In 2015, I was fortunate to be awarded the American College of Surgeons (ACS) Murray F. Brennan, MD, FACS, International Guest Scholarship. As the recipient of this award, I attended the ACS Clinical Congress 2015, October 4−8, in Chicago, IL, and then traveled to a number of renowned institutions of my choosing.
Although this was an amazing opportunity, the thought of organizing such a complex trip was daunting. However, with the advice of the ever-patient Kate Early, ACS International Liaison, and my assigned mentor, Quyen Chu, MD, the scholarship began to take shape.
As an oncoplastic breast surgeon, I selected each institution for its particular area of research or expertise. Visits to these institutions would help clarify situations we found challenging in our weekly multidisciplinary tumor board meetings and allow me to fine-tune my operating techniques. In surgery, decision making is a key aspect of successful outcomes, and I thought that by spending one week in a number of institutions I would get a feel for how similar patients are managed in different centers.
The first stop on my trip was the Windy City for the ACS Clinical Congress. It was the first U.S. clinical meeting I had attended, and I had never experienced anything on this scale. McCormick Place is a vast conference hall, and the number of participants far exceeded attendance at the Royal College of Surgeons annual meeting.
Convocation on Sunday, October 4, gave me a sense of what was to come. As I viewed the flags on stage, I was struck by how we are united across the globe by a common purpose. Incoming ACS President J. David Richardson, MD, FACS, was unable to attend, but his message was clear. We practice in challenging times, and the future is in our hands. My philosophy is that it is better to do than to be done to, and this speech resonated with me. Health and politics often are entwined, and we must take ownership of our profession for the benefit of our patients.
The international theme continued in the Opening Ceremony on Monday morning. After the ACS leadership was introduced, distinguished visitors were acknowledged. At work, we often grumble that we don’t have the latest kit or enough staff, but during the Martin Memorial Lecture, Paul E. Farmer, MD, PhD, Kolokotrones University Professor of Global Health and Social Medicine, Harvard Medical School, Boston, MA, reminded us that many people in the world lack access to lifesaving essentials, such as clean syringes, drinking water, and health care services. Many of us make sacrifices to care for our patients, but few of us risk our lives to do so.
The choice of educational sessions was huge, and I was pleased to have the opportunity to attend sessions devoted to lifestyle concerns—topics usually addressed only in the social program at U.K. meetings.
It is rare that we get to meet our heroes—surgeons with vision and who have shaped our daily practices—and hear them speak. Everywhere I turned at this Clinical Congress, however, I saw heroes of mine. The I.S. Ravdin Lecture in the Basic and Surgical Sciences, Radical Mastectomy to Radical Conservation: Revolutionary, by Melvin J. Silverstein, MD, FACS, medical director, Hoag Breast Center, Newport Beach, CA, offered material that will stay with me for years.
I also had a new challenge in Chicago when I was invited to write about my experience for the Clinical Congress News, the convention daily. This process was a useful and fun way to reflect on the start of the scholarship, and the finished article seemed to be warmly received by the readers.
The highlight of the Clinical Congress was having the opportunity to meet my fellow International Guest Scholars. After informally meeting at the Opening Ceremony, we attended a number of sessions together and were formally introduced at the International Relations Committee meeting and were presented with our certificates at the Scholars and Travelers Luncheon. It was fascinating to attend the College’s International Scholars and Travelers session and learn more about everyone’s specialty interests. We also had ample opportunity to discuss surgical practice in our different countries at the Scholar’s Luncheon and the Governors Dinner. I anticipate that the friendships and professional connections that I formed at these events will last for many years to come.
Massachusetts General Hospital
The first post-Clinical Congress visit was to Massachusetts General Hospital (MGH), Boston, MA, where Amy S. Colwell, MD, FACS, quality director, division of plastic surgery, was my host. Many plastic surgeons do acellular dermal matrix reconstructions, and several go directly to implant, but I had heard Dr. Colwell speak at a previous clinical meeting and was impressed with the large number of patients she had treated who experienced few complications. Many of my patients express a preference for having a one-stage reconstruction, and I am interested in expanding the range of patients to whom I could offer this option.
The team at MGH could not have been more welcoming. It is odd for a busy surgeon to be uprooted and placed in a strange environment, but the residents at MGH went out of their way to ensure I was escorted around, that my many questions were answered, and that I could get the most from my visit. Dr. Colwell asked me a number of questions about my practice so that she could advise me on how to develop using her techniques. At this point, I wished I could have popped home for a few weeks to try my new techniques before continuing my trip!
The Mayo Clinic
The most rapidly evolving area of breast surgery at present is the management of the axilla. Judy C. Boughey, MD, FACS, professor and vice-chair of research, department of surgery, Mayo Clinical, Rochester, MN, and chair, ACS Clinical Research and Program Education Committee, was the author of the Z1071 trial, which studied the management of the positive axilla in patients who then had neoadjuvant chemotherapy. This treatment plan is still a source of controversy in the U.K., and I wanted to see firsthand how the Mayo Clinic managed these patients.
Dr. Boughey initially trained in the U.K. and thus had insight into the key differences between the two health care systems and cultures. I had a fantastic week with the multidisciplinary team at the Mayo Clinic and came away with a clear understanding of how to manage these patients. As in many of the centers I visited, I saw cutting-edge imaging and radiotherapy technology and learned about innovative research and trials not yet available to patients in the U.K.
MD Anderson Cancer Center
My sponsor at the University of Texas MD Anderson Cancer Center, Houston, was Steve Kronowitz, MD, FACS, a plastic surgeon. After I had arranged my placement he let me know he had left his position as a professor at MD Anderson to go into private practice.
This afforded me an opportunity to visit MD Anderson as well as experience a different side of practice in the U.S. I have an interest in health care systems and I spent a morning with Dr. Kronowitz learning about his new practice and talking about the different models of care. My reason for visiting MD Anderson was to learn about their techniques with radiotherapy and implants. Dr. Kronowitz and the team at MD Anderson clarified how they safely deliver these services to patients.
I was fortunate also to see some lymphoedema surgery—still a developing practice in the U.K., and my new sponsor Mark Clemens, MD, FACS, assistant professor, department of plastic surgery, had just lectured in the U.K. on Breast Implant Associated Anaplastic Large Cell Lymphoma —a condition that we are just starting to study. Dr. Clemens provided me with the most up-to-date guidelines on managing this rare but important condition.
Georgetown University Hospital
I had wanted to visit Scott L. Spear, MD, FACS, past-chief of plastic surgery, Georgetown University Hospital, Washington, DC, since I was a junior oncoplastic trainee, so this opportunity to observe his practice was not to be missed. Dr. Spear is now in private practice but kindly arranged for me also to be hosted by Troy Pittman, MD, assistant professor of surgery, Georgetown University School of Medicine, and a plastic surgeon at MedStar Georgetown University Hospital.
I was able to visit Dr. Spear at his practice and even had the privilege of being featured in his blog. It was fantastic to have time to learn from someone who was so instrumental in shaping our specialty. He was incredibly patient and answered most of my questions about the techniques he has developed through the years by providing me with one of his papers. One of my interests is revision reconstruction, and I picked up several novel techniques from Dr. Spear and his team that I can use for my patients in the U.K. Team members at Georgetown were also extremely welcoming, and it was fascinating to see them use one of their four hyperbaric chambers for their post-reconstruction patients if they had anxiety about the skin flaps. The team was studying this approach, but, unfortunately, I cannot see this becoming an option in the U.K. anytime soon.
Memorial Sloan Kettering Cancer Center
The trial that the majority of plastic surgeons would probably agree has changed breast surgery most in the last five years is the Z0011 trial. This study has received a reasonable amount of criticism but nonetheless has been widely adopted. I wanted to see how it was applied to patients at the medical center that conducted the trial—Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY.
My host there was Hiram “Chip” Cody III, MD, FACS, attending surgeon on the breast service, department of surgery, MSKCC, and professor of clinical surgery, Weill Cornell Medical College, New York. Dr. Cody is a fount of knowledge about all matters related to breast surgery, and many of my questions were answered, “Ah, we wrote a paper about that.”
Dr. Cody also arranged for me to meet with Monica Morrow, MD, FACS, chief of breast surgery at MSKCC. Dr. Morrow was extremely generous with her time and knowledge in helping me grapple with the key differences between management of breast cancer in the U.K. and the U.S. My role as chief of the breast service in the U.K. is quite different from Dr. Morrow’s, but she was more than willing to give me some pointers on managing my team.
While at MSKCC I also had the pleasure of being able to thank Dr. Murray himself for affording me this opportunity.
Moffitt Cancer Center
The last stop on my trip was the H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. My hosts were a fellow Brit, Bryan McIver, MD, PhD, program leader, head and neck, and endocrine oncology; and Nazanin Khakpour, MD, FACS, a surgical oncologist specializing in breast cancer at Moffitt’s Center for Women’s Oncology. Since this was my last stop on the scholarship, the team here went out of their way to accommodate any areas of my practice that hadn’t been covered at the other centers. I spent a week in their new breast unit and talked with the administrators who had helped design the building and organize the move. I also spent time with other members of the team, including the genetics counselors, nurse practitioners, and breast radiologists.
Back in the U.K.
I am keen to spread knowledge about everything I learned on my trip. I have already spoken at a national meeting and given several talks locally. In February of this year, I spoke at a European Multidisciplinary Breast Cancer Collaborative meeting held in Paris. At the meeting, I addressed our trainees at the Royal College of Surgeons Oncoplastic Course on management of the axilla in the U.S.
With my team, I am drafting a plan to incorporate my new ideas and learning into our daily practice for the benefit of our patients.
I cannot thank everyone enough for making this trip possible. Special thanks go to Ms. Early and Dr. Chu for their help in organizing the trip, to all my hosts and their teams for their generosity and patience, to my team back in the U.K. for allowing me to leave them for a few months, and to Dr. Brennan and the International Scholarship Committee for this award. This has been an amazing experience for me and will benefit our patients enormously.