2013 Traveling Fellow reports on trip to Australia and New Zealand

BarnetandDimick_SkyTower

Drs. Barnett (left) and Dimick preparing to jump off the Sky Tower.

Dr.Hanney_bungeejumping

Dr. Hanney bungee jumping.

Drs.HanneyKao_Queenstown

Dr. Baxter with Drs. Hanney and Kao in Queenstown.

SkyTower

Sky Tower

St.VincentsHospitalMelbourne

St. Vincent’s Hospital in Melbourne.

SydneyOperaHouse

The Sydney Opera House, a work of art in light.

It was a great honor to have been selected the 2013 American College of Surgeons (ACS) Traveling Fellow to Australia and New Zealand (ANZ). The fellowship allowed me to travel across the world to visit spectacular places, learn from colleagues, and reconnect with old friends. This truly was a trip of a lifetime. The opportunity to visit surgeons in their practices in two countries, to learn about their training, their approach to patient care, and their health care system showed me that while we can learn a great deal from these differences, our worries, struggles, and successes are similar.

Well before my visit, the Australasians went out of their way to welcome me and help with planning. My experience started at the 2012 ACS Clinical Congress where I received a warm greeting from Ian Civil, MB, ChB, FACS, PRACS, a general and trauma surgeon at Auckland City Hospital, NZ, and president of the Royal Australasian College of Surgeons. He put me in contact with Ian Bissit, MD, FRACS, associate professor of surgery at the University of Auckland and head of the department of surgery and consultant colorectal surgeon at Auckland City Hospital, and Mattias Soop, MD, PhD, department of surgery, University of Auckland, NZ, who helped coordinate my involvement in the Royal Australasian College of Surgeons (RACS) Annual Meeting in Auckland. Dr. Civil advised me on specifics of the trip, including top places to visit.

Just before my visit “Down Under” I was greeted at the American Society of Colorectal Surgeons annual meeting by Bruce Waxman, MB, BS, FACS, head of colorectal surgery, Monash Health in Melbourne Australia, and Frank Frizelle, MB, ChB, MMedSc, FACS, academic head of the department of surgery at the University of Otago in Christchurch. I was pleased to share Minnesota connections with Bruce and Frank, and meeting them before my travels reassured me that I would have a terrific trip.

Auckland

After traveling from Toronto via Vancouver to Auckland, I arrived at the North Island at 5:00 am. Fortunately, I was able to check into my hotel and get some sleep. With lingering jetlag, I found myself falling asleep at the dinner table on a number of occasions; thankfully, my hosts were understanding.

In Auckland, I attended the RACS Annual Scientific Congress, May 6–10, at the Crowne Plaza Convention Centre. The convention center is attached to the Sky Tower, the tallest building in New Zealand. The Scientific Congress is a well-organized and well-attended meeting of surgeons of all specialties in Australasia. The meeting is organized according to specialty tracks. Dr. Soop organized a phenomenal colorectal surgery program in which I was pleased to participate.

On the first full day of the conference, I was involved in a master class—a group session of approximately 80 attendees. The topic was Research: How to Publish Your Research in a Good Journal. My presentation was titled How to Design Good Studies—a subject that is tough to tackle in 20 minutes, but my efforts were warmly received. Later in the week I presented the ACS Lecture as part of the colorectal program titled Quality Control in Colonoscopy: How to Avoid Missing Tumors. During the talk I highlighted other surgeons’ and my research into the effectiveness of and quality measures in colonoscopy.

In preparation for the talk, I learned a great deal about the status of colorectal screening in Australia and New Zealand and what each country is doing in terms of colonoscopy quality assurance. Matt had invited a number of prominent colorectal surgeons to the meeting, and I was lucky to have the opportunity to network with Torbjörn Holm, MD, a colorectal surgeon at the Karolinska Institute, Stockholm, Sweden, and Thomas Read, MD, FACS, a colorectal surgeon in Burlington, MA. I also had the opportunity to attend the Women in Surgery Symposium, coordinated by Eva Juhasz, BHB, MB, ChB, FRACS, a colorectal surgeon in Brightside, NZ, who, unfortunately was unable to attend. The symposium focused on Past and Present Inspirations in Surgery, with presentations by several international visitors, including myself and the following: Lillian Kao, MD, FACS, associate professor of surgery and critical care, University of Texas Medical School, Houston, and a faculty member for the university’s Center for Clinical Research and Evidence-Based Medicine; Monica Bertagniolli, MD, FACS, a general surgeon, at the department of surgery, Brigham & Women’s Hospital, Boston, MA. It was great to network not only with women from Australasia, but also with leaders of the ACS. My presentation was on International Perspectives in Women in Surgery.

I also attended the lunch meeting of the ANZ Chapter of the ACS. I was fortunate to hear A. Brent Eastman, MD, FACS, then-President of the ACS, give an inspirational talk highlighting the benefits of international networks and collaborations. He emphasized the importance of building links between Australasian surgeons and the ACS and made me feel very proud to represent the College.

I attended a number of wonderful social events where I met international colleagues. I attended the welcome reception on May 6, the colorectal section dinner on May 8, at the Auckland Art Gallery hosted by Dr. Soop, and on the final evening of the meeting, I attended a lovely gala dinner held at the Langham Hotel.

In addition, a number of high-spirited surgeons from the Association of Academic Surgery attend the RACS meeting annually to help lead the course, Developing a Career in Academic Surgery, with the Academic Section of RACS. I shared an adventure with these surgeons, or, more precisely, watched an adventure unfold. Carlton Barnett, MD, FACS, a general surgeon, Denver Health Medical Center/University of Colorado, and Justin Dimick, MD, FACS, a general surgeon, University of Michigan, Ann Arbor, took the plunge from the top of Sky Tower mentioned previously and lived to tell the tale. Only in New Zealand.

On May 10, I visited Auckland City Hospital, where I toured the facility with Arend Merrie, MB, ChB, PhD, FRACS, a general surgeon and director of general surgical training, Auckland Hospital, and Julian Hayes, MB, ChB, FRACS, a general and a colorectal surgeon at Auckland City Hospital. I presented grand rounds to the colorectal surgery group. My talk, How Effective Is Colonoscopy for the Prevention of Colorectal Cancer Mortality?, was well-received, and the surgeons in attendance offered thoughtful comments.

I was very impressed by the health care system and the focus of the hospital on population health. Most notable were the perioperative smoking cessation programs implemented on site and the quality metrics in place for smoking cessation at the institution. Patients are motivated to stop smoking around the time of surgery, and the institution provides organized, systematic help to these patients, which is likely to result in increased rates of smoking cessation, improved surgical outcomes, and more lives saved. Since I have returned from my trip I have already taken steps to see if a similar program might be implemented on a provincial level through Cancer Care Ontario. The Auckland City Hospital staff was welcoming, and Dr. Merrie provided further insights into the health care system and practice of colorectal surgery in New Zealand.

Queenstown

I then flew from Auckland to Queenstown on the South Island. The view of the amazing mountains and farming stations is breathtaking. Queenstown is the home of unparalleled outdoor adventure touring. I was fortunate to have two travel companions, Richard Hanney, MB, BS, FRACS, University of Sydney; and Dr. Kao. Queenstown is also the home of bungee jumping. Lillian and I watched Richard jump off a bridge, and who could blame him? His friends Carlton and Justin had just jumped off a building.

I traveled to Christchurch where I received a warm welcome from Frank Frizelle MB, ChB, MMedSc, FACS, a colorectal surgeon and department head, department of surgery, University of Otago, Christchurch, and his wife Marguerite Crooks, DMD. They opened their home to me and provided me with an opportunity to visit the Christchurch Hospital, the major tertiary referral center in the South Island and affiliated with the University of Otago. During my two-day visit I was able to observe in the operating room, attend multidisciplinary tumor rounds and teaching rounds, and meet the general surgical trainees. Chris Wakeman, BSc, MB, ChB, MMedSci, FRACS, a colorectal surgeon at Christchurch Colorectal, NZ, and Tim Eglinton, MB, ChB, MMedSc, FRACS, a consultant colorectal surgeon at the hospital, helped with my visit.

Christchurch suffered a massive earthquake on February 22, 2011, which caused widespread damage to this beautiful Victorian city. The response of the team at
Christchurch Hospital to this natural disaster and their participation in the recovery was inspiring. I promised to return in 10 years to see the city rebuilt. I shared a wonderful meal with the faculty and was encouraged to enjoy the magnificent local oysters. We drank some terrific wine from the vineyards of New Zealand native Murray Brennan, MD, FACS, the Benno C. Schmidt Chair in Clinical Oncology and director of the center for international programs at Memorial Sloan-Kettering Cancer Center, New York, NY.

I then traveled up the east coast of the South Island to Kaikoura and fulfilled a lifelong dream of swimming with wild dolphins. New Zealand is a magical place with wonderful people in a spectacular setting. I will be back.

Melbourne

I then left New Zealand and flew to Melbourne, Australia, where my stay was brief but engaging. This wonderful Victorian city has become a foodie’s paradise, and I was able to reconnect with several friends and colleagues in medical oncology whom I knew from their fellowship days at Princess Margaret Hospital in Toronto. With their help I had two stops arranged. First I visited St. Vincent’s Hospital where I was hosted by Rodney Woods, MB, BS, FRACS, director of colorectal surgery; and Jamie Keck, MB, BS, FRACS, director of anorectal physiology. I attended two multidisciplinary rounds, as well as tumor board and inflammatory bowel disease rounds. St. Vincent’s Hospital is a major force in Australia for the management of inflammatory bowel disease (IBD). I had heard about this program and the rounds throughout New Zealand and Australia. Based on the same principles as tumor boards, they facilitate multidisciplinary management of complex IBD patients, enabling real-time communication between gastroenterologists, surgeons, radiologists, pathologists, and nurses. I hope to institute these principles at my hospital where we see a large number of IBD patients.

Next, I visited the Peter MacCallum Cancer Centre and met my host, Sandy Herriot, MA, MB, BChir, MD, FRCS, a colorectal surgeon, department of surgical oncology, Peter MacCallum Cancer Centre, Melbourne; department of colorectal surgery, St. Vincent’s; and honorary senior lecturer, University of Melbourne. I presented at grand rounds and toured the facilities, which include an extensive tumor bank and offer opportunities for translational research.

Newcastle

I then flew to Newcastle, Australia, where I had been invited by Stephen Deane, MB, BS, FACS, FRACS, FRCSC, a general surgeon with the John Hunter Hospital, to visit the hospital and the University of Newcastle. He and Stephen Smith, MB, BS, BSc, FRACS, a colorectal surgeon, John Hunter Hospital and the University of Newcastle, who were the visitors from Australasia to the 2013 ACS Clinical Congress, coordinated the arrangements for my visit. I received a wonderful welcome in Newcastle, and my hosts ensured an enjoyable stay.

We started with a dinner with the surgeons in the colorectal service at John Hunter, including Dr. Smith, Brian Draganic, FRACS, conjoint senior lecturer, University of Newcastle, and Peter Pockney, MB, BCh, colorectal surgeon, division of surgery, and senior lecturer, John Hunter, and their spouses. These surgeons are committed to excellence in patient care and research, but they also have built a wonderful, collegial team.

On May 22, I attended the morning training meeting with registrars (residents and fellows). Later that day, I rounded with Dr. Smith at the John Hunter Hospital and was amazed at the amount of clinical research performed there. This colorectal unit has achieved the goal of enrolling all patients in a clinical study. This feat shows the dedication of the unit’s surgeons, nurses, and patients to research and continuous quality improvement. Having learned of this inspiring achievement, I now am committed to getting more patients enrolled in clinical studies.

At city-wide rounds for the Newcastle Gut Club, I delivered two presentations during two-well-attended meetings of gastroenterologists and general surgeons, one in the evening on colonoscopy effectiveness for prevention of colorectal cancer mortality, and one the next morning, where I presented my research in cancer survivorship to the general surgery faculty and residents at the John Hunter Hospital.

Later that day, I took a scenic train ride to Sydney. It is a wonderful place where the people are friendly, the sun is almost always shining, and the most fabulous beach you have ever seen is just a ferry ride away. Michael Solomon, MB, BCh, BAO, MSc, FRACS, a colorectal surgeon at Concord Repatriation General Hospital and Royal Prince Alfred Hospital in Sydney, met me at my hotel and drove me to the Royal Prince Albert Hospital. Professor Solomon and I have been friends since he completed his colorectal surgery fellowship and master of science degree in clinical epidemiology at the University of Toronto. We began the tour of the hospital with a visit to the clinical research training unit that he initiated, the Surgical Outcomes Research Centre. Professor Solomon developed and led a master’s of surgery program that provides training and expertise in clinical epidemiology to surgeons throughout Australia.

Next, we participated in ward rounds. Professor Solomon’s clinical work is remarkable. He is pushing the field of radical surgery for locally aggressive primary and recurrent pelvic cancers forward and is one of the world leaders in pelvic exenteration. He is a wonderful and inspiring individual. I would encourage anyone interested in additional training in this area to seek him out. My professional visits ended with a wonderful dinner off Sydney Harbour. I was able to stay an extra day and visit friends. I was fortunate to catch the Sydney Light Festival. The Opera House is an amazing building that, when lit up, becomes a work of art.

Inspiring experience

My experience as the ANZ Traveling Fellow was an incredible adventure. I interacted with and learned from wonderful surgeons who have a passion for quality patient care. The trip made me look at my practice in different ways and has inspired me to try to achieve more and do better in the future. I made new friendships, reconnected with dear friends from the past, and developed potential collaborations for future research.

I am truly grateful to all the surgeons who made my trip such a wonderful experience and to the ACS for selecting me to serve as the 2013 ANZ Traveling Fellow.

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