Department of Surgery 2011-2012 Annual Report, Lecture notes of Medicine

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Department of Surgery

Annual Report

JULY 1, 2011 – JUNE 30, 2012

R.S. Mclaughlin Professor And Chair Dr. J.T. Rutka Associate Chair And Vice-Chairs Dr. O. Rotstein Associate Chair Dr. D.A. Latter Vice-Chair, Education Dr. R.R. Richards Vice-Chair, Clinical Dr. B. Alman Vice-Chair, Research/A.J. Latner Professor and Chair of Orthopaedics Dr. R. McLeod Vice-Chair, Quality Dr. A. Kapus Associate Chair, Research Surgeons In Chief Dr. J.G. Wright The Hospital for Sick Children/Robert B. Salter Chair in Surgical Research Dr. J.S. Wunder Mount Sinai Hospital/Rubinoff-Gross Chair in Orthopaedics Dr. L.C. Smith St. Joseph’s Health Centre Dr. O.D. Rotstein St. Michael’s Hospital Dr. R.R. Richards Sunnybrook Health Sciences Centre Dr. L. Tate The Toronto East General Hospital Dr. S. Keshavjee University Health Network/James Wallace McCutcheon Chair in Surgery Dr. J.L. Semple Women’s College Hospital University Division Chairs Dr. C. Morshead Anatomy Dr. C. Caldarone Cardiac Surgery Dr. A. Smith General Surgery/Bernard and Ryna Langer Chair Dr. A. Lozano Leslie Dan Professor and Chair of Neurosurgery Dr. B. Alman A.J. Latner Professor and Chair of Orthopaedics Dr. C. Forrest Plastic Surgery (Interim Chair) Dr. T. Waddell F.G. Pearson/R.J. Ginsberg Chair in Thoracic Surgery Dr. S. Herschorn Martin Barkin Chair in Urological Research Dr. T. Lindsay Vascular Surgery

Chair’s Report

Dr James T Rutka, MD, PhD, FRCSC

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n preparing this year’s Chair’s Report, I was inspired by the concept of “the journey” which all of us take in our professional careers, and by this quotation by Greg Anderson: “Focus on the journey, not the destination. Joy is found not in finishing an activity but in doing it”. As surgeons, we are all very goal-oriented, and try to close the cover of one book before we open the cover of another. This past year was characterized by the completion of our Strategic Plan: “Transforming Surgery: Beyond the Cutting Edge”. While the ink was still drying on the pages of the published version of our Strategic Plan, it felt good to have completed this document which took a better part of an academic year to do. However, I soon realized thereafter that our “journey” in the Department of Surgery was just beginning. Our plan is filled with numerous short and long-term goals, and with the hope that we will take our Department to a new destination once we have completed this 5 year journey. The Strategic Planning Steering Committee was exceptionally busy from September through to December in separate working groups focusing on our five main strategic goals: 1) Research; 2) Education;

3. Faculty Development; 4) Best Practices; and 5) Integration. On January 27th, 2012, we held a Strategic Planning retreat at the University Club at which we heard inspiring presentations from Dean Catharine Whiteside, Dr. Robert Bell President and CEO of the University Health Network, Dr. Jay Rosenfield Vice Dean Undergraduate Medical Education, and Dr. Mark Bernstein Greg Wilkins-Barrick Chair in International Surgery. We were also very fortunate to have Deputy Minister of Health and Long Term Care, Mr Saad Rafi, as a special invited guest who spoke to us about the challenges and opportunities with the future provincial health care programs and initiatives. The retreat culminated with various break-out sessions, and collations afterwards of key themes and concepts, all of which were used to inform the final strategic plan report. This can be found at: http://surgery.utoronto.ca/about/ strategic-plan.htm. To accomplish all of our goals within the pages of this plan will definitely be a journey, and I look forward to traveling the road with all of you. A good portion of this past year was spent upgrading our efforts in Undergraduate Medical Education (UME) in the Department of Surgery. To this end, after an exhaustive search, we were very fortunate to appoint Dr. George Christakis, Cardiac Surgery, Sunnybrook Health Sciences Centre, into the role as Director of UME. George replaced Dr. David Backstein who had served admirably in that role over the past many years. Soon after, George appointed Mr. Shibu Thomas as the Co-ordinator of UME. Together, they have worked assiduously to improve the curriculum for medical students by adjusting the content and timing of the lectures in the “crash course” for Year 3 students, and by solidifying their clinical experiences at each site. Furthermore, we have organized a “Life in Surgery” evening event for medical students so that they can learn about how to achieve work and life balance in a career in surgery. We have initiated a “Suture-tying Workshop” in which Year 1-2 medical students have an opportunity to learn the art of hand- and instrument-assisted suturing techniques instructed by some of the best in our faculty. We have offered a Student Surgical Skills Development (S3D) event in which representatives of the different Divisions meet with medical students at a dinner or lunch event to provide informal advice about careers in surgery. This year was the first that we initiated a Surgery Exploration and Discovery (SEAD) course providing medical students with an in-depth, hands-on 2 week course to enable them to learn about the different surgical specialties. Finally, I was delighted to inaugurate a “Breakfast with the Chairman” seminar series where eager medical students would join me for breakfast in an informal setting in the Banting Conference Room to hear my thoughts about the excitement of a selected career path in Surgery. All of these new initiatives and programs helped us prove to the Committee on Accreditation of Canadian Medical Schools (CACMS) and the Liason Committee on Medical Education (LCME) in the US that we highly value the opportunties to teach and mentor medical students at the University of Toronto. You will be pleased to know that the Faculty of Medicine passed its Accreditation cycle this year with flying colours. There were some administrative changes this past year. Neil Fleshner was appointed as the Martin Barkin Chair in Urology following Sender Herschorn who had served in this position for over 10 years. Carmine Simone was appointed as Chief of Surgery at Toronto East General Hospital following Laura Tate in this role. And, Avery Nathens was named Surgeon-in-Chief at Sunnybrook Health Sciences Centre, following on the heels of Robin Richards who had served in this position for 11 years. Finally, Oleg Safir, Orthopaedics, Mt Sinai Hospital, was appointed as the Director of the Surgical Skills Centre, replacing Helen MacRae who had served in that capacity for the past 10 years. Helen, on the other hand, jumped

immediately into the position of program director of the Colorectal Surgery fellowship program, taking over from Marcus Burnstein who had served admirably in the role for 16 years. In this age of rapid communications, the Department of Surgery is leading the way with its monthly newsletter, Excelsior , which provides timely and important news to all faculty members. We have also created “ e -clips”, as a rapid fire communication which delivers congratulatory notes to deserving faculty members, important deadline information, and notices to all. The Surgical Spotlight remains our main method of reaching out to faculty and alumni on a quarterly basis, and I should like to thank Dr. Martin McKneally and Alina Gaspar for the wonderful work they do in making this periodical as informative, and interesting as possible. This year, Todd Penner was promoted to Assistant Professor; and Jack Barkin, Natalie Coburn, Jeff Fialkov, Carol-Anne Moulton, Katalin Szaszi, and Homer Tien were promoted to Associate Professor. To Full Professor, I am delighted to report the successes of Helen MacRae, Sandro Rizoli, and Cari Whyne. Finally, we are indeed proud of Dimitri Anastakis, Past Chair of Plastic and Reconstructive Surgery (PRS), who was appointed to the position of Vice Dean of Continuing Education and Professional Development. It was an extremely busy year with the following surgeons successfully undergoing and passing their Continuing Appointment Reviews as adjudicated by Dr Ori Rotstein: Darlene Fenech, General Surgery; Ralph George, General Surgery; Rebecca Gladdy, General Surgery; Clement Hamani, Neurosurgery; Armando Lorenzo, Urology; Carol-Anne Moulton, General Surgery; Catherine O’Brien, General Surgery; Giuseppe Papia, Vascular Surgery; Tom Schweizer, Neurosurgery; John Theodoropoulos, Orthopaedics; Kazuhiro Yasufuku, Thoracic Surgery; Gelareh Zadeh, Neurosurgery; and Toni Zhong, PRS. Numerous awards were once again earned by a plethora of faculty members and residents in the Department. Some to make mention of here include: Peter Ferguson, Tovee Postgraduate Prize; Georges Azzie, Tovee Undergraduate Prize; Marilyn Heng, the DR Wilson Award for Resident Teaching; Mojgan Hodaie, Bernard Langer Surgeon-Scientist Award; Teodor Grantcharov, George Armstrong-Peters Prize; Jonathan Yeung, Gallie- Bateman Award; Kristen Davidge, Shafie Fazel Award; Albert Yee and Cari Whyne, Charles Tator Mentoring Award; Benedict Rogers and Boris Krischek, Zane Cohen Clinical Fellowship Achievement Award; and Ren-Ke Li, the Lister Prize. We were indeed very fortunate to be partners with our fully affiliate hospitals in the announcement of several new Chairs held by Department of Surgery faculty including: Mark Bernstein, Neurosurgery, Greg Wilkins-Barrick Chair in International Surgery at UHN; Robert Nam, Urology, Ajmera Family Chair in Urologic Oncology at Sunnybrook; Robert Magissano, Vascular Surgery, Inaugural Maggisano Chairholder at Sunnybrook; Homer Tien, General Surgery, Major Sir Frederick Banting Term Chair in Military Trauma Research, Sunnybrook; and Tom Waddell, Thoracic Surgery, Richard and Heather Thomson Chair in Thoracic Translational Research at UHN. Additional notable awards include election to the Canadian Academy of Health Sciences for Ben Alman and Robin McLeod; the William K Lindsay Faculty teaching award to Oleh Antonyshyn; the 2012 American Urological Association Foundation Distinguished Mentor Award to Darius Bagli; the 2012 Excellence in Public Relations Award to Bob Bell; the Bernard Goldman Award to George Christakis; the Ontario Genomics Institute for Societal Impact of Genomics Prize to Abdallah Daar; the Alan R Hudson in Neurosurgery to Peter Dirks; the International Neuropsychology Society Lifetime Achievement Award to Maureen Dennis; the CPSO Council Award to Fred Gentili; the Distinguished Service Award from the American Hepato- Pancreato-Biliary Association to Paul Grieg; Excellence in Postgraduate Medical Education to Robert Mustard; Orthopaedic Research Society New Investigator Award to Diane Nam; PAIRO Los Ross Resident Advocate Award to Gelareh Zadeh; and the Gallie Lecturer Award by the RCPS to Charles Tator. While far too numerous to mention in this report, our faculty have continued to distinguish themselves with the receipt of grants from many national peer-reviewed granting agencies including the CIHR, Physician Services Incorporation, Colon Cancer Canada, Cystic Fibrosis Canada, Canadian Cancer Society Research Institute, Heart and Stroke Foundation, and NSERC. In total, our faculty received $38 Million in research funding this past year. In addition, two of our faculty distinguished themselves with publications in Nature , arguably the world’s most authoritative and high impact journal. Michael Taylor, Neurosurgery, described subgroup-specific structural variation across 1, medulloblastoma genomes in Nature 488: 49-56, 2012. And Michael Tymianski, Neurosurgery, reported on the treatment of stroke with a PSD-95 inhibitor in the primate brain in Nature 483: 213-217, 2012. Thanks to the ongoing efforts of our Senior Development Officer, Darina Landa, we have continued to make excellent progress with our Advancement Program. This past year, we received $2.7 Million in philanthropic and industry related sponsorship. New faculty recruits included: Marcelo Cypel, Thoracic Surgery, UHN; Anand Govindarajan, General Surgery, Mt Sinai; Paul Karanicolas, General Surgery, Sunnybrook; Martin Koyle, Urology, Sick Kids; Girish Kulkarni, Urology, UHN; Jason Lee, Urology, St Michael’s; Paul Kuzyk, Orthopaedics, Mt Sinai; Mark Wheatcroft, Vascular Surgery, St Michael’s; and Tony Moloney, Vascular Surgery, St Michael’s. Sadly, we lost several revered and trusted colleagues in the Department of Surgery who passed away this past year: Leith Douglas, PRS; Ab Guha, Neurosurgery; Ara Keresteci, Urology; Tait McPhedran, General Surgery; and Tom Morley, Neurosurgery. For the upcoming year, I have identified the following goals and objectives to help us along our journey. We will be working diligently to ensure that all residency training programs in the Department pass the Royal College Accreditation cycle; we will aim to surpass

Research

Ben Alman, Vice-Chair Research, A.J. Latner Professor and Chair in Orthopaedic

Surgery

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s surgeons, we remove diseased parts of the body or perform operations to improve the function of select organs. The field of regenerative medicine focuses on how we can harness the inherent ability of cells to rebuild body parts or improve the function of degenerating organs. Knowledge from regenerative medicine thus has tremendous potential to improve outcome in surgical patients. This includes using cells in tissue engineering to build new parts outside of the body and then surgically implant them, as well as harnessing progenitor or stem cells to repair or rebuild tissue in-vivo. Members of our faculty have made tremendous inroads into making regenerative medicine a clinical reality, and we learned of their work at this year’s Gallie Day, whose theme was “ Building Better Bodies: Regeneration and Tissue Engineering and Surgery”. The day included a symposium in which several of our faculty members reported on advances in diverse areas in regenerative medicine. Participants included Abdallah Daar (Chief, Science & Ethics Officer, Grand Challenges Canada, Professor of Public Health Sciences and Surgery, U of T), who spoke on how regenerative medicine can improve health internationally, and brought up some ethical issues related to the field. Rita Kandel (Chief, Dept of Pathology & Laboratory Medicine, Mount Sinai Hospital; Professor, Laboratory Medicine and Pathobiology, cross appointed to Surgery, U of T), spoke on the work of her team developing a biologic joint replacement, which could be a longer lasting solution to joint degeneration than conventional total joint replacements. Michael Sefton (University Professor, IBBME, Michael E. Charles Professor, Dept of Chemical Engineering & Applied Chemistry, U of T), spoke on rebuilding blood vessels and the importance of vascularity in regenerating multiple organs in the body. Thomas Waddell (Pearson-Ginsberg Chair, Division of Thoracic Surgery, Thomson Family Chair in Translational Research, Dept of Surgery, U of T), spoke on the use of multiple approaches in regenerative medicine to improve outcome in a variety of lung and respiratory disease. They demonstrated an impressive depth and breadth of work in this field, and gave a fascinating glimpse into how their work will revolutionize surgical care in the near future. Pr Philippe Menasché , (Unité de Chirurgie Cardiaque, Hôpital Européen Georges Pompidou, Paris, France) was this year’s GORDON MURRAY LECTURER. His talk was entitled, ”Stem cells for the treatment of heart failure: What is still missing for a prime time use?”. He outlined the journey that he and others took to study the role of stem cells in cardiac regeneration, and develop their use in the clinic. In addition to his exciting talk and the impact of his work, he gave a touching thank you for his invitation, and for all the help Canada provided to France historically, especially in the Second World War. There were 10 platform presentations and 46 poster presentations from trainees working with our faculty members. The Gallie Bateman Awards (for Surgeon Scientist Program participants) and the McMurrich Awards (for any trainee working with a member of the faculty of surgery) were judged for both platform presentations and poster presentations. The multiplicity of the topics and researchers highlighted the diverse, yet high quality, research being conducted in our Department. The Gallie Bateman Award for best work by a trainee in the Surgeon Scientist Program 1st prize went to oral presentation by Jonathan Yeung: “Ex vivo lung perfusion for evaluation and repair of donor lungs for transplantation” (Supervisor: Shaf Keshavjee ); 2nd prize tie went to Lakhbir Sandhu: “Separating the wheat from the chaff: Empirically identifying the characteristics of high quality non-randomized studies” (co-authors: George Tomlinson, Erin Kennedy, Alice Wei, Nancy Baxter, [supervisor: David Urbach]), for her poster presentation; Francis Zih: “Polo-like kinase 4 enhances cancer cell motility and invasion” (Supervisor: Carol Swallow), for his oral presentation; 3rd prize oral presentation award went to Nathan Perlis: ”Radical cystectomy with perioperative chemotherapy vs. selective bladder preservation with radiation therapy for muscle- -invasive bladder cancer: A decision analysis” (Supervisor: Antonio Finelli). 1st prize tie for the McMurrich Award (for research by a trainee not in the Surgeon Scientist Program) was awarded to David Shih (supervisor: Michael D. Taylor): “Genomic copy-number profiling identifies actionable targets in medulloblastoma subgroups” ; and Shabana Amanda Ali (Alvin Lin, Heather Whetstone, [supervisor: Benjamin Alman]): “Identifying hedgehog signaling target genes in osteoarthritis using an optimized method for Rna extraction from human cartilage”. 2nd prize three way tie: Julia Izrailit (supervisor: Michael Reedijk): “TRB3 regulates MAPK- and SMAD-dependant notch activation in breast cancer” ; Wenxi Gao (supervisors: Mingyao Liu, Shaf Keshavjee ): “Alpha 1-antitrypsin improves lung function in a rat lung transplantation model”; Elaine Mau (Yufa Wang, David Wright, David C.

Silkstone, Benjamin A. Alman Heather Whetstone, Cari Whyne, [supervisor: Diane Nam): ”T-lymphoctyes enable osteoblast maturation via il-17f during the early phase of fracture repair”. 3rd prize four-way tie: Anna Bendzsak (Nancy Baxter, Gail Darling, Peter Austin, [supervisor: David Urbach]): ”Within hospital change in surgical volume and operative mortality in lung cancer: does practice make perfect?”; Crystal Ruff (Hui Ye, Natasha Stribbell, Jean Legasto, Jian Wang, Liang Zhang, [supervisor: Michael Fehlings]): ”Stem cell based transplantation strategies for perinatal sub cortical remyelination”; Kathryn Ottolino-Perry ( Nan Tang, [supervisor: Judith Andrea McCart]): “Combined oncolytic virotherapy and chemotherapy treatment of peritoneal carcinomatosis”; Alenoush Vartanian ( Abhijit Guha, [supervisor: Gelareh Zadeh]): “Metabolic modulation of glioblastoma multiforme (gbm) by depleting hexokinase II: Potentiating the effect of standard therapies”. Faculty research awards went to Mojgan Hodaie ( Bernard Langer Surgeon Scientist Award , awarded to an outstanding graduate of the Surgeon Scientist Program in the Department, who shows the greatest promise for a career in academic surgery), Teodore Grantcharov ( George-Armstrong Peters Prize , awarded to a young investigator who has shown outstanding productivity during his initial period as an independent investigator as evidenced by research publications in peer reviewed journals, grants held, and students trained), Albert Yee and Cari Whyne ( Charles Tator Surgeon Scientist Mentoring Award , to recognize individual supervising participants in the SSP who emulate Professor Tator’s qualities, namely excellence in research, commitment to SSP mentoring and dedication to promotion of Surgeon-Scientists) and Ren-Ke Li ( Lister Prize , awarded to an investigator who has shown outstanding and continuing productivity of international stature as evidenced by research publications, grants held, students trained and other evidence of stature of the work produced). Our high impact journal publications continue to grow by numbers. Our faculty has given research presentations throughout the globe and participated in over a hundred national and international research meetings. The increased competitiveness of research funding from the Canadian Institutes of Health Research, CCSRI, and other funding agencies continues. Despite this, our department members continue to receive new grant at an increasingly phenomenal pace from these agencies. Benjamin Alman, Nancy Baxter, Gregory Borschel, Christopher Caldarone, Sean Cleary, Timothy Daniels, Karen Davis, Michael Fehlings, Geoff Fernie, Anna Gagliardi, Steven Gallinger, Teodor Grantcharov, Sevan Hopyan, Andrew Howard, Keith Jarvi, Marc Jeschke, Andras Kapus, Paul Karanicolas, Shaf Keshavjee, Laurence Klotz, Wolfgang Kuebler, Wey Liang Leong, Ren-Ke Li, Mingyao Liu, Andres Lozano, Cindi Morshead, Avery Nathens, Sandro Rizoli, James Rutka, Emil Schemitsch, Hong-Shuo Sun, Michael D. Taylor, Vasu Venkateswaran, Cari Whyne, Thomas Waddell, and Toni Zhong, were among the great number of faculty who received new grants this year. Our total research funding continues to exceed that of even many of the Universities in Canada, this year was over $50,000,000. We continue to train residents at the graduate level in research. We returned to our roots by renaming the program that trains our residents the Surgeon Scientist Training Program, its original name, We have over thirty residents participating this year. 94% of our Surgeon Scientist Training Program trainees were successful in receiving full or partial salary support from external granting agencies. Johnson & Johnson Medical Products funding support for the Surgeon Scientist Program provided funding to 5 trainees for 2011-2012, who were Ryan Alkins, Bheeshma Ravi, Sunjay Sharma, Megha Suri and Francis Zih. The Departmental Research Committee continues its strong work on expanding the breadth of research activities in the Department, establishing links to emerging research areas, improving the links with the scientists in the Department, developing standardized evaluations for faculty, and optimizing the strengths of Gallie Day and research educational activities. A second scientist retreat was organized by Andras Kapus and Val Cabral on November 23, 2011. Steven Gallinger, Andrew Howard, and Thomas Waddell worked on the White Paper to be included in the Strategic Plan for the Department. This White Paper as well as the Scientist White Paper worked on by Andras Kapus from the Scientist Retreat, were used as starting points in the Departmental Strategic Planning Sessions. Research will always play a leading role in our department and we have made astonishing accomplishments in the past year. There is no doubt in the upcoming years our research activities will continue to expand, with new avenues of investigation being developed, and improvements in our research infrastructure to increase the breadth and depth of our work, ultimately improving the outcome for our patients. Special thanks to Val Cabral for her co-ordination of all aspects of the Departmental research activities. 4 Gallie Day Gala Dinner: Ori Rotstein, James Rutka, Robin McLeod, Ben Alman, David Latter.

Three new residents were accepted into the program and thus far it seems to be extremely successful due to the hard work of the Division of Orthopaedic Surgery. Educators from around the world are awaiting the results of this program. There was a retreat for new faculty in June that was coordinated by Dr. David Latter. It was highly successful and the plan is to continue this retreat. The Department of Surgery will be alternating it on a yearly basis with a faculty development day on how to be a better teacher. The fellowship programs in the Department of Surgery are extremely important. Not only do the fellows learn important skills that they take back to their countries of origin, but they all bring their experiences from around the world to our residents and medical students. At the present time we have 216 fellows in the Department of Surgery. The fellowship committee under the leadership of Dr. David Latter has moved to formalize all the fellowships in the Department of Surgery with definitive goals and objectives and uniformity of salaries for each fellowship. In an effort to improve the social environment for our clinical fellows and their families the Department hosts an annual BBQ in August specifically inviting spouses and children so that the families can get to know each other. The Women in Surgery group is now under the leadership of Dr. Carol-Anne Moulton. The group met twice this year. This group discusses issues of finding the balance of family life with a surgical career. It is well attended by medical students, residents and faculty. Dr. Peter Ferguson was awarded the 2012 Bruce Tovee Award for Postgraduate Teaching. The 2012 D.R. Wilson award for Resident Teaching of medical students was won by Dr. Marilyn Heng. The running of the Department of Surgery with 267 residents, 216 fellows and 265 faculty members is a huge endeavor. This is masterfully done by Tess Weber and Robert Gardin. 5 Tovee Postgraduate Prize: Ron Levine, Peter Ferguson. 6 Gallie Day Gala Dinner

Undergraduate Education

George Christakis, MD Director, Undergraduate Education

011-12 has been typical of a restructuring year for undergraduate education. After eight years of hard work marked by substantial and successful changes to the program, David Backstein stepped down as Director of Undergraduate Education. Also, after more than 25 years of exceptional service, Carmela Calorendi, undergraduate coordinator, retired. Shibu Thomas took over from Carmela and I assumed David’s role as director in September 2011. A mini retreat for undergraduate education headed by Drs. Rutka and Latter took place in late September 2011. Information provided by the student questionnaire in preparation for the medical school accreditation in May 2012, was helpful in creating new ideas as well as promoting the goals and objectives for education in surgery. Recommendations were also made at the mini retreat for changes in the crash course as well as the promotion of new leaders in undergraduate education to improve communication and teaching of clinical clerks. The conclusions from the mini retreat were that undergraduate surgical education will continue to be valued as an important contributor to the Department of Surgery and will be recognized through promotions, practice plan points as well as financial reimbursement. The strength of this support for undergraduate education was further reinforced in the Department’s Strategic Plan meeting in Jan 2012. ‘Crash Course in Surgery’ week: Taking into account general feedback from students, effective March 2012, the Crash Course hours were reduced (from 8:00 a.m.

• 6:00 p.m. to 9:00 a.m. - 5:00 p.m.), thereby slashing 10 hours off the week-long course while still retaining all critical content. Furthermore, starting September 2012, in order to accommodate and make allowances for students coming from the Mississauga Academy of Medicine, the crash course hours will be changed to 10:00 a.m. - 6:00 p.m. The method of teaching in the crash course has also changed. The didactic form of lectures was gradually replaced over the year with ‘case-based clinical questions’ and ‘interactive sessions.’ Starting November 2011, selected crash course sessions have been video- recorded and uploaded to the portal for 24x7 student access. A new learning module called ‘Introduction to the NBME examination,’ was included in the crash course schedule. In this session, students are taken through a sample NBME examination over a period of three hours in order to prepare them for their end-of- rotation written examination. This was introduced during the first week to allow the students to familiarize themselves to the types of clinical scenarios they may encounter while on their clinical sub-rotations. Students are being provided with an NBME study book as well. Clinical sub-rotations: During this academic year, with the help and support of each hospital-based academy, we have instituted a formal, standardized communique that goes to each preceptor, just before a clinical clerk is to come to their service. The letter details the roles and responsibilities of the preceptor as well as providing relevant information, including a picture, of the clerk. In addition to this, monitoring of each clerk’s T-Res progress is done at the Undergraduate Education office. If a lapse or lack of progress is observed, actions are instituted to ensure that the student is offered the opportunity to achieve these mandatory experiences. As a result, we are happy to report 100% compliance in the completion of T-Res requirements over this past year. Organizational changes: The Undergraduate Education Committee was expanded by 75% in 2011-12 in order to allow for more site representation. The Committee also created a larger committee for undergraduate education known as the Surgical Leaders of Undergraduate Education (SLUE). Each surgical division has appointed a divisional director for undergraduate education who will collaborate with other SLUEs in their division. There is now a SLUE from every division at every hospital. In this way there will be a facilitator for undergraduate education representing every division at every hospital site. These committed and enthusiastic surgeon/ educators will facilitate every clerk’s sub-rotation. The SLUEs will also be compiling and completing a handbook for their specialty which will be site non-specific and will have all the information necessary for a clerk’s sub- rotation on their service. Furthermore, these handbooks will contain the basic objectives and requirements of/ for a clerk as well as essential information that any physician should know. The SLUEs will be also responsible for several other important initiatives such as review and revision of educational objectives for every surgical specialty, continuing development of the undergraduate surgical curriculum, etc. Resident Leaders of Undergraduate Education: While conducting a review of surgical undergraduate education, it quickly became apparent that a great majority of the teaching that occurs is performed by surgical residents. It is also clear that there exists in this

Continuing Education and Professional Development

Terry Axelrod Director and Chair, and Professional Development Committee

OVERALL CEPD GOALS

• Promote best practices in continuing education and professional development (including Faculty Development, CHE Professional Development)
• Foster scholarship and research in continuing education
• Broaden the scope and inclusiveness of continuing education (including international, interprofessional)
• Reinforce infrastructure and funding base (including COI, industry relations)

2011-12 ACTIVITIES

• 27 CE events run through the CEPD office, either fully or partially with accreditation only
• 23 live meetings, 3 faculty development, 1 research- based
• Superb success with enrollment in the hundreds for several courses, such as the Update in General Surgery 2012, Urology Update 2011, etc.
• Many faculty members involved as Chair and faculty in CE events nationally and internationally outside of the CEPD jurisdiction

OBJECTIVES FOR 2012-

• Encourage all Divisions to run or accredit courses through CEPD office.
• Catalogue the National and International CE that is done outside of the CEPD office
• Improve the support provided through the Department of Surgery for CE events
• Encourage the development of more Web based programmes. 9 Suture Workshop for medical students

Surgical Alumni Association

Martin Barkin, President

The Surgical Alumni Association steering committee members are: Dr. Andrew Bruce, Dr. Bernard Goldman, Dr. Tirone David, Dr. Griff Pearson, Dr. Hamilton Hall, Dr. Jacob Langer, Dr. James Waddell, Dr. Joseph Schatzker, Dr. Richard Reznick, Dr. Dr. Charles Tator, Dr. Wayne Johnston, Dr. Zane Cohen, Dr. Dimitri Anastakis, Dr. Bernard Langer, Dr. John Wedge In 2012 the Association participated in and contributed to the formation of the Strategic Plan for the department of Surgery that was led by the Department Chairman, Dr. James Rutka. The Surgical Alumni Database has been integrated with the Alumni Data base of the Faculty of Medicine. In order to better understand the needs of our surgical alumni, 2012 saw the preparation of a comprehensive questionnaire that was sent to all alumni on our updated data base in early 2013. We are currently reviewing these responses and will formally present the finding to the Chairman in May. Based on these responses we will direct the efforts of the steering committee to meeting these needs and expectations. As always, your Surgical Alumni Association is, once again, prepared to provide strong support to the Department and its Chair, Dr. James Rutka. 10 Past Chairs of the Department of Surgery: Richard Reznick, Bernard Langer, Donald Wilson, John Wedge, James Rutka, David Latter.

Division Of Anatomy

Cindi Morshead, Chair

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he Division continues to meet the diverse educational needs of students from many programs including Medicine, Residents, Dentistry, Physical Therapy, Occupational Therapy, Speech and Language Pathology, Pharmacy, Physicians Assistant Program, Biomedical Communications, Physical and Health Education, and Arts & Science. Our current faculty is following in the tradition of developing innovative approaches to teaching and this year saw the launch of an online Anatomy course that was developed in collaboration with the Department of Physiology. Faculty research accomplishments are equally impressive. Despite the increased competitiveness of research funding, the Division continues to achieve awards, funding and accolades in support of their research endeavours. Two members of the Division filed patents related to their innovative work in neural regeneration (P Koeberle – Novel Peptides and methods and uses thereof for preventing retinal disorders; CM Morshead, MS Shoichet and 4 others - Methods and devices for local delivery of an agent to the brain).

PROMOTIONS

Dr. Paulo Koeberle was awarded tenure and was promoted to Associate Professor.

RESEARCH GRANTS funded in 2011-2012 academic year

PHuman: Parametric multiscale modeling and simulation of human anatomy. Fels S, Agur AMR, Abolmaesumi P, Singh K. Khan A, Autodesk Canada Inc. NSERC Collaborative Research and Development Grant. ($480,000 2012-2015). Focal Adhesion Kinase: A pivotal role in CNS apoptosis and regeneration. Koeberle PD. CIHR. ($554,525 2012- 2017). Molecular interaction that modulate P13 Kinase and MAP Kinase pathways during Apoptosis. Koeberle PD. NSERC Discovery Grant. ($130,000 2012-2017). Bioengineered cell delivery systems. Shoichet MS, Morshead CM, Tator CH, van der Kooy D. NSERC/CIHR Collaborative Health Research Program. ($658,000 2011- 2014). Repairing the injured spinal cord. Fehlings MG, Morshead CM, van der Kooy D, Shoichet MS, Nagy A. Krembil Foundation Research Grant. ($1,500,000 2011-2014). Promoting self-repair of the stroke injured brain using neural stem cell stimulation and rehabilitation. Morshead CM, Shoichet MS, Corbett D. Heart and Stroke Foundation. (280,000 2012-2015). Novel biotechnology for moedulation of the neurovascular niche to promote regeneration and rehabilitation after ischemic stroke. Corbett D, Morshead CM, Shoichet MS. Canadian Stroke Network Collaborative Research Initiative. ($202,500 2012-2013). Advances in Cerebral Palsy: Cell to Person. Fehlings D, Morshead CM, van der Kooy D, Fehlings MG. Ontario Brain Institute. ($2,000,000 2012-2014). Cellular and Molecular mechanisms of stroke in diabetes and its potential therapeutic treatments. Sun HS. Canada Foundation for Innovation, Leaders Opportunity Fund. ($120,000 2012-2017).

GRADUATE STUDENTS & AWARDS

Congratulations to Ms. Christine Bae who received her MSc under the supervision of Hong Sun. Ms. Nadia Sachewsky (PhD candidate – supervised by Cindi Morshead) was the recipient of the CIHR-TPRM scholarship. Nadia was also a finalist for the Laidlaw Manuscript Competition at Scientific Research Day in IMS. Mr. Dave Piccin (PhD candidate – supervised by Cindi Morshead) the Recipient of Eureka’s 4th Annual International Certificate Program award (2012). Dave had the opportunity to travel to Italy and participate in this international training program in translational medicine and career mentoring designed for young “high potential” professionals. Mr. Robert Babona-Pilipos (PhD candidate – supervised by Cindi Morshead) was the recipient of the NSERC- CREATE CARE studentship. Faculty welcomed many new and award winning graduate students to our Division: Mr. Anton Semechko and Mr. Zhi (James) Li - supervised by Anne Agur Ms. Kristina Wakimoto (supervised by Anne Agur). Kristina is the recipient of a SIRF grant fromHumber College ($7,032) and a grant from the Opportunities to Innovate, Higher Education Quality Council of Ontario. 2012-13 ($8,323) for “The effectiveness of the antomy glove learning system in the training of massage therapy students” (2012-13).

Ms. Megan Lysko and Mr. Philip Donofrio - co- supervised by Anne Agur and Paulo Koeberle Ms. Parvati Dadwal - supervised by Cindi Morshead. Parvati received an IMS entrance scholarship. Mr. Andrew Chow - supervised by Cindi Morshead. Andrew was awarded an Ontario Graduate Scholarship and an IMS entrance scholarship.

FACULTY HONOURS/AWARDS/POSITIONS

HELD

Anne Agur was appointed to the Division of Physiatry, Department of Medicine, Faculty of Medicine at the University of Toronto. Cindi Morshead was appointed as Graduate Coordinator in the Institute of Medical Science. Anne Agur was appointed President of the American Association of Clinical Anatomists. Anne Agur received the Department of Occupational Science and Occupational Therapy Exellence in Teaching Award in recognition of her sustained teaching excellence. Mike Wiley was awarded the Harry Whittaker Memorial Teaching Award in the Faculty of Medicine in 2012. The award is decided upon annually by the students of the first year medical class and awarded to a lecturer, demonstrator or tutor who gave encouragement and displayed genuine concern for student well-being and, through personal commitment to quality teaching, provided practical and clear insights in the basic sciences during the first year of the undergraduate medical program. Ian Taylor was the recipient of the Dr. E. Mary Hollington Pre-Clinical Teaching Award. The Dr. Mary Hollington Excellence in Pre-clinical Teaching Award is presented to a teacher who has demonstrated excellence in the preclinical undergraduate medical education curriculum as selected by 4th year students. Hong Sun received the “Outstanding Professional Alumni Award” from Sun Yet-Sen Univ ZhongShan Med School. Hong Sun was the Guest Editor for Acta Pharmacologica Sinica on Special Topic of Stroke. 12 The Harland Smith Lecture, March 29, 2012: Cindi Morshead, Michael Fehlings, Daniel Riew, Andres Lozano.

FACULTY HONOURS/AWARDS (alphabetical)

Staff Teaching Awards George Christakis was the recipient of the Bernard Goldman Award for Excellence in Cardiac Surgery Teaching. David Latter was the recipient of the James Yao Award for Excellence in Cardiac Surgery Teaching. Ren-Ke Li was honored as the 2012 recipient of the Lister Prize in the Department of Surgery which is the highest honor bestowed upon a member of the Department of Surgery for research. Glen Van Arsdel l was the recipient of the William G. Williams Award for Excellence in Cardiac Surgery Teaching. Subodh Verma was renewed as a Canada Research Chair for an additional five years Terry Yau was the recipient of Lynda L. Mickleborough Award for Excellence in Cardiac Surgery Teaching.

FACULTY GRANTS (alphabetical)

Stephanie Brister holds a grant from the Heart and Stroke Foundation of Canada (An RCT of Women’s Adherence to Women-Only, Home Based and Traditional Cardiac Rehabilitation). Christopher Caldarone holds a grant from the Heart and Stroke Foundation (Randomized Trial of Hybrid and Norwood Single Ventricle Palliation) and the Saving Tiny Hearts Foundation (Pulmonary vein stenosis is congenital heart disease). Dr. Caldarone continues to manage the finances of the CHSS Datacenter. Gideon Cohen continues to hold two grants from the Cardiothoracic Surgery Network (NIH/CIHR). John Coles holds a grant from the Ministry of Health of Ontario (Cardiovascular Biomarker Discovery and Validation) and the Garron Family Cancer Centre (Repurposing of FDA-approved drugs to prevent cardiotoxicity in cancer chemotherapy). Stephen Fremes holds four grants from the Canadian Institutes of Health Research (Steroids in Cardiac Surgery Trial, CABG Off or On Pump Revascularization Study, Transfusion Requirements in Cardiac Surgery, Canadian Network and Centre for Trials Internationally) and the Heart and Stroke Foundation (Improving the Assessment and Treatment of Severe Aortic Stenosis by Evaluating Care Gaps and Advancing Risk Predictions, Superior SVG Patency Trial-Surgical and Pharmacological novel in Interventions to Improve Overall Results of Saphenous Vein Graft Patency in CABG Surgery: An International Multi-centre RCT). Osami Honjo holds one grant from the Labatt Family Heart Centre (Establishment of mechanically-assisted primary cavopulmonary connection physiology in infantile piglets: A proof of concept animal study) and one grant from the University of Toronto Roscoe Reid Graham Scholarship in Surgical Science (Age-dependant vulnerability of developing brain to cardiopulmonary bypass-associated hypoperfusion and ischemia in neonates and infants undergoing congenital heart surgery). Fuad Moussa holds one grant from the JP Bickell Foundation (Usability Testing of Virtual and Usable Resources for Training Off Pump for Coronary Artery Bypass Surgery) and one grant from SEAC Education Research and Scholarship (Developing and Evaluating a Simulation Based Program for Treating Off Pump Coronary Artery Bypass Surgery). Mark Peterson holds one grant from the SMHA Innovation Funds (TAC-CALL: Thoracic Aortic Care

• Comprehensive Aortic Care on-Line From Acute Presentation to Long-Term Follow Up) and one grant from the Canadian Institutes of Health Research (Frailty Assessment Before Cardiac Surgery and Transcatheter Interventions). Vivek Rao holds a grant from the Heart and Stroke Foundation of Canada (Prognostic Role of Endothelial Progenitor Cells in Patients with Heart Failure) and one grant from the UHN/MSO Academic Medical Organization Innovation Fund Competition (Use of Volatile Anaesthetics for Long Term Sedation in Critically Ill Patients). Glen Van Arsdell holds one grant from the Heart and Stroke Foundation of Ontario (Can Sustained Post- Operative Biventricular Pacing Improve Hemodynamics in Children with Electro-Mechanical Dyssynchrony After Surgical Repair of Congenital Heart Disease?) and one from the Canadian Institutes of Health Research (Clinical Assessment of Thrombosis in Children after Heart Surgery: The CATCH study). Subodh Verma holds two grants from the Heart and Stroke Foundation of Ontario (Elucidating the Role of MicroRNA-145 in Atherosclerosis, Surgical and Pharmacological Novel Intervetions to Improve Overall Results of Saphenous Vein Graft Patency in CABG Surgery: An International Multi-Centre RCT ), one grant from the Canada Foundation for Innovation (Zebrafish Centre for Advanced Drug Discovery: A High Throughput Screening Platform for Targeting Cardiovascular Disease), one grant from AstraZeneca Canada (Primary cARe AuDit of Global risk Management: PARADIGM Study), one grant from Physicians’ Services Incorporated Foundation (Elucidating the Role of Birt-Hogg-Dube in Adverse Cardiac Remodelling), one grant from the Canadian Institutes of Health Research (Canada Research Chair in Atherosclerosis) and one grant from Bayer AG (Current Trends in the Management of Atrial Fibrillation in Canada). Richard Weisel holds a grant from the Innovation Fund of the Peter Munk Cardiac Centre (The Next Generation of Cell Therapy) and a grant from the Canadian Institutes of Health Research (Ultrasound Targeted Gene Delivery to Enhance Cell Engraftment in the Aged Heart After Ischemic Injury). Terrence Yau holds a grant from the Heart and Stroke Foundation of Ontario (Electrophysiological Implications of Regenerative Therapy), one grant from the Ryerson New Faculty SRC Development Fund (Facilitators and Barriers to Effective Discharge Following Open Heart Surgery: Patients’ and Nurses’ Experimental Accounts), one grant from the Innovation Fund (Improving Transfusion Practice and Clinical Outcomes in Cardiac Surgery), two grants from the Canadian Institutes of Health Research (Screening for Dysphagia in Patients Following Prolonged Intubation:

Validation of the Toronto Bedside Swallowing Screening Test, The Design and Planning of a Randomized Controlled Trial to Evaluate a Tailored Cardiovascular Surgical Patient Education Intervention in Reducing Post-Hospital Discharge Complications and Readmission Rates), and one grant from the Peter Munk Cardiac Centre Innovation Committee (Cardiac Regeneration – The Next Generation of Cell Therapy).

RESIDENTS AND FELLOWS HONOURS/

AWARDS (alphabetical)

Saswata Deb under the mentorship of Steve Fremes was awarded a 2012 Canada Vanier Scholarship which involved a steep 4-level multidisciplinary competition across Canada Praphulla Shukla under the mentorship of Subodh Verma was honored as a finalist in the 2011 American Heart Association Vivien Thomas Young Investigator Award for his paper entitled “MicroRNA- 145 is a novel regulator of atherosclerosis” New Residents The Division of Cardiac Surgery welcomes Rachel Vanderlaan as our newest Cardiac Surgery Resident.

VISITING PROFESSORS (alphabetical)

James Cox presented the 2011 Heimbecker Lecture entitled “25 Years of Surgery for Atrial Fibrilation” Nimesh Desai presented “Contemporary Management of Aortic Arch Aneurysm: Penn Approach” at the Terrence Donnelly Day on April 21, 2012. John S. Ikonomidis presented “Proteinase Systems and Thoracic Aortic Aneurysm Progression” as a Distinguished Visiting Professor on March 26, 2012. Sidney Levitsky presented the 2011 Bigelow Lecture entitled “Healthcare Inflation: Evidence based medicine vs the Medical-Industrial Complex” Philip Menasche presented “Stem cells for heart failure: Roadblocks that still impede broad clinical applications” St. Michael’s Hospital Research Grand Rounds on June 25, 2012 13 Gallie Day Gala Dinner: Alex Mine Jazz Quartet 14 The John Palmer Lecture: Paul Greig, Michael Choti, Ori Rotstein.