Inaugural Murray F. Brennan, MD, FACS, International Guest Scholar provides report

Howle, Julie 3

Dr. Howle

Howle pic 1

Dr. Howle relaxing between cases in the surgeons’ lounge at Duke University Medical Center.

Howle pic 2

The Opening Ceremony of the Clinical Congress.

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Dr. Howle at the Chicago Marathon.

It was my great privilege to be selected as the inaugural American College of Surgeons (ACS) Murray F. Brennan, MD, FACS, International Guest Scholar. I sought to make the most of the wonderful opportunity afforded by the scholarship and was able to visit a number of medical centers in the U.S.

I am a surgical oncologist based in Sydney, Australia, and my practice encompasses melanoma and non-melanoma skin cancers, soft tissue sarcoma, thyroid, and parathyroid disease.

Duke University

My trip commenced with a visit to the surgical oncology division at Duke University Medical Center, Durham, NC. My hosts were Julie Ann Sosa, MD, FACS, professor of surgery and chief, section of endocrine surgery at Duke, and Sanziana Roman, MD, FACS, professor of surgery and chief of general surgery, Durham Veterans Affairs (VA) Medical Center. I spent the first day at Duke with Dr. Sosa, attending clinic and observing her in the operating room (OR) performing thyroidectomies. I enjoyed participating in the thyroid tumor board meeting and finished the day by attending grand rounds.

The following day I observed Dr. Sosa conducting an interesting case—resection of a parathyroid adenoma from the superior mediastinum, followed by a thyroidectomy and central neck dissection for a locally invasive papillary thyroid cancer. I began my third day at Duke by attending the morbidity and mortality meeting and grand rounds, followed by more time in the OR with Dr. Sosa.

I spent my final day at Duke with Dr. Roman. I had the opportunity to observe her and Randall Scheri, MD, FACS, assistant professor of surgery, perform a laparoscopic retroperitoneal adrenalectomy via a posterior approach. Later that day, I attended clinic in the VA Medical Center, which was rather similar to the public hospital clinics I have encountered in Australia.

During my time at Duke, I stayed with Drs. Sosa and Roman, who were generous hosts. I also met Douglas Tyler, MD, FACS, chief, division of surgical oncology, and Paul Mosca, MD, FACS, associate professor of surgery, during a delightful evening meal that Drs. Sosa and Roman had prepared.

Clinical Congress

I then traveled to Washington, DC, to attend the 2013 ACS Clinical Congress. Before the conference, I attended part of the Association for Academic Surgery fall courses and the ACS Presidential Dinner with my husband at the kind invitation of the incoming ACS President, Carlos A. Pellegrini, MD, FACS, and his wife Kelly. The dinner took place in the Blue Room at the Omni Hotel, which is where President John F. and Jacquelyn Kennedy had their wedding reception. It was intriguing that the dinner commenced with a toast to the Queen, reflecting the shared origination of the ACS in Canada.

Before embarking on the educational programs at the Clinical Congress, I met the other International Scholars at our hotel. It was great to mix with surgeons from so many different countries, backgrounds, and specialties. Upon arrival at the convention center, we were escorted backstage, where it was an honor to participate in the prestigious Opening Ceremony.

My Clinical Congress experience was truly memorable. As an International Guest Scholar, on the first day, not only did I participate in the Opening Ceremony, but I also attended the Centenary International and Volunteer Reception at the Carnegie Library, and the breakfast meeting of the International Relations Committee. In addition, all the scholars were presented with a commemorative certificate at a luncheon hosted by the International Liaison Section of the ACS. The final official engagement was the Board of Governors Dinner.

It was great to spend time with my ACS mentor at the Clinical Congress, Rebecca Sippel, MD, FACS, associate professor, division of general surgery, and chief, section of endocrine surgery, University of Wisconsin-Madison, who did a stellar job. The Clinical Congress was amazing both in its scale and the variety of sessions offered. I attended sessions that included topics such as melanoma, chest wall reconstruction, emergency surgery, acute pancreatitis, parathyroid disease, and smoking cessation. A highlight of the conference was listening to the other International Scholars’ and Traveling Fellows’ presentations and having the opportunity to present my own work.

Following my time in Washington, DC, I diverted from my academic schedule and traveled to Chicago, IL, to run in the Chicago Marathon. I had a great race and ran a personal best (3:16:27). I also appreciated the beer offered at the finish line!

University of Wisconsin

From Chicago I traveled to Madison to visit the University of Wisconsin (UW) Hospital and Clinics. In addition to Dr. Sippel, my hosts were Herb Chen, MD, FACS, professor of surgery; chairman, division of general surgery; and vice-chairman of research, department of surgery, and Layton F. Rikkers, MD, FACS, ACS First Vice-President and professor emeritus, UW. They had generously planned a varied and full schedule of activities both at work and after hours.

On my first day, I attended the endocrine case conference and a lab meeting. Later that day, I had meetings with Ken Meredith, MD, FACS, associate professor of surgery, and Greg Kennedy, associate professor of surgery, before attending clinic with Dr. Chen which featured several patients with multiple endocrine neoplasia.

I went out for dinner with Dr. Sippel and Adjwoa Opoku-Boateng, MD, FACS, one of the endocrine surgery fellows, at which time I sampled fried cheese curds—a Wisconsin dish far tastier than it sounds—before going to a blues concert.

On the second day of my visit, I attended the morbidity and mortality conference and grand rounds before observing thyroid cases in the OR with Dr. Chen. That afternoon I met with Mark Albertini, MD, associate professor of medicine, and had a useful discussion comparing melanoma services at UW and in Sydney, followed by dinner with another endocrine surgery fellow, Dawn Elfenbein, MD.

My third day in Madison started with a delicious breakfast with Dr. Chen and his wife, Harriet, followed by an informative guided tour of the state Capitol building, constructed over 11 years, from 1906 to 1917. I then met with Stephanie Orzechowski, RN, MBA, the director of oncology services, who took me on a tour of the UW Carbone Cancer Center, which provides comprehensive services to oncology patients. This was followed by a meeting with Howard Bailey, MD, the interim director of the cancer center and professor of medicine. I also met with Heather Neumann, MD, assistant professor of surgery, whose practice covers breast, sarcoma, and melanoma. We had a useful discussion about the pros and cons of minimally invasive inguinal node dissection, the subject of a trial in which she was participating. I had a pleasant sushi dinner that night with Caprice Greenberg, MD, FACS, associate professor of surgery, and Carla Pugh, MD, FACS, associate professor of surgery.

The following day I visited the OR with Emily Winslow, MD, FACS, assistant professor and a hepatobiliary surgeon. I then met with Mary Beth Henry, NP, and Sarah Schaefer, RN, MS, ANP-BC, who offered useful insights into their roles, which was interesting because nurse practitioners are far less common in Australia than in the U.S. I then met with the chair of the department of surgery, Craig Kent, MD. Later that afternoon, I met with Lauren Howard, director of clinical research, and Emily Breunig, clinical research co-coordinator. That evening, I had dinner with Dr. Chen and his wife and Dr. Neumann and her husband, Abe.

On my last day in Wisconsin, I managed to go for a jog alongside Lake Mendota at sunrise. I then went to the farmers’ market with Dr. Chen and, to my astonishment, found a stall selling emu meat! I appreciated being able to meet both formally and informally with a variety of clinicians and health care workers during my time in Wisconsin, which reflected my usual multidisciplinary work environment in Sydney.

Memorial Sloan-Kettering

I then flew to New York, NY, where I spent the week visiting Memorial Sloan-Kettering Cancer Center (MSK). It was an honor to meet with Murray Brennan, MD, FACS, and a privilege to have the opportunity to visit such a world-renowned cancer center. My visit commenced with grand rounds, and I spent the remainder of the day observing in the OR. I was able to observe cases by Samuel Singer, MD, FACS, chief, gastric and mixed tumor service; Mary Sue Brady, MD, FACS, surgical oncologist; Jatin Shah, MD, FACS, FRCSEd, chief, head and neck service; and Ashok Shaha, MD, FACS, chair, head and neck surgery and oncology. During the remainder of my time at MSK, I observed Daniel Coit, MD, FACS, surgical oncologist, in the OR, and attended several clinical meetings, including the general surgery conference, the gastric and mixed tumor pre-op conference, the head and neck conference, and the hepatobiliary conference. I also had the opportunity to meet with Peter J. Allen, MD, FACS, surgical oncologist; Dr. Shaha; and Christopher Barker, MD, a radiation oncologist.

In addition, I attended the sarcoma outpatients clinic and Dr. Shaha’s thyroid clinic. After work I was fortunate to spend some time with Laura Wang, MD, an Australian surgical resident doing research in thyroid cancer in the head and neck unit, who helped introduce me to the sights of New York City at night. I also spent an evening with Jim Barone, MD, FACS, who writes The Skeptical Scalpel blog, and family, who kindly hosted a dinner on my behalf. I made the most of my time in New York City, sampling various cuisines, seeing the Book of Mormon and a performance by the New York Philharmonic, enjoying runs in Central Park, and a stroll across the Brooklyn Bridge.

Vanderbilt

After the hustle and bustle of New York City, I headed south to Nashville, TN, to visit the Vanderbilt University Medical Center and meet my host, Carmen Solórzano, MD, FACS, professor of surgery and director, Vanderbilt Endocrine Surgery Center. I was born and raised in Tamworth, Australia’s country music capital, which made Nashville an interesting cultural experience. My first night there was marked by dinner in the home of Naji Abumrad, MD, FACS, chairman of the department of surgery, where it was a pleasure to catch up with Nipun Merchant, MD, FACS, professor of surgery and cancer biology.

After a weekend of soaking up the Nashville vibe, I had a productive two days at Vanderbilt. I was fortunate to observe Dr. Solórzano’s operative approach to parathyroid disease on both days of my visit. It was interesting to attend the melanoma clinic where I met with Mark Kelly, MD, FACS, associate professor of surgery and chief, division of surgical oncology. I also attended a surgical oncology teaching session and had a useful discussion with Dr. Solórzano regarding the use of clinical databases. Dr. Solorzano was a generous host during my time in Nashville.

Moffitt Cancer Center

My next port of call was Tampa, FL, where I visited the Moffitt Cancer Center. My hosts were Vernon Sondak, MD, FACS, chair of the department of cutaneous oncology and professor of surgery, and Bryan McIver, MD, FACS, program leader of head and neck and endocrine oncology and professor of medicine. I was fortunate to be able to stay in Dr. McIver’s home during my time in Tampa.

On my first day at Moffitt, I attended Dr. Sondak’s cutaneous oncology clinic and the melanoma tumor board meeting. I also met with Jane Messina, MD, associate professor and member of the cutaneous oncology group. On my second day at Moffitt, I spent time with the head and neck and endocrine oncology program, attending the head and neck clinic with Tom McCaffery, MD, FACS, professor of otolaryngology-head and neck surgery, and Dr. McIver’s endocrinology clinic. The following day I visited the OR and spent time observing Dr. Sondak; Jonathan Zager, MD, FACS, surgical oncologist, associate member of the departments of cutaneous oncology and sarcoma, and director of regional therapies; and Judith McCaffery, MD, FACS, associate member, head and neck oncology program and associate professor.

No trip to Florida would be complete without a visit to the beach, so I spent a lovely weekend visiting Santa Maria Island and St. Petersburg with the McIvers.

The following Monday, I spent the day in clinic with Dr. Zager. It was interesting to see how clinics were run and the number of mid-level providers that are employed. On Tuesday, I attended the head and neck tumor board meeting, followed by observing Tapan Padhya, MD, FACS, an otolaryngologist and head and neck surgeon in the head and neck clinic. Wednesday commenced with the endocrine tumor board meeting, followed by clinic with Dr. Sondak and a melanoma tumor board conference.

That night, Dr. McIver flew us down to St. Petersburg in his plane. I had never been in such a tiny aircraft, and it was a great experience.

On my final day at Moffit, I attended clinic with Ricardo J. Gonzalez, MD, FACS, sarcoma program leader and assistant professor of surgery, before spending time in the OR with Dr. Zager observing an isolated limb infusion case, and subsequently participating in the sarcoma tumor board meeting. The day ended with dinner at a local Greek restaurant with members of the cutaneous oncology and head and neck/endocrine units—a great way to finish an enjoyable and informative visit.

MD Anderson

I then traveled to Houston, TX, to visit the MD Anderson Cancer Center. Unfortunately, due to various bureaucratic obstacles, my visit was shorter than planned, but it was nonetheless interesting and enjoyable.

After spending half a day attending to paperwork, I met with Jeff Gershenwald, MD, FACS, professor, department of surgical oncology, who took me on a tour of MD Anderson. It is a remarkable facility in many ways, but possibly its most striking feature is its sheer size, dwarfing any center in Australia.

At MD Anderson, I observed the activities of the melanoma and the endocrine surgery units. I watched Dr. Gershenwald and Anthony Lucci, MD, FACS, professor, department of surgical oncology, perform thyroid operations with Nancy Perrier, MD, FACS, professor, department of surgical oncology, and chief, section of surgical endocrinology. I also attended a melanoma clinic with Richard Royal, MD, FACS, associate professor of surgical oncology, and again was impressed by the use of nurse practitioners.

I had a meeting with Elizabeth Grubbs, MD, FACS, assistant professor of surgical oncology, at which we discussed approaches to parathyroid disease and the use of the intraoperative nerve monitor. I also attended clinic with Dr. Perrier.

While in Houston, I was able to take the opportunity to catch up with Lillian Kao, MD, FACS, associate professor, department of surgery, The University of Texas Health Science Center, and greatly appreciated the hospitality extended by Scott Lemaire, MD, FACS, professor of surgery at Baylor College of Medicine, and family, with whom I had an enjoyable stay.

Career highlight

The Murray Brennan International Guest Scholarship has been one of the highlights of my professional career. I made the most of the opportunities I had to learn and exchange experiences with my American colleagues and to sample the American way of life.

It was great to be able to interact with so many prominent and inspiring female surgeons and to network with so many fantastic professionals. I look forward to being able to reciprocate such wonderful hospitality in Sydney. On reflection, I have realized that although there are great differences between the U.S. and Australia in the way health care is funded, we all face the same fundamental challenges.

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