A tribute to Robert N. McClelland, MD, FACS, founder of SRGS

Dr. McClelland

Dr. McClelland

The heart of academic surgery skipped a beat, and the University of Texas (UT) Southwestern, Dallas, lost one of its heroes September 10, 2019, when Robert N. McClelland, MD, FACS, died after an extended illness.

On the national stage, Dr. McClelland may be best known for his participation in the efforts to save the life of President John F. Kennedy November 22, 1963, but it is the multiple generations of students, residents, and faculty members who knew this humble giant as “Dr. Mac” on whom he made an even more profound and lasting impact. And his legacy lives on at the American College of Surgeons (ACS) as the visionary educator who created Selected Readings in General Surgery (SRGS®).

This article pays tribute to Dr. McClelland’s impact on his trainees and describes how SRGS went from being one surgeon’s effort to help his residents improve their knowledge base to a globally accessible tool for practicing evidence-based medicine.

Lifelong Texan

Dr. McClelland was born November 20, 1929, in Gilmer, TX, and he spent his early childhood in the east Texas town. His first contact with what would become UT Southwestern was a high school summer job at the historic Old Parkland Hospital at Maple and Oak Lawn Avenues in Dallas, which was the location of the Southwestern Medical College, now known as UT Southwestern. After graduating from the University of Texas, Austin, he matriculated to the University of Texas Medical Branch, Galveston; he graduated from medical school in 1954—the same year that Parkland Hospital moved to Harry Hines Boulevard. After interning for a year at the University of Kansas Medical Center, Kansas City, Dr. McClelland served in the U.S. Air Force (USAF) as commander of the 7232 USAF Dispensary in Trier, Germany. His military service was followed by two years of training in general surgery at Parkland Memorial Hospital and a one-year hiatus in private practice in Canyon, TX, before returning to Parkland Hospital to complete his surgical residency in 1962. Such interruptions in surgical training for military service and private practice were common at the time.

Under the leadership of G. Thomas Shires, MD, FACS, in 1962 Dr. McClelland joined the faculty of the UT Southwestern Medical Center department of surgery, where he would remain for his entire career. The following year, 1963, was a particularly memorable one for Dr. McClelland. He became certified by the American Board of Surgery, he celebrated his 34th birthday, and two days later he found himself at the head of a stretcher in the Parkland Hospital emergency room during the desperate attempt to save the life of President Kennedy. Along with Malcolm Perry, MD, FACS, and Charles Baxter, MD, FACS, Dr. McClelland performed a tracheostomy on the President. During an interview published in the December 2007 issue of Center Times, UT Southwestern Medical Center’s newspaper, Dr. McClelland said, “Obviously, this was a very unusual occurrence that one would never expect in an ordinary life, and this experience will always be with me.”* Dr. McClelland often described this episode as so vividly etched in his memory that it seemed to have happened yesterday.

Dr. McClelland’s research career at UT Southwestern included investigations into splanchnic hemodynamics, trauma, intravenous alimentation, peptic ulcer disease, gastroesophageal reflux, portal hypertension, and biliary tract disease. He received numerous honors, including the first Alvin Baldwin Jr. Chair in Surgery. He retired in 2007 as an emeritus professor of surgery.

Dr. McClelland became a Fellow of the ACS in 1965 and served on the Committee on Graduate Medical Education (1989−1991). He also was a member of many other prestigious surgical societies, such as the American Surgical Association.

The Parkland Surgical Society named the Robert N. McClelland Lectureship in his honor. Parkland Hospital moved across Harry Hines Boulevard in 2017, and upon its new opening, alumni and friends established a wall of photos titled “Giants of Surgery.” Those who had the honor and privilege of training under him know Dr. McClelland as the titan among those giants.

Dedication to lifelong learning

In the operating room (OR), the classroom, the conference room, and social surroundings, Dr. McClelland created a sense of calm. He often did this with earthy humor and a self-deprecating manner. Residents, when pressed to describe Dr. Mac, would often respond, “He knows everything.” But when referred to as an expert, Dr. Mac would recall “the east Texas definition of an ‘expert’ was someone who had just spurted.” Sometimes, when one of the residents gave an incorrect answer to a question, Dr. Mac’s response would be, “Well, that would be correct but in a 180-degree different way.” When we marveled at his expertise in describing some point in surgery, he would respond, “Even a blind hog occasionally finds an acorn.” These “McClellandisms” have endured.

Dr. McClelland Photo courtesy of UT Southwestern Medical Center

Dr. McClelland
Photo courtesy of UT Southwestern Medical Center

Soft-spoken, rarely cross, humble to a fault, patient as a saint, well-read, and willing to share his knowledge are not always phrases residents use to describe an academic surgeon. Yet Dr. McClelland fit all of these descriptions. He was an inspiration. He taught us that we had embarked on a lifelong learning journey before any committee had coined the term. We were taught that being a surgeon required a mastery of skills and cognitive knowledge as represented in the most up-to-date information.

Those of us who stayed at UT Southwestern and transitioned to junior faculty positions quickly learned that Dr. Mac, along with other, more senior UT Southwestern faculty, set a high mark for us. Saying “no” to a request from a student or trainee was unacceptable. Help was always available, whether it was in the OR, seeing a ward patient, or just reviewing a case. The latter with Dr. Mac was especially rewarding. He gave advice without condescension while providing the appropriate evidence and offering his expertise. These conversations taught us how colleagues relate to each other. Dr. Mac had a way of making you feel that you knew as much as he did, which was never true.

The amazing thing about Dr. Mac was that all of the people he touched had similar experiences. He set the bar high. He helped people reach it. He continued to espouse his educational principles, his humanity, and his professionalism until the day we lost him.

His wisdom was widely recognized, and he was invited to comment on surgical problems in conferences, at the bedside, and by telephone nearly any time of day or night. He encouraged us to learn new things, intellectually and in the OR. It seemed he knew everything about all things surgical, and about many other topics, as well.

For many years, Dr. McClelland invited the graduating residents and fellows to his home the weekend before oral boards for a two-day review session. When Dr. Bergen, co-author of this article, took the board exams in 1989, she attended this important session—a rite of passage for Parkland-trained residents. That Sunday evening, Dr. McClelland reviewed an article on colon cancer staging and treatment; Dr. Bergen realized she did not know that area well and focused intently. Of course, that very question was asked during the exams. With Dr. Mac in her head and gratitude in her heart, she gave an acceptable answer.

Dr. Mac taught thousands of surgeons many lessons about lifelong learning, surgical planning, execution, and professional and personal conduct either through direct contact, SRGS, or the inherited wisdom of those of us who benefited from his tutelage as residents and colleagues. We were so lucky to have him for so long.

Founding SRGS

A remarkable feature of Dr. McClelland’s life was his prodigious reading, particularly in surgery. In his later life, he pursued his love of history, often reading several books simultaneously. Many conversations with Dr. McClelland began with, “What are you reading, Dr. Mac?”

Dr. McClelland established SRGS in 1974 in response to requests from residents for copies of the papers discussed in a journal club that he had started previously.

Dr. McClelland established SRGS in 1974 in response to requests from residents for copies of the papers discussed in a journal club that he had started previously. The original journal club evolved into the UT Southwestern department of surgery’s Selected Readings Conference, held every Saturday morning and led by Dr. McClelland. He ran these conferences using SRGS as a matrix. His voice was never very loud, and he brought a portable sound system to the conferences to make sure that we heard him—although, it might have been to make sure that we did not fall asleep. On any topic, he could always add material from other sources, which often represented the most up-to-date information. Dr. Mac developed Selected Readings as he saw the need for himself, surgical residents, and eventually practicing surgeons to learn from the surgical literature.

When “evidence-based medicine” became popular, the phrase seemed to have an artificial ring to it. Those of us who trained under Dr. Mac figured out that evidence-based medicine was SRGS and that Dr. McClelland had taught his minions how to practice evidence-based medicine long before someone coined the phrase. Most of us could not imagine our professional lives without SRGS.

SRGS needs some perspective for those surgeons who grew up with the Internet. Picture a very large room filled with bookshelves. On the bookshelves are rows of black file boxes. All had numbers on them that were listed with paper titles in a key book—a filing system that Dr. McClelland devised and that those surgeons who were raised on the paper phase of SRGS duplicated at home. In those boxes were papers from all of the major journals—all and then some. Dr. Mac was essentially the Internet browser. He drew articles from the more than 100 journals to which he subscribed. He reviewed those journals, tore out the papers, and placed file numbers on them based on the topics that they addressed. Every article in Dr. Mac’s library was complete. As the boxes became full, he added more boxes. Throwing away articles was not in the plan.

Many people have used SRGS in their careers, but unless you trained at UT Southwestern or made a special attempt to understand how SRGS was produced, you couldn’t truly appreciate the value and magnitude of Dr. Mac’s library. In fact, residents rarely went to the UT Southwestern library. Instead, they went straight to Dr. Mac’s library when they needed information. It was kind of like an early Internet cafe.

Just as you search the web today, getting articles from Dr. Mac’s library was always diversionary. You would start off looking for an article on a very specific topic. You would find it, but you would also find another 10 articles that you just felt needed to be read. You copied the articles and returned them to their boxes for the next user. It was a resource that was built out of a need at the time and nurtured by the love of learning that Dr. McClelland held dear.

SRGS goes national

SRGS
Ultimately, Dr. McClelland determined that students and residents outside the confines of UT Southwestern might benefit from SRGS. In a December 2007 Center Times interview, Dr. McClelland said, “I conceived the basic idea for Selected Readings because it seemed that the available surgery textbooks were too much for medical students and not enough for residents. I borrowed $2,700 from the bank and advertised Selected Readings among surgery programs in the United States. I thought if we could obtain 500 subscribers the publication would be practical. Within a month 500 had subscribed. By the beginning of 1975, there were 1,500 subscribers. This number ultimately reached approximately 5,000.”*

When SRGS “went national,” Dr. Mac worried about the cost to subscribers. So, he made reprints of papers on a printing press in his office and drafted residents and their spouses to hand-assemble the papers. Nobody said “no” to Dr. Mac. SRGS subscriptions ultimately extended worldwide. Over the five-year period of a general surgery residency, SRGS covered the entire field of general surgery. At one point, it was estimated that more than 60 percent of the general surgery residents in the U.S. read SRGS.

It is worth noting that Dr. Mac moved into the computer age with remarkable facility, establishing a computer-based reference manager when few of us knew what that was.

Prior to concerns raised by the Health Insurance Portability and Accountability Act, Dr. Mac bought cameras for all the residents so they could document interesting findings from the OR for use in conferences. Later, they brought the images to him, and he catalogued them, establishing a media library of some significance. Residents and faculty alike raided his media to flavor our presentations. In his later years, after he stopped operating, he was easily found at his roll top desk, with his computer open, reviewing and cataloguing papers. He kept candy at hand to encourage the residents to drop by and chat, which they did often.

Clinical Congress 2005: The College honors Dr. McClelland’s efforts in spearheading SRGS. From left: Dr. Russell; Edward M. Copeland III, MD, FACS, then ACS President-Elect; Dr. McClelland; and Dr. Sachdeva.

Clinical Congress 2005: The College honors Dr. McClelland’s efforts in spearheading SRGS. From left: Dr. Russell; Edward M. Copeland III, MD, FACS, then ACS President-Elect; Dr. McClelland; and Dr. Sachdeva.

 

ACS proud to maintain his legacy

In 2004, the ACS Division of Education learned of Dr. McClelland’s impending retirement and his interest in discussing with the ACS possible strategies to ensure the longevity of SRGS. Then ACS Executive Director, Thomas R. Russell, MD, FACS, brought this opportunity to the attention of Ajit K. Sachdeva, MD, FACS, FRCSC, FSACME, Director, ACS Division of Education.

The SRGS website today

The SRGS website today

Subsequently, Drs. McClelland and Sachdeva met several times in Dallas, during which the transfer of Selected Readings to the ACS Division of Education was discussed. Issues relating to transfer of copyright and intellectual property to the ACS were specifically addressed. L. D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), a Regent at the time and subsequently ACS President, and Patrice Gabler Blair, MPH, Associate Director, ACS Division of Education, then joined the discussions with Dr. McClelland and Robert V. Rege, MD, FACS, chair, department of surgery, University of Texas Southwestern Medical Center. A Board of Directors for Selected Readings, with Dr. Britt as Chair, was appointed to oversee the transition. The formal gifting of Selected Readings occurred at the ACS Board of Regents Meeting in October 2005, and Dr. McClelland was recognized for his landmark gift.

Following a national search that Drs. Britt and Sachdeva led, Lewis Flint, MD, FACS, was selected as Editor-in-Chief. In July 2007, the editorial office and operations of the Selected Readings were transferred from Dallas to the ACS headquarters in Chicago, IL, under the aegis of the Division of Education. Now in its 14th year as a product of the ACS, Selected Readings continues to thrive, with a stable subscriber base and an international editorial board.

Under Dr. Flint’s leadership, SRGS remains a critical resource for all general surgeons. SRGS is published eight times a year and focuses on a revolving cycle of the most relevant topics in general surgery, including breast disease, colorectal disease, and biliary tract disease.

SRGS helps maximize surgeons’ time by reviewing 150 of the latest and most valuable articles published in the world’s most prominent medical journals. In addition, subscribers can earn 80 hours of Self-Assessment Credit every year. SRGS also offers different subscription types to best meet the needs of its diverse surgical readership and can be read on any mobile device.

To stay current with surgical literature, improve patient outcomes, and earn Continuing Medical Education Self-Assessment Credit, subscribe to SRGS.


*UT Southwestern Medical Center. In memoriam: Professor Emeritus of Surgery Dr. Robert McClelland, provided emergency care to President John F. Kennedy. September 13, 2019. Available at: www.utsouthwestern.edu/newsroom/articles/year-2019/robert-mcclelland.html. Accessed January 30, 2020.

*Rian R. McClelland named professor emeritus. UT Southwestern Medical Center Center Times; December (holiday) 2007, page 2.

 

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