SELF-STUDY REPORT Department of Surgery External Review 2020 SELF-STUDY REPORT Department of Surgery External Review 2020 Submitted by Dr. James T. Rutka RS McLaughlin Professsor and Chair of Surgery TABLE OF CONTENTS Surgery by the Numbers 2014–2019 ................6 1. Executive Summary ....................................9 2. Introduction .............................................. 13 3. Key Findings From the 2015 External Review 17 4. Chair’s Statement .......................................23 4.1 Historical Perspective .............................24 4.2 Developing the Brand .............................25 4.3 Strategic Plan ..........................................26 4.4 Communications ...................................33 4.5 Academic Performance ..........................33 4.6 Chairs and Chairholders .........................34 4.7 Promotions .............................................35 4.8 Appointments .........................................36 4.9 Continuing Appointment Reviews ........38 4.10 Retention ...............................................39 4.11 Transition ...............................................39 4.12 Education ...............................................39 4.13 Research .................................................40 4.14 Major Awards Recipients ........................41 4.15 Advancement ..........................................42 4.16 Departmental Firsts ................................43 4.17 Strengths and Challenges ........................44 4.18 Future Directions ...................................45 5. Organization and Financial Structure .......... 47 6. Resources and Infrastructure ......................55 7. Education ..................................................57 8. Research Report ........................................65 9. Best Practice in Surgery .............................71 10. Faculty Development ..................................79 11. Continuing Professional Development .........83 ABBREVIATIONS TABLE OF CONTENTS AAP: Annual assessment of productivity AEF: Academic enrichment fund AFP: Alternate Funding Plan BPiGS: Best Practice in General Surgery 12. Global Surgery ...........................................87 CACMS: Committee for Accreditation 13. Surgical Skills Centre .................................91 of Canadian Medical Schools 14. Spine Program ...........................................95 CAR: Continuing appointment review 15. Trauma Program ..................................... 105 CaRMS: Canadian resident 16. Report of Faculty Members........................111 matching service 17. Report of Learners ....................................117 CBC: Competency Based Curriculum 18. Division Reports ...................................... 121 CPD: Continuing Professional 18.1 Anatomy...............................................122 Development 18.2 Cardiac Surgery ....................................125 CRC: Canada Research Chair 18.3 General Surgery ...................................134 FEAC: Fellowship Education 18.4 Neurosurgery ....................................... 142 Advisory Committee 18.5 Orthopaedic Surgery ............................150 18.6 Plastic and Reconstructive Surgery ...... 161 IDEAS: Improving & Driving 18.7 Thoracic Surgery ................................. 172 Excellence Across Sectors 18.8 Urology ................................................ 177 LCME: Liaison Committee 18.9 Vascular Surgery ................................... 179 on Medical Education 19. Hospital Reports ...................................... 197 LHIN: Local Health Integration Network 19.1 Michael Garron Hospital ...................... 198 MAM: Medical Academy of Mississauga 19.2 Mount Sinai Hospital ...........................206 MOHLTC: Ministry of Health 19.3 North York General Hospital ............... 211 and Long-term Care 19.4 St. Joseph’s, Unity Health Toronto ....... 213 19.5 St. Michael’s, Unity Health Toronto ..... 215 MOU: Memorandum of understanding 19.6 Sunnybrook Health Sciences Centre ....226 NBME: National Board of 19.7 The Hospital for Sick Childrens ...........235 Medical Examiners 19.8 University Health Network ..................240 NEAL: New and Emerging Leaders 19.9 Women’s College Hospital....................248 PCC: Patient Centred Care 20. Conclusion .............................................. 255 PGME: Postgraduate Medical Education Appendices (A, B and C)........................... 259 Also available electronically Q/BP: Quality and best practice RCPSC: oyal College of Physicians and Surgeons of Canada SEAD: Surgery Exploration and Discovery SIC: Surgeon-in-Chief SLUE: Surgical Leaders of Undergraduate Education SSTP: Surgeon Scientist Training Program TES: Teaching Effectiveness Score UME: Undergraduate Medical Education SURGERY BY THE SURGERYNUMBER BY THE NUMBERS2014–2019 2014-2019 FULL-TIME 296 49 NEW HIRES PART-TIME 079 25 NEW HIRES 40 FACULTY ADJUNCT RESEARCH 545 170 31 NEW HIRES SCIENTISTS Faculty have MEDICAL STUDENTS published more than 225 4-YEAR UNDERGRADUATE CURRICULUM 11 RESIDENCY 8,500 RESIDENT peer-reviewed 277 TRAINEES PROGRAMS publications CLINICAL FELLOWS from 40 countries 249 The largest clinical fellowship program in the country FACULTY MEMBERS PROMOTED 73 TO HIGHER ACADEMIC RANKS CITY-WIDE in annual Grant capture: BRAIN TUMOUR ADVANCEMENT 1 BANKING INITIATIVE FUNDING 404M NEW UNIVERSITY 8M up from 4M annually 2 DIVISION CHAIRS NEW SURGEON-IN-CHIEFS 3 NEW PROGRAM DIRECTORS FACULTY 64 Pediatric general surgery SUCCESSFULLY COMPLETED SUB-SPECIALTY Colorectal surgery Continuing Appointment Reviews (CARs) PROGRAMS Surgical oncology 4 Sunnybrook Health Sciences Centre Thoracic surgery St. Michael’s Hospital, Unity Health CANADA RESEARCH Mount Sinai Hospital CHAIR HOLDERS 5 University Health Network FULLY-AFFILIATED Women’s College Hospital TEACHING The Hospital for Sick Children 6 HOSPITALS in annual DIRECT ENTRY RESEARCH ROYAL COLLEGE OF PHYSICIANS AND SURGEONS FUNDING 7 TRAINING PROGRAMS 76M up from 40M annually BEST GLOBAL UNIVERSITIES IN SURGERY Founded in 1933, the US News and World Report has Analytics InCites, are based on academic research published rankings of top institutions throughout the performance, as well as indicators for global and regional world in education, health, and technology. It is the oldest reputation in each specic subject. The rankings in surgery and best-known ranker of academic institutions. were based on excellence in such areas as organ transplantation, trauma surgery, minimally invasive surgery, In addition to rankings of the world's top 1,500 surgical technology and academic research performance. universities overall and by region and country, the sixth The bibliometric indicators are based on data from the annual U.S. News Best Global Universities rankings Web of Science for the ve-year period from 2013-2017. include an examination of the leaders in key academic subject areas. U.S. News used a separate methodology to For 2020, the US News and World Report identied the publish the top global universities in 28 subject areas. Department of Surgery at the University of Toronto as the fourth best academic institution throughout the world for These subject-specic rankings, powered by Clarivate surgery. The Top 5 Best Global Universities in Surgery 1 EXECUTIVE SUMMARY Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 9 1EXECUTIVE SUMMARY Executive Committee of the Department of Surgery: Back row – M. Fehlings, O. Rotstein, A. Nathens, S. Keshavjee, R. Richards; Front row – N. Ahmed, J. Rutka, R. McLeod The Department of Surgery at the University of 249 clinical fellows, and 40 scientists. There Toronto has been ranked fourth in the world for are 7 direct entry Royal College of Physicians global universities in the recent 2020 US News and and Surgeons training programs (Cardiac World Report. Its global reputation is based on a Surgery, General Surgery, Neurosurgery, highly talented faculty who demonstrate exemplary Orthopaedics, Plastic and Reconstructive patient care, excellence in teaching and training Surgery, Urology, Vascular Surgery) and 4 sub- the next generation of surgeons, state-of-the-art specialty programs (Pediatric General Surgery, research across the continuum of investigative Colorectal Surgery, Surgical Oncology, and ideology, and devotion to surgical innovation, Thoracic Surgery). The Division of Anatomy entrepreneurship, and commercialization. is housed within the Department of Surgery in a relationship that has been mutually The Department is the largest across Canada with productive and beneficial for over a decade. 296 full-time faculty members, 277 residents, 10 Department of Surgery, Faculty of Medicine, University of Toronto | Self-Study Report, External Review 2020 Members of the faculty are distributed at 6 major basis, the Department of Surgery receives $5 – teaching hospitals: St Michael’s Hospital, Unity 10M in Advancement funds to support Chairs, Health, Mount Sinai Hospital, Sunnybrook Health research investigators, clinical fellows, and the 1. Sciences Centre, Women’s College Hospital, advancement infrastructure. This past year was a Executive Summary University Health Network, and the Hospital banner year for the Department of Surgery in which for Sick Children. Part time and adjunct faculty $11.8M in Advancement funds were received. members are found in an ever-expanding array of community-affiliated hospitals in and around The Department has developed an ambitious the Greater