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10 Questions from an Interview with Richard Reznick

Current Surgery Chair to Assume the Role of Dean of The Faculty of Health Sciences at Queen's University

Cheryl and Richard Reznick
Cheryl and Richard Reznick

Q1: Why are you leaving and going to Queen's University in July as the dean of the Medical School?

A: This is one of the greatest surgical departments in the world, with spectacular talent in all disciplines and wonderful programs. I have been the chairman for nearly 8 years. I think that during the next two years I would participate in incremental changes, not transformative ones. We are all restless to some extent; restless for change, restless for a new challenge.

Eight years ago I was offered the opportunity to become dean at another medical school but took this job instead. So I've thought a lot about what it means to be a dean. I feel I am now poised and ready for a dean's role. The orbit of a dean is different; there is more involvement with government, with the boards of all the affiliated hospitals, and an opportunity to serve as the point of contact for the university with the Ministries of Education and Health. The enterprise is more complex; it includes all the basic science disciplines, and the deans participate more on the national stage. The 17 deans of medicine in Canada meet regularly and advocate for the research enterprise on a national level.

Q2: Can you give some examples of opportunities you have had to participate in transformative change?

A: I had the opportunity to revamp the licensure examination for physicians in Canada, introducing the OSCE exam. I was given the opportunity by Alan Hudson and Arnie Aberman to form the Wilson Centre. The Wilson Centre is now a research centre - its subject is education, but it is a research centre with significant publications, grants, eleven scientists and twenty graduate students per year. We have trained 30 surgeons to the Masters level in Education, many in skills-related activity. Brian Hodges is doing a spectacular job as director, expanding the programs I was privileged to start as the first director. Allan Okrainec and his international telesurgery program is a product of this focus, populating a new concept in international training (Teaching Minimal Access Surgery in Africa Using Skype, The Surgical Spotlight, Winter 2009)

In the Wilson Centre, our checklist project on communication with Lorelei Lingard led to significant changes in the operating room and formed the basis for the international surgical checklist project, so well executed at the University Health Network by Bryce Taylor and his colleagues and at other sites throughout the world. (see Surgical Spotlight Winter 2009) [All surgical readers will enjoy Atul Gawande's recently published book "The Checklist Project", in which Atul gives appropriate credit to Lingard and Reznick as initiators. Ed]. The important lesson from this project is that it is not enough to learn the motor skills required for performing an operation - it's critical to know how to make it all work safely.

I am extremely proud of our Surgical Skills Centre at Mount Sinai Hospital. This centre, under the leadership of Helen MacRae and stewardship of Lisa Satterthwaite, has become known world-wide. It has been a fantastic addition to our surgical education programs.

The new concept of a Competency Based Curriculum for training surgical residents being developed in the orthopaedic division is the most exciting project I have had the opportunity to work on in my twenty-year career. It is currently at the proof of principle stage, but will potentially compete with the Halstedian model dominant throughout the world. Its goal is to meet the current challenges we face in training by creating a very different educational model. If we are to train surgeons who are better than we are, we will have to change, and change fundamentally.

Q3: I know you don't like the word legacy because it is too pretentious. For the moment, what would you say best describes your most important contribution?

A: I believe my most important contribution is helping to establish surgical education as a bona fide academic focus. Twenty years ago 98% of surgical chairs would have discouraged a young faculty member from pursuing education as an academic route. Today, almost all surgical chairs would be supportive.

In the microcosm of the department, my most important contribution has been to be the glue binding the department together. I've cared about each faculty member, and worked hard to help them. I think that if they were asked a two part question about caring and helping, they would probably answer 'yes' to both. Importantly, all our division heads and surgeons-in-chief do the same thing.

Q4: How did that come about?

A: During my first year, I met with every surgeon in the faculty. I took University Rounds and Gallie Day seriously to bind the department together, reminding us of our unity. I tried to be present in some division every week - at a dinner, a retreat, a fund raiser; providing the departmental glue.

Q5: What are you proud of?

A: The department has come together more. There is a sense of partnership, belonging and coherence around sensible goals like the Spine Program, the Integrated Trauma Program and the Bariatric Program. One hospital couldn't provide these programs in their entirety, but a consortium of up to five or six hospitals could. The bariatric program in particular is proving that we can work as a consortium of hospitals as "The University of Toronto Bariatric Surgery Program". It's a unique entity that we took to the government, and it was adopted and funded on the strength of a collective and comprehensive approach.

There is now near total compliance with our departmental practice plans. This is bringing about a cultural change to team practice instead of a solo practitioner mindset. Eighty new surgeons and scientists have been hired out of our faculty of 250. This has been incredibly rewarding. We brought Humber Hospital, Trillium, Credit Valley and North York Hospital into the University family, enhancing the sphere of Toronto surgical training. Our trainees need a breadth of experience that is best provided across a spectrum of hospitals.

I introduced the mandatory search process in order to bring all the right people together, so that when the memoranda of agreement of new surgeons are signed, all those necessary to help them reach their goal are at the table and committed to their success.

Q6: What is the Karolinska prize (see Awards section) that you have recently received ?

A: The Gunnar Hoglund and Anna - Stina Malmborg Foundation insightfully recognized that the Karolinska celebrates excellence in science and medicine with the Nobel prize, but medical education, the foundation of these disciplines, is not similarly recognized. They founded this prize to recognize contributions to medical education. I will be the fourth person to receive it, shared this year with Professor David Irby from the University of California in San Francisco.

Q7: Who are the mentors and leaders you would like to have acknowledged?

A: There are too many of them to list. I have been the beneficiary of career advice from many wise teachers and colleagues who endorsed and advanced my choices. I have also had the benefit of a superb executive committee in the Department and the remarkable common sense advice of our associate chair Bryce Taylor.

Q8: How is the financial health of the Department?

A: We have been extremely fortunate to receive over 40 million dollars in grants thanks to Ori Rotstein and more recently Ben Alman as vice-chairs for research. The finances of our department have been good despite a recession and constant pressures to contain costs. We were the first department to hire an advancement officer and this has helped keep the Department financially sound.

Q9: Besides the glue, what management techniques brought the members of this complex Surgery Department on board and developed such a cohesive feeling of unity and common purpose?

A: I made it flat, not hierarchical. To get things done I empowered people in their own territory. I think of my job as that of helper - helping division chiefs run their divisions or helping John Bohnen run his highly successful accreditation effort. There are no uphill battles where there are no hills, that's the advantage of a flat management program. At the start of my term, I asked the Banting office staff in our first meeting: "Do you know who your boss is?" I made it clear that the answer is: "Our two hundred surgeons. We are here to serve them".

Q10: Any closing thoughts?

A: Three words that come to mind are: privilege, hard work and fun. It has been a privilege to serve as chairman, the work has been hard and it has been fun [The fun test is a very reliable measure of competence. The only people who are having fun skiing the expert slopes or performing complex procedures are those who have the expertise to enjoy them. Ed.]

The support from my wife, Cheryl, has been dedicated, constant and amazing. I have never felt pulled two ways. Few people in the world experience that kind of support. It was always "I'll be there" - never "why aren't you here?"


Richard Reznick and I concluded that we would collaborate on this interview in lieu of his final column. Richard, we thank you for all you have done for each of us. We wish you continued success in the next exciting iteration of your remarkable career. Ed.

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