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Editor's Column

Martin McKneally
Martin McKneally

In this issue of the Spotlight, we celebrate the arrival of a talented group of residents, who will carry on the tradition of surgical scholarship exemplified by Bill Bigelow.

Those following Bill’s legacy into cardiac surgery have entered a six year direct entry residency. This innovative entry program in General Thoracic Surgery was also established in Canada in 1994 (1). Only recently a few training programs the United States have experimented with direct entry into cardio-thoracic surgery. In the November issue of the Annals of Thoracic Surgery, an early report from Mount Sinai Hospital in New York City indicates that their new 6 year direct entry program is attracting academically excellent candidates - similar to Jordan Van Orman p11 - with advanced degrees and more life experience than recent medical school graduates applying to the traditional programs (2).

A direct entry program was established at the same time in Canada in General Thoracic Surgery. This proved impractical, as graduates who entered practice settings where they were the only thoracic surgeon in town were required to share on-call duties in general surgery. They were undertrained for this scope of responsibility and lacked adequate cross-coverage of their own specialty. Focused training may become more practical for Thoracic Surgery as regionalization of develops, concentrating the operations and practitioners in specialized centers the way cardiac surgery is organized.

Like our Department of Surgery, Canada has a communitarian ethic that enables cooperation toward agreed upon goals like these. This requires some sacrifice of individualism for the good of the community. Sid Levitsky drew attention to this attribute in his Bigelow Lecture p7. He reminded us that Canadians share a background derived from an imperial culture, whereas the entrepreneurial competitive character of US surgery and medicine derive from a revolutionary culture. The collaborative approach has fostered the development of a nearly universal system of healthcare insurance in Canada and a co-operative approach to healthcare delivery, illustrated in this issue by Mike Tymianski’s Neurosurgery colleagues at the Toronto Western Hospital.

As the country enters a two year period of discussion leading to the 2014 renewal of the Canadian Healthcare Act, we will need similar professional models of care delivery and management of the health enterprise to renew and sustain our practice. Our surgeons have developed exemplary programs of efficient care in the surgical treatment of trauma, obesity, cancer, cataracts, cardiac and joint disease. Stitching these and similar programs together, integrating them effectively with homecare and family practice, and coordinating the whole into a system are challenges for the next several years.

The resources needed to accomplish these goals will take more than the public currently invests in healthcare. It is encouraging to see the investment by philanthropists like the late Jim McCutcheon, Terry Donnelly, Peter Munk, Seymour Schulich and other donors. The Li Ka Shing auditorium where Jim Rutka gave his annual address and the five new operating rooms planned for St. Michael’s Hospital indicate the growing support and insight into the needs of Canadian Healthcare.

Surgeons can provide much of the leadership required for this transformation, because of their accustomed role as responsible decision makers. Our contribution can be strengthened by the kind of management and business training Mike Tymianski receives from his company’s board of directors.

As we enter the winter season of holiday gatherings with family and friends, let’s be grateful for the satisfactions we derive from our work, for the richness of our professional lives, and the good fortune we enjoy – to be members of the remarkable department described in this issue.


1. Mulder, D., McKneally, M. The education of thoracic and cardiac Surgeons: A canadian initiative; Ann Thorac Surg, 1995;60:236-238

2. Chikwe, J., Brewer, Z., Goldstone, A., Adams, D. Integrated Thoracic Residency Program Applicants: The Best and the Brightest?, Ann Thorac Surg , 2011;92:1586-1591

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