Cold Steel: Canadian Journal of Surgery Podcast – Details, episodes & analysis

In this episode, we spoke with Drs. Jen McCall and Romy Nitsch about imposterism. Dr. McCall is a minimally invasive gynecology fellow at the University of Ottawa and Dr. Nitsch is a minimally invasive gynecologist at Queen’s University. The two researchers, along with Jessica Pudwell and Jamie Pyper, recently published a study in the Journal of American College of Surgeons on imposter phenomenon in women surgeons. Their study highlights the near universal phenomenon of imposter phenomenon among women surgeons, some of the risk factors associated with imposterism, and perhaps some strategies for how we might mitigate it. 

Jennifer McCall X/Twitter: https://x.com/jenn__mccall 

Romy Nitsch X/Twitter: https://x.com/romynitsch

Links:

1. Dr. McCall and Nitsch’s article in JACS: Impostor Phenomenon and Impact on Women Surgeons: A Canadian Cross-Sectional Survey. https://pubmed-ncbi-nlm-nih-gov.proxy.queensu.ca/38712839/
2. Mann A, Shah AN, Thibodeau PS, et al. Online well-being group coaching program for women physician trainees: a randomized clinical trial. JAMA Netw Open 2023;6:e2335541 –e2335541.

On this episode, Dr. Elizabeth Squirrell joined us to talk about Crohns disease. Dr. Squirrell is a staff gastroenterologist at Queen’s University and has a special expertise in inflammatory bowel disease. In this two part series, we first talk about the diagnosis of crohns disease and the different patterns of its presentation. In part 2, we talk about the changing landscape of medical therapy for Crohns disease and how Dr. Squirrell approaches the treatment of Crohns. Make sure to check out the links below for all the papers that are discussed in both part 1 and part 2 of this series. 

Links:

1.  Is there an optimal sequence of biologic therapies for inflammatory bowel disease? – Brian Bressler: https://journals.sagepub.com/doi/10.1177/17562848231159452
2. Vedolizumab as Induction and Maintenance Therapy for Crohn's Disease – Sandborn et al. - https://www.nejm.org/doi/full/10.1056/NEJMoa1215739
   • They measured Clinical remission at week 6 and did have a significant result in one of their groups (p=0.02) but had a remission rate of 14.5% in the double-blind group and 17.7% in the open label group. Contrasted to the ustekinumab study (below) where they measured at 8 weeks and record 40.2% remission in biologic naïve patients and 20.9% remission in prior TNF exposed patients (the vedo study was a mix of bio exposed and bio naïve so would expect somewhere between). 
3.  Ustekinumab as Induction and Maintenance Therapy for Crohn’s Disease – Feagan et al. - https://nejm.org/doi/full/10.1056/NEJMoa1602773#APPNEJMoa1602773SUP
4. ECCO-ESCP Consensus on Surgery for Crohn’s Disease – Bemelman et al. - https://academic.oup.com/ecco-jcc/article/12/1/1/3813784
5. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis – Ytterberg et al. - https://www.nejm.org/doi/full/10.1056/NEJMoa2109927
6. ACG Clinical Guideline: Management of Crohn's Disease in Adults – Lichtenstein et al. - https://journals-lww-com.proxy.queensu.ca/ajg/Fulltext/2018/04000/ACG_Clinical_Guideline__Management_of_Crohn_s.10.aspx
7. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Luminal Crohn’s Disease – Panaccione et al. - https://www.cag-acg.org/images/publications/CAG-CPG-Luminal-Crohns-Disease-JCAG-July2019.pdf   

This is a re-broadcast to honour the memory of the "Boss" Dr. Feliciano.

Original shownotes:

It’s not an understatement to say that Dr. David Feliciano is a true giant in trauma surgery. Dr. David V. Feliciano received his medical degree in 1970 from Georgetown University in Washington, D.C. He completed his general surgery training at Mayo Clinic, in trauma at Wayne State University, and vascular surgery at Baylor College of Medicine (where he trained under Dr. DeBakey). He was Professor of Surgery at Emory University and Surgeon-in-Chief at Grady Memorial Hospital in Atlanta, Georgia from 1991 to 2011. He is now a Clinical Professor of Surgery at the University of Maryland and an attending surgeon at Shock Trauma.

We discuss with him how he recruited such amazing faculty, developing one’s technical skills, research, and the future of trauma.

1.Trauma textbook: www.amazon.ca/Trauma-Eighth-Erne…oore/dp/1259860671

2.“Everything You Ever Wanted to Know about Trauma” public lecture: www.youtube.com/watch?v=99yddsDe6oU

3.“Leftovers” by Dr. Feliciano has one of the best lines in a paper ever: At this point, the chief surgical resident on the trauma service met with the attending surgeon for violating his own well-known rule—“wounds that don’t heal contain dead tissue, infected tissue, cancer, or a foreign body.” www.ncbi.nlm.nih.gov/pmc/articles/PMC6263419/

4.Pitfalls in the management of peripheral vascular injuries. www.ncbi.nlm.nih.gov/pmc/articles/PMC5877918/

This week we were joined by an icon of surgery, Dr. Ken Mattox. Dr. Mattox talked to us about the evolution of trauma surgery, the development of the Trauma textbook, the Las Vegas Trauma, Critical Care, and Acute Care Surgery Conference, and why he thinks we need to challenge the status quo.

Links:

1. Trauma textbook: https://www.amazon.ca/Trauma-Seventh-Kenneth-L-Mattox/dp/0071663517

2. Top Knife: https://www.amazon.ca/Top-Knife-Craft-Trauma-Surgery/dp/1903378222

3. Comment on trauma care systems in Saudi Arabia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931788/

4. Trauma, Critical Care, and Acute Care Surgery (TCCACS) Las Vegas course: https://www.trauma-criticalcare.com/tccacs/home/

5. Quiet Zone Facebook group: https://www.facebook.com/groups/538557893206223/

6. Randomized trial of pneumatic antishock garments in the prehospital management of penetrating abdominal injuries. https://pubmed.ncbi.nlm.nih.gov/3578970/

7. Extreme Ownership: How U.S. Navy SEALs Lead and Win. https://www.amazon.ca/Extreme-Ownership-U-S-Navy-SEALs/dp/1250067057

View full episode transcript: http://canjsurg.ca/cold-steel-episode-80-kenneth-mattox/ 

Bio (from https://www.bcm.edu/departments/surgery/meet-our-team/history-of-leadership/kenneth-l-mattox-m-d):

Dr. Kenneth L. Mattox is a distinguished service professor at Baylor College of Medicine and formerly chief of staff and surgeon-in-chief at Ben Taub Hospital, where he has worked since 1973.  One of his most remarkable contributions was his work in establishing and developing the internationally renowned Ben Taub Hospital Emergency Center and Trauma Center. Dr. Mattox is past President of the American Association for the Surgery of Trauma and Secretary-Treasurer of the Michael E. DeBakey International Surgical Society. He previously chaired the Mayor's Red Ribbon Committee to address the Houston Fire Department Emergency Medical Service. He sat on the Hospital Subcommittee of the Mayor's Special Task Force on the Medical Aspects of Disaster. Currently, Dr. Mattox serves as a consultant to the Center for Biologic Evaluation and Research of the FDA.

Dr. Mattox has served on the Board of Directors of the Rotary Club of Houston, Doctors’ Club of Houston, Wayland Baptist University, the American Association for the Surgery of Trauma, the Southeast Texas Trauma Regional Advisory Council, the American College of Surgeons Board of Governors, and serves as Chairman of the Board of the John P. McGovern Museum for Health and Medical Science.

Leena Yousefi is a multiple award winning family lawyer and founder of YLaw in Vancouver, BC. We asked her to come on the show to talk a difficult subject: divorce. Leena has some really insightful comments on some of the factors that specifically seem to play a role in physician divorce, as well as some of the advice she gives her clients who unfortunately end up going through a divorce.

YLaw website: https://www.ylaw.ca/
YLaw twitter: https://twitter.com/ylawfamilylaw?s=20
Leena Yousefi featured on BBC: https://www.bbc.com/news/business-52481276

Bio (from YLaw website): 

Leena (Ronak) Yousefi is a multi award winning family lawyer, accredited mediator and the founder of YLaw, the fastest growing female-led law firm in Western Canada.

She has been chosen as one of the Top 25 Most Influential Lawyers in Canada, one of  Business in Vancouver’s Top 40 under 40, and voted as the #1 top-rated Vancouver Divorce Lawyer in BC*. She has won over 90% of her family law cases from 2013 to present*.

In 2020, she was named by Lexpert as the only family lawyer in Canada to become the Rising Star of the legal profession.

Dr. Brian Cameron is a pediatric surgeon at McMaster University in Hamilton, Ontario. He has dedicated himself both to pediatric surgery and to global surgery, and has worked around the world in resource-limited settings. This was a particularly memorable episode for us because Dr. Cameron retires this year! This episode was a chance for us to ask him about his career, his life story, and of course, global surgery. Congratulations again to Dr. Cameron on his well-earned retirement!

Links:

1. Establishing disability weights for congenital pediatric surgical conditions: a multi-modal approach. Poenaru D, Pemberton J, Frankfurter C, Cameron BH, Stolk E. Popul Health Metr. 2017 Mar 4;15(1):8. doi: 10.1186/s12963-017-0125-5. PMID: 28259148 Free PMC article.

2. Procedural skills training for Canadian medical students participating in international electives. Margolick J, Kanters D, Cameron BH. Can Med Educ J. 2015 Apr 20;6(1):e23-33. eCollection 2015. PMID: 26451227 Free PMC article.

3. Surgical training in Guyana: the next generation.
Cameron BH, Martin C, Rambaran M.
Can J Surg. 2015 Feb;58(1):7-9. doi: 10.1503/cjs.010414.
PMID: 25621909 Free PMC article.

4. Evaluating the long-term impact of the Trauma Team Training course in Guyana: an explanatory mixed-methods approach.
Pemberton J, Rambaran M, Cameron BH.
Am J Surg. 2013 Feb;205(2):119-24. doi: 
10.1016/j.amjsurg.2012.08.004. Epub 2012 Dec 13.
PMID: 23246285

5. International surgery: the development of postgraduate surgical training in Guyana.
Cameron BH, Rambaran M, Sharma DP, Taylor RH.
Can J Surg. 2010 Feb;53(1):11-6.
PMID: 20100407 Free PMC article.

6. Teaching in Fiji: practising medicine, coping with coups.
Cameron BH.
CMAJ. 1989 Apr 1;140(7):833-5.
PMID: 2924235 Free PMC article. No abstract available.

7. Lancet commission on global surgery: https://www.thelancet.com/commissions/global-surgery

8. Bethune Roundtable: https://www.cnis.ca/what-we-do/public-engagement-in-canada/bethune-round-table/

9. Morad Hameed Trauma system app: https://www.em-consulte.com/article/859211/the-electronic-trauma-health-record-design-and-usa

10. Masters of Global Surgical Care at UBC: https://www.grad.ubc.ca/prospective-students/graduate-degree-programs/master-global-surgical-care

Bio ( from https://www.ccghr.ca/q-brian-cameron/):

Dr. Brian Cameron is a Professor of Pediatric Surgery at McMaster University and a pediatric surgeon at McMaster Children Hospital. He is the director of both the McMaster International Surgery Desk and MacGlObAS. His research interests include global surgical research and education.

This week we have a treat for our listeners – two episodes with Dr. Colin Schieman. Dr. Schieman is a thoracic surgeon at the University of Calgary and the current program director for the thoracic surgery program. We discuss a key issue in modern surgical training – are direct entry programs good or bad for training and trainees? Dr. Schieman also gives his approach for intra operative teaching. 

Don’t forget to check out our bonus episode this week, where Dr. Schieman gives us his approach to lung nodules and lung cancer screening!

Links:

1. Scott Gmora: https://soundcloud.com/cjs-podcast/e05-scott-gmora-on-surgical-training

2. Thoracic surgery training in Canada: https://www.jtcvs.org/article/S0022-5223(16)31423-4/pdf

3. General thoracic surgical training in North America: Contrasting general thoracic surgery residencies in Canada and the United States. https://www.sciencedirect.com/science/article/pii/S0022522318318579?via%3Dihub

Bio:
Dr. Colin Schieman is a Clinical Associate Professor at the University of Calgary in the section of thoracic surgery. He did medical school, residency, and thoracic surgery fellowship at the University of Calgary. He then went on to do additional thoracic surgery training at Mayo Clinic, and subsequently practiced at St. Joseph's Hospital in Hamilton, Ontario. He came back to the University of Calgary as Assistant Professor in 2016, and is now the Program Director for the Thoracic Surgery Fellowship program.

E77 Masterclass With Colin Schieman On Lung Nodules And Lung Cancer Screening by Canadian Journal of Surgery

Dr. Peter Angelos (https://twitter.com/pangelos1?s=20) is an endocrine surgeon at the University of Chicago and is really one of the founders of the field of surgical ethics. We ask him to define for us the term “surgical ethics” and chat about a number of important ethical issues such as informed consent, paternalism, and the limits of disclosure. 

Links:

1. SOUTHWESTERN SURGICAL CONGRESS EDGAR J. POTH MEMORIAL LECTURE. Surgical ethics and the challenge of surgical innovation. https://www.americanjournalofsurgery.com/article/S0002-9610(14)00457-7/fulltext

2. Dr. Angelos’s column on MD Edge: https://www.mdedge.com/authors/peter-angelos-md-phd-facs

3.The personal dimension of informed consent: https://www.mdedge.com/surgery/article/79179/personal-dimension-informed-consent

4. David Urbach on the word “leaks”: https://soundcloud.com/cjs-podcast/e17-david-urbach-on-checklists-wait-times-in-the-time-of-covid-and-medical-devices

5. Tim Pawlik: https://soundcloud.com/cjs-podcast/e26-tim-pawlik-on-surgical-regret-leadership-and-academic-success

6. The Right Choice? Paternalism, Autonomy, and the Incidental Finding. https://www.mdedge.com/surgery/article/88487/right-choice-paternalism-autonomy-and-incidental-finding 

7. How was your night, Doc? The limits of disclosure in preop. https://www.mdedge.com/obgyn/article/77752/how-was-your-night-doc-limits-disclosure-preop

8. How to Solve Ethical Conflicts in Everyday Surgical Practice: A Toolbox. https://link.springer.com/chapter/10.1007%2F978-3-030-05964-4_29

Bio (from https://www.uchicagomedicine.org/find-a-physician/physician/peter-angelos)

Peter Angelos, MD, PhD, is a highly regarded surgeon who has extensive experience in surgery of the thyroid, parathyroid and adrenal glands. He is also an expert in treating endocrine cancers, including thyroid, parathyroid and adrenocortical cancers, as well as islet cell tumors of the pancreas.

Dr. Angelos has a special interest in minimally invasive endocrine surgery, a type of surgery that is performed through small incisions. Minimally invasive surgery has many benefits for patients -- from less scarring and pain, to a shorter hospital stay and a quicker recovery.

An accomplished author, Dr. Angelos has published many journal articles and book chapters on his research into improving outcomes of thyroid and parathyroid surgery, minimally invasive endocrine surgery and best practices for thyroid cancer treatment.

Dr. Angelos is a recognized expert in medical ethics, and serves as associate director of the University of Chicago MacLean Center for Clinical Medical Ethics. He has written widely on ethical issues in surgical practice and how to best teach medical ethics to surgical residents.

He is past president of the American Association of Endocrine Surgeons.

Jessica Grossman is a digital marketer, actress and model. She also is a powerful advocate for patients with Crohns disease. She specifically has done so much to destigmatize what it’s like to live with a stoma, which is a surgically created opening that allows stool to exit the body into a bag. Her work with her website uncoverostomy.org has garnered widespread attention and is an incredible resource for patients with inflammatory bowel disease. In this episode, we explored what it’s like to live with a stoma, and what physicians and surgeons can do better when counseling patients who might have or need a stoma. 
Jessica's social media:

Instagram: https://www.instagram.com/jessgrossman/?hl=en
Twitter: https://twitter.com/JessGrossman?s=20

Uncoverostomy on Social Media:
Twitter: https://twitter.com/uncoverostomy?s=20
Instagram:  https://www.instagram.com/uncoverostomy/

Links:

1. https://uncoverostomy.org/
2. https://uncoverostomy.org/2021/04/22/the-covid-19-vaccine-whats-the-worst-that-can-happen/
3. https://uncoverostomy.org/2019/10/03/time-stop-showing-off-ostomy-10-years-uncover-ostomy/