologist with a clinical full time faculty. Until this year, our third surgeon interest in image-guided ablation of small renal was an individual with courtesy privileges tumours. who worked here intermittently helping predominantly with call. With the recruitment Specifc Initiatives of Dr. Karen Cross as the third fulltime surgeon, 1. Lithotripsy the part time surgeon will no longer work here. The hospital has one of the Provincial Lithotripsy Manpower issues were among those raised at the machines. Surgeons from across the Greater last review and I feel that the addition of a third Toronto Area have privileges in the Lithotripsy full-time member should address this issue for unit. The presence of the unit, however, has the present time. The clinical expertise in the afforded our faculty an opportunity to gain Division is in the area of general plastic surgery, clinical expertise as well as investigative renown breast reconstruction, and wound care. in the area. Specifc Initiatives 2. Robotics 1. Complex Wound care St. Michael’s Hospital was the frst hospital at Under the direction of the Dr. James Mahoney, the University of Toronto to have a surgical the Division heads a signifcant complex wound robot. The Da Vinci Robot, purchased in 2007 care management group which provides cross is used by urology as well as the Department of hospital care to patients with wound problems. Obstetrics and Gynecology. In addition to using Dr. Mahoney is recognized provincially for his this technology for prostatic cancer surgery, work in this area and leads an interdisciplinary our urologists have utilized this technology team of Advanced Practice nurses and research to facilitate surgical care in stone disease, assistants. Dr. Cross has a translational research particularly ureteral and ureteropelvic strictures. focus in wound healing which should augment the clinical care provided by the service. 3. Renal Transplantation The renal transplant program at St. Michael’s 2. Breast reconstruction. Hospital is the second largest in Canada after The divisional work in this area focuses on our sister hospital in Toronto, the University the use of pedicled faps, implants and Health Network. We perform both cadaveric oncoplasty. We do not offer reconstruction with donor transplantation as well living donor free faps. transplantation in a ratio of approximately 70:30. Our surgeons perform laparoscopic

152 Five Year Review 2009-2014 Neurosurgery/Trauma-Neurosurgery terms, the number of aneurysms that underwent Program endovascular repair in 2006 was 60 compared Since 2009, there have been two to approximately 120 in 2008-2009 and 170 retirements from the Division of Neurosurgery cases in the past fscal year. The complexity of (Drs Muller and Tucker) and one recruitment cases has also increased and novel approaches (Dr. Sunit Das). Dr. Das is a surgeon-scientist to dealing with larger and more complex with a clinical and research interest in neuro- aneurysms have been pioneered by our team. The oncology. The Division of Neurosurgery has multidisciplinary neurovascular clinic evaluates three areas of clinical expertise. These are neuro- 1500 patients per year. This program has proven oncology, neurovascular disease and spine. The to be a model for collaborative interactions Division has selectively recruited in these areas between surgery and medical imaging. to augment its capabilities. 3. Spine Specifc Initiatives: In July 2004, the hospital did not have a 1. Neuro-oncology surgeon with expertise in spine. Subsequently, Neuro-oncology is an active participant in the one neurosurgeon (Howard Ginsberg) and an Wait Time initiative. As a major referral centre orthopedic surgeon (Henry Ahn) have been for brain tumours, the Division has progressively recruited to spearhead the spine activities in increased its annual surgical oncology numbers the institution. We have recently completed from 330 in 04-05 to 360 in 08-09 (9% increase) a formal search process to identify our next to 430 cases in 2013-2014 (~20%) increase. The spine surgery recruit. A signifcant contributor vast majority of these are brain cancers, with a to the increase in volume relates to an increase small number of spine tumours. This increase in thoraco-lumbar spinal trauma. The group coincides with substantial upgrading in the neuro- has integrated minimally invasive approaches imaging capabilities of the operating room. We and modern technology in the operating room. also inaugurated an awake craniotomy program Thanks to these approaches, Lumbar disc surgery in collaboration with Anaesthesia commencing is now routinely done as an outpatient. With in 2012 and have performed 19 cases. During the successful implementation of 3-D spinal awake craniotomy, neuropsychological testing navigation, the group has become a national is performed to map the functional critical areas teaching centre for 3-D spinal navigation. of the brain. Thereby helping to determine the Finally, we have pioneered the use of ultrasound safest corridor to pursue tumor resection. in spinal surgery and incorporation of Japanese minimally invasive surgical techniques. 2. Neurovascular The Neurovascular program at St. Michael’s 4. Neurosurgery as a provincial resource Hospital was formally started in 2006. It is With a fnite number of neurosurgical centres in multidisciplinary involving neurosurgery, the province and a commitment by the Ministry neuro-radiology and neurology. Its area of focus of Health and Long Term Care (MOHLTC) to is on the management of hemorrhagic stroke. ensure that emergent neurosurgical cases are Since the program’s inception, growth has managed in a timely fashion and importantly, been signifcant with the number of aneurysm remain within the province of Ontario, there management growing by 20% per annum. In real has been an increasing need to accommodate

Five Year Review 2009-2014 153 neurosurgery transfers to our hospital. St. (11/12- 59; 12/13- 33; 13/14- 47). The hip and Michael’s hospital is an active and willing knee arthroplasty program is extremely effcient participant in the MOHLTC “Life or Limb” in achieving their annual numbers- this is to a policy for transfer of surgical emergencies signifcant extent due to excellent collaboration and participates in the “Last Call” rotor for between the Division members, the operating the Greater Toronto Area. The latter of these room administration and the Mobility program. involved the allocation of new resource to help accommodate this increase in patient load. 2. Foot and Ankle Surgery Dr. Timothy Daniels is internationally known for Orthopedic Surgery his expertise in Foot & Ankle surgery. Over the The Division of Orthopedic Surgery past fve years he has successfully integrated an has recruited one individual since 2009. Dr ankle arthroplasty program into his service. Aaron Nauth is a surgeon-scientist with clinical expertise in trauma surgery and a research interest 3. Sports Medicine and Complex Upper in the use of stem cells in fracture healing. He Girdle surgery has added to our capacity to provide high quality This program is headed by Dr. Michael McKee clinical care for our trauma patients. and Dr. Daniel Whelan. The Sports medicine component of this program is integrated with the Specifc Initiatives; broader University of Toronto effort centred at 1. Hip and Knee Arthroplasty Women’s College Hospital. Dr. Whelan now has The number of these cases has fuctuated regular operating room time there. considerably over the past decade. This is a result of the Provincial Wait Times initiative program 4. Trauma cases were allocated to institutions . This All members of the Division are active participants program presently falls under the Quality based in the Trauma program. With the recruitment of procedures (QBP) program and the numbers Dr. Jeremy Hall in July 2009, expertise in the area appear to have stabilized (11/12- 728; 12/13- of pelvic and acetabular surgery has been added. 809; 13/14- 768). Three of our surgeons are Dr. Whelan has coordinated the development of actively involved in hip and knee arthroplasty. a multidisciplinary team to deal with major knee Of note, Dr. Emil Schemitsch has a robust disruptions. program in metal-on-metal hip arthroplasty

4. department education activities

St. Michael’s Hospital is well regarded specifc data are not available, the popularity of among university hospitals as a desirable location the FitzGerald as a preferred site for training is for undergraduate, postgraduate (PG), and overwhelming. The FitzGerald is currently the fellow education. The best data are available for top choice for clerkship training at the University Undergraduate (UG) Education. The University of Toronto. The UG students cite the quality of sends its UG students to hospital based teaching and commitment by teachers, positive “Academies” for their clinical rotations. The learning culture and the quality of the Academy FitzGerald Academy at St. Michael’s Hospital staff as being signifcant themes underlying their is the home of our UG students. While Surgery- positive experience.

154 Five Year Review 2009-2014 1. Education Governance in the Department: she organizes orientation each new rotation, Given the University of Toronto system, it is coordinates the assignment of individual mentors not surprising that the governance of education in and oversees Dr. Stewart’s “Pizza with the the hospital department is a somewhat complex Professor” rounds. She also debriefs the students matrix. PG education is coordinated from regularly and has served as a sounding board for the central University Department of Surgery various other complaints and worries of students offce though each of the University Divisions. and residents. She has also been responsible UG education is more distributed with the for organizing assignment of faculty to student Fitzgerald Academy serving the UG students at seminars, as well as monitoring attendance and St. Michael’s. The hospital Department works in collating data for feedback on a year to year conjunction with these bodies to coordinate the basis. In the PG domain, Ms. Dominey plays delivery of teaching to the students. a lesser organizational role as the majority of resident activities are coordinated centrally As noted above, the members of this in the University Department. However, she Council are Dr. David Latter, Vice Chair of organizes bi-yearly orientation sessions for the Surgery at St. Michael’s Hospital and Vice Chair residents, coordinates year end social gatherings of Education in the University Department; and is generally available for trouble shooting on Dr. Timothy Daniels who is responsible for resident issues. Ms. Dominey reports to me for postgraduate education; and Dr. Rob Stewart, her annual activity review. My participation on responsible for undergraduate education. Each this Council ensures that I am intimately involved month this group convenes to discuss education in the teaching mandate of the Department. issues in the institution. We regularly evaluate Teaching Effective Scores (TES) scores of 2. Teaching evaluation: the faculty and clerkship debriefngs. Most The University Department of Surgery importantly, when problems are identifed one provides feedback regarding teaching through of more of these individuals is tasked with the calculation of the “Teaching Effectiveness addressing the problem. These may include Score (TES)”. This score, used for both UG and private meetings with individual teachers with Postgraduate (PG) trainees is based on student recommendations for improvement, including evaluation of multiple parameters including attendance at workshops to improve the skill set operating room teaching, ward teaching, formal of individuals with consistently low TES. The teaching, challenging environment good rapport, data is also discussed with individual Division provision of feedback. These scores are fed back Heads particularly when a particular individual to the individuals as well to the SIC on a yearly is problematic. The Division Heads have basis. Because of a need for confdentiality, there identifed a point person responsible for UG and is generally a one-year lag in receiving this data. PG education in each of their Divisions. The scores are rated: Outstanding (18.5-20); Excellent (17.0- 18.49); Average (14.0-16.99); Ms. Michelle Dominey is jointly employed Below average (<14). by the Department and the Hospital to serve in the role of administrator of educational activities. Teaching awards In this role, she has coordinated UG and PG Teaching awards were established to education in the institution. In the UG domain, recognize the important contributions of

Five Year Review 2009-2014 155 the faculty and residents to our educational - “Pizza with the Professors” rounds, in which mandate. The Department now has six teaching each student rotating through surgery is mandated awards to recognize excellence in undergraduate to present a case to their colleagues, typically a education, postgraduate education, continuing rotation group of 10. These cases are ones that education, best resident teachers and an award piqued their interest, but overwhelmingly are for mentoring. Plaques recognizing excellence topics that demonstrate sound surgical principles. are clearly displayed in the operating room. The students present a 10-minute case with The awards are also presented at the Hospital- relevant literature review, there is a period for wide Annual Physician Education Achievement questions, and then cases are uploaded to the U Awards, hosted by the VP of Education and of T portal where all students will have access attended by the President/CEO, member of to these Powerpoint ® presentations as part of the hospital Board and the Dean of Medicine. an e-learning library that is rapidly growing. As This highlighting of education achievement has students do not rotate through all subspecialty heightened the profle of education in surgery as areas, access to these presentations by their peers well as across the hospital. offers an opportunity to review areas of surgery In addition to our “own” teaching that they have not been exposed to. It has been award program, our surgical teachers have been very well received, and the best presentation recognized for their excellence in teaching beyond by a student receives a prize from the U of T our own Department. Several are noteworthy bookstore. The presentations are otherwise in terms of the magnitude of recognition for not graded and the atmosphere is relaxed and individual teaching accomplishments. Dr. provides an opportunity to talk about principles Ralph George was selected for the Fitzgerald of surgery in a very non-threatening and Academy Master Teacher Award. Dr. Bob encouraging environment Mustard, now retired, was a perennial recipient of a Postgraduate Education Award. Dr Marcus - “Lunch with the Chief”: Each group of Burnstein received the prestigious Colin Woolf students rotating through surgery share a lunch Award and the University of Toronto Surgical hour with Dr. Rotstein. This is an opportunity Skills Award in 2012/2013. Finally, Dr. Rob to get to know the students at the Fitzgerald Stewart has been recognized with a number of Academy and hears any concerns that they have awards for his prowess in UG education. about the curriculum or specifc rotations. The message that the learners receive is one of support Other Departmental Initiatives: from the highest level of our Department, and 1. Undergraduate Education: a serious commitment to make their experience Under Dr. Rob Stewarts’s leadership, our the best it can be. These discussion also focus department augmented the regular University of on career planning and in particular, discussions Toronto UG curriculum with a number of other about opportunities in both academic and opportunities for students with the view that these non-academic medicine. Insights from these might bring the surgical experience closer to the discussions with learners are brought to our learner, hopefully make it less intimidating and Education Council in the Department of Surgery more fun. for discussion and action as appropriate These include: - “Popular Science” The Popular Science

156 Five Year Review 2009-2014 lecture series is one which was inaugurated The initiation of Faculty Development by Dr. Rotstein and has been a very successful Evenings endeavour aimed at bringing “bench to bedside” Under the direction of Dr. Tim Daniels, we concepts to the undergraduate learners in surgery. have had faculty development evenings with It is hoped that these types of experiences the stated purpose of enhancing physician skill of seeing real basic observations translate to set for the broad range of issues that might arise clinical practice will stimulate some of the in practice. The format is unique in that it is an UG enthusiasts to pursue a career in academic “all faculty-only faculty” event that combined a medicine. Attendance at these by UG students social evening with educational activities. Tim’s has been somewhat variable, but it is hoped that creativity in putting together these sessions is more regular attendance by the students can be worthy of recognition. achieved. Enrollment in Faculty development opportunities - Surgical Lead in Undergraduate Education There have been a number of other activities in (SLUE): At the suggestion of the University which surgeons have been supported with the Department, each of the hospitals has been goal of enhancing personal career development. encouraged to develop a SLUE program. The These have included participation by our faculty intent is to help UG students navigate their way in teaching programs, leadership development through rotations on each of the services. Under programs, Quality sessions, and courses on Dr. Stewart’s leadership, our hospital department management. has embraced this initiative, appointing a SLUE - Unique Educational events sponsored by the director in each Division and having an evening Department event on July 2, 2013 where experiences were Landmark Lecture Series: The Division of shared.. Not all divisions have embraced this Cardiac Surgery has sponsored a series of high initiative with equal enthusiasm, with General profle lectures over the past fve years. This Surgery and Vascular Surgery taking the lead. series, conceived of by Dr. Subodh Verma, has It is anticipated that there will be increasing attracted a series of internationally-renowned enthusiasm and participation in this program scientists with a general interest in cardiovascular disease to Toronto. The intended audience is 2. Faculty Development broad, consisting of physicians and surgeons As Surgeon-in-Chief, I am personally committed from both the University and the community as to playing an important role in the development well as research scientists, students and fellows- of our faculty members. During the frst three Perioperative Services Rounds years of faculty appointment, I meet with The Department of Surgery has been the driving each of the new faculty on a one-two monthly force behind the creation and presentation of basis to speak informally about a variety of monthly perioperative services rounds. By issues, including practice problems, academic intention, these rounds which are attended opportunities and personal issues. However, we by faculty, house staff and nursing from have also promoted faculty development in other perioperative services have been broad based in ways: their content. As one can appreciate, they range from discussion of the hospital’s strategic plan by the CEO through to more eclectic topics

Five Year Review 2009-2014 157 such as the role of music in the development of Wheatcroft, have been responsible for the technical skill. Ms. Michelle Dominey is the topic selection, speaker selection and overall administrative assistant for these Rounds. Dr. coordination of these rounds. Mark Peterson and more recently, Dr. Mark

5. Research and Innovation The academic face of the Department has of infrastructure grants from the Canadian changed considerably over the past fve years. Foundation for Innovation. Targeted recruitment of clinician-scientists and non-clinician scientists was the predominant The Li Ka Shing Knowledge Institute contributor to this changed. Since 2009, of the 15 (LKSKI) opened in the fall of 2010. The two tower new clinicians added to the department, 13 have centre houses a basic research centre in the west advanced academic degrees (7/15 PhD; 6/15 tower (now called the Keenan Research Centre) MSc). The two without advanced degrees are and the east tower dedicated to education and in the process of completing their MSc degrees Knowledge Translation. the Waters Simulation and one of the MSc recruits is in the midst of Centre is located in the east tower St. Michael’s her PhD training. As shown, the new surgeon Hospital has also fostered the development of recruits were weighted towards job description the Applied Health Research Centre (AHRC). of Surgeon scientist (6/15) and Surgeon This unit focuses on various aspects of clinical investigators (7/15). With the addition of 2 full trials and health services research and represents time scientists in the past year to our Department, a resource for our Department. The general buzz we now have recruited a total of 6 non-clinician around research at the Institution has defnitely scientists to our Department to complement the aided in my recruitment of excellent clinician- research activities. The grant funding database of scientists to our Department. the University of Toronto Department of Surgery is attached for review. The total funding to the Research reports have the potential to be department in 2008/2009 was approximately $4 exhaustively long. To economize on space and million and in every year since then has exceeded time of the reviewer, I will focus on highlights $6 million per year. It is noteworthy that this of research activity and refer the reader to the listing includes both peer review and non peer University of Toronto Surgery web site which review sources of funding. Importantly, the provides the Annual Report of all hospitals in number of members of our Department holding the system over the past 5 years. The University at least one Research Grants from the Canadian of Toronto surgery website link is: http://www. Institutes of Health Research, the major federal surg.med.utoronto.ca funding agency has increased from 6 in 2004 to 11 in 2014 (held during the period of 2009- The Grant Funding database is available on 2014). Peer reviewed funding is also derived request. from The Heart and Stroke Foundation, The Kidney Foundation of Canada, the Physicians’ 1. Research chairs: Services Incorporated Foundation, the Ontario It would be an understatement to suggest that Neurotrauma Foundation and the Canadian Chairs are an essential element of recruitment Cancer Society. We have also been the recipient and retention of outstanding faculty and in our case, this is clearly true as all Chair holders are

158 Five Year Review 2009-2014 international leaders in their felds. We have held Rezende (resuscitation) are just setting up their 8 Chairs in the Department over the past 5 years research groups. a. Dr. Avery Nathens: Tier 2 Canada Research Chair in Trauma Systems 2. Vascular disease. In this area research (now relocated to Sunybrook Hospital) activity spans fundamental research, clinical b. Dr. Subodh Verma: Tier 2 Canada Research trials and health services research. The Chair in Vascular biology fundamental science is focused in the areas of c. Dr. Nancy Baxter: Tier 1 Chair in Health endothelial cell biology as well as vasospasm. Services research from Cancer Care Ontario On the clinical research side, activities focus on d. Dr. Loch Macdonald: Endowed Keenan innovation (neurovascular/endovascular) and Chair in Surgery on development and use of large multicentre e. Dr. Sandro Rizoli: Endowed Chair in Trauma registries. This activity spans several divisions Surgery including neurosurgery, cardiac surgery and f. Dr. Emil Schemitsch: Term Chair in Fracture vascular surgery. Care g. Dr. Tim Daniels: Term Chair in Foot and 3. Oncology: The Institution has traditionally Ankle Research been involved in medical oncology clinical trials h. Dr. Julian Spears: Term Chair in especially in the area of breast cancer. With Cerebrovascular and Brain Surgery the arrival of Dr. Nancy Baxter, institutional (mixed clinical and research Chair profle in health services research in the area of colorectal oncology and screening has expanded Dr. Teodor Grantcharov has been nominated considerably, a conclusion supported by Dr. for a Tier 2 Canada Research Chair. This is baxter’s publication record and grant capture. currently under consideration at the CIHR. To support our effort in neuro-oncology, Dr. Sunit Das was recruited as a clinical surgeon and 1. Research foci has a robust basic research group in the biology Our major areas of research and innovation are: of glioblastoma. To facilitate his research, his research group has been intentionally located 1. Trauma/critical care. Trauma/critical care with like-minded researchers at the Labatt Brain research is performed across multiple divisions Tumour Research Centre at the Hospital for Sick with a concentration in General Surgery and Chidren. Orthopedic Surgery. In trauma/critical care, methodologies include a. fundamental research 4. Simulation/Education: Prior to 2007, the in the areas of infection, infammation and use of the Simulation Centre by the Department bone regrowth, b. clinical trials in both surgical of Surgery was very limited. With the infection and fracture management, c. Health recruitment of Dr. Teodor Grantcharov, there has Services Research in trauma care, and spine been increasing surgical input into the Centre. surgery and d. Knowledge Translation including In particular, a comprehensive training and trauma systems, fracture management, injury assessment curriculum for skills in basic and prevention and complex wound care. Our advanced laparoscopic surgery has been designed new surgeons- Dr. Karen Cross (innovative and implemented and several randomized trials approaches to wound imaging) and Dr. Joao assessing the impact of these curricula on

Five Year Review 2009-2014 159 performance in the operating room have been scientists relate to infection/infammation and performed. Dr. Grantcharov is considered an wound healing. Their expertise in Bioimaging international leader in the use of simulation as brings important methodological skills to the an adjunct to technical training in the operating Department and in the institution. All four room. He has now initiated his studies adapting hold funding from the Canadian Institutes of the use of “black box technology” to the Health Research as well as at least one other operating room where his group will study the major granting agency. Dr. Tom Schweizer is genesis of errors during surgical care. Our new a cognitive neuroscientist who is part of the recruit, Dr. Sandra de Montbrun is completing Division of Neurosurgery. His expertise meshes her PhD under Dr. Grantcharov’s supervision. well with other Departmental members in the She has already established herself as a leader in study of brain tumours, head injury, and effects of the use of technical testing of surgical graduates alcohol on the cerebellum. Finally, Dr. Krishna as part of the certifcation of colorectal trainees Singh is a recently appointed scientist at the under the auspices of the American Board of Institution. He has a longstanding collaborative Colorectal Surgery. As noted above, a listing interactions with the Divisions of Cardiovascular is available via the web on the University of and Vascular Surgery. His appointment as a Toronto Site. scientist will consiolidate his work with this group over the long term. Publications: The 5. Non-clinician scientists: A number of annual publication record of the department is individuals are appointed in the Department of included in the University report. As a summary Surgery as full time scientists without clinical of activity, in the most recent Annual Report activities. Since 2004, the Department has of the University Department, in 2013, 310 recruited 6full time scientists to work within publications were attributed to our St. Michael’s various research groups. In General Surgery, four Hospital Department of Surgery, compared to scientists, Dr. Andras Kapus, Dr. Katalin Szaszi, 173 publications in 2009. Dr. Gregory Fairn and Dr. Wolfgang Kuebler have joined the Department. In broad terms, the research interests of these four fundamental 6. Knowledge Translation Quality patient care is one of the guiding help to hire a KT practitioner. Second, the KT principles in healthcare and is a major focus practitioner worked with each of the Divisions at St. Michael’s Hospital. One of the barriers to identify a feasible KT project for that group. to providing best care is the gap in knowledge Third, the KT practitioner developed the between what is known in the scientifc literature components of individual projects and worked and actual practice,, the so-called “ Knowledge with identifed members of the Divisions and Translation gap” In 2011, our Department also other health care personnel to initiate initiated a “KT-Quality Program” to help our the necessary intervention. Finally the KT Divisions catalyze projects which would serve practitioner reported back to the Divisions and to improve patient care. There were several also to an oversight committee established by components of this program. First, we discussed me to ensure the projects were on track. The this program with each of the Divisions to gain program is now in its third year and has, in their support of this initiative. This involved many ways, been successful. Projects have been fnancial support from each of the divisions to initiated in 5 of the seven divisions; a number of 160 Five Year Review 2009-2014 projects have been completed and have had clear publications emanate from the work. impact on patient care (or in the process of doing so); some of the projects have received external funding and fnally, we have had some scholarly 7. Fundraising In our healthcare system, fundraising about the importance of fundraising and the has become an important aspect of hospital ways to help the Foundation’s efforts in doing operations allowing us to support clinical care, so . As part of this activity, we undertook a research and education beyond that provided by qualitative research project to gain a more in the government. Surgical care is a high profle depth understanding of grateful patient donation activity in our institution and without naming in our health care environment. Specifcally, individuals, I think that all have been supportive we hoped to gain insight into the perspectives of the Foundation’s effort by supporting of physicians regarding the approaches they specifc projects and also by participating in believe lead to successful or unsuccessful patient the larger campaigns over the past decade. I philanthropy to SMH, to better understand the have personally been a strong supporter of barriers and enablers associated with fostering the philanthropic efforts of our Institution grateful patient philanthropy and to learn through personal donation and also through a about physicians’ relationship with the SMH commitment to aiding the fundraising effort. foundation and the role the foundation played in I do so both through personal belief but also their philanthropic efforts. The learnings from because I feel that it is one of the components this work (presently under review) have helped of Physician leadership in academic medicine. to guide both the physicians and the Foundation To this end, I have taken on the role of Head of in their fundraising efforts. the Physician Engagement Committee, a group convened to help physicians understand more 8. Challenges and Opportunities The Department of Surgery has grown exacerbated having to deal with hospital wide considerably over the past fve years and in my budgetary issues. While we have been able view, the clinical and academic activities have to generally preserve the OR budget over the fourished. past 5 years, future pressures may look to the operating room as a potential source for savings. 1. Clinical Domain: Several other factors may impact on the OR A number of signifcant issues face the budget: 1. The inauguration of the quality Department in the clinical arena. based procedures (QBP) program may impact a. Over the past decade, we have recruited on the cost per case remuneration received. with great success and have integrated new To this point, we have not been impacted by surgeons, to a signifcant extent into the QBP in Hip and Knee arthroplasty and in fact, existing resource. While we do not anticipate have beneftted from our effciency. 2. The an urgent need to continue the same pace of per cost case of advanced interventions (heart recruitment, there is continuing pressure on valves, joint prostheses, novel approaches to the OR and ward resource. This may be further care e.g. TAVR) is steadily increasing. This

Five Year Review 2009-2014 161 will require budgetary diligence to manage. by each of the services to proactively shift The Institution has a strong track record of elective time to urgent blocks. Clearly, going to government for separate funding for we will have to work with nursing and many of these areas. 3. Pressure of urgent/ anaesthesia to address this issue. emergent cases due to our role as a provincial centre for care in a number of surgical areas. c. Quality is one of the Corporate Principles of Several strategies are being considered to our current strategic plan (2011-2014) and address the current and future perceived will undoubtedly remain a primary focus of pressures. We are currently beginning an the Institution going forward. Obviously, operational review of the operating room to each surgeon is focused on delivering the ensure that we are right sized and operating at highest quality of care for his/her patients. optimal effciency. We have also considered However, it will be critical to systematize in the past the possibility of decanting cases this focus and, in so doing, align it with the outside of the institution. We already perform hospital activities. Some divisions have done much of our arthroscopic surgery at Women’s this well. Involvement in the KT program in College Hospital. The potential role of the department (see Section 6) has augmented “surgicentres” to deal with high volume, low care in several of the divisions and hopefully intensity cases should be considered. The sustaining this program will be a priority of development of the Kensington Centre for this activity. Data acquisition and feedback cataract surgery is an example of a successful to stakeholders is a key aspect of monitoring government initiative. We should explore quality of care, devising interventions to these as well as other opportunities outside of improve care, following up on the success of the main hospital. the intervention and ensuring it is sustained over time. In the Department, we have had b. The operating room is increasingly some success in the use of registries to help with burdened with urgent/emergent cases. This this process. The most notable is the Trauma competes with and disrupts a busy elective Registry, which ensures accountability of the operating room schedule. The tension is quality of care of our unit. We are now in further exacerbated by Provincial Wait time the early stages of implementing registries imperatives for elective cases. While our in both cardiac and vascular surgery, and hospital is generally a strong performer, have also made progress in the initiation of we have areas where we have problems the NSQIP program for other services. The including hip arthroplasty, anorectal successful implementation and appropriate disease, foot and ankle surgery. We have use of these databases will help ensure the had reasonable success at balancing urgent delivery of quality care in our department. and elective cases, but as the burden of Clearly, it will require leadership, focus and urgent cases increases, it will be essential to commitment from our Department to take resolve this confict, as it is not sustainable advantage of these opportunities. Obviously, from a patient care standpoint or from a this is just one aspect of the multiple facets of staff satisfaction point of view. Potential Quality, but, in my view, should be a priority solutions include reconsideration of nursing of the Department over the next fve years. shifts to accommodate different and perhaps more fexible scheduling and consideration

162 Five Year Review 2009-2014 d. Wherever we have initiated partnerships the General Internal Medicine Division at with other institutions/facilities over the past St. Michael’s Hospital. (iv) Finally, I see as decade, there has been an overall beneft to the a mandate of our University to develop the provision of care for our patients. We should medical leaders of the future. We current have continue to seek these out and advocate for a regular faculty event focused on leadership them when appropriate. and I will propose to extend this to Senior resident and fellows. 2. Education a. The UG and PG educational experience b. Faculty Development: In my view, this will remain a priority of our Department. remains a relative weakness of our University. While our evaluations are in the very good In my role as Associate Chair of Surgery in the to excellent range, we should aspire to University, I have been given the responsibility continuous improvement in this area. This to oversee the Faculty Development is clearly a challenge as TES scores are a portfolio. The mentoring program in somewhat subjective measure of quality of place at present within our Department is the teaching experience for our students. currently undergoing revision and by the Several approaches will be used. First, end of next year, we anticipate that we will within the next six-12 months, the Education have a robust program, with trained Faculty Council members will meet with the VP of mentors and accountability to the Department Education of the hospital to get an accounting for this program. Within the hospital, we of the strengths and weaknesses of the will continue our faculty development Education program in our Department. We evenings as a means of augmenting the will then convene a retreat attended by skill sets of our Surgeons. In addition, as a SMH surgical faculty, selected UG and PG Department, we need to take advantage of students and educators to discuss the existing various programs available to our faculty circumstances and propose innovative including the Education Scholar programs approaches to improving education in the through the Centre for Faculty Development Department. Other initiatives: (i) The SLUE as well as various leadership programs program has had some success at our hospital, available for both junior and senior faculty. but its profle as a mechanism for improving the UG experience could be improved. (ii) Addressing the late career needs of our senior Our Department is committed to supporting surgeons is one of the foci of our University the University Longitudinal Integrated Faculty Development initiative. At the Curriculum as a pilot this coming year and University level, the Chair, Dr. James Rutka as it expands in the future. We will look is gathering ideas from various hospitals for opportunities for our faculty to improve with a view to hosting a mini-retreat to share individual teaching skills (e. though the thoughts around retirement. At a local level, Centre for faculty Development), with a view we have had some success in transitioning to further enhancing this experience for the senior surgeons to retirement. It is a given students. (iii) We will explore the feasibility that this discussion should start early, but the of a more longitudinal experience for our PG involvement of Division Heads in the planning trainees who are rotating here for > 3 months. process has been and will continue to be This program has been very successful in important.

Five Year Review 2009-2014 163 c. Use of the Simulation Centre: The Waters and Academic Financial Plans compensate to Simulation Centre offers the opportunity for some extent for this shortfall, these sources trainees to augment skills in a simulation are stretched and generally insuffcient. We setting. In our University Department, we have had some success in increasing the have expertise and interest in using simulation number of Chairs in the Department over the to enhance clinical training. A recent summit past 5 years and as Chief, I will continue to at the University has concluded that a coordinated approach to accessing simulation strongly advocate for bringing these Chairs facilities across the University would optimize to our Department In my role as Head of the its use in clinical training. Obviously, the Physician Engagement Committee, Department is very supportive of participating b. Alignment of Research in Surgery in this initiative and will work with the Director with the directions of the LKSKI. As for of the Simulation, Dr. Doug Campbell to clinical programs, alignment of research ensure that our hospital is involved. activities in the Department with that of the Research Institute is key to ensuring 3. Research: that we have the fnancial and physical a. Financial issues. In my view, salary support resource to expand our academic for faculty to protect time for research is activities. The Research Institute has the single most important challenge for established two themes for translational Departmental leadership. Granting agencies research: neuroscience and Critical Care are increasingly cutting back their awards trauma, with a plan for a third theme in programs as a means of protecting their cardiovascular disease. It is vital that funding for operating grants. This directly our Department takes advantage of the affects junior and mid level investigators, who unique opportunities for patient-oriented are most dependent on these funds for time research provided by clinician-scientists. protection. Similarly, hospital and University sources are challenged in the current economic environment. While practice plans 9. Closing remarks and Personal perspectives: This is an exciting time at St. Michael’s key enablers of our goals. Both the research and Hospital. Our unique roles as care providers education mandates of the hospital have been for our local community and as a Provincial strongly enhanced by the building of the LKSKI resource for the delivery of Critical Care and through its integration with the hospital. services demand that we provide the highest Upon refection of the specifc goals I set for quality care in a timely and effcient way. We the Department at the beginning of my term, I are engaging in a new Strategic Planning process am greatly pleased with how the Department which will undoubtedly reiterate the importance has evolved and what the Department and its of this objective. The new patient tower and the members have accomplished since then. We expansion of the Emergency Department will be have built a vigorous Department with strengths

164 Five Year Review 2009-2014 in clinical care, education and research. Our I believe that excellence will be the driver for external profle has increased considerably over gaining support for our initiatives. Finally, I am this period. The opportunity to interact with very thankful to the leadership at the Hospital all levels of management has been extremely for sharing and being supportive of my vision educational and profoundly satisfying. My for the development of our Department over the surgical colleagues have been both collegial and past fve years and I look forward to helping supportive and have made my job a pleasure. our Department participate in the shaping of the Budgetary issues will undoubtedly exert future of St. Michael’s Hospital. continued pressure on the way we do business. However, even in constrained environments,

Five Year Review 2009-2014 165 Department of Surgery Sunnybrook Health Sciences Centre University of Toronto

FIVE YEAR REVIEW 2009-2014

Avery Nathens, MD, PhD, FRCSC Surgeon-in-Chief, Sunnybrook Health Sciences Centre Professor of Surgery, University of Toronto

166 Five Year Review 2009-2014 SUNNYBROOK HEALTH SCIENCES CENTRE DEPARTMENT OF SURGERY 2009-14

Overview has a signifcant focus on quality improvement The Department of Surgery at Sunnybrook with the hiring of a surgical PI coordinator, 30-d is comprised of 7 Divisions: General Surgery, mortality reviews, and number of initiatives Orthopaedic Surgery, Urology, Plastic and borne through data from ACS NSQIP. It is Reconstructive Surgery, and Neurosurgery. In recognized for these activities and was one of 2012, the Division of Cardiovascular Surgery the few institutions rolled into the provincial divided into two separate divisions: Cardiac NSQIP collaborative in early 2015, while others Surgery and Vascular Surgery. The Surgeon- were required to compete for funding. in-Chief transitioned from Dr. Robin Richards, who held the position since 2001 to Dr. Avery The Department has hosted several faculty Nathens in Sept 2012. development opportunities, including Crucial Conversations (2012/13) and leadership day Sunnybrook is home to the Ross Tilley Burn focusing on the Art of Confict Resolution with Centre and the Tory Trauma Centre, the largest expert mediator Gary Furlong in 2013/14. These burn and trauma centres, respectively in Canada. events were very well received and served as an It is also home to the Odette Cancer Centre, excellent model for improving communication the 6th largest cancer centre in North America. and teamwork within the Department. There are approximately 15,000 surgical cases per annum and this volume of surgical activity, Divisional activities are outlined below: coupled with an extraordinarily busy emergency department has resulted in tremendous bed Cardiac Surgery pressures. In 2009, the hospital initiated the Division Head: Dr. Gideon Cohen “Drive to 95% occupancy”, with a push toward more outpatient activity. To date, occupancy Overview remains a major challenge and a distraction from The Division is comprised of four cardiac more strategic activity. surgeons and has a focus on minimally invasive cardiac surgery, with the largest programs in Over 2009-2014, signifcant investments Transcatheter Aortic valve Implantation and were made in expanding the M-Wing, with a Mitral Clip in the greater Toronto area. Dr. fully integrated breast centre fnally coming to Bernard Goldman (earlier Division Head and fruition in 2012. The Louise Temerty Breast Surgeon-in-Chief) received the Order of Canada Cancer Centre provides patients with expanded for his contributions to cardiac surgery in 2010. facilities for breast care and fosters greater Dr. Gideon Cohen took over as Division Head collaboration in the areas of imaging, clinical from Dr. Stephen Fremes in 2013. Within the care, research and trials. Division, Dr. Gideon Cohen was appointed Program Director in the University Division of The Department of Surgery initiated Cardiac Surgery (2011), Dr. George Christakis participation in ACS-NSQIP in 2013, and now was appointed Departmental Director of

Five Year Review 2009-2014 167 Undergraduate Education (2012) and Dr. operating room. The Division became a Stephen Fremes was appointed as the inaugural separate academic and fnancial unit from Dr. Bernard S. Goldman Chair in Cardiovascular the Division of Cardiac Surgery in 2012, at Surgery (2012). Dr. Fuad Moussa was appointed which time Dr. Dueck assumed the role of as the Undergraduate Lead in the Department Division Head after a national search. of Surgery at Sunnybrook (2013) and was the recipient of the Peters-Boyd Academy Clerkship In 2013, the Division developed formal Teaching Award in 2014. relationships with two community hospitals through a Memorandum of Understanding: New appointments/departures North York General Hospital and Mackenzie Dr. Fuad Moussa was hired in 2010 at Health. This MOU assures cross coverage the rank of lecturer and job description of and credentialing across the three sites surgeon teacher with a focus on surgical and assures ongoing referrals for the most simulation. He has since been promoted to complex cases to Sunnybrook. Dr. Dueck Assistant Professor (2013). is the Division Head for all three sites in what is a single vascular division. Major University-related initiatives The Division was one of the frst groups New appointments/departures participating in the University of Toronto Dr. Giuseppe Papia (2010) joined the Cardiac Surgery Databases as early as Division of Vascular Surgery and the 2013/14, an opportunity for risk adjusted Department of Critical Care Medicine benchmarking with other Toronto cardiac at the rank of Assistant Professor as a centres. The Division also participates in the Surgeon-Teacher with special interest in new Toronto Aortic Collaborative, designed minimally invasive vascular reconstruction, to distribute referred cases across the city, patient safety and quality assurance. He has review outcomes and provide opportunities since left the Department of Critical Care for research. Medicine to focus on his vascular practice.

Vascular Surgery Major awards/recognition Division Head: Dr. Andrew Dueck Dr. Robert Maggisano was named the Maggisano Chair in Vascular Surgery to Overview enhance the development and evaluation of The Division is comprised of 4 surgeons less invasive image-guided interventions in and has a major focus on endovascular 2011. procedures, particularly limb salvage using peripheral angioplasty. The Division Dr. Dueck received the Peters Boyd Award also shares in the care of a large volume for Clerkship teaching (2010/11) and the of patients with the most complex aortic Undergraduate Teaching Award within the disease with the Division of Cardiac Department of Surgery at Sunnybrook over Surgery. This relationship was formalized 13/14. in 2014, with multidisciplinary pre-review of cases, an established management Major University-related initiatives plan and collaborative procedures in the Up until 2014, the Division of Vascular

168 Five Year Review 2009-2014 Surgery was not well integrated into Dr. Nam received the Postgraduate Urology University activities. In 2014, the Division Teaching Award for Surgical Training began participation in the shared fellowship (2009/10) and was appointed the Ajmera program. Member of the Sunnybrook Family Chair in Urologic Oncology to division also work closely with Division pursue his research focus on the molecular members at St. Michael’s Hospital for the genetics of prostate cancer in 2011/12. most complex aortic cases. Dr. Sender Herschorn was awarded the 2010 Life Time Achievement Award in Division of Urology recognition of “signifcant contributions Division Head: Dr. Ron Kodama and leadership in the feld of voiding dysfunction” by the Society of Urodynamics The Division of Urology is comprised and Female Urology. He was also appointed of 5 surgeons and one scientist with two areas Chair of the Departmental Appointments of focus: prostate cancer and reconstructive Committee in 2010/11 and continued in urology. Dr. Ron Kodama was appointed his fnal year as the Chair of the University head of the Division of Urology, taking over Division over that same year. Dr. Sender the position from Dr. Laurence Klotz. Dr. Herschorn received the F. Brantley Scott Kodama’s expertise in post-trauma urethral Award from the AUA in 2013/14 for his reconstruction draws referrals from across the contributions to reconstructive urology. province; Dr. Klotz has received international acclaim for demonstrating that watchful waiting Dr. Laurie Klotz was elected as an Honorary for prostate cancer is safe, while Dr. Sender Member of the American Urological Herschorn has accumulated remarkable surgical Association in 2009/10 and was chair expertise in reconstructive urology, resulting in of the Chair of the World Uro Oncology referrals from across Canada. Dr. Robert Nam’s Federation and Editor-in-Chief of the clinical focus is prostate cancer and has an active Canadian Urological Association Journal in research laboratory. He was appointed leader of 2010/11. He won the Lister Prize at Gallie the GU site group in 2009. The Division also has Day in 2013/14, recognizing his outstanding within it a scientist (Dr. Vasu Venkateswaran) and continuing research productivity of with a focus on prostate cancer research. international stature. He also received the Society of Urologic Oncology Medal Major awards/recognition from the American Urological Association Dr. Kodama won the WT Aikins Award (AUA) for signifcant achievements in the for teaching performance in 2009/10. Dr. feld. Kodama was appointed pre-clerkship coordinator for the University Department New appointments/departures in 2011/12. In 2013/14, he received None the University Award for Excellence in Postgraduate Medical Education and a Major University-related initiatives Peters-Boyd Academy Clerkship Teaching The Division participates in a city-wide Award. fellowship program in the area of uro-

Five Year Review 2009-2014 169 oncology. The Division at Sunnybrook is Toronto neurosurgical centres and increased the sole division among the major academic emergency surgical volumes by approximately centres in the city without a robot. However, 30%. the Division initiated a cooperative robotic surgical program located at the Toronto East Major awards/recognition General Hospital in 2011/12, which appears Dr. Leo Da Costa and his team were to be highly functional. The lack of an on- the only Canadian research group to be site robot potentially is a threat to further awarded a grant from a partnership between recruitment of uro-oncologists. the National Football League and General Electric to support research in mild TBI. Neurosurgery New appointments/departures Division Head: Dr. Todd Mainprize (interim) Dr. Nick Phan was appointed as a Surgeon-Investigator in 2009/10 at the The Division includes 7 neurosurgeons, rank of Assistant Professor with a focus in with area of foci including traumatic brain injury, traumatic brain injury. neurovascular (endovascular in particular), and skull base tumours. The two neurovascular Dr. Victor Yang was appointed to the neurosurgeons work in collaboration with Division of Neurosurgery in 2013 as a interventional radiology to support an surgeon scientist at the rank of Associate interventional stroke program at Sunnybrook. Professor with a clinical focus in Urgent spine activity is coordinated between endovascular neurosurgery. As an engineer, the three orthopaedic spine surgeons and the he also holds a position as a scientist at Division of Neurosurgery who all participate in Sunnybrook Research Institute (Physical spine call. Dr. Michael Schwartz transitioned Sciences platform) where he focuses on from his role as Division Head in 2013 to applying biophotonics to improve surgical fulflling a role primarily in the research domain. navigation in spine procedures. Dr. Mainprize has been interim Division Head since that time. The Division has a research focus Major University-related initiatives that aligns closely with the work of imaging The Division participates in the University scientists at Sunnybrook Research Institute of Toronto Spine program, a collaborative and includes MRIgFUS in essential tremor and between the University Divisions of Parkinson’s disease, white matter tractography in Orthopaedic Surgery and Neurosurgery to tumors, MRIgFUS for tumor ablation and blood integrate spine care, education and research brain barrier disruption, and blood oxygen level- across the city. dependent (BOLD) cerebrovascular reserve in trauma and subarachnoid hemorrhage. General Surgery Division Head: Dr. Natalie Coburn Since 2013, the hospital has invested heavily in resources to better support emergency The Division of General Surgery is neurosurgical care. This investment has resulted comprised of 16 members and one scientist in Sunnybrook’s Division of Neurosurgery to with several areas of focus including trauma, participate fully in a shared call rota across the breast and melanoma, colorectal cancer, and

170 Five Year Review 2009-2014 hepatobiliary surgery. The Division is very well Dr. Avery Nathens, a surgeon scientist aligned with the institutional priorities (trauma, and Director of Trauma from St. Michael’s colorectal cancer, breast cancer), which has Hospital was recruited in 2012 as the new enabled signifcant recruitment. Leadership Surgeon-in-Chief with a clinical focus on transitions over this time interval included trauma surgery and quality and has a strong Dr. Andy Smith who handed the baton on to health services research background. Dr. Natalie Coburn in 2011. Dr. Smith was Dr. Shady Ashamalla was recruited to appointed Chief of the Odette Cancer Centre and the Division at Sunnybrook in 2012 as a Regional Vice President of Cancer Care Ontario clinician teacher with a focus on colorectal at that time and then moved on to an Executive cancer and simulation. Vice President Position at Sunnybrook in 2013. Dr. Calvin Law was identifed as the inaugural Dr. Sandro Rizoli left the Division to take chairholder of the Hanna Family Chair in Surgical on the role as Trauma Medical Director, St. Oncology Research at the Odette Cancer Centre Michael’s Hospital. in 2010 and was appointed leader of the GI Site Group at the Cancer Centre. He went on to head Dr. Nicole Look Hong was recruited to the the Division of Surgical Oncology in 2011 from Division of General Surgery in 2013/14 as Dr. Sherif Hanna and then took over the position a surgeon investigator with a clinical focus as Chief of the Odette Cancer Centre from on surgical oncology, breast cancer and Dr. Smith in 2013. Dr. Frances Wright was melanoma. Dr. Look Hong holds a position appointed the Head, Breast Cancer & Melanoma as an Associate Scientist at Sunnybrook Surgery, Temerty Breast Cancer Centre in 2013. Research Institute (Evaluative Clinical Sciences platform), where she focuses her Dr. Fred Brenneman completed a ten- work on improving cancer care effciency year term as Trauma Program Chief in 2009 and through economic analyses and systematic was recognized for his successful leadership evaluation of new technologies. of the Program. Dr (and Colonel) Homer Tien succeeded him as Medical Director of the Tory Dr. Junaid Bhatti was recruited as a Regional Trauma Centre. scientist at Sunnybrook Research Institute (Evaluative Clinical Sciences platform) in New appointments/departures 2014 with a focus on injury epidemiology, Jean François Boileau joined the staff particularly the relationship between of the Division of General Surgery with a obesity, motor vehicle crashes and injury. special interest in the treatment of breast cancer in 2009 and returned to his home in Quebec in 2012. Major awards/ Recognition Dr. Calvin Law received a Peters-Boyd Dr. Paul Karanicolas in 2010/11 was Academy Teaching Award (2009) appointed as a Surgeon-Scientist in the Division of General Surgery with special Dr. Homer Tien was promoted to the interest in hepatobiliary cancer management rank of Colonel in the Canadian Armed and health services research and clinical Forces (2010) and received the Order of trials in surgical and hepatobiliary oncology.

Five Year Review 2009-2014 171 Military Merit by the Governor-General at Carolyn Tuohy Impact on Public Policy Rideau Hall in 2011. In 2012, he became Award (2014). Dr. Nathens was also named the inaugural chairholder of the Canadian the de Souza Chair for Clinical Trauma Forces Major Sir Frederick Banting Term Research (2014). Chair in Military Trauma Research. Major University-related interactions and Dr. Frances Wright received the initiatives Bruce Tovee Award for excellence in Dr. Darlene Fenech co-directs the MMMD undergraduate education for 2010/11. second year course for undergraduate medical students.

Dr. Darlene Fenech receiving the The Division supports the University of Brue Tovee Award for excellence in Toronto Surgical Oncology Fellowship and undergraduate education for 2013/ 2014 is a major training centre for these fellows. Dr. Frances Wright was appointed Dr. Sherif Hanna embarked on a sabbatical Program Director for this University-wide in Egypt to develop a surgical residency fellowship in 2009. program and received a special award at In 2013/14 Dr. Shady Ashamalla hosted the Harrison Dinner for his longstanding TORSO-tech, a one day teaching and service to the Department of Surgery. He simulation-based course featuring live was also the recipient of the Leo Stevens surgery and simulation in order to transfer Excellence in Leadership award for his knowledge to practicing surgeons. This contributions as head of surgical oncology educational endeavour was suffciently and Division Head, General Surgery. novel that CTV News featured this event as a model for knowledge transfer to practicing In 2013, Dr. Claire Holloway was surgeons. recognized for her system-level contributions to Cancer Care and has joined The Division supports the University CCO as the inaugural Provincial Clinical of Toronto Trauma Program led by Dr. Lead, Disease Pathway Management, where Nathens, which was conceived in 2011 to she has ben charged with developing and coordinate trauma-related activities across supporting the evolution and execution of the University. This includes a shared the Disease Pathway Management (DPM) fellowship program, QI and education approach and the Diagnostic Assessment activities, and annual trauma conference. Program. The Program received support for a named Dr. Avery Nathens received the Lister lectureship (the “Tile Lecture”) in 2014, Award for research productivity in 2013 which supports a visiting professor for and the Charles Tator Surgeon Scientist the last University Grand Rounds of the Mentoring Award in 2014 and was the academic year. Dr. Marvin Tile is credited recipient of the Peters-Boyd Academy in creating the frst trauma centre in Canada Clerkship Teaching Award. Dr. Nathens at Sunnybrook and is a former Chief of leadership in policy development led to him Surgery at Sunnybrook. being awarded the University of Toronto’s

172 Five Year Review 2009-2014 Plastic and Reconstructive Surgery Management, and Evaluation focusing on Division Head: Dr. Paul Binhammer outcomes after burn injury.

The Division of Plastic and Reconstructive Major awards/recognition Surgery focuses their activity on craniofacial Dr. Oleh Antonyshyn received the William reconstruction, hand trauma and burn care. The K. Lindsay Faculty Research Mentor Division is comprised of 5 plastic surgeons and Award in 2010 and in 2012. This award 4 burn surgeons. The burn surgeons provide is presented to the faculty member in the care to patients in the Ross Tilley Burn Centre Division of Plastic and Reconstructive (RTBC). Dr. Marc Jeschke was recruited from Surgery in recognition of their signifcant Galveston, TX as Medical Director of RTBC contributions to the nurturing of plastic in 2009/10, who shepherded the unit through surgery residents’ research. a successful site visit by the American Burn Association, which led to verifcation (the frst in Dr. Marc Jeschke was awarded the George Canada) in 2011 and then reverifcation in June Armstrong Peters Prize in 2013. This award 2014. is to a young investigator who has shown outstanding productivity during his/her initial period as an independent investigator New appointments/departures as evidenced by research publications in Dr. March Jeschke was recruited as a peer reviewed journals, grants held, and surgeon scientist and Medical Director of students trained. the Burn Unit in 2010. Dr. Oleh Antonyshyn led a medical mission to the Ukraine in 2014 to address Dr. Laura Snell was appointed in 2010 at the injuries and necessary education to the rank of Assistant Professor as a surgeon- support medical care subsequent to the investigator having received a Master’s Euromaidan demonstration. degree in Clinical Research Methods from Columbia University. Her clinical focus is Orthopaedic Surgery breast reconstruction. Division Head: Dr. Hans Kreder

Dr. Joan Lipa was recruited from UCLA as This Division of 17 surgeons and one a surgeon investigator in the 2011 at the rank scientist has activity spanning both the Bayview of Associate Professor. Her focus is breast site and the Holland Centre. The Division reconstruction and together her and Dr. has three areas of focus: the management of Snell work closely with the breast surgical orthopaedic trauma, the provision of spine oncologists to deliver comprehensive care care, and arthroplasty. Virtually all arthroplasty to this population. activity occurs at the Holland Centre. In 2010/11, a surgical program funded by the Workmen’s Dr. Manuel Dibildox was recruited as Safety and Insurance Board (WSIB) was a burn surgeon at the rank of Assistant initiated at the Holland Centre for patients with Professor with a job description of surgeon shoulder, elbow, hip and knee problems. While investigator in 2011. He was to complete his staffed primarily by Sunnybrook surgeons, MSc through the Institute for Health Policy, several staff from other academic health science

Five Year Review 2009-2014 173 centres help support the program. Dr. Jeffrey spinal metastasis. Gollish oversees activity within the arthroplasty program, recognized for its effciency and Dr. John Murnaghan received the Donald throughput across Canada. Internationally, the Richard Wilson award for excellence orthopaedic surgeons are very well recognized integrating CanMEDS roles into a Royal and active in the AO Foundation. Further, they College Training Program in 2011/12. are involved in a large number of randomized controlled trials to identify best practices in Dr. Markku Nousiainen was the recipient orthopaedic trauma care. of the 2013 PGME Award for Excellence in Development/Innovation for his work New Appointments/departures in the implementation of the competency- Dr. Richard Jenkinson was appointed based curriculum in orthopaedic surgery. as a Surgeon-Teacher in the Division of Orthopaedic Surgery at the rank of Lecturer Dr. Hans Kreder, Dr. David Stephen, and in 2010. His clinical focus is orthopaedic Dr. Richard Jenkinson were awarded the trauma. He subsequently was promoted to Orthopaedic Trauma Association Bovill Assistant Professor and changed his job Award for best paper in 2013/14. description to a surgeon investigator in 2014. Major University-related interactions and initiatives Awards/Special Recognition Dr. Robin Richards completed a ten- Dr. Richard Holtby received the Surgical year term as Chair of the Departmental Skills’ Centre Distinguished Educator Promotions Committee in 2011. Award for 2009/10. Dr. Terry Axelrod was appointed Director of Continuing Education for the Department Dr. Albert Yee received a Faculty Award of Surgery in 2009/10 for Excellence in Postgraduate Medical Education for Development and Innovation Dr. Albert Yee is co-director of the (10/11). Albert Yee was selected as one University of Toronto integrated spine of two 2013 ABC Travelling Fellows by program since its inception in in 2008/9. the Canadian Orthopaedic Association. This program integrates clinical care, This travelling fellowship allows for the research, teaching and educational activities educational exchange of young orthopaedic with respect to spine across the academic surgeons selected by the American, British, health science centres in Toronto. Canadian, New Zealand, Australian and South African Orthopaedic Associations. Dr. Markku Nousiainen was appointed Dr. Yee along with Dr. Cari Whyne received Associate Program Director for the the Charles Tator Mentorship Award for University Division of Orthopaedic 2011/12. That same year, Dr. Yee also Surgery in 2011 with responsibility for the received the prestigious Eduard Samson Division’s competency-based curriculum. award from the Canadian Orthopaedic Foundation for his work on the treatment of

174 Five Year Review 2009-2014 Department of Surgery The Hospital for Sick Children University of Toronto

FIVE YEAR REVIEW 2009-2014

Christopher Caldarone, M.D., FRCSC Surgeon-in-Chief, The Hospital for Sick Children University of Toronto

Five Year Review 2009-2014 175 Current Division Heads: Glen Van Arsdell Cardiovascular Surgery Agostino Pierro General and Thoracic Surgery James Drake Neurosurgery Martin Gargan Orthopaedic Surgery Christopher Forrest Plastic and Reconstructive Surgery Martin Koyle Urology

1. Overview Of Departmental To further defne direction, the focus for activities 2009-2014 was driven by two retreats. The 2009 retreat centred on communication and patient The Hospital for Sick Children (SickKids) fow and 2013 retreat on Innovation. We have is Canada’s largest and premiere Paediatric made substantial progress in these areas, some Academic Health Science Centre. SickKids is of which are described below. often compared with London’s Great Ormond Street Hospital, Boston Children’s Hospital, and We have worked hard to reduce Children’s Hospital of Philadelphia. SickKids administrative cancellations of elective surgery. treats the sickest and most complex children in With the expansion of the Critical Care Unit Canada. Comparators, where available, place from 27 to 33 beds and the creation of separate the quality of care among the best in the world. Pediatric and Cardiac Units, the cancellation rate SickKids has a world-renowned Research for “administrative reasons”, which peaked at 6% Institute (RI) with more than 480 faculty engaged per month in 2007 is now down to approximately in all types of basic, clinical, and educational 1% per month. research. SickKids is consistently more successful at the Canadian Institute for Health A three-phase Surgical Safety Check List Research (CIHR) (the Canadian “National (SSCL) was implemented in 2012. Individual Institutes of Health or NIH equivalent”) than patients are discussed briefy when they enter the the national funding rate and receives more room, specifc details confrmed during the time- funding than the University of Western Ontario out and post-operative plans confrmed during and Queen’s University combined. Many of the the debriefng. We have exceeded our 2013-14 clinical faculty are world-renowned scientists in target of 97% complete for all three phases. their own right. The hospital educates medical This effort, led by Dr. Darius Bagli as Associate students, residents, fellows, graduate students Surgeon-in-Chief, received enormous and vital and performs Continuing Medical Education support from the nursing staff. (CME). Many of the Fellowship Programs are the largest in North America and attract fellows A “Commitment to Safety” by the surgeons from around the world. The faculty at SickKids had also been developed. This commitment to are leaders in their respective disciplines. safety has become part of the reappointment process and signed by each surgeon on an

176 Five Year Review 2009-2014 annual basis. Many important safety initiatives use. Other aspects of reducing SSI, including including POCU Quality/Safety Rounds have appropriate methods of hair removal and patient also been developed. Dr. Darius Bagli, using warning, have been completely addressed. While POS Innovation Fund, developed a smartphone compliance with antibiotics remains below Safety and Near-Miss POCU reporting web ideal, improved antibiotic used has resulted in a application. contemporaneous drop in surgical site infection rates. The use of the antibiotic prophylaxis Quality is of prime concern at SickKids. guideline is associated with a 30% drop in the However, the dilemma is to defne quality SSI. and then measure it. In the area of quality, our primary focus has been on reduction of surgical Concurrent with this effort to improve the site infections (SSI) including the appropriate use of antibiotics, a strategy was developed use of perioperative antibiotics, reduction of to expand the determination of surgical site pain, and improvement in access. infections through the use of health records. Monitoring of SSI currently relies on Infections Although described in more detail in draft Control Practitioners (ICP), which due to limited manuscripts, in the area of reducing SSI the frst resources, monitor infections only in orthopaedic step was to revise our guidelines for antibiotics. spine surgery, neurosurgery and cardiac surgery. Guidelines available in 2005 were incomplete A preliminary comparison has shown neither for all specialties and did not consider patients ICP nor health records are completely accurate with specifc allergies to preferred antibiotics. methods for identifcation of infection. The Revised and expanded evidence-based guidelines revisions to coding practice in health records are were developed, reviewed, and endorsed by all ongoing leading hopefully to a comprehensive specialties. The next step was for a task force, and accurate assessment of SSI for all disciplines. led by Drs. Annie Fecteau and Igor Luginbuehl, to develop a series of processes to improve the Pain management is another major quality use of perioperative antibiotics. The expanded initiative which has been addressed in several guidelines were posted on the E-formulary, ways. First, an institution-wide approach modeled in each OR, and on every anesthetic cart. In after the “Blue print for Patient Safety” has led addition, KidCare computerized order entry that to an institutional commitment to improved pain came online in November 2008 was modifed management. Second, the creation and approval to indicate the appropriate use of antibiotics. of the Pain Management Centre has further The use of antibiotics was also included in the integrated clinical care, teaching and research in surgical pause. A specifc compulsory Rounds the area of pain medicine. Third, the creation and was created for residents and fellows to orient expansion of the Acute Pain Service, Chronic them to the use of guidelines. Beginning in Pain Service, and Palliative Care have enhanced 2009, surgeons have been receiving “real-time” our ability to address access to care. Fourth, the automated email informing them of patients who Department of Anesthesia has been renamed the did or did not appropriately receive antibiotics. Department of Anesthesia and Pain Medicine in These efforts are ongoing and we repeated an audit recognition of the key role of the Department in the spring of 2009 and 2013 demonstrating and the importance of reduction in pain for substantially enhanced appropriate antibiotic children, increasing pain education throughout

Five Year Review 2009-2014 177 the hospital. Fifth, specifc initiatives, including of graduated complexity for new surgeons, we the creation of practice guidelines for patients are in the process of developing a peer-to-peer receiving foot surgery and shifts in practice to support policy including an expanded clinical using blocks, enhanced post-operative pain mentoring program that will be implemented in management. At an institutional level, the 2014. percent of patients with moderate or severe pain in the previous 24 hours has decreased from 46 Academic Leave to 25%. Perioperative Services did not have a specifc academic leave policy. After some deliberation, We participate in provincial benchmarking an academic leave policy was developed which through the Provincial Wait Time Initiative has been implemented with success in several and the Surgical Effciency Target Program. Divisions. In 2013, we expanded and harmonized SickKids was certifed in 2011 as the second across all Divisions and Departments our Away most effcient teaching hospital in Canada. Time Policies including an accountability While effciency can always be improved process that was implemented early in 2014. (particularly turnover), cost per worked hour (labour and equipment costs/worked hours) Leadership Development has increased since 2006 from $73 to $93. Leadership development is a key investment Over the same period the cost of an OR hour in staff. We fnished our second of fve, two- (labour and equipment costs/number of OR day module leadership development course for hours) has decreased from $420 to $410. Thus, Division Heads/Department Chiefs and future the fxed costs of running the operating rooms leaders in partnership with the hospital and has increased by 26% but due to the effciency Rotman School of Business. This course had efforts, the cost of conducting the average multidisciplinary participation and was linked to operation has dropped by 4%. a specifc SickKids project. The evaluations have been phenomenal and we are in early stages of SickKids out-of-window rates, Wait 2 planning for a third course. defned as time waited between decision to treat date to surgery date, peaked at 46% but has To develop further enhanced innovation, steadily dropped and is now 13.7% as of April the fourth Perioperative Services (POS) Retreat 2015. When we began our efforts to reduce our facilitated by David Weiss focused on innovative wait list we had approximately 3,000 children thinking. To support innovation we developed the waiting for surgery at SickKids -- this list is now POS Innovation Fund. We choose to fund many at 2,170 as of April 2015. projects of low-cost with a maximal funding amount of $10,000. The fund has received 114 Dr. Walid Farhat developed a clinical applications (including summer studentship mentorship policy whereby new surgeons for applications) and funded 61 projects for virtually the frst six months are required to discuss all all disciplines and Division/Departments in a elective surgical cases with a senior staff member. wide array of innovative topics as of April 30, In addition, new surgeons are encouraged to 2015. have a senior colleague scrub on diffcult cases While Cardiac Surgery has an explicit model

178 Five Year Review 2009-2014 2. recruitment Kellie Leitch joined the Division of Orthopaedic Surgery in July 2009 on an interim Greg Borschel was recruited from locum assignment. Washington University, St. Louis to the Division of Plastic and Reconstructive Surgery. His Simon Kelley joined the Division of clinical feld of expertise is peripheral nerve, Orthopaedic Surgery in July 2010. His medical upper extremity and microsurgery. He is cross- training was in the United Kingdom. He was the appointed as surgeon-scientist with a research inaugural Trans Canada Pediatric Orthopaedic focus devoted to improved understanding and Fellow, pending six months in Montreal, Toronto outcomes in peripheral nerve injury using and Vancouver. His area of expertise is in limb growth factor delivery systems for motor nerve deformity. injury and the use of type I collagen conduits for the repair of peripheral nerve gaps. Osami Honjo was recruited as a staff cardiovascular surgeon in July 2010. His clinical Joel Fish joined the Division of Plastic and practice focuses on open heart surgery in neonates Reconstructive Surgery as the Medical Director and infants, surgical palliation for single ventricle of the Burn Program. He is a graduate of the patients, mechanical cardiopulmonary support University of Toronto surgeon-scientist program in pediatric population, and surgery for patients in Plastic Surgery and was on staff at the Ross with adult congenital heart diseases. Dr. Honjo’s Tilley Burn Unit for many years. He has a strong research focuses on seeking clinical predictors/ research interest in the application of infra-red factors that infuences outcome, which improve spectroscopy in determination of burn wound the quality of surgeons’ decision making. depth. Martin Koyle, Division of Urology was Tessa Gordon who has an international recruited in 2010-11. He was the former Division reputation as a basic scientist in the feld of of Urology Head at Seattle Children’s. peripheral nerve injury and repair, joined Division of Plastic and Reconstructive Surgery. Ed Hickey joined the Division of Tessa’s work has attracted international attention Cardiovascular Surgery starting in July 2012. for her studies of neurophysiology, nerve He served as the Kirklin/Ashburn Fellow in the regeneration, electrical stimulation and novel Congenital Heart Surgeons Society Data Center surgical paradigms. during his residency and completed a clinical fellowship at The Hospital for Sick Children. Lucas Murnaghan joined the Division of Orthopaedic Surgery in August 2009 to develop Agostino Pierro was recruited as Division the sports medicine program in children and Head of General and Thoracic Surgery, Senior young adolescent in Toronto. He was a joint Associate Scientist at the Research Institute and recruit between The Hospital for Sick Children, Program Director for Pediatric Surgery in April Women’s College Hospital and Mount Sinai 2013. He also holds the Robert M. Filler Chair Hospital. in Paediatric Surgery and Professor of Surgery, University of Toronto. His expertise and

Five Year Review 2009-2014 179 interests are related to necrotizing enterocolitis, 2. Michael D. Taylor, Division of regenerative medicine, and minimally invasive Neurosurgery, was promoted to surgery. Associate Professor. 3. Reinhard Zeller, Division of Orthopaedic Karen Wong, Division of Plastic and Surgery, was appointed as a member of Reconstructive Surgery, was recruited in 2013- the American Orthopaedic Association. 14. She is completing her PhD through McMaster University focusing on the development of a 2010-11 patient-reported outcome measure to assess the 1. Abhaya Kulkarni, Division of impact of cleft surgery on children, teens and Neurosurgery, was selected as the new young adults. Residency Program Director. 2. Georges Azzie, Division of General and Thoracic Surgery, was promoted to 3. Departures Associate Professor. 3. James Drake, Head of Neurosurgery Peter Kim of the Division of General and and Senior Associate Scientist, Thoracic Surgery departed in 2010-11 to become Neurosciences & Mental Health, has Vice-President of the Sheikh Zayed Institute for been appointed as interim lead of the Pediatric Surgical Innovation at the Children’s Centre for Image-Guided Innovation National Medical Center in Washington. and Therapeutic Intervention (CIGITI). 4. James Rutka, Division of Neurosurgery, Osman Al-Radi, Division of Cardiovascular was appointed Chair of the Department Surgery, returned to his home country Saudi of Surgery for a fve-year term Arabia in 2010-11. commencing April 1, 2011. 5. Joao L. Pippi Salle was appointed Herbie Benjamin Alman stepped down as Head, Doctor of the Year. Division of Orthopaedics effective June 1, 6. Kellie Leitch, Division of Orthopaedic 2013 to begin his position as Chairman of the Surgery, was elected MP for Simcoe- Department of Orthopaedic Surgery at Duke Grey and appointed as the Parliamentary University School of Medicine, North Carolina. Secretary to the Minister of Human Resources and Skills Development and Pippi Salle’s departed in April 2014 to to the Minister of Labour. pioneer a formal paediatric urology clinical and 7. Osami Honjo, Division of training program at Sidra Hospital in Qatar. Cardiovascular Surgery, was appointed 4. appOintments anD prOmOtiOns Associate Scientist in the Physiology and Experimental Medicine Program by There are multiple Appointments and Promotions, the SickKids’ Research Institute. some of which are summarized below. 8. Unni Narayanan, of the Division of Orthopaedic Surgery, was promoted 2009-10 to Associate Professor. Christopher 1. David Fisher, of the Division of Plastic Caldarone, Division of Cardiovascular and Reconstructive Surgery was Surgery, was promoted to Senior promoted to Associate Professor

180 Five Year Review 2009-2014 Associate Scientist by The SickKids’ Surgery at the University of Cape Town, Research Institute. South Africa. 2011-12 5. James Rutka was appointed Fellow of 1. Annie Fecteau was appointed Interim the American Surgical Association. Head of the Division of General and 6. James Wright was appointed the Vice Thoracic Surgery. President, Medical, at the Hospital for 2. Christopher Forrest was appointed Sick Children. Interim Chair of the Division of Plastic 7. Michael Taylor was promoted to Surgery at the University of Toronto. Professor, Department of Surgery, 3. Christopher Forrest, Division of Plastic University of Toronto. Surgery, was appointed Interim Chair of the Division of Plastic Surgery, 2013-14 University of Toronto. 1. Armando Lorenzo was promoted as 4. Greg Borschel was promoted to Associate Professor at the University Associate Professor in the Department of Toronto and as Director of of Surgery, University of Toronto. Nephrourology at SickKids in 2013-14 5. Michael Taylor was appointed to Senior 2. Peter Dirks was appointed as Chair Scientist, The Hospital for Sick Children Holder, The Hospital for Sick Children, Research Institute. the Garron Family Chair in Childhood 6. Michael Taylor, Division of Cancer Research Neurosurgery, was appointed to Senior Scientist at The Hospital for Sick 3. Walid Farhat, Division of Urology, was Children’s Research Institute. promoted as Director of the Fellowship 7. Ted Gerstle was named Chair of the Training Program at SickKids, and Canadian Association of Pediatric Professor of Surgery, University of Surgery Program Training Directors. Toronto

2012-13 1. Abhaya Kulkarni was also appointed 5. Honours and Awards to the Editorial Board of Journal of There are too many honours and awards Neurosurgery: Pediatrics. to mention, some of which are summarized 2. Agostino Pierro was re-appointed as below. Benjamin Alman and James Wright won Chairman of the European Pediatric the highest research awards of the American Surgery Association (EUPSA) Network Academy of Orthopaedic Surgery, Canadian dedicated to the establishment and co- Orthopaedic Association and Pediatric ordination of multicentre research in Orthopaedic Society of North America (Unni 2012-13. Narayanan also recently won this last award). 3. Andrew Howard was appointed interim Christopher Caldarone, James Drake, James Division Head of Orthopaedic Surgery Rutka and James Wright (recently stepped at the Hospital for Sick Children. aside) are editors or editorial Board members 4. Georges Azzie was appointed an of their respective leading specialty journals. honorary Professor in the Department of James Rutka was President of the American

Five Year Review 2009-2014 181 Association of Neurologic Surgery. James Rutka 2. Armando Lorenzo was granted is Chair of the University of Toronto Department outstanding reviewer for the Journal of of Surgery, Benjamin Alman (until recently), Urology. Christopher Caldarone, and Christopher 3. James Rutka was inducted as a Fellow of Forrest are Chairs of their respective University the Royal Society of Canada. Divisions. Benjamin Alman and James Wright 4. James Wright was awarded the inaugural have served on the Board and as Chairs of the Sickkids’ President’s Award “for his Research Council of the Pediatric Orthopaedic outstanding leadership, commitment Society of North America. James Rutka was the to high quality and performance, and honored guest of the Congress of Neurosurgery dedication to improving access to and Peter Dirks won the Terry Fox Award and surgical services for children across the the Farber Award of the American Association country.” of Neurosurgery. Darius Bagli has won both the 5. James Wright was awarded the John American Urological Association Foundation’s Sharrard Memorial Medal, from the Distinguished Mentor Award and its Pediatric British Society Children’s Orthopaedic and Basic Science Research Prizes. Armando Surgery, to recognize academic Lorenzo won the SickKids Humanitarian Award. contributions to children’s orthopaedics. Jacob Langer won the James IV Traveling 6. Kellie Leitch was awarded the Order of Fellowship (and was the frst pediatric surgeon Ontario for providing a national voice on to ever win the award). Christopher Caldarone Children’s Health. leads the Congenital Heart Surgeons database, 7. Michael Taylor ranked #2 on the Toronto a prospective cohort collecting data from Star’s list of the biggest scientifc approximately 30 hospitals. discoveries of 2010. 8. Walid Farhat was awarded third prize 2009-10 for a clinical poster at the European 1. Armando Lorenzo won the Michael Society for Pediatric Urology on Impact A.S. Jewett Award for Excellence in of Biofeedback on Self –Esteem in Postgraduate Teaching in the Division Children with Voiding Dysfunction: A of Urology. He received an Award as the randomized controlled trial for which he best reviewer for the paediatric section was PI. of the Journal of Urology. 2. Michael D. Taylor won The Royal 2011-12 College of Physicians and Surgeons of 1. Armando Lorenzo was awarded the A.W. Canada Gold Medal Award in Surgery, Bruce Faculty Undergraduate Teaching 2010 and The Canadian Cancer Society Award, Division of Urology, University Award for Excellence in Cancer of Toronto. Research-Young Investigator Award in 2. Darius Bägli was named the Biomedical Science, June 2009. Distinguished Mentor for 2012 by the American Urological Association 2010-11 Foundation. This was the frst time the 1. Armando Lorenzo was awarded a award was made to a urologist in Canada, European Association of Urology Travel and the frst ever for a pediatric urologist. Scholarship.

182 Five Year Review 2009-2014 3. Georges Azzie was the recipient of the 5. Martin Koyle was awarded the Women’s Herbie Fund Doctor of the Year Award Auxiliary Chair of Urology and for his work in developing countries Regenerative Medicine. and the Bruce Tovee Award as the 6. Michael Taylor was the selected recipient best teacher in surgical undergraduate of a Garron Family Cancer Centre Chair. education. 7. Paul Wales won fve awards this past year 4. Greg Borschel was awarded the Early with the latest being the Best Published Researcher Award (ERA) by the Ontario Clinical Research Article in May 2013. Ministry of Economic Development and 8. Simon Kelley was awarded the Innovation. Orthopaedic Chair’s Teaching Award 5. Pippi Salle was awarded the Chair in from Division of Orthopaedic Surgery, Urology by the Women’s Auxillary at Department of Surgery, University of SickKids. Toronto. 6. Unni Narayanan received the Dr. John 9. Walid Farhat, with Dr. M. Koyle, received Whittaker Memorial Cerebral Palsy the Award for Teaching Excellence for Award. the Paediatric Resident Lecture Series, 7. Walid Farhat received the Award for University of Toronto. Teaching Excellence for the Paediatric Resident Lecture Series, University of 2013-14 Toronto. 1. Greg Borschel was awarded the George Armstrong Peters Prize for 2014. 2012-13 2. Jack Langer was named one of the top 1. Benjamin Alman was awarded the 30 doctors in Toronto by Toronto Life Award for Excellence in Innovation by magazine. the Association for Surgical Education 3. James Rutka was elected to the Order of in Los Angeles, CA. Ontario in June, 2014. 2. Darius Bägli was recognized for 4. John Wedge was awarded the Doctor outstanding contributions to innovation, of Laws (LLD)(Hon.), University of and cross-team leadership as the Saskatchewan. Associate Surgeon-In-Chief by being 5. Paul Wales won fve awards this past year named to the ‘President’s Circle’ of The with the latest being the Best Published Hospital for Sick Children. Clinical Research Article in May 2013. 3. James Rutka was the recipient of 6. Ronald Zuker received an Honorary numerous awards including the 2012 Fellowship of the College of Plastic Abhijit Guha Award, The Society of Surgeons of South Africa, an Honorary Neuro-Oncology. Membership in the Association of 4. James Wright received the Peter Plastic Surgeons of South Africa, the Armstrong, MD Shriner’s Hospital Humanitarian Award from The Smile for Children Award for his Foundation of South Africa, and the manuscript “Antimicrobial Prophylaxis 2014 Canadian Society of Plastic and Rates of Surgical Site Infection in Surgeons Lifetime Achievement award. Children”.

Five Year Review 2009-2014 183 7. Unni Narayanan was awarded the 2013 linked kinase pathway to promote cardiac stem Arthur Huene Memorial Award of cell proliferation and self-renewal. POSNA. General and Thoracic Surgery 6. DivisiOnal summaries The Centre for Image-Guided Innovation and Therapeutic Intervention (CIGITI) (www. Cardiovascular Surgery cigiti.com), developed by a team headed by Over the past fve years the division has had Peter Kim, was offcially opened in 2009-10. the second highest level of publication impact Peter Kim’s team developed new innovative points, with respect to congenital heart surgeons’ technologies focused on paediatric and fetal publications, in the world. The Heart Centre (in applications in three areas: image-guided which the division is a key participant) held surgical intervention, simulation for educational symposiums in 2009-10 and 2010-11, attended applications and miniaturized robotic surgery. by over 150 and over 200 individuals from The CIGITI is funded by approximately $20 around the world respectively. The division million in grants, from a variety of governmental co-hosted, with Division of Cardiology, the and industrial sources. International Symposium which focused on the treatment of Hypoplastic Left Heart Syndrome. Annie Fecteau served as Chair of the American Pediatric Surgical Association Ethics The Division of Cardiovascular Surgery has committee and was a senior author an article in focused on team clinical performance, for the past CMAJ on the health risk of rare earth magnets several years, in a forum labeled Performance in toys which was instrumental in getting them Rounds. The concept was driven by the idea banned in Canada. She served as Interim Head of that best patient outcomes are achieved by the division while the search for a new Division making optimal decisions and interventions at Head was being conducted each point along the care pathway. Performance Rounds is a management system that entails Georges Azzie and Ted Gerstle are involved reviewing each patients’ clinical course, from in a number of important initiatives measuring the diagnosis through hospital discharge, using a burden of surgical disease on population health proprietary individualized patient graphic. The and developing training programs and surgical weekly review is performed with team members expertise world-wide including the Schools of from cardiology, intensive care, anaesthesia, and Medicine of the Universities of Botswana and allied health professionals. Through this system Namibia. They, including Dr. Doruk Ozgediz we are able to identify specifc patient issues as (paediatric general surgery fellow) and Engineer well as structural areas for improvement even in Brian Carrillo, developed the only validated the face of good patient outcome. The long term Pediatric Laparoscopic Surgery simulator. goal is to gradually enhance team learning and team performance. The concept is also a strong Georges Azzie continues to develop an academic platform. innovative tele-mentoring program teaching minimal access surgical skills to surgeons The division holds one US patent in Botswana. He continues to be an Adjunct US923218B2 for: Modulation of the integrin-

184 Five Year Review 2009-2014 Associate Professor in the Department of Surgery multi-disciplinary clinic for esophageal atresia at the University of Pennsylvania and supervises patients that will formally evaluate and treat their senior residents on surgical electives in patients from birth to adulthood. She also led the Botswana for two months a year. effort to establish the frst international registry to track the long-term outcomes for congenital Jack Langer was part of the team that diaphragmatic hernia patients with the registry established the SickKids Obesity Management starting in 2013. She will take over as the CAPS Program (STOMP), which ultimately anticipates Program Committee Chair in 2014. Dr. Chiu performing 10-15 bariatric surgical procedures continues as a member of the CAPSNet Steering per year. He is also Chair of the Research Committee and a member of the EPIQ review on Committee of the newly formed University CDH Care. of Toronto Collaborative Bariatric Surgery Program, and sits on the provincial Bariatric Sharifa Himidan was interim Medical Surgery Steering Committee. He was the Director of CIGITI, with Peter Kim’s departure in Director and then nominated President-elect of 2010. Work has focused on establishing programs the Canadian Association of Paediatric Surgeons that bridge relationships between academic and (CAPS) for a two-year term beginning 2011-12. community centres affliated with the University He hosted the biennial Winter CAPS meeting of Toronto. She is actively involved in Surgical in Toronto in February 2013. After 12 years, Innovation and collaborating with many national Jack stepped down as Division Head. He took and international centres in the feld of Surgical a sabbatical at the University of California, San Robotics, Smart tools and simulation Francisco, and studied new techniques in fetal surgery and worked with the Pediatric Device Ted Gerstle is co-principal investigator Consortium based at UCSF. on a grant from the Canadian International Development Agency (CIDA) which provides Paul Wales continues to advance the $420,000 over three years for healthcare treatment of intestinal failure, in his role as leadership development in Tanzania and Director, through the Group for Improvement of Ethiopia. He has taken on the role of Surgical Intestinal Failure and Treatment (GIFT). He is Director at the new Children’s Hospital in involved in translational studies using a porcine Qatar as part of the partnership with SickKids’ model of short bowel syndrome in order to International He was named the Director of the develop novel medical and surgical approaches Surgical Oncology Program at Sickkids in June to this problem. . The program treated its 2013 and is the co-lead for the Department of 200th patient in 2011-12 and continues Annual Surgery in the Toronto Addis Ababa Academic Fundraising. This is the only formalized program Collaboration. for intestinal failure in Canada SickKids ‘Liver Transplant Program had a Priscilla Chiu is part of the Steering record year in 2011-12, with 30 pediatric liver Committee for the Garron Family Cancer Centre transplants. The program was highlighted as and the Leukemia Research Group - a city-wide having the lowest hepatic artery thrombosis rate effort to bring local leukemia researchers together of all the 27 centres participating in the Study in for collaborations and idea exchange. She was Pediatric Liver Transplant (SPLIT). part of an effort to establish the frst city-wide

Five Year Review 2009-2014 185 Neurosurgery Canadian Academy of Health Sciences (CAHS) In 2011-12, James Drake was appointed and continues to take on new responsibilities Director, Image Guided Innovation and including Scientifc Program Chair - Pediatric Therapeutic Intervention (CIGITI) and is a Neuro-Oncology Basic and Transitional mentor to members of The Canadian Pediatric Research Conference, President of the World Neurosurgery Study Group. He was re-appointed Academy of Neurological Surgery, and Editor- as Division Head for a third fve-year term in in-Chief, Journal of Neurosurgery. 2012-13 after a review. He continues to supervise a large cadre of undergraduate engineers from Michael Taylor was the selected the University of Waterloo, and Toronto, and recipient of a Garron Family Cancer Centre Chair graduate students in the IBBME and Mechanical and is on the Executive Council, Garron Family Engineering Department Cancer Centre. He is an Associate Section Editor (Pediatrics) for Brain Tumor Pathology. Michael James Drake and Abhaya Kulkarni supervised Steve Mack, winner of the prestigious continue their involvement with research and Governor General’s Gold Medal Award, created quality improvement initiatives lead by the in 1873 by Lord Dufferin to encourage academic Hydrocephalus Clinical Research Network and excellence across the nation. Steve Mack continuously review the care and treatment of completed his doctoral dissertation entitled “The hundreds of children affected by hydrocephalus. Genetic and Epigenetic Basis of Posterior Fossa Ependymoma” in April 2014. Abhaya Kulkarni was selected as the Residency Program Director after a rigorous Bruce Hendrick Visiting Professor in Pediatric search in 2010-11 and continues to attract the top Neurosurgery pool of candidates to the University of Toronto 2011-12: Dr. Richard Ellenbogen, Professor program. He was elected to membership in the and Theodore S. Roberts, Endowed Chair Society for Neurological Surgeons in 2011-12 of Pediatric Neurological Surgery at the and was invited to be a Steering Committee University of Washington, delivered two member for the United Kingdom Medical excellent talks, “Neurosurgery in Diffcult Research Council in 2012-13, Locations: The Case for Pineal Region” and “Concussion: Education & Advocacy”. James Rutka became President of 2012-13: Dr. P. David Adelson, Director, the American Association of Neurological Barrow Neurological Institute, delivered Surgeons (AANS) and Honoured Guest at the a highly engaging lecture entitled “Adding Congress of Neurosurgery in 2009-10. One insult to injury: Improving Outcomes of the highlights in 2010-11 was the AANS through Aggressive Management”, followed meeting in Denver where Toronto shone under by a presentation on “Epilepsy surgery his presidency. He became Past President of in children” for residents. He also served as the AANS; Member of the Finance Committee; an evaluator for resident case presentations Strategic Planning Committee; the Van Wagenen given later that morning. Fellowship Committee and Neurosurgery PAC; 2013-14: Dr. John Kestle, University of Chair of the Nominating Committee in 2013- British Columbia, was the Guest Lecturer. 14. Dr. Rutka was elected to Fellowship in the

186 Five Year Review 2009-2014 In December 2013, Dr. Drake, with Deformity Journal, Scoliosis Research Society. co-chairs Drs. Rutka and Kulkarni hosted the American Association of Neurological Surgeons The Division of Orthopaedic Surgery – Pediatric Section which in addition to the continues to build the Bone Health Centre. main scientifc program (Drake), included a This centre focuses on the care of children pediatric epilepsy course (Rutka and Drake), with musculoskeletal conditions requiring an Advanced Practitioners course (Kulkarni), multidisciplinary care, and in the development breakfast seminars (Kulkarni and Mazzola), of collaborative research. The centre is on the a social program (Drake), followed by a verge of beginning its frst clinical trial, using a fellowship reunion celebrating 80 years of cell therapy approach to disorders. pediatric neurosurgery at Sickkids (Drake). Meeting evaluations were extremely high and broke previous attendance records. Robert B. Salter Visiting Professor Orthopaedic Surgery Peter Newton, Orthopaedic Surgeon, Rady Children’s Specialists of San Diego Benjamin Alman was named the and President of POSNA Interim Director of the Toronto Musculoskeletal 2012-13: Daniel Sucato, Orthopaedic Centre of the University of Toronto in 2010-11. Surgeon, Chief of Staff, Texas Scottish Rite This is an extra departmental unit focusing on Hospital for Children. interdisciplinary translation research. The centre 2013-14: The division hosted a father and son will be developing a collaborative graduate duo. Dr. Perry Schoenecker, orthopaedic program, a new mechanism for research funding surgeon, Chief of Staff at Shriners Hospital, and will help recruit new MSK researchers to St. Louis and Acting Chairman of the Toronto. He was elected to a Fellowship in the Department of Orthopaedics at the St. Canadian Academy of Health Sciences in 2011- Louis Children’s Hospital and Dr. Jonathan 12. Schoenecker, orthopaedic surgeon, Monroe Carell Jr. Children’s Hospital Andrew Howard successfully ran at Vanderbilt and Assistant Professor, the 12th Bethune Round Table Conference in Department of Orthopaedics, Pathology, Toronto in 2011-12. He became a member of Pediatrics and Pharmacology, Vanderbilt the Institute of Medical Science in 2013-14 and University, Nashville, TN. was appointed Interim Head of the Division of Orthopaedics at the Hospital for Sick Children Mercer Rang Visiting Professor from June 2013 to September 2014. 2011-12: Michael Sussman, staff orthopaedic physician, Shriners Hospital Lucas Murnaghan took part in the for Children Research, Portland, OR. POSNA/BIOMET Travelling Fellowship in 2012-13: Martin Gargan, Orthopaedic 2013-14. Surgeon, University Hospitals, Bristol, UK 2013-14: Professor Christopher Lavy, Reinhard Zeller sits as an Associate orthopaedic surgeon, Oxford, UK. Editor on the Editorial Board of the Spine

Five Year Review 2009-2014 187 The division boasts four faculty members who of the International Confederation of Plastic, hold CIHR-funding as primary investigators, Reconstructive and Aesthetic Surgery that was making them the highest proportion of CIHR- held in Vancouver May 2011. This was a highly funded orthopaedic surgeons in any one division successful meeting with over 1700 registrants in the country. from all around the world with signifcant participation from all division members. Plastic and Reconstructive Surgery

Greg Borschel was chosen as the new Annual Lindsay Thomson Symposium in Deputy Editor for the Journal of Plastic Pediatric Plastic Surgery Reconstructive and Aesthetic Surgery in 2011- 2011-12: Professor Yu-Ray Chen visiting from 12. Taipei, Taiwan was the Vale Visiting Lecturer. 2012-13: Dr. John B. Mulliken, Professor of Howard Clarke, with the help from Emily Surgery, Harvard Medical School was the Ho, hosted the Toronto Obstetrical Brachial Vale Lecturer. Plexus Palsy Workshop on May 10, 2014 with 2013-14: Mr. Jonathan Britto, Consultant and neurosurgery, orthopedic surgery, plastic surgery, Pediatric Craniofacial Surgeon at Great OT and PT participation. Ormond Street Hospital in London, UK was the Vale Lecturer.

Joel Fish and the entire Pediatric Burn Post-graduate fellowship education in Program team at SickKids were the frst pediatric plastic surgery continues to be a high pediatric burn program in Canada to receive full point in the division profle with 99 applicants accreditation by the American Burn Association for the fve-fellow positions in 2010-11. in 2013-14. The division organized two educational Christopher Forrest underwent a 10- exchanges via the Sickkids-Operation Smile year review of his leadership of the division program and had visits from two trainees from in November 2012 and was successfully re- West Bengal and three trainees from Assam in appointed for a third fve-year term. India via SickKids-India Educational Exchange Program in 2010-11. In a continuing relationship John Phillips embarked on a unique with Operation Smile and the facility in Guwahati, sabbatical opportunity that he entitled “Teach Asaam, India, Ron Zuker, Greg Borschel and the teacher”. His goal was to visit as many two clinical fellows travelled in January 2014 former fellows as possible and charge them for another site visit. Surgeons, anaesthetists, with the mission to teach him something that speech and language pathologists and dieticians they have subsequently modifed or learned from the Guwaharti Comprehensive Care Centre after completing their fellowship in pediatric have visited SickKids to see frst-hand how cleft craniofacial surgery. John travelled to California, care is delivered here. This model of an ongoing Texas, Colorado, Taiwan, Singapore and made collaboration is working exceptionally well, multiple stops in Australia in 2013-14. many thanks to the personnel involved on both sides. Ron Zuker was the Chair of the Organizing Committee for the 16th Congress

188 Five Year Review 2009-2014 The division hosted four CME events in 13, he spearheaded a successful initiative using 2010 including the Advanced Craniomaxillofacial iPads for wireless point-of-care billing, to Surgery Symposium, Pediatric Upper Extremity achieve record billing compliance of over Symposium, the Lindsay-Thomson Pediatric 99%. Following his introduction of the Surgical Plastic Surgery Symposium and the Composite Safety Checklist to SickKids Hospital, Dr. Tissue Allotransplantation Symposium in 2010- Bägli continues major efforts in health technology 11. development to reengineer the surgical pathway The Annual University of Toronto for patients and families at SickKids. Along Transplant Day was held on December 17, with Drs. Lorenzo, Salle and Koyle, he was 2012 with division members Ron Zuker and signifcantly involved in the First International Greg Borschel organizing a half-day symposium Consensus Symposium in Hypospadias held in on Composite Vascularized Allotransplantation Las Vegas in September, 2013. He was appointed (CVA), the highlight being a lecture by Visiting for a three-year term to the American Urological Guest Speaker, Dr. Bohdan Pomahac, from Association’s Research Council and represented Boston. This day coincided with the Ministry SickKids at the First Innovation Leadership of Health’s successful approval of a Pediatric Forum held in La Jolla. Vascularized Composite Allotransplantation Program that has been generated through the Walid Farhat became the associate huge efforts of Ron Zuker and Greg Borschel. editor of the paediatric section of the Journal of Urology in 2009-10. He continues to organize The frst Hugh G. Thomson Award was and direct the Annual North American Pediatric received by Dr. Karen Cross at the 2013 Gala Urology Fellows Laparoscopy Course. He co- Graduation dinner. This award was established chaired the Canadian Urology Association and funded by the SickKids’ division members Laparoscopy course for the 4th year in 2011- and acknowledges Dr. Thomson’s values of 12 and was instrumental in developing a collegiality, collaboration and simply being a multidisciplinary clinic with the Nephrology good human being. Division for children with stone disease. He and Dr. Koyle were extensively involved in the 2014 The frst Pediatric Wound Care Annual Paediatrics Update discussing “Nuts & Symposium was held on November 1, 2013 with Bolts of paediatric urology: a rational primary course directors Joel Fish and Irene Lara-Corrales care approach to common problems”. (Pediatrics). Over 130 health care providers from surgery, pediatrics, dermatology, nursing and Martin Koyle succeeded Pippe Salle as wound care specialists attended this event. Over Division Head on April 1, 2013. He led a volunteer half of the attendees were community based with educational and surgical mission to Kampala, representation from London, Hamilton, Ottawa, Uganda in cooperation with International Montreal and the GTA hospitals. Volunteers in Urology and members of the Urology Pediatric Surgery and Anesthesia Divisions at Vancouver Children’s Hospital. Along with Darius Bagli continues as Associate Chief Dr. Salle, he was co-organizer of the meeting of Surgery at Sick Kids and staff coordinator of on transitional care entitled “Moving Beyond Urology Resident Research within the University Pediatric Incontinence” in June 2013. of Toronto Urology residency program. In 2012-

Five Year Review 2009-2014 189 Armando Lorenzo organized and Divisions of Surgery Reviews chaired the Society for Fetal Urology meeting in Atlanta, GA in 2011-12. He has been extremely Without exception, each division has active internationally in the Children’s Oncology been favorably reviewed in the past fve years Group and Society for Fetal Urology. He also acts and in many cases ranked among the best in the as the division representative in the selection of world. I quote below from written comments by residents for the University of Toronto, Division the external reviewers. of Urology and leads the medical student Urology elective program at SickKids. Dr. Lorenzo Cardiovascular: The cardiothoracic continues to develop collegial relationships with surgeon Dr. William Gaynor from the Children’s colleagues at Mt. Sinai in the feld of andrology. Hospital of Philadelphia (CHOP) was one of In 2013-14, he completed a handbook for the three reviewers for the Cardiology/Cardiac medical students rotating at SickKids Surgery review. Cardiologist, Dr. Robert Shaddy from CHOP and Dr. Jane Newburger from Joao Pippi-Salle successfully chaired Boston Children’s Hospital, cardiologist stated, the 3rd World Congress of the Society of “We must state at the onset that the Heart Centre Hypospadias and Disorders of Sex Development at the Hospital for Sick Children is one of the in 2009-10 when he was elected President of this premier programs, not only in North America but Medical Association. In addition, he fnalized the in the world, and that the current leadership has video component of the Reconstructive Pediatric brought this program to ever-greater heights”. Urological Video-Atlas. He was instrumental in organizing a major world-wide congress on The Labatt Family Heart Centre exstrophy that was held in Morocco in May 2013. (of which the division is a key participant) Both he and Warren Snodrass were involved underwent a 10 year external review led by three in a live surgery webinar on hypospadias in well known individuals from Children’s Hospital February 2013 and were both invited to direct a Philadelphia and The Children’s Hospital, postgraduate course on that subject at the Annual Boston. The following is a quote that opens their American Urological Association meeting in summary: “The reviewers unanimously found May 2013. the Heart Centre at the Hospital for Sick Children to be a premier pediatric cardiovascular centre, Dr. Michael Mitchell was the inaugural with superb performance in domains of clinical Robert Jeffs Visiting Professor in Paediatric care, clinical research, academic scholarship Urology at SickKids and the University of extramural funding, and education.” Toronto in 2013-14. General and Thoracic Surgery: Dr. The division attracted its top fellowship Keith E. Georgeson from the University of choices for both the American Board of Urology Alabama School of Medicine stated, “the accredited and the international 2-year spots, clinical activities of the Division of General hosted numerous observers and represented and Thoracic Surgery at the Hospital for Sick SickKids in multiple venues from around the Children in Toronto seem strong”. world. Neurosurgery: Dr. John Kestle from University of Utah stated, “the HSC pediatric

190 Five Year Review 2009-2014 Neurosurgery Division is outstanding. In the Surgery, Armando Lorenzo and Walid Farhat neurosurgical community it is universally from the Division of Urology and Georges Azzie recognized as one of the best in the world”. from the Division of General and Thoracic Surgery who won the Bruce Tovee Award for Orthopaedics: Dr. Matthew Dobbs from Undergraduate Teaching. St. Louis Missouri stated, “the Department is extremely well accomplished and viewed in the Continuing Medical Education has been highest regards around the world. The history an area of innovation in the Centre for Image- of the Department speaks for itself as many of Guided Innovation and Therapeutic Intervention the great leaders in pediatric orthopaedics were (CIGITI) and the Divisions of Urology and here, are here, or have been trained here.” Plastic and Reconstructive Surgery. These divisions have been using real-time surgical Plastic Surgery: Dr. Richard Hopper education through web-technology whereby from Seattle Children’s Hospital, University live surgery is either linked to our auditorium or of Washington stated, “the Hospital for Sick webcast. Dr. Walid Farhat developed a Paediatric Children’s Division of Plastic Surgery has an Urology Laparoscopy course. Dr. Darius Bagli unparalleled international reputation”. developed a Microsurgical Skill course now in its 5th year. The Department of Surgery is Urology: Dr. Andrew MacNeily from involved in education on an international level Vancouver, British Columbia described the with several outreach activities. Drs. Georges Division of Pediatric Urology as “internationally Azzie (Division of General and Thoracic renowned, and deservedly so. It ranks alongside Surgery) developed a low fdelity tele-simulation other famous Divisions such as those at Boston approach to developing laparoscopic skills in Children’s Hospital, Children’s Hospital of Africa. The No Boundaries Group, an annual Philadelphia and Great Osmond Street Hospital medical mission, has an educational component for Sick Children”. intended to build local capacity and has recently developed a specifc partnership with a medical 7. s ummary Of eDucatiOnal school in Ethiopia. Drs. Christopher Caldarone activity and Glen Van Arsdell developed partnerships in China to teach and improve local capacity in We completed our Royal College Review cardiac surgery. in 2013. All programs were approved and while receiving many compliments, not a single Other examples of exemplary education concern specifc to SickKids was identifed. The initiatives include Dr. Annie Fecteau (Division development of the Learning Institute (LI) and of General and Thoracic Surgery) developed a a Simulation Centre at SickKids, due to efforts curriculum for teaching of ethics to pediatric of Walid Farhat (Division of Urology), Associate surgical trainees that has been adopted by Chief of Education, has substantially improved the North American Association of Pediatric the effectiveness and effciency of teaching. Surgical Program Directors. Dr. Benjamin Alman, previously the University Division Chair Several of the staff have received teaching of Orthopaedics, began in July 2009 the frst awards including Drs. Unni Narayanan and competency-based surgical training program in James Wright from the Division of Orthopaedic the world.

Five Year Review 2009-2014 191 SickKids has always had global outreach Of 41 surgeons in Department of as mentioned above. Other examples are the Surgery, 30 have research grants, and 18 have partnership with Qatar has provided international CIHR grants. The total annual grant funding for experience for many of our faculty, including Perioperative Services is approximately $17.2 Dr. Ted Gerstle named Surgical Director at the million in 2012-13. The funding rate at CIHR new Children’s Hospital in Qatar. The Operation in 2012-13 for members of the Department of Smile Program and the India Educational Surgery was 23% (with CIHR national Funding Exchange Program organized by Dr. Ron Zuker. rate of 17%) with fve new CIHR grants. The creation of the Centre of Global Health under the leadership of Dr. Stan Zlotkin will Members of the Department published further enhance our international activities. 924 papers in the past fve years. Many of the publications are in high impact journals. For 8. s ummary Of research example, Drs. Benjamin Alman, Peter Dirks, activity Sevan Hopyan and Michael Taylor have The research accomplishments, involved published in Nature, Genetics, Dr. Agostino programs, area of collaborations, and type Pierro in the Lancet, Dr. Jacob Langer in the of research programs are too innumerable New England Journal of Medicine and Lancet, to mention. Briefy, Benjamin Alman was a Dr. Andrew Howard in the Lancet and Dr. James Canadian Research Chair (the only Orthopaedic Wright in the New England Journal of Medicine, Surgeon in Canada). James Drake, Martin British Medical Journal and the Lancet. Koyle, Agostino Pierro, James Rutka, Michael Taylor, Glen Van Arsdell, Agnes Wong and Of the 924 articles published from 2009-14, James Wright all have endowed Chairs. James Plastic Surgery published 9.43%, Urology Rutka was appointed to the Order of Ontario and published 10.42%, Cardiovascular Surgery John Wedge to the Order of Canada. published 12.17%, General Surgery published 17.54%, Orthopaedics published 20.5%, and Neurosurgery published 31.25% as indicated below.

Percentage of Articles Published January 1, 2010 to December 31, 2014 by Division

192 Five Year Review 2009-2014 The total journal impact factor attained year peaked at 44.71 in Plastic Surgery, 72.35 in between July 1, 2009 to June 30, 2014 is,163.70 Urology, 115.29 in General Surgery, 150.85 in in Plastic Surgery, 240.41 in Urology, 390.56 Cardiovascular Surgery, 168.35 in Orthopaedics in General Surgery, 453.58 in Cardiovascular and 591.88 in Neurosurgery as demonstrated Surgery, 709.35 in Orthopaedics and 2148.09 below. in Neurosurgery. The journal impact factor per

The current activities and expertise with stem the CIGITI and has many successes including cells research within Developmental Biology Otosim (a computer-based simulation model of the RI has been enhanced by the recruitment to teach otoscopy skills) and craniofacial skull of Drs. Gregory Borschel and Agostino Pierro. templates. Robotics, led by Dr. James Drake The Department of Surgery also has tremendous with support from the Ontario Research Fund strength in tumor biology particularly in the and the Canadian Foundation for Innovation, has Division of Neurosurgery and Orthopaedics. been a major focus. Dr. Drake, who took over for Dr. Peter Kim, has assembled a multidisciplinary The Centre of Image Guided Innovation group of industry and researchers who in and Therapeutic Intervention (CIGITI) is an addition to many other areas of innovation has amazing accomplishment having raised more focused on robotics designed for children while than $20 million due to the efforts of Dr. Peter integrating image guidance incorporating newer Kim and the Division of General and Thoracic “disruptive” technologies. Surgery. CIGITI brings together surgeons and We are changing education through bioengineers to develop innovative treatments simulation and competency-based curriculum, including imaging, particularly the integration surgery through robotics with image guidance, with real-time imaging, and surgical robotics, and research with regenerative medicine and an MR compatible pediatric surgical robot. The stem cells medicine. group is the “research and development” base for

Five Year Review 2009-2014 193 Department of Surgery Toronto East General Hospital University of Toronto

FIVE YEAR REVIEW 2009-2014

Carmine Simone, MD Surgeon-in-Chief Toronto East General Hospital University of Toronto

194 Five Year Review 2009-2014 Divisional Activity Urology, Rajiv Singal implemented his vision of a robotic surgical program with shared Our vision is simple: We want the Toronto capital and operative funding by establishing a East General Hospital (TEGH) to be the best partnership between TEGH and Sunnybrook’s place for our patients, friends, and family Odette Cancer Centre. The Da Vinci Robot members to receive high-quality surgical care. was installed, and training is now underway If we cannot provide the best care, we will seek for the urologists and allied professionals in out partnerships that will ensure our patients get laparoscopic surgeries (2012-13). Under the the care they need and deserve. We want TEGH leadership of Paul Bernick as Chair of all to be the best place for a community surgeon to TEGH Multidisciplinary Cancer Conferences, work in Toronto. the partnership continues to provide treatment of various surgical conditions with low wait times, The TEGH Department of Surgery is a very as well as the development of a regular tumor popular destination for learners of all levels. board (2012-13). Robert Zeldin continues to The Department accepts medical students, oversee the thoracic surgery program’s service at surgical residents, family medicine residents, multiple sites: the Odette Cancer Center, North internal medicine residents, and surgical fellows York General Hospital, and the Royal Victoria from within Canada and internationally. The Hospital in Barrie (2013-14). Department teaching effectiveness score (TES) for clinical fellows for 2012 was 19.24, the 2nd In 2011, Laura Tate organized the second highest in all teaching hospitals in Toronto. A annual Rotman Advanced Health Leadership total of 21 of the 24 active staff in our department program. She has also launched a University have university appointments and 20 of the 24 of Toronto Book Club with Karen Devon at active staff include teaching residents as part of their daily routine. Women’s College Hospital.

Patient safety stands at the forefront General Surgery TEGH’s focus. In 2009-10, the Surgical Safety The Fractured Hip Initiative and Checklist, in collaboration with Anesthesia and Bariatric Initiative were fully integrated into Nursing, was fully implemented. Antibiotic the Hospital in 2009-10, thanks to the leadership Stewardship has also proved to be a very useful and implementation from Mary-Anne Aarts strategy in our Critical Care and Surgical In- and Jamie Cyriac. patient Care, combining best practice and cost savings. Provincial funding of emergency Hany Sawires leads the Time to Treat department wait-times has affected in-patient Initiative for Breast and continues to strengthen bed management strategies (2010-11). The ties with the University’s model of breast cancer theme of “TEGH – Your Choice for Safe diagnostics (2010-11). Surgery” shaped the 2012-13 agenda and led to the development of a comprehensive website

with individual surgeons’ interests, contact Robert Zeldin has developed a core information, links of for post-operative care, and PGY3 general surgery rotation for University of a virtual journey for patients to better understand Toronto learners as a pilot project in 2012-2013. the quality initiatives they will encounter from It has been extremely popular and has now been initial referral to recovery. extended to the core thoracic anesthesia rotation for PGY5 anesthesia residents. Cross-site partnerships are also vital to the delivery of high-quality community care. After TEGH’s relationship with the Royal 11 years of serving as Head of the Division of

Five Year Review 2009-2014 195 Victoria Hospital respirologists and oncologists in the Division of Urology (2009-10). in Barrie continues to be effective. A partnership between TEGH’s Thoracic group and the Najib Safeddine was recruited as staff RVH to deliver thoracic surgery services in thoracic surgeon in the Division of General North Simcoe Muskoka LHIN and establish a Surgery (2009-10). Diagnostic Assessment Unit at RVH led to the achievement of the 2010 Cancer Care Ontario Appointments Quality Award. Rob Zeldin was promoted to Assistant Professor in the Division of General Surgery Orthopedic Surgery (2009-10). Bill Kraemer successfully developed and implemented a Competency-Based Curriculum Atul Kesarwani, Ryan Groll, and Hany in the Division of Orthopedics (2009-10). Sawires were promoted to the rank of His landmark work led to his 2010 Award for Lecturer (2009-10). Excellence in Postgraduate Medical Education in the Design & Innovation category. John Kell was appointed as Head of the Division of Urology (2012-13). Plastic and Reconstructive Surgery Carmine Simone assumed the role For the frst time since 1984, TEGH has had of Surgeon-in-Chief after Laura Tate regular rotation of PGY3 residents in Plastics & successfully completed her mandate (2012- Reconstructive Surgery. This marks a signifcant 13). investment in the teaching efforts of the Hospital (2010-11). Rajiv Singal was promoted to Assistant Professor in the Department of Surgery Linda Dvali has developed a hand surgery (2013-14). and peripheral nerve program within the Division of Plastic and Reconstructive Surgery, a unique feature to a community hospital (2013-14).

Urology With Rajiv Singal serving as the Clinical Lead for the Robotic Surgery Program, the hospital continues to serve as a template for inter-hospital collaboration for robotic prostrate surgery. Sender Herschorn and Laurence Klotz, both senior staff urologists from Sunnybrook, are now cross-appointed at TEGF in order to perform robotic prostatectomies using the new Da Vinci robot.

Recruitment Linda Dvali joined the Division of Plastic and Reconstructive Surgery as Division Head (2009-10). Ryan Groll was recruited as staff surgeon

196 Five Year Review 2009-2014 Department of Surgery University Health Networks University of Toronto

FIVE YEAR REVIEW 2009-2014

Shaf Keshavjee, MD Surgeon-in-Chief University Health Networks University of Toronto James Wallace McCutcheon Chair in Surgery Director, Toronto Lung Transplant Lung Program Director, Latner Thoracic Research Laboratories Vice Chair, Innovation, Department of Surgery Professor, Division of Thoracic Surgery & Institute of Biomaterials and Biomedical Engineering, University of Toronto

Five Year Review 2009-2014 197 A. Introduction Research Activities: Surgeons at UHN The Surgery and Critical Care Program have been accomplished researchers (Please see at University Health Network encompasses 127 attached Department of Surgery 5 year Trend surgeons and 8 surgical specialties (including Publication Report) divisions of Cardiac Surgery, General Surgery, Neurosurgery, Orthopedic Surgery, Plastic C. Achievements Surgery, Thoracic Surgery, Urology and a. Endowed Chairs – there are currently 36 Vascular Surgery) as well as the other surgical endowed chairs held by surgeons at UHN. related departments of Otolaryngology/Head This philanthropic support is an important & Neck Surgery, Ophthalmology Gynecologic enabler for the department driving innovation, Oncology, Anesthesia and Critical Care and the recruitment and retention of talented surgeons. sections of Surgical Oncology and Transplant Surgery. b. Development of new operating room suites – the Multi-Purpose continues to be a very The programs are committed to the UHN successful leading edge endeavor. The Da vision statement (achieving global impact), the Vinci Robotic OR is also or fully utilized mission statement (exemplary patient centered now (by Urology and Gyne-Oncology and care, education and research), and to the more recently by Thoracic Surgery and purpose statement “we are a caring, creative General Surgery). Canada’s frst robotic and accountable academic hospital transforming lung lobectomy was performed at TGH last healthcare for our patients, our community and year. The frst-in-the-world Organ Repair the world”. Laboratory was built and it is operational in the TGH OR. The Guided Therapeutics Image The Surgical Programs continue to Guided OR is now operational. It is evident make signifcant progress in innovation and that going forward, all OR’s will be built to in achieving clinical excellence and academic this level of sophistication, with advanced productivity. Surgery at University Health imaging capability built in, and with minimally Network holds a national and international profle and maximally invasive surgical capability. of clinical and academic excellence in the felds of A second Da Vinci robot is now needed. transplantation, surgical oncology, neurosurgery, Staffng models which include engineers as cardiovascular surgery, musculoskeletal health part of the OR team need to be developed and arthritis, and minimally invasive surgery to and appropriately funded to properly take name a few,– many of the surgeons, divisions maximal advantage of the new technologies. and programs are leaders in Canada and in North A simulation center for education of surgeons America. (and the surgical team) will be built to train our surgeons and to create a world class teaching B. Education and Research center for students of surgery at all levels. Education: Surgeons at UHN have been accomplished educators at the undergraduate, c. Information Systems - Information management postgraduate and fellowship levels. In both is recognized as a critical element for SPCC. quality and quantity of education they have While there have been some innovative provided excellent experiences for local, national explorations in surgery and anaesthesia, this and international students. clearly must be integrated into the UHN wide

198 Five Year Review 2009-2014 EPR, which in turn, needs to be integrated and ICU’s. This is being disseminated in with our research databases. Our IT support hospitals across the country and is now a at UHN (Advanced Clinical Documentation recognized safety indicator in the province of and mobility solutions) needs signifcant Ontario. investment and development to bring us to a level where we can truly call ourselves a f. Technology and Surgery – To continue to lead leading research and clinical hospital. and innovate in surgery, we must maintain and enhance our focus on technology in d. The Surgical Scorecard – the UHN surgical surgery. Major strides have been made scorecard is a useful tool for measurement with: i) the establishment of a robotic surgery of surgical activity and outcomes, and for program which has expanded from urology quality improvement in every division. The and gynecological oncology, to thoracic electronic e-booking form aids surgeons, surgery, general surgery and Head and Neck secretaries and assistants in booking elective Surgery; ii) the opening of the MPOR with cases, and subsequently contributes to further image guided advances in vascular and data collection. This has allowed us to lead cardiac procedures, iii) the opening of the the province in the wait times data collection Organ Repair Laboratory in the TGH OR for process. The scorecard has been revised to organ repair and stem cell treatment and iv) include the SET (Surgical Effciency Targets) with the construction of the GTxOR (Guided data and wait time data, as well as a number of Therapeutics OR). We are well into an era of quality indicators. advanced surgical technology. We will need to plan to add an additional robot and a second e. Patient Safety – patient safety is a major GTx OR in the near future. Furthermore, focus of surgical practice at University Health we will need to improve in training and Network. There is a well-developed system of education with the establishment of a Surgical quality committee review in that each division/ Simulation Centre. We have fnalized a process department and program participates in quality for review of proposed innovations by the improvement rounds(QCC – Quality of Care Surgical Innovation Committee. We have also Committees), which are overseen by our developed a streamlined stratifed application Surgical Programs Quality of Care Committee program for Innovations that are: i) new to (SPQCC).This committee in turn reports to the hospital, but already Health Canada and the UHN Quality of Care Committee chaired FDA approved, ii) new technology that is not by the CEO. Deliberations by the Surgical yet FDA approved and iii) frst in man novel Programs Quality of Care Committee are technologies with appropriate overview for the used to implement changes in practice and level of innovation and appropriate feedback developments of new policies and guidelines. and follow-up as well as Research Ethics Board consultation and review. The World Health Organization Surgical Safety Checklist which was co-developed g. International Patient Program –The IPP by UHN (Dr Bryce Taylor) has become a program continues to focus on humanitarian standard operating procedure in our operating cases and operations that cannot be provided rooms and now also in our endoscopy units in the patients home country. We have

Five Year Review 2009-2014 199 established one IPP room per week at the TGH surgical education and education as a whole site. This will help with planning and ability at UHN. I am actively leading a fundraising to deliver service in a timely manner. It also initiative for this and am coordinating with clearly separates this activity from service to the VP Education towards an institution wide Ontario patients. Furthermore, if the room is strategy. not flled, then the staff will be used to treat Ontario patients so actually a net beneft to j. UHN Biobank- We have been working for Ontario patients will be realized. some time with the various stakeholders in the biobank project to move us forward in h. Fundraising – We are working on a number of the development of a state of the art biobank fundraising initiatives with our foundations. with appropriate governance that all will be These include: i) Re-development of TWH comfortable with. While we have hit some operating rooms – in progress ii) Further bumps in the road, I think we are moving investment in the Sprott Department of in the right direction. The recruitment of Surgery, iii) Major Naming opportunity for a new biobank director and investment of UHN Lung Center – in progress, iv) ongoing money from all of the major UHN programs activities in thoracic surgery, lung transplant hopefully should facilitate this. The Sprott fundraising, MOT Program fundraising and Surgery Innovation Fund will be outftting our v) support of fundraising activities in other operating rooms with liquid nitrogen tanks divisions and UHN at large. in each OR – to collect the highest quality samples 24/7 right as they are removed from i. Centre of Excellence for Simulation Education the patient. This requires coordination with the & Surgical Innovation - Simulation is an biobank staff, pathology and IT. area where we have not invested suffcient resources and it is a threat to the future of D. Department of Surgery Divisional 5 Year Summary Report: a. Cardiac Surgery Vivek Rao MD (Division Head) Maral Ouzounian MD Stephanie Brister MD Anthony Ralph-Edwards MD Mitesh Badiwala MD William Stansfeld MD Robert J. Cusimano MD Terrence Yau MD Tirone David MD Richard Weisel MD Chris Feindel MD Recruitments/Promotions/Retirements: Drs. Vivek Rao & Terry Yau were promoted a graduate of the University of North to Full Professors Carolina surgical training program Dr. Maral Ouzounian was recruited for her and will augment our advanced heart expertise in the area of thoracic aortic disease. failure team and participate in our In 2014, two new surgical recruits joined minimally invasive surgery program. the Division. Dr. William Stansfeld is He is appointed as a Surgical-Scientist

200 Five Year Review 2009-2014 and his research interests focus on the training program and recently completed molecular changes that occur in cardiac an advanced fellowship in valvular tissue during ventricular remodeling. repair at Northwestern University in Dr. Mitesh Badiwala is a graduate of our Chicago. Major Accomplishments/Appointments/Awards: Dr. Richard Weisel received the Scientifc Editor in Chief of the premier journal Achievement Award of the American in cardiothoracic surgery - Journal of Association of Thoracic Surgery. Dr. Thoracic and Cardiovascular Surgery. Hugh Scully received the Canadian Several members of the Division serve in Medical Association’s 2010 Medal of key administrative roles including the Service Award. Provincial Chair of Cardiac Surgery Dr. Vivek Rao was appointed as Division for the Cardiovascular Care Network Head. (Dr. Chris Feindel), Chair of the Drs. Terrence Yau, and Richard Weisel, Physician Payment Review Board successfully launched the province’s (Dr. Vivek Rao) and a director of the frst stem cell program for cardiac Trillium Gift of Life Network (Dr. disease in addition to maintaining Vivek Rao). Dr. Hugh Scully serves as a extramural support from the Heart and Canadian representative on the Board of Stroke Foundation. Governors for the American College of Dr. R.J. Cusimano was awarded Surgeons. the Wightman-Berris award for Undergraduate Teaching. Dr Richard Weisel has been appointed

b. General Surgery Allan Okrainec MD (Division Head) Ian McGilvray MD Mark Cattral MD Carol Anne Moulton MD Tulin Cil MD Catherine O’Brien MD Sean Cleary MD Todd Penner MD Karen Devon MD Fayez Quereshy MD Jaime Escallon MD Michael Reedijk MD Steven Gallinger MD Lorne Rotstein MD Anand Ghanekar MD Markus Selzner MD David Grant MD Eran Shlomovitz MD Paul Greig MD Bryce Taylor MD Timothy Jackson MD David Urbach MD Wey Leong MD Alice Wei MD David McCready MD

Recruitments/Promotions/Retirements: Dr. Markus Selzner was recruited as a to the strong research foundation in surgeon-scientist, adding signifcantly transplantation.

Five Year Review 2009-2014 201 Dr. Ian McGilvray was promoted to Professor & Carol-Anne Moulton who Associate Professor. was promoted to Associate Professor. Dr. Timothy Jackson was recruited to Dr. Fayez Quereshy was recruited with the program. Tim’s academic area research interests in colorectal of interest is quality assessment of surgery and in the area of Operations quality control. This has lead to the Management and Process-level implementation of NSQIP at UHN and Evaluation and Optimization. provincially. Dr. Karen Devon was recruited with a Dr. Richard Reznick left the Division to on research interest in medical ethics. the position of Dean of the Faculty of Dr. Anand Ghanekar was promoted to Health Sciences at Queen’s University Assistant Professor and Dr. Alice Wei Medical School, Kingston ON. was promoted to Associate Professor. Dr. David Urbach was promoted to Dr. Karen Devon was recruited, a Toronto Professor of Surgery. trained Endocrine surgeon. Dr. Anna Gagliardi was promoted to Sean Cleary was promoted to Associate Associate Professor. Professor. Todd Penner was promoted to Assistant

Major Accomplishments/Appointments/Awards: Drs. Allan Okrainec, David Urbach and more than $5,000,000 from National Todd Penner help to develop the new granting agencies; the Canadian Institute University of Toronto Bariatric Surgery of Health Research (CIHR), Ontario Program. Institute for Cancer Research, Canadian Division enrolled in the General Surgical Liver Foundation, the Ministry of Module of NSQIP (National Surgical Research and Innovation, the Royal Quality Improvement Program) which College of Physicians and Surgeons of allow for improvements in assessment of Canada, the Medical Council of Canada, process and outcomes in General Surgery Physicians Services Incorporated (PSI), at our centre and across the breadth of the Ontario Research Fund, The Canadian General Surgery. Dr. Timothy Jackson Cancer Society Research Institute, spearheaded this initiative. National Cancer Institute of Canada and The Division initiated a Robotic Colorectal International Grants; National Institutes Surgery Program. of Health (NIH). The UHN Multidisciplinary Bariatric Dr. Paul Greig was honoured with the Program at the Toronto Western site University of Toronto Award for continues to grow, the program was Excellence in Medical Education for designated a Level 1A Facility by the Teaching Performance Mentorship and American College of Surgeons Bariatric Advocacy; Dr. Carol-Anne Moulton Surgery Center Network (ACS BSCN) was honoured with the 2013 PAIRO Accreditation Program, the highest level Excellence in Clinical Teaching Award. of accreditation for Bariatric Centers of Dr. David Urbach was awarded a James Excellence. IV Travelling Fellowship in Surgery. General Surgery hold current grants totalling A number of Faculty members were

202 Five Year Review 2009-2014 recipients of prestigious awards; Paul Greig received the Francis Moore Visiting Professors: Excellence in Mentorship in the Field · 2011-12 The John Palmer Lecturer was Dr. of Transplantation Surgery Award by Michael Choti from Johns Hopkins School the American Society of Transplant of Medicine; The Peter Crossgrove Lecturer Surgeons. Fayez Quereshy and Michael was Dr. Louis Hugh Francescutti from Reedijk were both recipients of a the University of Alberta and the Langer Wightman-Berris Academy Individual Lecturer was Professor Malcolm Dunlop Teaching Excellence Award. Timothy from the University of Edinburg. Jackson received the Frank Mills Award · 2012-2013 Dr. Richard Reznick, a former for Excellence in Teaching by a General member of the Division of General Surgery Surgery Faculty Member. Catherine and present Dean of the Faculty of Health O’Brien received the Associated Science at Queen’s University, delivered the Medical Services Recognition Award for Division of General Surgery and Canadian Exemplary End of Life Care. Association of General Surgeons Langer Catherine O’Brien’s publication in Nature Lecturer. Dr. Quan-Yang Duh, from the Medicine titled “Self-renewal as a University of California San Francisco therapeutic target in human colorectal was the John Palmer Lecturer. The Peter cancer”, David Urbach’s publication in Crossgrove Lecture was presented by Dr. the New England Journal of Medicine Jeffrey Matthews, Chair, Department of titled “Introduction of surgical safety Surgery at the University of Chicago. checklists in Ontario, Canada”, and · 2013-14 Dr. Scot Helton from Virginia Carol-Anne Moulton and Steve Mason Medical Center in Seattle delivered Gallinger’s publication in JAMA titled the Division of General Surgery and “Effect of PET before liver resection on Canadian Association of General Surgeons surgical management”. Langer Lecturer in September, 2013. The Dr. Carol-Anne Moulton was appointed Peter Crossgrove Lecture was presented by as Medical Director, TGH Operating Dr. Charles Balch from the University of Rooms Texas Southwestern Medical Center in June Allan Okrainec was appointed as the 2014. new Head of the Division of General Surgery and University of Toronto Peter Crossgrove Chair.

c. Neurosurgery Michael Tymianski MD (Division Head) Andres Lozano MD Mark Bernstein MD Eric Massicotte MD Michael Fehlings MD Ivan Radovanovic MD Fred Gentili MD Mohammed Shamji MD Mojgan Hodaie MD Charles Tator MD Suneil Kalia MD Taufk Valiante MD Paul Kongham MD Gelareh Zadeh MD

Five Year Review 2009-2014 203 Recruitments/Promotions/Retirements: Drs. Eric Massicotte, Taufk Valiante and Canadian Pain Society Early Career Gelareh Zadeh and were promoted to Investigator Research Grant. Associate Professors, UofT. Dr. Gelareh Zadeh was appointed to the new Dr. Mojgan Hodaie was promoted to role of Director of Academic Affairs for Assistant Professor. the University of Toronto Division of New faculty recruits include; Dr. Ivan Neurosurgery effective March 1, 2014, Radovanovic (Cerebrovascular), Neuro- and the new Chair of the Neuro-oncology Oncology (Dr. Paul Kongkham),Spine Committee for World Federation of (Dr. Mohammed Shamji) and Dr. Suneil Neurological Surgeons. She was the Kalia (Functional Neurosurgery). recipient of the 2014 Bernard Langer Dr. Andres Lozano was appointed to the Surgeon-Scientist Award, the Wightman- rank of University Professor, the most Berris Academy Postgraduate Education prestigious and distinguished rank at the Teaching Excellence Award and The University of Toronto. Ross Fleming Surgical Teaching Award. Dr. Mohammed Shamji received the

Major Accomplishments/Appointments/Awards: Dr. Michael Fehlings received the prestigious Dr. Mojgan Hodaie was awarded the Olivecrona Award from the Karolinska Wightman-Berris Award for postgraduate Institute in Stockholm for excellence education. and impact in the feld of neurosurgery, Dr. Charles Tator was the recipient of the related to his work in spinal cord injury. UHN 2011 Global Impact Award, given He also received the Leon Wiltse Award to a UHN staff member have been leaders from the North American Spine Society in medicine and science, and whose past for excellence in spine clinical research. work has led to improvements in health Dr. Andres Lozano won the Winn Prize and care well beyond our borders. the Donald Calne Award for Parkinson’s Dr. Michael Tymianski was appointed as disease Research. Head of the Division of Neurosurgery at Dr. Michael Tymianski was named the UHN Canada Research Chair (Tier 1) in Michael Fehlings was appointed as President Translational Stroke Research. of the Cervical Spine Research Society Dr. Michael Fehlings was awarded the (CSRS). Hansjörg Wyss Foundation Award from Taufk Valiante is Co-Director of the Krembil AOSpine International. Neuroscience Center’s Epilepsy Program Dr. Mark Bernstein was appointed as the Dr. Michael Fehlings received a Golden inaugural Greg Wilkins-Barrick Chair in Axon Award from the Brain Mapping International Surgery. Foundation, given in recognition of Dr. Gelareh Zadeh received the Annual individuals who have demonstrated Clinician Scientist Award and the Best world-class leadership in neuroscience Abstract Award at the American Society and have reached out to their local for Therapeutic Radiation and Oncology communities. (ASTRO).

204 Five Year Review 2009-2014 Drs. Fred Gentili & Dr. Charles Tator received Division members also published ground- a Council Award from the College of breaking research, including the world’s Physicians and Surgeons of Ontario frst positive randomized controlled trial in recognition of outstanding Ontario of a stroke neuroprotectant (Tymianski; physicians who have demonstrated Lancet Neurology 2012); the world’s frst excellence and come closest to meeting report of treatment of Anorexia Nervosa society’s vision of an “ideal physician”. with Deep Brian Stimulation (Lozano; Dr. Andres Lozano was also selected as the Lancet 2013) and the world’s frst report recipient of the 2012 Herbert Olivecrona of transcranial magnetic resonance Medal from the Karolinska Institute. guided focused ultrasound to treat tremor Dr. Charles Tator was presented with the (Lozano; Lancet Neurology 2013). Outstanding Achievement Award by Dr. Mark Bernstein was honoured in the the Medico-Legal Society of Toronto in Senate of Canada on March 26, 2014 recognition of signifcant contributions in recognition of his humanitarian work to the society, the professions and the helping those less fortunate in developing community at large. countries. Dr. Andres Lozano was awarded a renewal Dr. Michael Fehlings was appointed as Vice of his Tier 1 Canada Research Chair in Chair Research in the Department of Neuroscience. Surgery at the University of Toronto. The Division collectively, brought in He was also elected as a Fellow of the $4,395,788.31 in peer-review research Royal Society of Canada and to the grants. Canadian Academy of Health Sciences Dr. Mark Bernstein was appointed as the (CAHS) due to his exceptional academic inaugural Barrick-Wilkins Chair in achievements. International Surgery. Dr. Fred Gentili was appointed as the Alan In 2013 Several members of the Division and Susan Hudson Chair in Neuro- have received international awards: Oncology at the University Health the 2013 Humanitarian Award of the Network. AANS (Dr. Mark Bernstein); the Margolese National Brain Disorders Visiting Professors: prize from the University of British 2011-12 Dr. Jacques Morcos, Professor of Columbia (Dr. Andres Lozano); the Clinical Neurosurgery, University of Jonas Salk Award and the Richard Winn Miami, 29th Annual E. Harry Botterell award for excellence in translational Visiting Lectureship in Neurosurgery neuroscience research and the Queen Christopher Ogilvy, Director, Elizabeth Diamond Jubilee Award for Endovascular and Operative signifcant contributions to Canadian Neurovascular Surgery, Harvard Medical society in science and medicine (Dr. School and Massachusetts General Michael Fehlings); the Society of Neuro- Hospital, City-Wide Rounds at Toronto oncology Excellence in Translational Western Hospital Research award (Dr. Gelareh Zadeh); Christopher Shaffrey, Harrison Lumbar Spine Research Society basic Distinguished Teaching Professor of science award (Dr. Mohammad Shamji). Neurological Surgery, University of

Five Year Review 2009-2014 205 Virginia, 37th William S. Keith Visiting Center. Professorship 2013-14 Drs. Juan C. Fernandez-Miranda, University Division Chairs at UHN: University of Pittsburgh; Sebastien Dr. Andres Lozano Professor and Chair, Froelich, Hôpital Lariboisière, Paris; Neurosurgery, Department of Surgery, Franco De Monte, MD Anderson Cancer University of Toronto. d. Orthopedic Surgery Nizar Mahomed MD (Division Head) Wayne Marshall MD Jaskarndip Chahal MD Darrell Ogilvie- Harris MD Rod Davey MD Raj Rampersaud MD Rajiv Gandhi MD Khalid Syed MD Johnny Lau MD Christian Veillette MD Stephen Lewis MD Andrea Veljkovic MD

Recruitments/Promotions/Retirements: Dr. Nizar Mahomed was promoted to Full WCH. Professor. Dr. Andrea Veljkovic was recruited as the Dr. Stephen Lewis was promoted to Associate new foot and ankle surgeon who will Professor. focus on complex MIS surgery. Dr. Jas Chalal was recruited as the new orthopaedic sports surgeon for UHN &

Major Accomplishments/Appointments/Awards: Dr. Rod Davey was appointed Co-Chair of events in the intraoperative and in the the Joint Health & Disease Management perioperative period to provide an Steering Committee for the Toronto infrastructure for quality improvement Central LHIN. Dr. Darryl Ogilvie-Harris and patient safety strategies. This is was appointed Director of the University modelled after the program that Raj of Toronto Sports Medicine Program. has developed in spine surgery called Dr. Christian Veillette has developed Spine AdVerse Events Severity system an integrated clinical outcomes (SAVES). measurements database called UHN Dr. Christian Veillette was awarded with the DADOS. This is a web based health Canadian Orthopaedic Association Award information platform that provides the of Merit in recognition of leadership and core data management and outcomes innovation in orthopaedic informatics, research infrastructure for prospective technology and communication. data collection in clinical and translational Dr. Raj Rampersaud received a $2.8 million research. grant from the Ministry of Health and Dr. Raj Rampersaud implemented an Long Term Care to establish and evaluate integrated adverse events tracking to beneft of a new spine model of care program called ORTHOSAVES. The across the province. goal of this project is to capture adverse

206 Five Year Review 2009-2014 Division successfully reached the target of raising $35 million in the Campaign to Cure Arthritis.

e. Plastic Surgery Stefan Hofer MD (Division Head) Steven McCabe MD Jamil Ahmad MD Anne O’Neill MD Dimitri Anastakis MD Herb Von Schroeder MD Peter Bray MD Toni Zhong MD Brent Graham MD

Recruitments/Promotions/Retirements: · Dr. Toni Zhong was promoted to Assistant the UHN Hand Program at the Toronto Professor in the Department of Surgery. Western Hospital. His goals are to transform · Dr. Christine Novak was recruited appointed the Hand Program into a University wide as Associate Professor as a Scientist at the collaborative group, to develop a program UofT. in hand transplantation, and to invigorate the · Dr. Stefan Hofer was promoted to Full academic activities of the Hand Program. Professor. Dr. Anne O’Neill was also recruited the · Dr. Steven J. McCabe was recruited and Division. appointed to the position of Director of

Major Accomplishments/Appointments/Awards: Dr. Stefan Hofer was appointed as Editor Development Award from the American of the Journal of Plastic, Reconstructive Society of Clinical Oncology (ASCO) – and Aesthetic Surgery (JPRAS). He is Conquer Cancer Foundation. the frst non-British plastic surgeon to Dr. Hofer has been appointed to serve as the hold this position. Editor-in-Chief for the Journal of Plastic, The UHN Breast Restoration website was Reconstructive and Aesthetic Surgery for launched in December 2009 as an a second term. information resource for patients and Dr. Toni Zhong was appointed by Cancer referring clinicians. At the same time, Care Ontario as the Provincial Clinical the division published the frst edition of Lead to establish Standardized Provincial the UHN Breast Reconstruction Patient Post mastectomy Breast Reconstruction Education booklet, with an electronic (PMBR) Clinical Guidelines. Dr. Zhong version available for downloading on the was nominated for the Gerald Kirsh program’s website. Humanitarian Award, Princess Margaret Dr. Toni Zhong was appointed as the Breast Cancer Centre. Cancer Reconstruction Fellowship Coordinator as well as the Clinical Visiting Professors: Fellowship Coordinator for the Division 2012-13 Dr. Gregory Evans, MD, FACS, at the University of Toronto. Professor of Surgery and Biomedical Dr. Toni Zhong received a 3-year Career Engineering, The University of California

Five Year Review 2009-2014 207 and President of the American Society of Plastic Surgeons was the Guest Speaker at Professors Rounds.

f. Thoracic Surgery Tom Waddell MD (Division Head) Shaf Keshavjee MD Gail Darling MD Andrew Pierre MD Marcelo Cypel MD Kazuhiro Yasufuku MD Marc de Perrot MD

Recruitments/Promotions/Retirements: Dr. Tom Waddell was promoted to Full transplantation and extra-corporeal life Professor in the Department of Surgery, support. UofT. Drs. Andrew Pierre and Kazuhiro Yasufuku Dr. Marcelo Cypel was recruited for his were promoted to Associate Professors. clinical and research work in lung

Major Accomplishments/Appointments/Awards: Dr. Gail Darling was named Kress Family Evidence-Based Care. Dr. Keshavjee Chair in Esophageal Cancer. was appointed to the Council of the A new Interventional Thoracic Surgery AATS. Dr. Waddell was appointed Program was established under the Chair of the AATS Research Committee direction Dr. Kazu Yasufuku; a state-of- and continued to serve on the Research the-art interventional thoracic surgery Committee of the TSFRE and the suite at the Toronto General site for early Program Planning Committee for the diagnostic and therapeutic management Annual Meeting of the STS. of lung and esophageal cancer. The publication of our clinical trial of The Division of Thoracic Surgery formed “Normothermic Ex vivo lung Perfusion a unique partnership with McMaster in Clinical Lung Transplantation” in the University as a joint academic and New England Journal of Medicine (Cypel clinical program in thoracic surgery. et al, NEJM, 364(15):1431-1440). Dr. Shaf Keshavjee was appointed to Dr. Tom Waddell was appointed as Division Surgeon-in-Chief, UHN. Head Dr. Cypel won the prestigious Michael New programs that have been initiated by DeBakey Research Scholarship as the the Division of Thoracic Surgery are most promising young faculty member the LungMets Program (Drs. Waddell in North America from the American and Cypel) and the Program in Robotic Association for Thoracic Surgery. Thoracic Surgery (Drs. Yasufuku and Dr. Darling was appointed as the surgical Waddell). lead for the thoracic site in the leading Dr. Tom Waddell was appointed as the radiation oncology trials group, RTOG. Thomson Family Chair in Translational Dr. Yasufuku was appointed to the lung Research. site group for the CCO Program in Dr. Shaf Keshavjee in recognition of the

208 Five Year Review 2009-2014 transformative impact that Ex Vivo Drs. Cypel and Keshavjee have achieved Lung Perfusion (and organ repair in stable Ministry of Health funding for the general) is having on the feld of organ Extra-Corporeal Life Support (ECLS) transplantation. These were the Zellers program. Senior Scientist Award (Cystic Fibrosis In 2014, Dr. Shaf Keshavjee was awarded Canada), the Distinguished Lecturer an Honorary Doctor of Science Degree in Respiratory Science Award (CIHR from Ryerson University, as well as an Institute of Circulatory & Respirology Honorary Doctorate of Science from Health & Canadian Thoracic Society) Queen’s University. He has also received and the Roche Award for Excellence in the country’s highest civilian honour Science (The Transplantation Society). with an appointment as an Offcer of the Dr. Gail Darling received the Gail E. Darling Order of Canada. He is also a Fellow Award for Excellence in Undergraduate of the Canadian Academy of Health Teaching and Dr. Tom Waddell received Sciences. the Robert J. Ginsberg Award for Dr. Tom Waddell was appointed to the Excellence in Postgraduate Teaching. Council of the newly inaugurated Ontario Dr. Marcelo Cypel was awarded a Canada Institute of Regenerative Medicine. Research Chair in Lung Transplantation. Dr. Marcelo Cypel was awarded a Premier’s Dr. Shaf Keshavjee was awarded two Queen Early Research Award. Notably, Dr. Elizabeth II Diamond Jubilee Medals Cypel led the devlopment of a hands-on and was named to the Order of Ontario course in ECLS technology at the Annual recognizing his many contributions in Meeting of the American Association for lung transplantation, thoracic surgery, Thoracic Surgery. and surgical leadership. Dr. Marc de Perrot, along with radiation Dr. Gail Darling was inducted into the oncology colleague, Dr. John Cho, American Surgical Association. Dr. have pioneered the use of neoadjuvant Tom Waddell was appointed Chair of radiation in mesothelioma prior to the American Association for Thoracic extrapleural pneumonectomy. Surgery Research Committee and was inducted into the American Surgical Association.

Visiting Professors: 2011-12 Dr. Sean Grondin (University of 2012-13 Dr. Alessandro Brunelli (University Calgary), Dr. Malcolm Brock (Johns of Ancona, Italy), Dr. Brian Louie Hopkins), and Dr. David Sugarbaker (Swedish Cancer Center, Seattle), and (Harvard). Refresher Course Visiting Dr. Ara Vaporciyan (MD Anderson Professor included Dr. Robert Cerfolio Cancer Center, Houston). Another highly (Alabama), Dr. Drew Bethune (Halifax), successful Toronto Thoracic Surgery Dr. Nasser Altorki (New York) and Dr. Refresher Course was held in June 2012 Eugenio Pompeo (Rome). Pearson Day and included the following Visiting Visiting Professor was Dr. Eric Vallieres Faculty: Phillippe Dartevele (Marie- from Seattle. Lannelongue, Paris), Scott Swanson

Five Year Review 2009-2014 209 (Brigham, Boston), Wayne Hofstetter Thierry Le Chevalier (Institute Gustav (MD Anderson, Houston) and Lorenzo Roussy, Paris, France), Steve Cassivi Ferri (McGill, Montreal). The Pearson (Mayo Clinic, Rochester, Minnesota), Day Visiting Professor was Dr. Richard and Michael Humer (Kelowna General Finley from Vancouver. Hospital, Kelown, BC). 2013-14 Benjamin Kozower (University The Pearson Day Visiting Professor was of Virginia, Charlottesville, Virginia) Dr. Bryan Meyers from Washington and Dr Gunda Leschber (Berlin Chest University in St. Louis. Hospital, Berlin, Germany). Another highly successful Toronto Thoracic University Division Chairs at UHN: Surgery Refresher Course was held in · 2011-12 Dr. Tom Waddell Professor and June 2014 and included the following Chair, Division of Thoracic Surgery, Visiting Faculty: Paul De Leyn Department of Surgery, University of (University Hospital, Leuven, Belgium), Toronto

g. Urology Neil Fleshner MD (Division Head) Michael Jewett MD Dean Elterman MD Girish Kulkarni MD Antonio Finelli MD Sidney Radomski MD Rob Hamilton MD Michael Robinette MD Magdy Hassouna MD John Trachtenberg MD

Recruitments/Promotions/Retirements: Dr. Magdy Hassouna was promoted to Full uro-oncologic surgeon. Professor Dr. Dean Elterman joined the faculty and Dr. Girish Kulkarni was recruited and his will lead the divisions Men’s Health focus will be on health services research program based at TWH site. in urological oncology. Dr. Robert Hamilton was recruited as a new

Major Accomplishments/Appointments/Awards: Dr. Neil Fleshner presented on the results career recognition awards from the of the REDEEM study which was a American and Canadian Urological featured paper at GU ASCO, AUA and Associations and the Society of Urologic EAU meetings. Oncology. Dr Neil Fleshner was awarded The Division collectively brought in over a Queen’s jubilee medal. 3 million dollars in peer reviewed grant Collectively grant funding was over 3 capture largely in the area of urologic million. oncology. The group published over 60 publications including such prestigious journals as Journal of Clinical Oncology and Lancet. Dr. Michael Jewett received the prestigious

210 Five Year Review 2009-2014 Visiting Professors: 2012-13 Visiting professors included Dr University Division Chairs at UHN: Marsden Linehan (NIH) and Dr Joel Dr. Neil Fleshner Professor & Chair, Division Nelson (University of Pittsburgh). of Urology, Department of Surgery, 2013-14 Drs Dean Assimos, John Denstedt, University of Toronto Jack Baniel and Joel Nelson .

h. Vascular Surgery Tom Lindsay MD (Division Head) Graham Roche-Nagle MD Thomas Forbes MD Barry Rubin MD Wayne Johnston MD Leonard Tse MD George Oreopoulos MD

Recruitments/Promotions/Retirements: Dr. Leonard Tse was recruited to the Division Dr. Thomas Forbes was recruited as the of Vascular Surgery as a surgeon- University Division Chair scientist. Major Accomplishments/Appointments/Awards: Dr. Wayne Johnston received the Lifetime outcomes, in terms of mortality and Achievement Award from the Society for morbidity are equal or exceed those of Vascular Surgery. At the same time he the VQI group. The Division has used the became Editor-in-Chief of the Rutherford data to identify areas for improvement Vascular Surgery textbook. such as routine EVAR length of stay. Dr. Tom Lindsay was awarded the Ross Dr Leonard Tse was the frst to use the Fleming Surgical Educator award at Anaconda fenestrated cuff and is the UHN. North American proctor for this new Several clinical frsts for this division EVAR device. included; the frst initial renal artery Dr. Wayne Johnston developed the new denervation procedure, and the frst content of the premier vascular surgery Anaconda fenestrated EVAR graft text book (Rutherford’s Vascular Surgery), co-editing the chapters, and implantation in Canada. organized the electronic output for Dr. George Oreopoulos was appointed to computers and e-books. In addition, the position of University of Toronto, he received the Pioneers in Gore Division of Vascular Surgery Program Performance Award for commitment to Director. ongoing learning. Currently, UHN is the only Canadian site Dr. George Oreopoulos won the Surgical and the only site outside of the USA to be Skills Centre Distinguished Educator participating in the Society for Vascular Award at Gallie Day 2014. Surgery’s Vascular Quality Initiative Dr. Roche-Nagle won The CSVS Gore Research Award for his project titled (VQI). The prospective data collection “The therapeutic and prognostic value of has demonstrated that Vascular surgery

Five Year Review 2009-2014 211 perfusion angiography with indocyanine green fuorescence in patients with critical ischemia.” University Division Chairs at UHN: Dr. Thomas Forbes Professor & Chair, Vascular Surgery, Department of Surgery, University of Toronto

Summary

In summary, we have the largest and most productive department of surgery in the country. Our department is academically productive and the dedication to patient care, teaching and research is exemplary. The members of the department are focused on academic productivity and also in clinical excellence with an understanding of the business aspects of delivery of surgical services – timely delivery of care and volume targets with performance measures in place. We will continue to work to develop and maintain the appropriate environment to enable leadership in academic productivity and surgical innovation.

212 Five Year Review 2009-2014 Department of Surgery Women’s College Hospital University of Toronto

FIVE YEAR REVIEW 2009-2014

John Semple, MD Surgeon-in-Chief Women’s College Hospital University of Toronto

Five Year Review 2009-2014 213 WOMEN’S COLLEGE HOSPITAL AT A GLANCE

Surgeon-in-Chief: Dr. John L. Semple

Division Heads: Orthopedic Surgery: Dr. John Theodoropoulos Plastic Surgery: Dr. John Semple

Staff Surgeons: Division of Plastic Surgery Dr. John Semple Dr. Mitchell Brown

Division of Orthopedics Dr. John Theodoropoulos Dr. Ogilvie-Harris Dr. Jaskarndip Chahal Dr. Lucas Murnaghan Dr. Tim Dwyer

Division of General Surgery Dr. Tulin Cil Dr. Karen Devon

Division of Urology Dr. Ethan Grober

Surgical programs with a focus in These innovations include the expedited Ambulatory Care continue to be a dominant discharge in postoperative patients and remote theme in the evolving structure of Women’s monitoring of patients at home using smart College Hospital as this institution continues to phone technology. These innovations include the progress as an Academic Ambulatory Surgical X OR-WCH to be the incubator for developing Centre that is fully integrated with the hospital’s processes that move in-patient surgeries to an primary ambulatory strategic plan and current Ambulatory setting. Women’s College Hospital services. Women’s College Hospital is a continues to develop a fully academic affliated designated facility for academic ambulatory site for inter-professional research and education surgery at the University of Toronto and the in ambulatory surgery focused on minimally Toronto Central LHIN. Our Surgical Programs invasive and specialized ambulatory procedures are dynamic and innovative and our mandate is and innovative models of systems solutions. to be a leader in academic ambulatory surgery.

214 Five Year Review 2009-2014 Women’s College Hospital continues to different hospitals now work at Women’s College develop as a hub of a citywide focus in Orthopedic Hospital in our key areas. Over the past 5 years Sports Medicine and building surgical strength we have actively recruited in Orthopedics and in our core programs of Urology, Orthopedic General Surgery, both were co-recruitments with Surgery, Plastic Surgery and General Surgery. the University Health Network and The Hospital Our goal is to become a leader in ambulatory for Sick Children. In addition, several staff have surgery as we continue to work on our strengths: been appointed, successfully passed their three innovation and collaboration. year reviews and continue to enhance divisional involvement. Activities Women’s College Hospital in 2010 Dr. Lucas Murnaghan joined the embarked on the development of a new way Orthopedic Division in August of 2009 with of viewing healthcare with a mandate to keep a focus in orthopaedic care of athletic injuries people out of hospital with the plans to design in the paediatric, adolescent and collegiate a new hospital. In the summer of 2010 the athlete. His clinical practice includes general construction of the new Women’s College pediatric orthopaedics with a sub-specialty Hospital commenced with the demolition of a interest in paediatric athletic injuries and the parking garage to make way for the frst Phase use of arthroscopy in the management of a wide of the new 10 storey tower which would be home spectrum of pathologies. His practice extends to 8 operating rooms, clinical and administrative to the adolescent and collegiate athlete with space. In May of 2013 we moved into Phase 1 close association with the MacIntosh Clinic at and within several weeks the old building was The University of Toronto and his young adult demolished. It was celebrated with various practice at Women’s College Hospital. In that events including “Paint the Halls” where 75 same year Dr. John Semple was awarded the artists were selected to feature their works of art Chair in Surgical Breast Cancer Research by the on the walls of WCH. Canadian Breast Cancer Foundation, Ontario Phase II which is set to be completed in the Region. The Chair is not only the frst surgical summer of 2015 will be comprised of a 9 storey research Chair awarded by the Canadian Breast building that will be joined to comprise the new Cancer Society but also the frst endowed Chair L-shape building. This new 400,000 square foot based in the Department of Surgery at Women’s facility will have the capacity to accommodate College Hospital. Dr. Semple still holds this 340,000 patients a year. It will also be the home chair appointment to date. to education, research, clinical centers and inter professional teams of various sorts all under 2010, Dr. Darrell Ogilvie-Harris was one roof. This new space will accommodate appointed Director of the University of Toronto, the core surgical activities and programs of the Department of Surgery Orthopaedic Sports Department of Ambulatory Surgery. Medicine Program. WCH has become one of the primary hubs for orthopaedic sports medicine Appointments within this city-wide network and a primary Since 2009 The Department of Surgery at training site for orthopaedic residents in this Women’s College Hospital continues to expand subspecialty. and thrive. Twenty eight surgeons from eight

Five Year Review 2009-2014 215 In 2011 Dr. John Theodoropoulos not FRCSC in General Surgery in 2010. Karen then only successfully defended his MSc thesis in completed 6 months of postgraduate training the Institute of Medical Science in Cartilage in Breast Surgical Oncology at UHN, followed Regeneration and successfully transitioned by a Clinical Fellowship in Endocrine Surgery his three year CARS process, during the past at the University of Chicago. This Fellowship year he was appointed Head of the Division of included one month in the Philippines studying Orthopedics at Women’s College Hospital. the surgical treatment of goitre. Additionally, Karen completed a Surgical Ethics Fellowship In 2012-2013 we welcomed three new at the MacLean Center for Clinical Ethics at the recruits Dr. Jaskarndip Chahal, Dr. Karen Devon University of Chicago. and Dr. Tim Dwyer. Dr. Tim Dwyer has recently joined Dr. Jaskarndip Chahal is an Assistant Women’s College Hospital in the division of Professor in the Department of Surgery at orthopedics with a cross appointment at Mount the University of Toronto with his primary Sinai Hospital., Assistant Professor at the appointment as an Orthopaedic Surgeon at University of Toronto, Dr. Dwyer’s surgical Women’s College Hospital. Dr. Chahal attended practice encompasses open and arthroscopic medical school at the University of Manitoba and surgery of the knee and shoulder, as well as completed his orthopaedic residency training the management of sports injuries. Dr. Dwyers here at U of T where he enrolled in the Surgeon- primary research focus is on the assessment Scientist Program in Clinical Epidemiology. of surgical competence in Competency Based His practice is focused on treating patients with Medical Education, which is the basis of his PhD orthopaedic sports medicine disorders. His thesis at the Institute of Medical Science. He research will focus on cartilage regeneration, designs and validates assessment methods for clinical measurement and conducting translation Medical Expert and Intrinsic CanMEDS Roles, outcomes research of novel cartilage repair as well as methods used to assess acquisition techniques. Dr. Chahal is currently enrolled of competence in surgical skill - research in a joint international Master’s of Business funded by grants from the American Orthopedic Administration (MBA) program at the University Association. of Toronto and the University of St. Gallen (Switzerland). This MBA program provides Departures strong exposure to leadership and strategy as well as innovation and entrepreneurship. The Department of Surgery at Women’s College Hospital has had the privilege of Dr. Karen Devon is an Endocrine and working with both Dr. George Hiraki and Lavina Thyroid Surgeon with an interest in Medical Lickley, both serving 4 decades of service to the Ethics and Education. After receiving her Department of Surgery. MDCM at McGill University Dr. Devon entered the General Surgery Training Programme and In 2010, Dr. George Hiraki retired from the Surgeon Scientist Programme here at the the Department of Surgery at Women’s College University of Toronto. She was awarded her Hospital after he had been a major fgure in our MSc in Clinical Epidemiology in 2008 and her Department of Surgery and was well recognized

216 Five Year Review 2009-2014 for his wide scope of practice and his passion Education for teaching. In November 2014, Dr. Lavina Women’s College provides a unique Lickley, surgeon, researcher and co-founder of surgical education setting because of its the Henrietta Banting Breast Centre and former ambulatory mandate. Over the past 5 years The Surgeon in Chief (1989-1999) also retired. Both Department of Surgery has worked in partnership still remain Honorary Staff within the Department with its various disciplines to develop an of Surgery at Women’s College Hospital. ambulatory curriculum with learning objectives specifc to ambulatory surgery. We have designated resident rotations in Plastic Surgery Divisional Activities and Orthopedics. In 2014 Dr. Karen Devon and Dr. Tulin Cil developed a new Ambulatory Since 2009 Dr. Mitchell Brown continues General Surgery Rotation with introduction of to host the Annual Toronto Breast Symposium, weekly guided refective practice. Women’s welcoming local, national and international College Hospital is now the primary rotation professors who are leaders in the feld of for Orthopedic Sports Medicine residents at Aesthetic and Reconstructive Breast Surgery. the University of Toronto Orthopedic Sports Women’s College Hospital continues to host Medicine that includes a Simulation Education international candidates under the University Centre in a multidisciplinary content, with a of Toronto Breast Reconstruction Clinical primary contribution by Orthopedic Surgery Fellowship Program. Since 2009 Women’s College Hospital has supervised 14 fellows Dr. Karen Devon has developed multiple from around the world. Dr. Ethan Grober in educational activities including the Endocrine 2010 successfully passed his three year review Surgery Journal Club, Department of Surgery while holding 6 research grants. Dr. Tulin Cil Book Club, Ethics Quality of Care Rounds Karen was awarded the Wightman-Berris Academy has also been invited to lecture extensively on Individual Teaching Performance Award and the ethics of social media in health care and is was appointed the Director of Undergraduate conducting research in this area. Dr. Devon has Education for the Department of Ambulatory been recognized for her scholarly work in Ethics Surgery at Women’s College Hospital. The and Education and received an Associated Department of Surgery continues its expansion Medical Services (AMS) Phoenix Fellowship on key programs. In 2012, Dr. Jamil Ahmad Award. Her most recent publications include was appointed the Director of the University of “Ethics and Genomic Medicine, How to Navigate Toronto – Women’s College Hospital Education Decisions in Surgical Oncology” and “Tragic Program in Aesthetic Plastic Surgery. This Knowledge: Truth telling and the maintenance Aesthetic Clinic is a key ambulatory program of hope in surgery”. that offers patients economically priced cosmetic procedures that are performed by the plastic The experience rated by undergraduate, surgery senior resident under the supervision of residents, fellows and the Continuing Medical faculty plastic surgeons certifed as specialists by Education (CME) continues to rate as excellent the Royal College of Physicians and Surgeons of with our teaching volumes steadily increasing. Canada. They continue to make their surgical mark in the Department of Surgery as our residents

Five Year Review 2009-2014 217 and fellows have been honored with numerous College Hospital Team. awards in recognition of their research and Joan Lesmond Quality Award for TRAM education in patient care and development Working Group “An Innovative Ambulatory Model of Care for Women Undergoing Breast Research Cancer Reconstruction”. 2011. Along with the Over the last fve years the ten core Women’s College Hospital Team. surgeons at Women’s College Hospital have held over 60 active research grants (including Dr. Semple was recognized in the 2011-12 Dean’s CIHR). We also have over 250 peer reviewed Report by The Faculty of Medicine, University publications from July 1, 2009 to June 30, of Toronto for his 30 day post op monitoring 2014. As in previous years they are engaged APP. 2012. in a variety of clinical, educational and basic research activities. Several of them supervise Mentor Canada Prize Best Clinical Paper residents and fellows in projects and graduate (Resident Award- Dr. Heather Baltzer) at degree programs. the Division of Plastic Surgery, University of Toronto Residents Research Day. MRI Awards Volumetric Analysis of Breast Fibroglandular Tissue to Assess Risk of the Spared Nipple in We continue to attract outstanding BRCA1 and BRCA2 Mutation Carriers. 2013. graduate and post graduate trainees who have Dr. John Semple, Supervisor been presented with a number of awards and prizes for their achievements. Our surgical staff American Society of Clinical Oncology, has also been very active in all levels of education (Resident-Heather Baltzer) awarded 1 of and has been recognized for their achievements 10 Novartis Oncology Young Canadian with 22 awards as listed below: Investigator Awards (NOYCIA) by the Program Committee. MRI Volumetric Analysis of Breast Fibroglandular Tissue to Assess Risk of the Dr. John Semple Spared Nipple in BRCA1 and BRCA2 Mutation Carriers. 2013. Dr. John Semple, Supervisor Dr. John Semple was awarded the Chair in Surgical Breast Cancer Research by the FM Woolhouse Award (Resident Award - Dr. Canadian Breast Cancer Foundation, Ontario Heather Baltzer) for the best presentation of a Region. The Chair is not only the frst surgical clinical study at the Canadian Society of Plastic research Chair awarded by the Canadian Breast Surgeons, Calgary Alberta. MRI Volumetric Cancer Society but also the frst endowed Chair Analysis of Breast Fibroglandular Tissue to based in the Department of Surgery at Women’s Assess Risk of the Spared Nipple in BRCA1 College Hospital. Dr. Semple still holds this and BRCA2 Mutation Carriers. 2013. Dr. John chair appointment. Semple, Supervisor.

Leading Practice Award: Ambulatory Model of Mentor Canada Prize Best Clinical Paper Care for Breast Reconstruction by Accreditation (Resident Award - Dr. Katie Armstrong), in the Canada 2010. 2011. Along with the Women’s Division of Plastic Surgery, University of Toronto

218 Five Year Review 2009-2014 Residents Research Day. “Breast Reconstruction patients: Is it cost effective?” Dr. John Semple, Follow-Up Using QoC Mobile App: A Societal Supervisor Economic Evaluation”. 2014. Dr. John Semple, Supervisor. Dr. Mitchell Brown The Cause Leadership Award from the Canadian Breast Cancer Foundation (Ontario Chapter) The Chair’s Award for “Going Above and in recognition for his Leadership in Breast Beyond”, Division of Plastic and Reconstructive Reconstruction in Breast Cancer patients and for Surgery, University of Toronto. 2013. his outstanding clinical accomplishments and research in this area. 2014. Best Paper - Breast Section, American Society Best Paper - Breast Section, American of Plastic Surgeons, Annual Meeting - Chicago, Society of Plastic Surgeons, Annual Meeting - ILL -- Quality of recovery in women undergoing Chicago, ILL -- Quality of recovery in women autogenous breast reconstruction in an undergoing autogenous breast reconstruction in ambulatory setting. Armstrong K, Davidge D, an ambulatory setting. Armstrong K, Davidge Brown M, Morgan P, Semple J. 2014. D, Brown M, Morgan P, Semple J. 2014.

The American Telemedicine Association - Best Dr. Jaskarndip Chahal Student Paper (Dr. Katie Armstrong) “ Breast Reconstruction Follow-up using QoC Mobile Arthroscopy Association of North America App: A Societal Economic Evaluation. 2014. Research Grant ($12, 250) – The Minimal Dr. John Semple, Supervisor Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) 68th Annual Meeting of The Canadian Society for the KOOS and IKDC in patients undergoing of Plastic Surgeons - Outstanding Paper surgery for articular cartilage defects of the knee. Presentation. “Quality of recovery in women Principal Investigator: Brian J. Cole MD undergoing autogenous breast reconstruction in MBA an ambulatory setting”. Davidge K, Armstrong Co-Investigator: Jaskarndip Chahal MD K, Brown M, Semple J. 2014. MSc FRCSC, Aileen Davis Presenter, “Quality of Recovery in Date Awarded: May 2012. Women Undergoing Autogenous Breast Reconstruction in an Ambulatory Setting”. Arthroscopy Assocation of North America SGS Conference Grant. $800: 2014. Dr. John Research Grant ($20,500). The Effect of Semple, Supervisor. Knee Flexion Angle for Graft Fixation During Single-Bundle Anterior Cruciate Ligament 2014 Mentor Medical Systems Canada Reconstruction – A Multicentre, Patient and Graduate Scholarship, the Division of Plastic Assessor Blinded, Stratifed, Two-arm Parallel & Reconstructive Surgery, University of Group Superiority Trial Toronto, Toronto, Ontario for the research protocol “Replacing ambulatory clinic follow-up with remote home monitoring using smartphone in breast reconstruction

Five Year Review 2009-2014 219 Principal Investigator: Jaskarndip Chahal Dr. Ethan Grober MD MSc FRCSC 2014 Jun Dr. Michael Jewett Post-Graduate Co-investigators: Daniel Whelan, Tim Teaching Award, Urology, Dept of Surgery, Dwyer, Darrell Ogilvie-Harris, Paul Marks, Faculty of Medicine, Division of Urology, John Theodoropoulos University of Toronto. Best Post Graduate Date Awarded: March 2014 Lecutre.

Dr. Tulin Cil: Dr. Lucas Murnaghan Education Research Award, September 2013 2014 Mar - 2014 Apr POSNA/BIOMET Canadian Association of General Surgeons, Traveling Fellowship, POSNA/BIOMET Ottawa, Ontario Canada. Women’s College Hospital Education Innovation Award-, November 2013

220 Five Year Review 2009-2014 18. CONCLUSIONS

The compilation of materials for this fve year review was instructional and benefcial in many ways. As opposed to the conventional Annual Report which has been prepared for the Department over the past 5 years, this present document amasses an extraordinary amount of information which demonstrates the required interplay in the Department between the Faculty of Medicine, the Hospitals, and the Research Institutes. While structure and governance are key features of any successful organization, I should like to stress once again the importance of the contributions of the faculty members (full-time, part-time, and adjunct), the scientists, the residents, fellows, and medical students to the mission and goals of the Department. The It has been my great pleasure and talent within the Department as a whole is both privilege to be the RS McLaughlin Professor and astounding and awe-inspiring. And fnally, Chair of Surgery at the University of Toronto I would be remiss if I did not mention the these past 5 years. Our future has never looked superior support that the Department receives as bright and promising as it does at this time. from its full-time staff who work tirelessly on Respectfully Submitted all functions and programs to ensure that smooth operations of the Department.

James T Rutka, MD, PhD, FRCSC, FACS RS McLaughlin Professor and Chair Toronto, September 10th, 2015

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