Being selected to serve as the American College of Surgeons (ACS) Traveling Fellow to Australia and New Zealand (ANZ) was truly a dream come true. As someone who has traveled considerably and has visited most continents, I had always wanted to travel to Australia and New Zealand, but they always seemed too far away. So, I was excited to represent the ACS on this trip and to share this experience with my 21-year-old son, Nima.
An adventurous start
We arrived in Auckland, New Zealand, at approximately 6:00 am on ANZAC Day, which is the equivalent of Veterans Day in the U.S. The esteem that New Zealanders of all ages have for their veterans was palpable. We had breakfast at a café on the nearby island of Devonport, where a memorial parade was under way.
From there we took a tour of Auckland with the President and Governor of the ANZ Chapter of the ACS, Ian Civil, MB, BCh, FACS. Dr. Civil took us to the highest point in Auckland, one of many volcanic craters in the area.
The next day we traveled south to visit the famous Waitomo caves. Perhaps because I consider myself a moderately adventurous surgeon, the name of the tour, The Abyss, somehow did not register as beyond my ability. The start of the tour involved “absailing,” which is rappelling nine stories down into a cave with an ice-cold river running through it. I had not calculated how we would be coming out of the cave in the dark at 8:30 at night. It involved climbing back up nine stories of sheer rock. I made it out alive, but it was the scariest thing I have ever done. Once we were back on firm ground, the view of the starry sky was amazing.
At dinner that night I learned from my host, Win Meyer Rochow, MB, BCh, PhD, FRACS, an endocrine laparoscopic and general surgeon at Waikato Hospital, one contributing factor to the national obsession with adventure and the general lack of worry about injuries: all New Zealanders and visitors to the country have no-fault personal injury insurance coverage through the Accident Compensation Corporation. This insurance provides compensation for virtually all physical and mental injuries and applies to all aspects of care, treatment, and rehabilitation. It is provided in place of the ability to sue for personal injury.
According to the surgeons I met, this system, which has been in place for more than 10 years, has eliminated lawsuits against surgeons while ensuring that all patients receive appropriate care for any surgical complications resulting in injury. The surgeons assured me that this system has allowed them to be honest with their patients and to candidly admit any complications so that they can be addressed in a straightforward fashion.
Waikato and North Shore Hospitals
My trip to Australia and New Zealand coincided with the week when senior registrars, or residents, prepare for their oral board exams. Preparations were intense, and I was asked to help prepare these residents with a variety of endocrine and head and neck cases. Richard M. Harman, MD, FACS, gave me a tour of North Shore Hospital in Auckland, including the operating rooms.
I learned that in the ANZ training system, the first year or two is spent as a registrar in a hospital, followed by training as a surgical registrar. Not all registrar spots are for training, and some registrars continue to function for many years almost as moonlighting residents do here in the U.S., tasked with the daily functions of the hospital and patient duties. The training registrars in general surgery go on to train in all aspects of surgical care, but in contrast to the U.S. system, in which residents match to a particular program, the registrars in New Zealand and Australia are free to move from hospital to hospital every few months.
Many residents thus seek the best training for a particular area of general surgery—such as a three- to six-month rotation at hospitals with expertise in surgical oncology or endocrine surgery. Resident training occurs in both the public and private hospital setting, as most attending surgeons practice at both sites. The private hospitals are often adjacent to or near the public hospitals, and the residents get the benefit of a bit of increased independence at the public hospitals.
The trainees were surprised by the U.S. work-hour restrictions and the results of the Flexibility In duty hour Requirements for Surgical Trainees (FIRST) Trial, which I described to them. In their system, the registrars work far fewer hours and get paid overtime if they have to stay beyond their regular work hours.
I asked exam questions similar to those we ask U.S. residents during mock oral boards at three different hospitals—Waikato Hospital, Auckland’s Northshore Hospital, and Sydney’s Northshore Hospital. There was great diversity among the residents, and they had a solid knowledge base and practical know-how. The senior residents are given a lot of independence at night to provide care for routine general surgery cases, and attendings are available nearby if needed.
Multidisciplinary research at the Kolling Research Institute
My next stop was Sydney, Australia, where I spent one day visiting the Opera House and nearby gardens. We could see the Opera House from all angles as we traveled to Manley Beach via the ferry. Biking the nearly vertical, winding roads to the bluffs above Manley beach was an exhausting effort, but the views were expansive and exhilarating.
I had the pleasure of meeting the endocrine surgeons and endocrinologist at the Royal North Shore Hospital and the Kolling Research Institute in Sydney. My lecture, Aggressive Thyroid Cancers—Lessons from Surgical Labs, was well received. I met with researchers and surgical colleagues and rounded with Mark Sywak, MB, BS, MMed Sci, FRACS, associate professor of surgery. We discussed opportunities for collaboration, and in the upcoming year we will be partnering with our endocrinology colleagues in a multicenter international clinical trial of immunotherapeutics for radioiodine-resistant thyroid cancer. Dr. Sywak and his team presented their annual endocrine surgery census, which is culled from their extensive database. It was interesting to see that in Australia, as in the U.S., there is a drive to extensively capture data about surgical patients, but no one wants to directly pay for the resources required to accomplish this. In Sydney, much like at U.S. hospitals, there is a yearly scramble to gather funds from various sources to pay for the database manager.
Operating with respect
The final leg of the trip was in Brisbane—the host city for the 85th Annual Scientific Congress of the Royal Australasian College of Surgeons (RACS). My host, Jenny Gough, MB, BCh, FRACS, an endocrine surgeon at Melbourne, arranged the entire endocrine surgery program at the RACS, which was superb. I gave a number of lectures in my three days there—one on vocal cord ultrasound, another involving thyroid nodules, and a third on difficult parathyroid surgical cases. I learned a lot from abstracts and talks presented at this meeting.
The theme of this RACS program was Operate with Respect. It was resoundingly clear that this surgical organization, like the ACS, believes that being inclusive and respectful of all members of the operating team, including the patient, will yield dividends in the future for patients and surgeons alike.
I was impressed with the equanimity of RACS president David Watters, MCh, FRCSEd, FRACS. His interest in promoting diversity was especially evident when he attended the Women in Surgery Breakfast where he individually interacted with the 80 attendees and answered questions about the RACS’ efforts to promote gender equity. He introduced the keynote speaker, Clare L. Marx, CBE, DL, MB, BS, the first woman President of the Royal College of Surgeons of England.
The Women in Surgery group of the RACS, under the leadership of Ruth Bollard, MD, BCh, FRACS, has started a mentorship program, and I put her in touch with the ACS Women in Surgery Committee, which also manages a successful mentorship program.
During the dinner at the RACS, we enjoyed three stunning operatic performances by the Melbourne Opera.
I was recognized for my contributions to the RACS, but it was my pleasure to have been there and to have met these wonderful colleagues with whom I hope to be in contact for years to come.
While I got to see only a sliver of Australia and New Zealand, I learned about the warmth of the people of these two countries, and now I understand why the RACS and ACS established this wonderful fellowship. The trip included so many high points, but it finally ended with two fantastic, fun days, which included a visit to Lone Pine Koala Sanctuary in Brisbane, the oldest Koala Sanctuary in the world, where I got to hug a koala; as well as three once-in-a-lifetime dives at the Great Barrier Reef. I cannot wait to go back and see all these lovely friends again soon.
