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Homer Tien Appointed the Major Sir Frederick Banting Chair

"Avery Nathens and I have been collaborating for more than a year in the development of a combined trauma program, starting while Avery was still at St. Michael's. We have organized a single fellowship in Trauma, as well as Joint Trauma Protocols and Joint Rounds. The fellows find the experience very enriching, as they see how different surgeons and others in the trauma programs of the 2 hospitals differ in their approaches. The fellowship has attracted excellent candidates from Canada and United States. This is a quantum leap for trauma in terms of scholarship and organization as well as care. The University of Toronto name provides great branding and gives us one voice, so that we can deal much more effectively with external agencies like the emergency medical transportation and government organizations. Avery brings great experience. Najma Ahmed is the Interim Director of Trauma at St. Michael's Hospital as well as the Program Director for General Surgery.

"Canadian Forces have a great relationship with academic centers by embedding their surgeons. In academic centers, we can keep our trauma skills up. We bring advances which often come from the military. The military has less research expertise, for example, in running randomized controlled trials. Sandro Rizoli's randomized controlled trial on transfusion was based on an idea from the war in Iraq, but had the advantage of the academic infrastructure.

"The Major Sir Frederick Banting Chair in Military Trauma Research recognizes the value of the academic centres for the military. In this role, I can seek civilian collaborators and fund research costs from the military budget. This is generally done as a block grant that comes with the Chair, but I can also go to the Department of Defense and others for more funds based on this entry access. It's a door to the Department of Defense.

Tien family

Homer Tien with Vivian and their three daughters Evalyn, Julia, and Abigail

What advice would you give to a student based on your experience?

"There is a traditional model for entering academic surgery. I went the non-traditional route, through the military. I was very fortunate to have Andy Smith, Robin Richards, Richard Reznick and Fred Brenaman as encouraging and thoughtful mentors. I originally intended to go into community general surgery. I was at Sunnybrook when 9/11 occurred. I signed up for the fellowship in Trauma and did research with Robin McLeod and Sandro Rizoli and Don Redelmeier as my academic mentors. My Master's Degree was in Clinical Epidemiology where I studied the causes of death in military personnel. The study was based on autopsy records kept in Ottawa. I spent the first year full time in research, the second year part-time while deploying some of the time for military duty. Frederick Banting was a military man." Homer had a lot to do with the development of the Chair, and he chose Sir Frederick Banting as the appropriate symbol.

Few know that Sir Frederick had a military career. He received the Military Cross for heroism in the battle of Cambrai, France during World War I. While serving as a medic, he tended the injuries of other soldiers for 16 hours despite his own wound. He later died of wounds and exposure following a plane crash during World War II en route to England to conduct research for the Canadian Air Force. "He led military research for the Canadian Forces in an era before there was a CIHR. He greatly preferred to be a frontline surgeon, compared to conducting research. He had already made his monumental contribution- the discovery of insulin. I can relate to his preference to be a frontline surgical officer."

Homer lives across the street from Sunnybrook. His wife Vivian has a dental practice in Stouffville and they have three children, ages 12, 10 and 6. 12 year old Abigail is a regional soccer player, involving the family in considerable travel. 10 year old Julia is a basketball and violin enthusiast.

His mentors in the military were doctors Hans Jung and J.R. Bernier, who were successively Surgeons-General in the Canadian Forces. "Both were great facilitators and importantly supported the publication of Canadian Forces supplements in the Journal of Trauma, the Canadian Journal of Surgery and the journal Injury, providing a repository of information to educate surgeons about the distinctive injuries that are characteristic of wartime, and to focus attention on war-related trauma research.

Currently there are several military surgeons in our department in addition to Homer: Andrew Beckett is a trauma fellow at St. Mike's, Dylan Pannell is a PGY2 in General Surgery, Josh Mayich is an orthopaedic fellow at St. Mike's. Gerald Slobogan was a fellow with Mike McKee and is now transferred to Vancouver. There are other military doctors in family medicine, intensive care and other programs. Queen's University has family medicine military people and Homer has added lectures to help train them in military trauma. He has also added didactic training in the Trauma section of our surgical residency, so that our residents are familiar with CBRI (i.e. chemical, blast, ballistic, biological radiation injury and mass casualty management).

"Surgery is a great adventure and a privilege. Patients walk in and trust you after 10 minutes exposure or less, based in large part on our University of Toronto training program. You can't view it as job and you have to love it."

What are the ethical issues that you face in your practice?

"The largest is bed occupancy and patient flow. Making beds available is complicated by the fact that patients like to stay at our centres. The rapport and trust that develops during their care makes them say ‘We don't want to leave' when it's time to transfer them to their own doctor or hospital. The second is resource allocation – triage is an essential skill in trauma surgery."

M.M.




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