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Changing the Guard in Undergraduate Medical Education

Carmela Calorendi with Ron Kodama

Carmela Calorendi with Ron Kodama

Having served as Director of Undergraduate Medical Education (UME) in the Department of Surgery for 7 years, David Backstein has stepped down from this position to focus on his academic position as Head of the Division of Orthopaedics at Mount Sinai Hospital. We take this opportunity to thank David sincerely for his tireless efforts and devotion to undergraduate medical education, and for putting into place a new curriculum for our students. Following a city-wide search this summer, I am pleased to report to you that George Christakis has been appointed as the new Director of UME. George is Professor of Cardiac Surgery with a long standing devotion to undergraduate education.

Assisting George Christakis with the UME program will be pre-clerkship coordinator, Ron Kodama, and newly appointed UME Coordinator, Shibu Thomas. Shibu is following in the footsteps of Carmela Calorendi who served capably in this role for 22 years. We would like to thank Carmela sincerely for her many years of service to the Department, and for assisting with the education of countless hundreds of medical students over those years.

Jim Rutka

Shibu Thomas


Shibu Thomas
Shibu Thomas

Undergraduate Surgical Education Coordinator Shibu Thomas, working with George Christakis, has taken a close look at the experience of our students and has made several useful recommendations. The Crash course, which helps assure that students enter their clinical rotation with sufficient background information "was excellent, but students couldn’t maintain their focus when the sessions ran from 8 AM to 6 PM". Shibu and George shortened the program to four days, running from 9 until 5. The fifth day is spent at the Li Ka Shing simulation centre in a hands-on trauma course, coordinated by Jameel Ali and his colleagues at St. Michael’s Hospital. This has been highly evaluated by the students. The next seven weeks are spent in 3 sub-rotations on surgical specialties, including one in general surgery.

All of the students are given an initial orientation on arrival and a handbook prepared by Shibu. They report that some of the rotations are "heavy on SCUT work (service component unrelated to training)", and they feel that they are not really perceived as part of the surgical team. This is an important insight e that requires remediation. At the mid- point of their rotation, there is a centralized lecture day with 2 hours of pediatric surgery, 2 hours of surgical radiology and one to three hours of palliative care. They also participate in an ungraded practice National Board of Medical Examiners exercise. At the end of the rotation, the students take the National Board of Medical Examiner’s test for credit. Their grade is based on an oral exam, the NBME exam and the ward evaluation, one third each. They are also required to bring their TRes, a log of their encounters and procedures, which can be entered from a portable device such as an i-phone or Blackberry.

Shibu was born in India, where his father was on attaché who traveled widely, giving Shibu a very varied life experience. He received a Master’s Degree in English at Bangalore and has worked as a copywriter and in administrative positions in healthcare on the wards and in the ICU within the University Health Network. He served as administrative coordinator for Plastic Surgery before taking his present position. He is enthused about his undergraduate responsibilities. He is a skilled medical writer who has prepared articles for U Toronto Medicine and other publications.


Attendants of the crash course

Crash Course in Surgery Nov. 11-3


  1. Know the goals and objectives of the surgery program
  2. Know the objectives of the course in surgery you are teaching
  3. Be familiar with key policies about student injury (e.g. Needlestick, student mistreatment)
  4. Get involved as a Program Based Learning tutor, mentor or scholar
  5. Take part in faculty development in the Department of surgery
  6. Watch your students interview and examine patients in the clinic
  7. Give students feedback regularly
  8. Be supportive and positive as role models
  9. Help students understand what careers in surgery are about
  10. Complete your student evaluations in a timely manner
Adam Rosanally
Adam Rosanally
Sindu Govindapillai
Sindu Govindapillai


Congratulations to our Year 3 students Adam Rosanally (Rotation E, Peters Boyd Academy) and Sindu Govindapillai (Rotation D, Wightman-Berris Academy) who scored 94% and 90% respectively, on the National Board of Examiners (NBME) Surgery examination.

A truly outstanding effort. Both Adam and Sindu need to be commended for the attitude, hard work, dedication and aptitude that these scores reflect.

Good luck with your studies and continued success in your future endeavours.

Shibu Thomas

George Christakis


George Christakis
George Christakis

George Christakis has been interested in surgery and surgical education since medical school. He received all of his medical and surgical training at the University of Toronto. Clerkship had the biggest impact on him, particularly exposure to surgeons Ulo Ambus, Bryce Taylor and John Palmer. He was inspired by the broad knowledge and critical thinking of these insightful role models.

George has always liked teaching undergraduates. He has written the learning objectives for the clerks on surgery, and participated in problem-based learning exercises with the first year students since 1990. He was the clerk coordinator at Sunnybrook, which provided excellent background for his current position. He likes to read history, and is currently reading "A World without Islam" by Graham Fowler. His children, Theodore, 13, Nicole, 12 and wife Monique travel, camp, and canoe together during vacation time.


A message from George


Those who know me know I don’t mince words. You’ll probably read some seemingly sacrilegious statements here. But please bear with me, I have a point. In fact, this is a result of a personal introspective exercise that made me reflect, ponder and then become charged with energy to institute positive change. I hope that for at least a few of you this will be a reason to look at things from a different perspective.

It has been a few months since I’ve taken on this role. I am daily reminded of, humbled, and applaud the efforts and insight that my predecessor, David Backstein and his team brought to the Department of Surgery education portfolio.

I know also, that there are some challenges and issues and shortcomings in the way we have been doing things. While the upcoming accreditation in May 2012 is a very important milestone for us, I see change as far more important as we seek to provide our students with an educational experience that is compelling, engaging and on par with the best in the world. The recent Independent Student Analysis (ISA) (www.md.utoronto.ca/Assets/FacMed+Digital+Assets/ ume/Accreditation/ISAfinal.pdf?method=1) findings are just manifestations of an underlying malaise in Undergraduate Education in the Department of Surgery. The following are some of my thoughts (in the form of, hopefully, thought-provoking questions) on this issue that I’d like to share with you.

Are we as University-appointed faculty seriously thinking about delivering quality education?

Is the level of interaction that we provide our undergraduate students on par with one that we (or our children) would be happy receiving?

Technology has changed, society has changed, and paradigms have shifted. Have our teaching methods effectively changed for the better?

Are we turning away some of the brightest young minds from a career in surgery by our perceived aloofness to clerks? This may be perception, but that is what may be often taken as reality.

Shouldn’t education in all its facets be the raison d’être of the University and the Department of Surgery in general and Undergraduate Education in particular?

In the upcoming issues of Surgical Spotlight, I hope to share with you a few ideas and policy changes - some mine, many from my colleagues in Surgery and a few mandated by the University UME.

This is not change that can be made by a few people, in weeks or months. It requires passion, perseverance, and steadfast purpose. I seek your assistance, encouragement, advice, support and best wishes as we embark on this exciting, important, and monumental endeavour - one little and progressive step at a time. Thank you for your contributions to undergraduate surgical education.


At the Clerkship Committee Meeting, chaired by Clerkship Director Undergraduate Medical Education Anita Rachlis, one of the points that was stressed at that meeting was the importance of the T-Res form being completed by our clerks.

I find this process to be very helpful as it gives us a checklist of the encounters and procedures that the clerks need to have been exposed to as part of their surgery rotation. If you are the "final preceptor," i.e. in the third surgical rotation of the 8 week period, we must have a plan to help students fulfill all the goals set out on the checklist, in the rare cases where a student has not had exposure to one of the clinical goals.

At the time of your clerk’s ward evaluation, please remember to ask them about this form (also referred to as Form 62 or 064)? Clerks have already been instructed to bring an updated form with them to their mid-term evaluation.

For your reference, T-Res forms can be viewed at: https://www.portal.utoronto.ca

Thank you,

George Christakis
Director, Undergraduate Education
Department of Surgery, Faculty of Medicine
University of Toronto

1. T-RES

T-Res is a mandatory component of the course and it lists the essential encounters and procedures that every clerk is expected to complete during their rotation. See image (Fig. 1) to see the manual logging sheet. The progress of a clerk’s T-Res compliance should be monitored at the time of the Midterm subrotation evaluation - see below.

2. Midterm subrotation evaluation form

This is used to provide formative feedback to the student at the midpoint of every subrotation.

3. MedSIS timeline for marks

Four (4) weeks after rotation for components, six (6) weeks for final marks. As per UME policy, component marks need to be published for students 4 weeks after their rotation. This means all evaluations forms need to be completed on MedSIS before this milestone. Optimally, all evaluations should be completed within one week of a clerk’s subrotation.

4. UME teacher manual

This is a very useful resource and is available online at http://www.md.utoronto.ca/handbook.htm

Figure 1: T-Res - Manual Logging Sheet 2011-2012 - Surgery

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