With Accreditation of our residency programs just around the corner, it is timely to provide you with the following update from the PGME office.  The following programs in the Department of Surgery have received an exemption from the on-site review:  Colorectal Surgery, Thoracic Surgery, Orthopaedics, and Vascular Surgery.  The following programs will undergo an on-site survey April 7 -13, 2013:  General Surgery, Cardiac Surgery, General Surgical Oncology, Neurosurgery, Pediatric Surgery, Plastic Surgery, and Urology.  Thus seven of our programs will be undergoing formal on-site review.  In February, the Vice/Associate Deans will be meeting with groups of residents and on site-schedules for the reviews will be determined.  In March, presentations and documentation for meetings will be finalized.  Ron Levine, PGME Director in Surgery, has provided us with the following important tips leading up to the on-site review:

Top Tips for Accreditation:

  1. Each rotation must have specific goals and objectives that are made known to residents and faculty at the beginning of the rotation.
  2. ITERS should be completed in a timely manner, both at mid-term and at the end of the rotation, with face-to-face discussions.
  3. ITERS should be based on the specific goals and objectives of the rotation.
  4. The Residency Program Committee (RPC) must discuss the promotion of residents for each year of their residency.
  5. All junior surgical residents must go home by 12 noon the day after in house call.   
  6. Senior surgical residents can stay after 12 noon the day after in house call for educational purposes only.
  7. Each specialty should have a safety policy that is adhered to by residents and faculty of that specialty.
I should like to take this opportunity to thank all the Program Directors in Surgery, the RPC’s, faculty, and residents for their attention to the upcoming Accreditation by the Royal College.  I will continue to provide strong messaging of the importance of the Accreditation Process over the next two months leading up to the Review.


James T. Rutka, MD, PhD, FRCSC
RS McLaughlin Chair


Department of Surgery University Rounds
Friday, February 1, 2013
7:30 a.m. – 8:30 a.m.
Kergin Lecture


Gerald Imber, M.D.
Clinical Assistant Professor of Surgery
Weill-Cornell Medical College
New York, NY

“Dr. William Stewart Halsted; Father of Modern Surgery”
Women’s College Hospital
The first 100 people will receive a signed copy of Dr. Imber’s book free.
GALLIE DAY 2013 will be on Friday, May 10, 2013
This year’s theme is “Personalized Medicine”, and Dr. John Niederhuber, CEO of Inova Translational Medicine Institute, Falls Church, VA, will be the Gordon Murray Lecturer.   The Gallie Day Reception and Annual Dinner will be held at the Windsor Arms Hotel.  Further details to follow soon.
Zane Cohen Clinical Fellowship Achievement Award
The deadline for receipt to the Department of Surgery of each division’s nomination is March 31, 2013.

The Division of Anatomy participated in the Graduate and Undergraduate Research Information Fair on January 16, 2013 run by Graduate and Life Sciences Education (GLSE).  The fair was a success with approximately 550 students in attendance.  

University Rounds were held on Friday, January 11, 2013 at Women’s College Hospital.  Drs. Warren Chan, James Drake, and Victor Yang spoke on Research and Science. Photo from left to right: J. Drake, W. Chan, B. Alman, and V. Yang.

Toronto honours Dr. Bernard Langer with the Reunion of Hepatobiliary and Transplant Fellows  
On October 26, 2012 a reunion of alumni of the hepatobiliary (HPB) and Transplant Fellowships honoured Dr. Bernard Langer for his tremendous mentorship and contributions to their careers. Forty-nine former Fellows from Europe, Australia, Saudi Arabia, South America, throughout the USA and most provinces of Canada were joined by many current and former faculty to acknowledge and celebrate Dr. Langer’s international impact on HPB & Transplant Surgery.

Dr. Langer began the “Liver Surgery Fellowship” in 1984 which has expanded into the current HPB Surgical Oncology Fellowship and the Abdominal Organ Transplant Fellowship. To date, 68 Fellows have graduated to successful academic careers throughout the world. These two Toronto Fellowships have become highly attractive to Surgeons committed to training towards an academic career in HPB and/or Transplantation.

The tribute to Dr. Langer included an all-day symposium entitled “The Future of HPB & Transplant Surgery” at which former Fellows presented their academic accomplishments and speculated on the future. The day was concluded with a reception and black-tie dinner at the Sheraton Centre. Bernie was joined by his wife Ryna and their children Jack, Pearl, David, and Michael and their spouses. Following a toast to Ryna by Dr. Bryce Taylor and a toast to Bernie by Dr. Steve Strasberg, Dr. Langer was presented with an oil painting by Dr. John Palmer.

The entire reunion was characterized by a tremendous spirit of camaraderie amongst the Fellows, and their mentors. The profound impact of Dr. Langer on the fellows in attendance was clearly visible in this reunion of Toronto Alumni, many of whom have become international leaders in HPB and Transplant Surgery.  

2013 Visiting Lecturer for the Anand and Saroj Aggarwal South Asian Heart Health Endowed Lectureship
Subodh Verma has recently been named the 2013 Visiting Lecturer for the Anand and Saroj Aggarwal South Asian Heart Health Endowed Lectureship.  This invitation was extended by the University of Ottawa Heart Health Institute Foundation.
Appointment of Director of Undergraduate Surgical Education, Sunnybrook Health Sciences Centre
Fuad Moussa will be assuming the role of Director of Undergraduate Surgical Education at Sunnybrook Health Sciences Centre, effective February 1st.  Fuad will use his enthusiasm and vision to ensure students have an outstanding and memorable learning experience on their rotations. 
Top Downloaded Paper in Cardiothoracic Surgery:
Kazuhiro Yasufuku’s study on minimally invasive biopsies of mediastinal lymph nodes is on the list top downloaded papers in the leading CardioThoracic Journals in the world (Yasufuku K, et al.  The Journal of Thoracic and Cardiovascular Surgery, 142(6):1393-1400, 2011).
Toronto Video Atlas of Liver, Pancreas and Transplant Surgery:
Paul Grieg and colleagues have recently established a comprehensive video atlas on liver, pancreas, and transplant surgery.  Some of the videos on this site include liver transplant, pancreatico-duodenectomy, and liver resection.  This is an excellent educational offering to all residents, fellows and faculty in general surgery.  I encourage all of you to go to the website below to see the contents of this atlas first hand.

Revolutionary Scalpel-free Surgery
In a Canadian first, Sunnybrook and UHN brain scientists led by Kullervo Hynynen and Andrew Lozano have pioneered the use of MRI-guided focused ultrasound to successfully treat  patients who suffer from debilitating tremors in their arms and hands. 

New Appointments to the Department of Surgery
I am pleased to announce the appointments of the following new faculty members in the Department of Surgery.
Dr. Ivan Radovanovic has joined the Division of Neurosurgery at the Toronto Western Hospital as an Assistant Professor at the University of Toronto.  Dr. Radovanovic obtained his medical degree and residency training at the University of Geneva, Switzerland in 1998 and then a diploma in molecular biology and genetics from the University of Zurich in 2002. In 2003, he completed the equivalent of a PhD at the University of Zurich. He then completed his neurosurgery residency training at Geneva University Hospital, Division of Neurosurgery (1998- 2007). From 2008 to 2010, Dr. Radovanovic was a clinical fellow in Neuro-oncology/Skull base surgery and then in Cerebrovascular Surgery (2009- 2010). Both fellowships were completed at Toronto Western Hospital in Toronto.  Between 2010-2011, Dr. Radovanovic was staff neurosurgeon at Geneva University Hospitals, Department of Clinical Neurosciences, Division of Neurosurgery.

Dr. Anne O’Neill has joined the Division of Plastic and Reconstructive Surgery (PRS) at UHN as an Assistant Professor at the University of Toronto.  Dr. O’Neill received her medical degree from the National University of Ireland, Galway, graduating with honours in 1999. She commenced her training in PRS in 2002 and entered the Higher Surgical Training Program in 2006. Concurrently, she studied towards her Masters in Medical Sciences and then PhD at the National University of Galway, while conducting her research at the Massachusetts General Hospital and Harvard Medical School in Boston where she was a research fellow. This year, she completed the second Master of Science Degree in Translational Medicine at the University of Edinburgh. She has been a clinical fellow in Microsurgery at the Department of Plastic Surgery at the University Health Network since 2011.  She has presented her research at many international conferences and has also published a number of scientific papers. She will be working as a Surgeon-Investigator on breast and sarcoma reconstructive surgery outcomes as well as composite tissue allotransplantation.
Dr. Bartolomeu Nascimento has joined the Division of General Surgery at Sunnybrook Health Sciences Centre (SHSC) as an Assistant Professor at the University of Toronto.  Barto completed his medical degree (1998).  Barto did a clinical fellowship in Trauma and General Surgery Research at SHSC.  He then completed another fellowship (2006-2008) in Adult Critical Care Medicine. In 2008, he enrolled in the Clinician Investigator Program at the University of Toronto and graduated in 2010.   During this time he was enrolled in a third fellowship in Transfusion Medicine, followed by a fourth fellowship in Critical Care Medicine (2010-2011). Concurrently, he also studied towards his Master’s in Clinical Epidemiology at the University of Toronto, and defended his thesis in the fall of 2011.  Barto has 27 publications (24 in the past 5 years) to his credit.

Promotions in the Department of Surgery 
John Theodoropoulos (Division of Orthopaedics, Mount Sinai Hospital) was promoted to Assistant Professor from Lecturer.
Thomas Willett, PhD (Division of Orthopaedics, Mount Sinai and Lunenfeld Reseach Institute) was promoted to Assistant Professor from Lecturer. 

The following Continuing Appointment Reviews (CARs) took place this month under the leadership of Ori Rotstein, Associate Chair, Department of Surgery:

Lucas Murnaghan  
Lucas joined the Division of Orthopaedics at The Hospital for Sick Children in 2009 and is an Assistant Professor in the Department of Surgery at the University of Toronto.  Dr. Murnaghan studied at Queen’s University where he completed his undergraduate and medical degrees. His orthopaedic residency was completed at The University of British Columbia. During that time he participated in a one-year elective in medical education and obtained his Masters of Adult Education. His did a fellowship in Arthroscopy and Athletic Injuries in Vancouver.  His paediatric fellowship training included six months at Royal Children’s Hospital in Melbourne, Australia and a one-year fellowship at Texas Scottish Rite Hospital for Children in Dallas, Texas.  Dr. Murnaghan’s main area of clinical interest is the orthopaedic care of athletic injuries in the paediatric, adolescent and collegiate athlete. Dr. Murnaghan is devoted to education at the medical student, resident and fellowship level.  Photo from left to right:  B. Alman, J. Wright, L. Murnaghan, C-A. Moulton
Todd Mainprize 
Todd joined the Division of Neurosurgery at Sunnybrook Health Sciences Centre in 2008 as an Assistant Professor in the Department of Surgery at the University of Toronto.  Todd graduated from the University of Saskatchewan College of Medicine in 1996.  He entered the Neurosurgery Training Program at the University of Toronto the same year. After completing the residency with several years of basic science training in brain tumour research, he became a Fellow of the Royal College of Physicians and Surgeons of Canada in 2008. His main clinical interest is in Neuro-oncology. He has a strong interest in medical student, resident and fellow education.  Photo from left to right:  A. Nathens, T. Mainprize, A. Lozano, M. Schwartz
Graham Roche-Nagle 
Graham joined the Division of Vascular Surgery, Toronto General Hospital, UHN in 2009 as an Assistant Professor.  Dr Graham Roche-Nagle is a native of Waterford, Ireland. He received his medical degree from the Royal College of Surgeons in Ireland in 1998 and finished his clinical training on the Irish Senior Registrar Training Program. He then completed a 2 year fellowship in vascular surgery at Toronto General Hospital and St. Michaels Hospital, Toronto. He is certified in general vascular surgery from the Royal College of Surgeons in Ireland and also holds certification from the European Board for Vascular Surgery. Dr. Roche-Nagle has been awarded an MBA in Healthcare Management (University College Dublin) and a Masters in Medical Education (Queens University, Belfast). His specialty interests include open/endovascular abdominal aortic aneurysm repair, arterio-venous fistula construction, peripheral artery bypass/intervention, carotid artery surgery, venous disease as well as thoracic endovascular aortic aneurysm repair.  His research interests include quality improvement in healthcare, patient and physician education and clinical outcomes research.  Photo from left to right:  T. Lindsay, G. Roche-Nagle, S. Keshavjee

Subodh Verma (Cardiac Surgery) has been selected as this year’s recipient of the Royal College of Physicians and Surgeons of Canada Gold Medal Award in Surgery.  This award recognizes outstanding research performed by a Fellow of the Royal College who is early in his/her career.  Subodh received his award for his manuscript entitled “BRCA1 is an essential regulator of heart function and survival following myocardial infarction”.  Subodh holds a Canada Research Chair, and has multiple peer reviewed grants and publications to his credit. 
Michael Tymianski (Neurosurgery) received the 2012 Canadian Stroke Network Paul Morley Mentorship Award in recognition of his exceptional contributions to the next generation of stroke researchers. Dr. Tymianski has successfully trained, motivated and supported both clinical fellows as a neurosurgeon in the Department of Surgery and research trainees at the Krembil Neuroscience Centre.
Michael Fehlings (Neurosurgery) was honoured with the Cervical Spine Research Society (CSRS) Presidential Medallion for outstanding leadership and contributions to cervical spine research.  The presentation took place at the 40th Annual meeting in Chicago after serving his term as President.   Michael is the only Canadian surgeon to have served in this role for the CSRS.

John Trachtenberg (Urology) has been awarded the Queen’s Diamond Jubilee Medal in recognition of his work to improve care and raise prostate cancer awareness in Canada. 
Mingyao Lau (Scientist, Department of Surgery) was awarded the Queen’s Diamond Jubilee Medal by the Government of Ontario for recognition of his research in and contributions to cardiovascular diseases. 
Neil Fleshner (Urology) and colleagues received a new Canadian Cancer Society Research Institute (CCSRI) Impact Grant for his research on “Randomized double blind trial of metformin in reducing progression among men on expectant management for low risk prostate cancer: the MAST (Metformin Active Surveillance Trial) study.
Dimitri Anastakis has been appointed as President of the Association for Surgical Education.  Other members from the University of Toronto serving on the Board of Directors are Carol Anne Moulton (General Surgery), Chair of the Committee Program; and Lisa Satterthwaite (Surgical Skills Centre), Chair for the Nurses in Surgical Education Committee. 
Gelareh Zadeh along with co-PI Michael Siu from York University Proteomics received a CCSRI Innovation Grant for $185,000.00 over 2 years for their project titled “Prognostic pathway-centric signatures in glioblastoma multiforme”.

Camp MW, Mattingly DA, Gross AE, Nousiainen MT, Alman BA, McKneally MF.
Patients' views on surgeons' financial conflicts of interest.  J Bone Joint Surg Am. 2013 Jan 16;95(2):e91-98.
David TE, Armstrong S, Manlhiot C, McCrindle BW, Feindel CM.  Long-term results of aortic root repair using the reimplantation technique.  J Thorac Cardiovasc Surg. 2012 Dec 19. doi:pii: S0022-5223(12)01516-4.
de Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Nathens AB. The Clinical Course of 10,304 Patients with Acute Cholecystitis Discharged Without Cholecystectomy. Journal of Trauma and Acute Care Surgery. 2013;74: 26-31
de Mestral C, Gomez D, Haas B, Zagorski B, Rotstein OD, Nathens AB. Cholecystostomy: A bridge to hospital discharge but not delayed cholecystectomy. Journal of Trauma and Acute Care Surgery. 2013; 74:175-80.
de Perrot M, Eaton D, Bedard PL, Jewett M.  Anterior transpericardial approach for postchemotherapy residual midvisceral mediastinal mass in metastatic germ cell tumors.  J Thorac Cardiovasc Surg. 2013 Jan 8. doi:pii: S0022-5223(12)01533-1534.
de Perrot M, Eaton D, Bedard PL, Jewett M.  Mediastinal mass in metastatic germ cell tumors.  J Thorac Cardiovasc Surg. 2013 Jan 8. doi:pii: S0022-5223(12)01533-4.
Dibajnia P, Morshead CM.  Role of neural precursor cells in promoting repair following stroke.  Acta Pharmacol Sin. 2013 Jan;34(1):78-90.
Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PR.  External fixation versus open reduction with plate fixation for distal radius fractures: A meta-analysis of randomised controlled trials.  Injury. 2013 Jan 5.
Fallah A, Raghavan LV, Valiante TA.  Wearable video display allowing freedom in head positioning for brain mapping.  Can J Neurol Sci. 2013 Jan;40(1):106-108.
Ford DT.  Commentary on: Cosmetic Surgery Training in Canadian Plastic Surgery Residencies: Are We Training Competent Surgeons?  Aesthet Surg J. 2013 Jan 1;33(1):166.
Forrest CR, Hopper RA.  Craniofacial syndromes and surgery.  Plast Reconstr Surg. 2013 Jan;131(1):86e-109e.
George J, Fehlings MG.  Is Routine Postoperative Cervical Bracing After Instrumentation Necessary?  World Neurosurg. 2012 Dec 25. doi:pii: S1878-8750(12)01481-7.
Hanna WC, Yasufuku K.  Bronchoscopic staging of lung cancer. Ther Adv Respir Dis. 2012 Dec 20. [Epub ahead of print]
Hsiao M, Sathya C, Nathens AB, de Mestral C, Hill AD, Langer JC.  Is activity restriction appropriate for patients with hereditary spherocytosis?  A population-based analysis.  Ann Hematol. 2013 Jan 10. [Epub ahead of print]
Kotani Y, Honjo O, Davey L, Chetan D, Guerguerian AM, Gruenwald C.  Evolution of Technology, Establishment of Program, and Clinical Outcomes in Pediatric Extracorporeal Membrane Oxygenation: The "SickKids" Experience.  Artif Organs. 2013 Jan;37(1):21-28.
Kraft R, Herndon DN, Finnerty CC, Hiyama Y, Jeschke MG.  Association of postburn Fatty acids and triglycerides with clinical outcome in severely burned children.  J Clin Endocrinol Metab. 2013 Jan;98(1):314-321.
Laliberte AM, Fehlings MG.  The immunological response to spinal cord injury: Helpful or harmful?  Exp Neurol. 2013 Jan 15. doi:pii: S0014-4886(13)00021-6.
Lipsman N, Lozano AM.  Editorial: Obsessive-compulsive disorder.  J Neurosurg. 2012 Dec 14. [Epub ahead of print]
Malempati H, Wadey VM, Paquette S, Kreder HJ, Massicotte EM, Rampersaud R, Fisher C, Dvorak MF, Fehlings MG, Backstein D, Yee A.  Spinal Surgery Fellowship Education in Canada: Evaluation of Trainee and Supervisor Perspectives on Cognitive and Procedural Competencies.  Spine (Phila Pa 1976). 2013 Jan 1;38(1):83-91.
McGirr A, Cusimano MD.  Social support in normal pressure hydrocephalus: unmet tangible social support.  Can J Neurol Sci. 2013 Jan;40(1):94-96.
Nakajima T, Yasufuku K, Saegusa F, Fujiwara T, Sakairi Y, Hiroshima K, Nakatani Y, Yoshino I.  Rapid On-Site Cytologic Evaluation During Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Nodal Staging in Patients With Lung Cancer.  Ann Thorac Surg. 2012 Dec 12. doi:pii: S0003-4975(12)02164-9.
Salehi F, Jalali S, Alkins R, Lee JI, Lwu S, Burrell K, Gentili F, Croul S, Zadeh G.  Proteins involved in regulating bone invasion in skull base meningiomas.  Acta Neurochir (Wien). 2012 Dec 13. [Epub ahead of print]
Singh KK, Shukla PC, Yanagawa B, Quan A, Lovren F, Pan Y, Wagg CS, Teoh H, Lopaschuk GD, Verma S.  Regulating cardiac energy metabolism and bioenergetics by targeting the DNA damage repair protein BRCA1.  J Thorac Cardiovasc Surg. 2013 Jan 12. doi:pii: S0022-5223(12)01594-2.
Sun L, Huang CW, Wu J, Chen KJ, Li SH, Weisel RD, Rakowski H, Sung HW, Li RK.  The use of cationic microbubbles to improve ultrasound-targeted gene delivery to the ischemic myocardium.  Biomaterials. 2013 Mar;34(8):2107-2116.
Vawda R, Fehlings MG.  Mesenchymal Cells in the Treatment of Spinal Cord Injury : Current & Future Perspectives.  Curr Stem Cell Res Ther. 2012 Dec 24. [Epub ahead of print]
Wasserstein D, Farlinger C, Brull R, Mahomed N, Gandhi R.  Advanced Age, Obesity and Continuous Femoral Nerve Blockade are Independent Risk Factors for Inpatient Falls After Primary Total Knee Arthroplasty.  J Arthroplasty. 2012 Dec 19. doi:pii: S0883-5403(12)00615-8.
Willett TL, Sutty S, Gaspar A, Avery N, Grynpas M.  In vitro non-enzymatic ribation reduces post-yield strain accommodation in cortical bone.  Bone. 2013 Feb;52(2):611-622.
Wilson JR, Fehlings MG.  Riluzole for Acute Traumatic Spinal Cord Injury: A Promising Neuroprotective Treatment Strategy.  World Neurosurg. 2013 Jan 4. doi:pii: S1878-8750(13)00008-9.
Wong SS, Roche-Nagle G, Oreopoulos G.  Acute thrombosis of an abdominal aortic aneurysm presenting as cauda equina syndrome.  J Vasc Surg. 2013 Jan;57(1):218-220.
Wood MD, Gordon T, Kim H, Szynkaruk M, Phua P, Lafontaine C, Kemp SW, Shoichet MS, Borschel GH.  Fibrin gels containing GDNF microspheres increase axonal regeneration after delayed peripheral nerve repair.  Regen Med. 2013 Jan;8(1):27-37.
Wood MD, Gordon T, Kemp SW, Liu EH, Kim H, Shoichet MS, Borschel GH.  Functional motor recovery is improved due to local placement of GDNF microspheres after delayed nerve repair.  Biotechnol Bioeng. 2012 Dec 13. doi: 10.1002/bit.24800. [Epub ahead of print]
Yasufuku K, Feith JF.  Cytological specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration: Sample handling and role of rapid on-site evaluation.  Ann Pathol. 2012 Dec;32(6):e35-46.
Zywiel MG, Brandt JM, Overgaard CB, Cheung AC, Turgeon TR, Syed KA.  Fatal cardiomyopathy after revision total hip replacement for fracture of a ceramic liner.  Bone Joint J. 2013 Jan;95-B(1):31-37.
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