The Elephant, the Rider and the Path:
A Time of Transition in the Department
David Latter
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Three months ago Richard
Reznick announced that he had
accepted the position of Dean
of Health Sciences at Queen's
University. This ended his term
as Chair of the Department
two years earlier than expected.
During Richard's eight year term
the Department underwent significant
changes. I would like to
highlight some of the accomplishments
that Richard Reznick championed.
The number of faculty members steadily grew over the
last 8 years and now numbers 250 full time surgeons.
In particular the number of surgeon scientists grew the
most and this is reflected in the increased "footprint"
of scientific productivity that Ben Alman, our Vice
Chair of Research, has so eloquently described (1).Our
rate of successful grant capture continues to be one
of the highest of all surgical departments in North
America.
The Surgeon Scientist Program is flourishing. A few
years ago there were serious concerns about the financial
viability of the program With thoughtful restructuring
of the program's method of revenue collection, improved
support from the Ministry of Health, effective lobbying
for industry support, and the incredibly inspiring 25th
Surgeon Scientist Program Gala held this past spring, the
SSP financial health is strong.
Surgical education became much more rigorous under
Richard's watch. The Department now has over 30
surgeons with Masters of Education degrees. Our
residency programs are the strongest in the country
and as a result our residency training programs
almost always fill their entry positions completely on
the first round of the CaRMS match. An organized,
more education - based clinical fellowship program
has been implemented across the Department. The
results of these changes in our Department's clinical
fellowships have been noticed by other departments in
the Faculty of Medicine, and many have been copied.
The surgical skills lab continues to grow in its scope
of student users and teaching activities. Our surgeons
significantly outperform in terms of number of teaching
awards captured at the university level as well
as nationally and internationally. Integrated medical
education at partially affiliated community hospitals
started in the Department years ago and continues to
grow. Competency Based Curriculum, a novel concept
in medical education is actually happening here
in the Division of Orthopedics. Many have written
about competency based medical education, but few
had the determination to begin to use it. For sure it
is still a concept being explored but indications to
date point to success. (See the CBC article on pg 12).
The Department (mainly Richard) felt that the recent
PAIRO agreement that included a provision of "home
by 2 hours post call" would negatively affect the surgical
education of our residents. Based on this belief the
Department requested and was granted an exemption
to this provision. We were the only department in the
province that objected and received this exemption.
Critical care illness insurance was introduced. The
Department holds a policy that covers all of our full time
faculty for $60,000 of critical care insurance, a vital link
before disability insurance payments start.
Day care for all of our full time faculty was introduced to
help busy surgeons, usually our younger recruits, manage
the difficulties and costs of obtaining quality day care
for their children.
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Perhaps Richard's most significant accomplishment
during his eight year term was to be the glue that
binds us all together for the greater good. He always
tried to promote the feeling that we all have a role to
play for the Department. That message was effectively
delivered.
When Richard Reznick announced that he was accepting
the position of Dean of Health Sciences at Queen's
University it was clear that the Department of Surgery
was about to undergo a period of transition. This
change will be valuable, not because we are deficient,
but because it will give us an opportunity to review
and enhance our strengths, and improve in any areas
of weakness.
This summer I have been reading an interesting book
- Switch. How to Change Things When Change is Hard
by Chip and Dan Heath. It is about the mechanics of
change and how to make change work. They use an
analogy developed by University of Virginia psychologist
Jonathan Haidt. Haidt states that our emotional behaviour
is like an Elephant and our rational behaviour is like
a Rider that sits atop our Elephant trying to direct decisions
and behaviour. For any given task the Rider can do
a pretty good job of controlling the Elephant, but over
time if the Elephant and the Rider do not agree, there
will be a problem. And not surprisingly, the Elephant
will win. The Heath brothers add a third element to the
analogy called the Path. The Path helps both the Rider
and the Elephant to know where they are going. If the
Path to effective change is not clear then there is great
likelihood that eventually the Rider and the Elephant
will get confused at a fork in the road and disagree on
their next move. Progress - effective change- will be
stopped.
The authors of Switch discuss numerous strategies that
include: identifying "bright spots", carefully describe the
critical steps, clearly define the destination, use many
small changes to add up to a large effect, like growing
your people, etc. The strength of the book lies in the
many real life examples of exactly how effective change
was successfully accomplished. Particularly germane to
our environment, many of the examples are medical.
I recommend this book to anyone who has a vision of
how our Department might improve for the future. We
should be ready for our next Chair and be ready for some
changes in our path. While the path may not yet be
entirely clear to anyone, I think we can all agree that our
destination ought to be recognition as the best surgical
department in the world.
For the next 3-6 months I have the honour as serving
as the Interim Chair of the Department. My duty
is to make sure that the day to day mechanics of the
Department continue without interruption. As in any
organization of this size, new issues arise continuously
and I will endeavour to make sure they are handled
appropriately. In many ways, I can thank Richard
Reznick for having developed a departmental culture
of including many in the essential dealings of the
Department. As a result, as Vice Chair Education for
the Department, I was well informed and well prepared
to accept the interim position. More importantly,
numerous other surgeons play vital roles in the management
of the department and all of these able colleagues
have stepped up to assist me.
We all look forward to the search committee's selection
for our next Chair. This individual will be given an
incredible responsibility to continue the legacy of the
Department of Surgery at The University of Toronto.
We are strong but undoubtedly we can be better. The
next Chair will have an opportunity to reflect and build
on our status. He or she will likely consult far and
wide, inside and outside of the Department. With judgment,
knowledge, and input from all members of the
Department, the new Chair will begin to determine our
new path toward our destination. And then the Riders
and the Elephants in all of us will start a trip down this
new Path to an even better Department of Surgery.
David Latter
(1) See also The Surgical Spotlight, 2009, Fall, Our Department's Global Footprint
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