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Editor's Column: Managing Surgical Science

Martin McKneally
Martin McKneally

In this issue of the Spotlight we report events of the past fall, and celebrate the outstanding Undergraduate Surgical Education Program developed by David Backstein, Yaron Shargall and Carmela Calorendi. We also welcome our new residents to the Department and to the dynamic and complex field of study Surgery has become.

Its complexity is exemplified in the remarkable story of the surgeon scientist Maria Siemionow. Her persistence and scholarship in developing face transplantation- for patients deformed beyond description - exemplifies the leading edge of our specialty. Her November presentation described on page 11 brought tears of pride to the eyes and thunderous applause from a packed auditorium at the Hospital for Sick Children. Her story illustrates the commitment, courage, determination and management skills of a great surgeon. The coordination of a team of 30 in the operating room is only the capstone example of the complexity of the enterprise she managed for over a decade. Its psychological, ethical, legal, organizational and resource issues and the ingenuity required to resolve them could only be described by the surgeon who accomplished this tour de force.

Similarly, the laboratory science programs led by Barry Rubin and Subodh Verma (described on page 11) featured collaborating scientists all over the world. As Ori Rotstein remarked, we do not really teach this complex management of science, except by example. Bryce Taylor's excellent book on effective medical leadership presents principles and techniques for managing teams in large clinical organizations. Perhaps his advice can be adapted to the scientific surgical enterprise by one or more of our surgeon scientists who are privileged to work with exemplars like these. The trial of deep brain stimulation coordinated by Andres Lozano will involve surgeons at 18 centres. Natalie Coburn's international expert panel brought together

scholars from around the world, and will soon involve collecting data from surgeons throughout the province of Ontario. Mohit Bhandari's study of tibial fractures and other international trials that he is developing further exemplify the need for skilled management of surgical science on a large scale.

David Latter reminds us that preparing surgeon scientists to lead the world cannot be accomplished without sufficient practice. As a result of the legally mandated limit of 48 hours of duty per week, bright dynamic surgical trainees are leaving the U.K. and Europe for less constricted programs in North America, Australia and the Far East where they can apply their energy and enthusiasm to learning surgical science in its current state of growth and development. The challenge to our department and to surgery in general is to provide the opportunities and role models needed to develop the knowledge skill and judgment that defines outstanding surgeons while maintaining life balance. A recent survey (1) of residents in the United States clearly indicates that renovation of the educational process is needed. These residents believe that limitation of duty hours won't improve their education, will lengthen their training, but will improve the quality of their lives during training. The initiatives underway in our department to renovate the Halstedian training model puts us at the leading edge of surgical education.

A spirited gathering of the families of our department was hosted at our Holiday Party at Far Niente by David and Sharon Latter. As we celebrate how fortunate we are, I encourage you in the giving spirit of the holidays to contribute to your department and your division for the education of our new residents. We wish them well on their entry into the world of surgery and send warm holiday greetings to all of our readers.

(1) Drolet, Brian, M.D., Spalluto, Lucy M.D., and Fischer, Staci, M.D. Residents' Perspectives on ACGME Regulation of Supervision and Duty Hours - A National Survey, N Engl J Med 2010; 363:e34

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