General Surgery Residency...

General Surgery Residency Program Excellent surgeons

2018 CaRMS INTERVIEW DAY


MESSAGE FROM THE PROGRAM DIRECTORS CaRMS Interview Day 2018 Welcome to Vancouver! The residents and faculty in the Division of General Surgery congratulate you on your many successes to date. It has been a privilege for us to get a glimpse of your lives through your applications. We feel strongly that we would welcome any of our interview candidates into our training program. We look forward to addressing your questions during the interviews and in the days and weeks ahead, and we hope that the information in this booklet will be helpful to you as you begin to contemplate how you will rank programs and how the University of British Columbia fits with your long term personal and career goals. We are very excited about our program. The caliber and spirit of our residents and faculty, the diversity of training opportunities and exceptional simulation opportunities are some of the strengths of our program. Every aspect of the program is run with resident input and leadership, and we are proud of the contributions that our residents have made. We welcome the perspectives of future classes of residents in defining the next steps the program will take. Thank you for interviewing with us. We wish you all the best during the CaRMS process and in your surgical careers. Please contact us anytime with questions or comments. Sincerely,

Ahmer Karimuddin, MD, FRCSC Associate Program Director

Tracy Scott, MD, FRCSC Assistant Program Director

Adam Meneghetti, MD, CCFP, MHSC, FRCSC Program Director

UBC GS CaRMS INTERVIEW DAY 2018 2


MESSAGE FROM THE RESIDENTS

Dear UBC General Surgery Applicant, Thank you for applying to UBC and the General Surgery Residency Program! We believe that our program has a great mix of academic and community rotations as well as excellent opportunities for research and technical skills training. New additions to the curriculum have provided even more opportunities and experiences unique to our program. We currently have a diverse, motivated, collegial (and fun!) group of residents within the program and we look forward to adding another eight strong residents to the group. We know that you have many options to consider and choices to make in the next few weeks and we are happy that you are interested in our program. We would like to encourage you to ask us as many questions as possible to learn about what the UBC program has to offer. We look forward to meeting you at the interviews. General Surgery Residents


Table of Contents

OVERVIEW ........................................................................................ 5

ROTATIONS ..................................................................................... 10

CURRICULUM ................................................................................. 15

LONGITUDINAL INITIATIVES ........................................................... 18

PEOPLE ............................................................................................ 24

PROGRAM CONTACTS .................................................................... 31


OVERVIEW

OVERVIEW

OVERVIEW


Overview The General Surgery Residency Program at the University of British Columbia is a 5 year training program beginning at the PGY1 level. It is designed to provide residents with the broad, comprehensive education required to attain excellence in the practice of general surgery, and to open up opportunities for innovative thinking and leadership in the advancement of our specialty. Clinical excellence is pursued through a spectrum of high volume rotations on general surgery and surgical subspecialty rotations across Vancouver and around BC. These rotations are supported by a rapidly evolving academic curriculum, delivered during dynamic academic half days and journal clubs. The program strives to measure performance and to provide timely, detailed and constructive feedback at every opportunity. In addition to attaining clinical excellence, over the past many years, all of our residents have developed the potential for imaginative and effective surgical leadership by the time of their graduation. While in many ways, the goals and aspirations of our residents guide their research productivity, all of residents by the end of their training have a solid grounding in clinical research and a resume of peer reviewed publications and conference presentations. The following document summarizes the strategies we use to pursue these goals, starting with an overview of the program’s administrative structure, and education framework (MATRIX). We then describe our rotations, educational curricula, and longitudinal initiatives in more detail. The document concludes with some profiles of the residents and faculty – many of whom we hope you will have the chance to meet during the interviews. General Principles Our efforts in surgical education are guided by 2 main principles: preserving the high standards of clinical training established by the program over the past 3 decades by ensuring ongoing access to high quality and high volume clinical rotations and meaningful evaluations, and recognizing and optimizing the unique strengths and leadership potential of our residents to promote imaginative and successful surgical careers. Program Administration The leadership and administrative structure of the program reflects key educational priorities. In addition to the Program Director (PD), we have an Associate PD and an Assistant PD who, with the Program Manager, form the Executive body of the Resident Education Committee, which sets the direction for the Program, and oversees resident promotion. The Program Director coordinates all simulation and has made technical skills training and simulation strong pillars in the training of UBC surgical residents – simulation is used liberally in the Basic Surgical Techniques Course, the Surgery CRASH Course, the junior and senior academic half days, high fidelity operative courses, and various rotations (Trauma, Endoscopy, ICU). The Associate Program Director monitors all clinical rotations and directs rotation scheduling. The Assistant Program Director is responsible for Curriculum Development and supervises the academic half days and related initiatives, ensuring that they remain innovative, interesting and evidence based. Additionally, the program benefits from having one of our senior surgeons act as the Research Director, to help to set clear agendas in the scientific training of residents, and mentors dozens of residents successfully through this process. An engaged and committed Residency Education Committee (REC), which now has representation from all key service chiefs and all residency years, has given the program access to excellent guidance and helped to forge consensus on new initiatives. Our Program Manager, Ms. Luiza Shamkulova primarily manages the operational and educational components of the Division’s Residency Training Program and supports the administrative management of the division. Our Senior Program Assistant, coordinates a complex Academic Half Day schedule and defines a key role in resident performance evaluation through his steady work on written and oral testing, technical skills testing, rotation evaluations, and creation and maintenance of performance dashboards. A resident run Curriculum Committee has proved to be a vital component of the REC, and has crafted and smoothly administered Academic Half Days that have maximized contributions from local experts, inspired independent and group learning, and become a foundation of surgical training at UBC. Finally, and most importantly, the program continuously benefits from the insights and ideas of its residents. Town Hall Meetings and program retreats are consistently exciting and creative, and consistently inspire and drive progress.


A MATRIX for Comprehensive Surgical Education The structure of our program is based on the idea that expertise in all of the CanMEDS roles is essential for effective surgical practice, and that relevant level of training-specific experiences in each of these roles can be found throughout surgical residency. The matrix table below, with columns representing CanMEDS roles, and rows representing academic curriculum and surgical rotations, reveals where specific CanMEDS roles figure prominently in surgical training and practice and provides a framework for training in non-medical expert roles within the context of surgical training.


The vast majority of experiences in surgical training are devoted to increasing competence in the Medical Expert role. Through reading, didactic teaching, and clinical and operative experience, residents will build basic knowledge and expertise in the care of surgical patients in every rotation and every educational encounter. Other CanMEDS roles can be taught at grand rounds or academic half days, but teaching of non-Medical Expert roles might be more effectively accomplished in the context that the roles are most intensely needed. For example, discharge of patients from a trauma service into the community provides an important opportunity to explore issues in Health Advocacy for junior residents, while trauma resuscitation situations provide an invaluable context to teach and evaluate the performance of the Manager role for senior residents. Similarly, attendance of and participation in multidisciplinary tumor board meetings on a surgical oncology rotation may illustrate the importance of surgeons as Collaborators in addition to Medical Experts. In our program, the busy, resident driven Acute Care Surgery service, with multiple trainees at various levels, will be used to run a clearly defined Surgical Residents as Teachers program that will be used to illustrate key aspects of the CanMEDS Scholar role. Finally, busy general surgery rotations in Kamloops, Prince George, Vernon and at the Royal Columbian Hospital will be used to set the stage for discussion of the importance of clear Communication between services, staff and patients in advancing care and optimizing outcomes. While all clinical rotations ultimately provide exposure to all CanMEDS roles, recognizing specific rotations as hubs for certain non-expert roles, allows explicit objectives to be expanded, formalized, and evaluated in detail and according to level of training. Our program is also attempting to create relevant strategies for teaching and learning CanMEDS roles outside of conventional rotations. Development of excellence in most CanMEDS roles requires an approach of graded responsibility and sophistication (in order to be relevant to level of training) and sustained effort throughout one’s residency and career. A longitudinal approach that cuts across rotations and years of training for teaching certain roles shows residents that their Medical Expert and non-Expert development can be balanced and sustained throughout their professional lives. For example, our Surgical Residents as Teachers Program, a key aspect of our CanMEDS Scholar training, starts in the first year of training with a two day retreat, where the importance of residents as teachers is emphasized, and where fundamental principles of bedside teaching and learning are highlighted and discussed. This initial exposure is supported and advanced at academic half day sessions throughout the year. Furthermore, our Acute Care Surgery rotation has expanded the profile of teaching in its goals and objectives for junior and senior residents, and in the corresponding rotation in-training evaluation reports.


Measurement A commitment to measurement of performance – The Surgical Dashboard In recent years, the program has embraced the notion that “if you cannot measure it, you cannot improve it” (Kelvin). We are now beginning to collect as much data as possible for each of our residents. Each of us can stand to improve, even in our strongest areas, and we hope to create an atmosphere of constructive criticism and continuous, data-driven performance improvement. Current metrics include: rotation and level of training specific evaluations, unit tests, semi-annual AHD curriculum-based written and oral exams, Global Rating of Technical Skills (GRITS) evaluations, review of electronic case logs (operative dashboard), laparoscopic time trials, CRASH Course evaluations (written exam, OSCE, OSTE), teaching evaluations (bedside and formal teaching), Expert Series evaluations (mock written and oral exams), and reviews of regularly updated CVs. These metrics are summarized in the residents’ Surgical Dashboards and can be reviewed at a glance in twice annual progress review meetings. The program has created a refinement of the electronic case log that will allow the visual display of case volumes against agreed upon benchmarks in a dashboard format. Representative operative cases, endoscopy and ultrasound studies will be selected and plotted. These dashboards will be reviewed with the residents on a semi-annual basis. A mock-up of this Operative Dashboard is presented below.


ROTATIONS

ROTATIONS

ROTATIONS


Rotations and Training Sites Associate Program Director, Rotations – Ahmer Karimuddin MD, FRCSC Clinical rotations are, of course, the core strength of our program. As a provincial program, our residents travel the length and breadth of British Columbia, through the largest distributed medical school infrastructure in Canada. Our training philosophy relies on broad based exposure to General Surgery, which requires that our residents be flexible and be able to travel as necessary for clinical rotations. The first two years of the program fulfill the requirements of the Royal College of Physicians and Surgeons of Canada Surgical Foundations program. This is a broad-based 24 month experience comprising general surgery, surgical subspecialties (pediatric, vascular, and thoracic), anaesthesia, emergency medicine, internal medicine, pediatrics, critical care and psychiatry. By the end of these two years the resident will be eligible for the Royal College Surgical Foundations Examination. After the core training experience has built a solid clinical foundation, the senior years (R3-5) are dedicated to a comprehensive exposure to increasingly complex clinical and technical surgery in hospitals around Metropolitan Vancouver and across the province. The program has recognized that its graduates must be equipped with strong training across all CanMEDS roles, if they are to fulfill their potential to become excellent surgeons, patient advocates and leaders. We have moved decisively toward ensuring that our training recognizes, teaches, and evaluates these roles explicitly where they are most prominent. In recent years, the UBC program has pioneered the MATRIX concept for comprehensive surgical training across the CanMEDS roles. The program is actively working to populate the cells of this grid with specific teaching modules and evaluation strategies. A few clinical rotations are already beginning to serve as specialized hubs for CanMEDS training (ACS – Scholar, Trauma – Manager, St. Paul’s – Health Advocate, etc.). A diversity of teaching hospitals across the province provides a balance between training in the fundamental principles of surgery, high volume operative general surgery, and surgical subspecialties. All rotations are committed to training highly competent surgeons with a command of the scientific literature. Rotation Overview – Graded Responsibility PGY1-2

• Core surgery years • Most of the training in Vancouver • Rotating through subspecialty services (e.g. Vascular, Thoracics, Peds) as well as General Surgery • Focus is on learning to manage sick patients, recognizing who needs to go to the OR and when, as

well as follow-up care • Usually working as part of a team • Principles of Surgery lecture each week with other surgical specialty residents-prep for the POS

exam spring of second year • A gradual progression from taking junior call, supported by senior residents, to senior call,

supported by attendings • Weekly AHD’s and skills labs • Other academic activities depending on the rotation • FLS Course • PGY1s – Surgical CRASH Course including ATLS, FCCS, SRAT, POEM • PGY2s – Research Month, LMCC Part 2, POS Exam

PGY3

• Rotations can be structured to facilitate your individual goals • Access to out of town rotations starts this year • Senior trauma surgery and GI/endoscopy done this year • Greater independence and leadership on the wards and in the OR • Opportunity to attend SAGES courses


PGY4-5

• The major cutting years. Can continue to combine academic and community rotations. Most residents at this stage are “filling in gaps” with their choices of rotations

• Confidence building years, as you become an independent surgeon • Opportunity to attend SAGES courses • DSTC (Definitive Surgical Trauma Care) Course • Expert Series and Mock Oral Exams • Elective rotations

Training Sites The rotations in our residency are distributed over many sites not only in Vancouver and the surrounding lower mainland communities but also hospitals throughout the province. Despite the inconvenience of being away from home, training at community sites is often cited by residents as a strength of the program, due to the focused teaching by community surgeons and the more relaxed operating rooms at the smaller hospitals.

Vancouver General Hospital • Tertiary care and Level 1 trauma centre • Much of the first 2 years are spent here • Academic hospital for the Faculty of Medicine Undergraduate and Postgraduate Programs • A new Acute Care Surgery Service and a call format which lets sub-specialty surgery residents have

very limited call • Subspecialty rotations in Hepatobiliary Surgery, Trauma, Surgical Oncology and Minimally Invasive

Surgery • Great training opportunities but as with any large institution the bureaucracy can seem

overwhelming at times • Known by surgery residents as the “mothership”

St Paul’s Hospital • Academic centre closer to downtown. Consequently has a large proportion from Canada’s poorest

postal code. A real inner-city hospital • PGY 2 and PGY 5 rotations • Strong focus on endocrine and colorectal surgery • Strong rotation for both juniors with large amount of autonomy in the case of patients, and more

consistent operating opportunities


UBC Hospital • Mostly day-procedures (lap choles, lap hernias, Nissens) performed by surgeons from VGH • Opportunity to focus on, study and read about the surgical procedures. You will not be too tired

from call • Friendly small hospital

Royal Columbian Hospital • Large hospital approximately 20 min drive (if no traffic) from Vancouver. S • Major tertiary hospital for Fraser Health • Combination of broad based General Surgery, Colorectal Surgery, Hepatobiliary Surgery, Surgical

Oncology • Sees a lot of major highway trauma • Royal College intern training site

University Hospital of Northern BC • Tertiary centre and major referral hospital for Northern BC • Very popular training site with the residents and has a fantastic group of surgeons. Very collegial. • Most Residents go as a senior (RIV to RV) • Site of the recent medical school expansion in 2004

Other training sites include:

BC Children’s & BC Women’s Hospital Mount St. Joseph’s Hospital

Surrey Memorial Hospital Lion’s Gate Hospital

Richmond Hospital Nanaimo General Hospital

Abbotsford Regional Hospital Langley Memorial & Cancer Centre Hospital


http://www.google.com/imgres?q=prince+george+regional+hospital&hl=en&biw=1516&bih=778&gbv=2&tbm=isch&tbnid=ZXvLr2MKs2l_tM:&imgrefurl=http://www.leespage.ca/h/tra/ca/bc/pg.html&docid=aXO-mikFC-r0BM&imgurl=http://www.leespage.ca/h/tra/ca/bc/i/pg/p148.jpg&w=450&h=228&ei=2voeT-3-JcrnqQHhv-DPDQ&zoom=1

Victoria General Hospital Campbell River Hospital

Royal Inland Hospital – Kamloops Cariboo Memorial Hospital – Williams Lake

East Kootenay Regional Hospital – Shuswap Lake General Cranbrook Hospital – Salmon Arm

Kelowna General Hospital Penticton Regional Hospital

Vernon Jubilee Hospital Kootenay Boundary Regional Hospital – Trail

ESSITES


CURRICULUM

CURRICULUM

CURRICULUM


Academic Half Day and Other Curricula Assistant Program Director, Curriculum Development – Tracy Scott, MD FRCSC Our educational curriculum is based around the program’s Academic Half Days (AHD). Throughout their training, residents attend an AHD with delivered reading assignments, dynamic formats and a strong emphasis on concurrent development of knowledge and technical skills. Within each subject block, 1-2 AHDs are purely dedicated to operative strategy and skills in simulated OR settings at the CESI the Jack Bell Lab and the UBC anatomy labs. There are division-wide educational activities as well; including weekly city-wide rounds, trauma conferences, M&M Rounds, and journal clubs. Each service has academic rounds involving the residents at least once per week. Junior Academic Half Day (AHD) PGY1s and PGY2s participate in a Surgical Foundations lecture and skills series in preparation for the principles of Surgery Examinations each Wednesday morning. Last year, we added a full AHD in General Surgery to the Surgical Foundations series. Creating a separate AHD curriculum for the juniors has allowed greater focus on educational goals, more rapid learning pace, more interaction and case-based teaching, and interestingly, more opportunities for operative experience for the juniors (due to offset AHDs). The AHD curriculum is based on a single textbook, which is to be completed in one academic year, and is punctuated by numerous unit tests, midterms and final exams. The split AHD format has so far had very positive reviews. Senior Academic Half Day (AHD) The senior AHD is divided into subject blocks arranged in a 2 year cycle. The residents are given access to on-line resources, but most efforts are directed toward the completion of 1 standard major textbook per year. Residents are assigned weekly readings from that text and are expected to come to each session with the readings completed. The program has attempted to “invert” the learning experience, by encouraging individual reading and mastery of the curriculum, while using class time as a forum for discussion, problem solving, and expert opinion. About 30% of the AHD sessions are conducted in the lab, with both low fidelity and high fidelity simulation used to advance technical skills. These lab sessions, coordinated by Dr. Adam Meneghetti take place in the Jack Bell labs and in CESEI, using pig or human models, depending on the anatomic area under consideration. The Surgical CRASH (Competencies in Resuscitation and Stabilization of Hospital Patients) Course The Surgical CRASH Course is a modular 1-month curriculum that emphasizes key cognitive and technical competencies in caring for unstable patients. The CRASH Course will include in-depth comprehension of essential scientific literature, critical appraisal skills, fluency in resuscitation algorithms on trauma and critical care, familiarity with technical aspects of resuscitation, and effective communication and management skills in high intensity situations. The course will incorporate a CanMEDS competency-based training platform and will be designed to integrate with existing activities on the UBC Surgical Foundations Program and the UBC General Surgery Program and residents will complete 2-3 relevant Fundamentals of Surgical Care (FSC) modules per week. All aspects of the CRASH Course including quality and value of the curriculum, and resident performance are rigorously evaluated and the curriculum is continuously modified to meet educational needs. By the end of this Course residents will have obtained formal certification in the ATLS program, the FCCS program, the SRAT program, and the basic Ultrasound Program of the American College of Surgeons. Residents will be excused from regular service activities but will still have nominal call responsibilities (which will allow immediate application and reinforcement of acquired competencies). Call will preferably be taken on Friday nights or Saturdays. Journal Club The Program’s journal clubs are designed to allow residents to use critical appraisal skills to evaluate relevant landmark literature. For the past year, the program has selected papers from the Evidence Based Reviews series, along with their methodological counterparts, based on the current focus of the AHDs.


Surgical Residents as Teachers The program has made an extensive commitment to developing and enhancing the teaching skills of its residents. A 3-year curriculum emphasizes the importance of teaching in surgery, and acknowledges the critical role played by surgical residents in the training of medical students and fellow residents, and in creating informed therapeutic partnerships with patients. The SRAT Program is based on the principles that strong resident teaching skills enhance the education and involvement of students in general surgery, increase patient safety, and more rapidly advance the knowledge of the teachers themselves. Fundamental Laparoscopic Skills (FLS) Basic and advanced laparoscopic skills, recognized as the future of general surgical practice are, of course, promoted across all clinical rotations. Simulation and repetition are promoted as key determinants of attainment of mastery, both in laparoscopy and endoscopy. Residents have 24 hour access to the box trainers and endoscopy simulator at CESEI, and all PGY2s are asked to complete the SAGES FLS Course under the supervision of the Program Director, Dr. Adam Meneghetti, and are encouraged to complete time trials for standard endoscopic knot tying. FLS training and endoscopy simulation are prerequisites for more advanced technical training on surgical rotations. SAGES Courses While these courses take place outside the jurisdiction of our program, all residents are encouraged to participate in the basic and advanced courses at SAGES, whose tuition is covered by an educational grant from Covidien. These courses have been extremely popular among our residents. Definitive Surgery for Trauma Care Course (DSTC) Operative strategy in trauma surgery has traditionally been difficult to teach, especially considering the variability of exposure of residents to operative trauma. The program has used and continues to use structured training and simulation with good effect. Recently, the program has secured access for its most senior residents to complete the highly acclaimed DSTC course, as part of their preparation for the Royal College Exam and for independent surgical practice. DSTC is now a mandatory component of surgical training at UBC. Expert Series and Mock Orals The program is active in the organization of a review curriculum and practice oral exam series for its final year residents. Practice oral exams will be graded using the Royal College evaluation template and the program will track performance. Basic Surgical Techniques (BST) and POEM Course Considerable investment has been made in the early education of UBC General Surgery residents. THE BST Course, conducted as 6-7 AHDs each summer in the PGY1 and PGY2 years, emphasize OR set up and communication, safety, operative dictation, and surgical anatomy. The Surgical CRASH Course, which is unique in Canada, is a high intensity month of training in trauma and critical care topics, diagnostic imaging, technical skills, as well as in surgical teaching (SRAT Course), crisis resource management (POEM – see below), surgical research, and critical appraisal. The course is fundamentally committed to training across all CanMEDS roles and is heavily and continuously evaluated by its students to ensure that teaching across these roles is relevant and useful. The students participate in a daylong evaluation as well, which included written tests, OSCEs and a new and innovative Objective Structured Teaching Evaluation (OSTE). The program has cooperated extensively with the UBC Surgical Foundations Program (Dr. Sonia Butterworth and Ms. Denise Archibald) in the design and implementation of the CRASH Course. At the conclusion of CRASH, all participants achieve certification in ATLS, FCCS, and SRAT.


LONGITUDINAL INITIATIVES




Longitudinal Initiatives Several longitudinal initiatives are currently planned or running in our program. These reflect patterns of lifelong learning and acquisition of skills that are characteristic of successful surgical careers. These initiatives include surgical endoscopy, diagnostic imaging, the Surgeon Scientist Program, health advocacy, and various curricula including the academic half days, Expert Series, and Surgical Residents as teachers.

Longitudinal education programs So far, there are 7 established or nearly established longitudinal education initiatives in our program. These initiatives are designed to promote thought and action around CanMEDS roles and to illustrate that advancement in these areas is a lifelong process that can be sustained alongside busy clinical practices.


Endoscopy

Longitudinal endoscopy curriculum Our program has a strategy to integrate endoscopy training across rotations. This involves a specified period of endoscopic simulator training, a dedicated endoscopy rotation at specific centers, and maximization of endoscopy experience on general surgery rotations where endoscopies are performed. Already, 3 general surgery rotations have created dedicated scope time as part of the weekly schedule. A fourth rotation focusing on interventional endoscopy is in the works. Our electronic operative dashboard will track numbers and compare these against thresholds that are established by the program. It is hoped that these measures will allow endoscopic skills to continuously evolve and stay fresh until the point of graduation.

Simulation has already proven to be a powerful adjunct to our clinical endoscopy training and has been formalized into the endoscopy rotations.


Surgeon Scientist Program Research Director – Garth Warnock, BMedSci MD MSc FRCSC FACS We recognize that our applicants come to us with strong track records of achievement in a diversity of fields and strong commitment to a diversity of ideals. The Surgeon Scientist Program (SSP) recognizes that these ideals are the seeds of surgical leadership, and will shape the future of general surgery. We have designed the SSP to ensure that ideals are developed into action and that they translate into innovative and ambitious surgical careers. Although UBC general surgery residents have had a longstanding history of academic productivity (including regular presentations at national and international meetings, publications in prestigious journals, major research awards and even success at peer-reviewed grant competitions), the residency program is rapidly moving forward with its most comprehensive research agenda to date. The SSP is a longitudinal program of research that will span the entire period of training for all residents. In the PGY1 year, residents will be linked with research groups of their choice in an introductory phase of the SSP (Research Matters). Informal experiences with these research groups will result in a full month research elective in the PGY2 year, during which time residents will prepare research proposals suitable for submission for research trainee awards from local and national funding agencies. Residents wishing to pursue research years or graduate degrees will be encouraged to do so. All other residents will continue to be involved in academic work alongside their clinical training for the duration of their residency program. In recent years, many of our residents have made important contributions in basic science or clinical research, public health, surgical education, quality improvement, and global health. We believe that success in academic surgery depends on excellent mentorship, and the program will continue to devote considerable attention to linking our residents to superb mentors and exciting research projects. Step 1: PGY1 Research Matters Early in the PGY1 year (see CRASH Course Evidence-Based Surgery), residents will be introduced to concepts in research including identifying a research area, choosing a mentor, developing a research question, writing a proposal, navigating ethics, and preparing a manuscript. CRASH residents also receive a primer on study design in surgical research. We encourage residents to explore existing research themes in our Division, as well as to forge cross disciplinary partnerships. Residents will be given time to attend the regular meetings of research groups whose work is most consistent with their interests throughout the remainder of their training. Step 2: PGY2 Research Rotation As interest in a particular research program increases, residents will arrange a full month research rotation with that group. It is hoped that this experience will result in a systematic review of a surgical topic and can lay the groundwork for a more involved research project. At the end of the rotation, residents are encouraged to complete an application for a Canadian Institutes for Health Research (CIHR) trainee award or a UBC Clinical Investigator Program (CIP) award. Step 3: Research Year and Senior Residency Residents with successful CIHR, CIP, or CHES applications and those with strong, non-funded research proposals will be encouraged to embark on dedicated research years and graduate studies according to their interests. They will continue with regular research group participation and will complete research projects as specified by the SSP.



Branch for International Surgery Committed to Advancing Global Surgical Care One of the reasons why medicine is inherently attractive as a career is its potential to open doors for work opportunities overseas and general surgery is no exception to this. UBC surgery-related faculty and residents are actively engaged in international surgery endeavors in over 50 countries involving over 40 recipient institutions and engaging in over 64 clinical faculty exchanges. The focal point for our commitment to global health is the Branch for International Surgical Care. With its network of UBC surgery-related departments it is now one of Canada’s foremost centres for advancing surgical care in international health. Our courses enable surgical and health professionals to acquire and enhance knowledge in global surgical care so they can positively reduce surgically treatable and preventable diseases. The Branch for International Surgical Care at the University of British Columbia is establishing itself as world leader in global surgery training. Our initial courses—unique in the world—have now graduated over 165 surgeons, residents, health professionals from across North America, Pakistan, Kuwait, Singapore and the UK. The Branch’s activities over the recent past years have included:

• Establishing a unique, accredited Graduate Certificate in Global Surgical Care (GCGSC) delivered completely online. Requirements for the Certificate consist of the four novel Branch courses: Surgery Surgery 510 – “Surgical Care in International Health”, Surgery 512 – “Global Disability, A Surgical Care Mandate”, and Surgery 514 – “Surgical Care in Humanitarian Disaster Response”, combined with School of Population and Surgery 516 “Program Planning and Evaluation in Surgical Care Low Resource Settings”;

• Creation of Masters in Global Surgical Care (MGSC). With the creation of three further Surgery online courses and the modification of existing courses within SPPH, the Masters program will be delivered completely online. The MGSC is planned to roll in 2018.

• Offering two global research awards for residents each year, this year one in each of Otolaryngology-Head and Neck Surgery and Orthopedics;

• Continuing research and national support for Spine Disease in Ethiopia, and Trauma care development in partnership with the Gondar Medical Centre in Ethiopia.

• Establishing global partnerships for faculty involvement in surgical-care training and education through signing of a Memorandum of Understanding between Canadian Red Cross, McGill and UBC. This will involve opportunities for training, deployment and research for both faculty and residents in the domain of humanitarian response to global crises.

• The development of a cross-cultural professional exchange for UBC General Surgery Residents in Mexico with the Mexican Red Cross.

Mentorship A unique strength of the General Surgery Residency Program is how residents are supported in their global surgical care interests. This is made possible through the flexibility of the mid-cycle rotation schedules, Program Directors, the Branch’s Directors with extensive international work experience, and other faculty who are individually involved in international health/surgery organizations. With the setting of appropriate goals and objectives the Residency Program has shown full support for those residents interested in applying their skills in resource-poor environments. General Surgery Research Award Recipients One reason more residents are not taking on international research is the limited availability of funds. Our Branch is addressing this. Through annual research awards our residents can enrich their learning by taking on an international research project in a low resource region.

Gareth Eeson, General Surgery Prevalence and Risk Factors of Fungal Colonization and Infection in Burn Patients at Mulago Hospital, Kampala

Field Mission: Fall 2011 – Uganda (Kampala) Publications: Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda. Pediatric surgical camps as one model of global surgical partnership: a way forward.

Eiman Zargaran, General Surgery Distribution and determinants of injury in Cape Town, South Africa: A prospective cohort study using an injury surveillance tool

Field Mission: January 2012 – South Africa (Cape Town) Publications: Injury Severity Score coding: Data analyst v. emerging m-health technology. An Objective Assessment of the Surgical Trainee in an Urban Trauma Unit in South Africa: A Pilot Study. Mobile health technology transforms injury severity scoring in South Africa. A global agenda for electronic injury surveillance: Consensus statement from the Trauma Association of Canada, the Trauma Society of South Africa, and the Panamerican Trauma Society. Trauma Surveillance in Cape Town, South Africa: An Analysis of 9236 Consecutive Trauma Center Admissions. The electronic Trauma Health Record: design and usability of a novel tablet-based tool for trauma care and injury surveillance in low resource settings.

Joseph Margolick, General Surgery Implementation of a bilateral, sustainable clinical exchange between UBC and HCC Polanco

Field Mission: August 2017 – Mexico Publications/Presentations: The foundations of a bilateral academic exchange between a high- and a middle-income country - the UBC-HCC Polanco partnership. Presented at WB & MH Chung Lectureship and Research Day, October 2017. An Analysis of Collaboration and Sustainability in Global Surgery. Presented at UBC Residents’ Research Day, May 2017. Procedural skills training for Canadian medical students participating in international electives

Dialogue Our Rounds on Global Surgical Care are accredited as a Continuing Medical Education activity by the Royal College of Surgeons and Physicians of Canada. They are delivered up to three times a year and tap into the breadth and diversity of our residents, and faculty. Residents are also encouraged to participate in the Annual Bethune Roundtable and other forums. The Department’s faculty are known for their leadership and engagement in numerous local, national, and international organizations including the Vancouver-based Canadian Network for International Surgery, the Canadian Association of General Surgeons, and the World Health Organization. To find out more about how our residents and faculty are thinking globally and acting globally visit: http://internationalsurgery.med.ubc.ca/


https://www.ncbi.nlm.nih.gov/pubmed/25270348













https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563617/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563617/

http://internationalsurgery.med.ubc.ca/

PEOPLE

PEOPLE

PEOPLE


Residents

Our residents are definitely one of the strongest assets of the program. The group is diverse coming from almost every province in Canada:

University of British Columbia 17 University of Ottawa 2 University of Calgary 2 McGill University 4 University of Alberta 2 McMaster University 3 University of Western Ontario 1 Northern Ontario School of Medicine 1 University of Toronto 4 IMG (China, Oman) 6

There are currently 42 residents, 21 women and 21 men. The residents in the program have a wide range of interests including skiing and hiking, field hockey, music and soccer. The UBC General Surgery Residency Program, although challenging, definitely supports each one of us throughout this difficult and rewarding process. Because of the diversity of our group, there are many challenges, both predictable as well as surprises, which have arisen over the years. We as residents can always count on the program to work with us to make adjustments to work around these challenges.

UBC GENERAL SURGERY CLASS OF 2017


Resident Comments How would you describe our program to a new resident? “fantastic program because the staff are good to work with and approachable. There is a breadth and variety of community opportunities, in addition to a great academic center experience. Our program consists of residents who share camaraderie and goodwill. Overall a supportive group of residents.” “enough flexibility in the program so that your interests/ goals can be accommodated” “the program is friendly, collegial and challenging” “The program is sensitive to your personal life and needs. There is also opportunity for dedicated research time. Can have a seamless transition into the surgical scientist program (Royal College Fellowship) because there is ample time to fulfill the requirements of the fellowship during the residency.” “The program structure and faculty teaches you to be an excellent all-round physician as well as surgeon. At times the workload and stress can seem overwhelming but the support of fellow residents and staff has always kept me going… Our program director is sincerely dedicated to improving our training in any way possible and has already made substantial improvements to our half day and helped along with other surgical staff to implement a formal program of surgical technical skills training.”

What do you like best about living in Vancouver?

“…best city in Canada. It is expensive. If you are motivated you can hike, explore the mountains, sail… and eat a lot of good food…” “…the mild weather…” “…it is a very young city with lots of things to do….” “…the natural beauty… the plethora of sushi restaurants… it is a safe/walkable city…” “..the temperate climate. It has everything for the sports enthusiast…” “…lots of amazing restaurants…” “…the city is an integration of cosmopolitan amenities/luxuries/social events and outdoor pursuits. I love how the cuisine is so diverse and there is something for peoples of different backgrounds. And the mountains!!!” “…Vancouver is generally a safe city where you can walk around… It is actually not a very big area and you can easily access where you want to go. It is consistently voted one of the top places in the world to live because it combines the amenities of a larger city with easy access to the outdoors… the views of the sunrises from the VGH tower are almost worth being up at 5 am…”


Resident Life The UBC General Surgery Residency Program is committed to ensuring that residents maintain strong family lives. We recognize that all residents have different family commitments and needs, and we strive to support all of these. The program also recognizes the challenges of balancing the arrival of children during surgical training, and has attempted to lead the way in initial policy development in this area (see Merchant; CJS.). We believe, and we have seen first-hand in the examples of our residents, that tough surgical training, surgical excellence and rewarding personal lives can be simultaneously developed and achieved.

PGY1 HOLIDAY PARTY 2017

PGY1s 2017


PGY1 TEAM BUILDING 2017

WELCOME BBQ 2016


RESIDENT RETREAT 2015

RESIDENT TEAM BUILDING


SPH FACULTY AND SENIOR RESIDENT

AHD LAB – LOOKING SHARP IN PROGRAM VESTS


Program Contacts

Dr. Adam Meneghetti Program Director [email protected]

Dr. Ahmer Karimuddin Associate Program Director, Rotations [email protected]

Dr. Tracy Scott Assistant Program Director, Curriculum Development [email protected]

Dr. Garth Warnock Research Director, Surgeon Scientist Program [email protected]

Luiza Shamkulova Program Manager [email protected]

TBA Senior Program Assistant

Diane Bousadda Senior Administrative Assistant [email protected]

Office General Surgery Residency Program Department of Surgery Room 3100, 950 West 10th Avenue Vancouver, BC, Canada V5Z 1M9 Tel: 604-875-4133 Fax: 604-875-4036 www.gsresidency.surgery.med.ubc.ca


http://www.gsresidency.surgery.med.ubc.ca/

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