general surgery matters - canadian association of...
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PUBLICATION MAIL REGISTRATION No.: 40809546
CANAD IAN CANAD IAN CANAD IAN CANAD IAN CANAD IAN AS SOC IAAS SOC IAAS SOC IAAS SOC IAAS SOC IAT IONT IONT IONT IONT IONOF GENERAL SURGEONSOF GENERAL SURGEONSOF GENERAL SURGEONSOF GENERAL SURGEONSOF GENERAL SURGEONS
General Surgery Matters
Station B, P.O. Box 1428
Ottawa, ON K1P 5R4
Tél.: 613-882-6510
www.cags-accg.ca
INSIDE:
SPRING 2012
CAGS membership hasits benefits
Continued on page 2
President’s Message
Dr. Ralph George
President’s Messagecontinued ......................... 2
Guyana Surgery Award . 3
Undergraduate GeneralSurgery App ..................... 4
CAGS Exm ChallengeNow Live ........................... 4
Colonoscopy Audit Tool 4
A New Home for CAGS 6
Bylaw changes forCAGS ................................. 6
By-Law No. 3 ................... 7
2012 SuturingCompetition! ................... 8
$25 K Grant Offered .... 8
Research Update from2011 CSRF Winner ..... 10
As most of you are aware2011/2012 has seen realchanges in the governance ofCAGS and our daily opera-tions. Already these changesseem to be favorably influenc-ing our financial bottom line,and will positively affect ourability to invest in memberprograms and services. As wetake a look on the horizon andplan where we will go in theyears ahead, let’s also takestock of where we are andlook at what the CAGSmembership offers:
Canadian Journal ofSurgery: As a member ofCAGS you receive a subscrip-tion to the CJS which iscirculated every two months.CAGS is a major sponsor ofthe journal. At present CJSprovides a venue for originalresearch, an outlet for editorialcomment on current surgicalissues (access to endoscopyfor instance), continuingeducation articles, job adver-tisements, and the publicationof abstract proceedings for
major Canadian meetingsincluding our CanadianSurgical Forum. As a majorsponsor we have input intothe direction and evolution ofthis publication as it keepspace with the CanadianSurgical Community.
Continuing ProfessionalDevelopment: CPD is one ofthe four organizational objec-tives of CAGS, and has beenidentified as one of the mostimportant areas in whichCAGS operates by CAGSMembers. It is the goal of ourCPD committee to provideany member with the opportu-nity of obtaining all theirrequired credits throughCAGS-sponsored activities.The CPD committee can alsohelp you accredit localactivities for formal RoyalCollege CPD hours.
The “Evidence BasedReviews in Surgery” (EBRS)led by past president RobinMcleod exemplifies a first classCPD opportunity for ourmembers. This is an interna-tionally organized approach tocurrent issues of concern topracticing surgeons andprovides a convenient meansof credit accumulation. EBRS isreadily accessed through our
website and CAGS hascommitted ongoing financialsupport to this flagshipenterprise. A membershipsurvey ranked this as amongthe most appreciated itemsoffered through CAGS.
ASAP (Accredited Self-Assessment Program) hasgrown into a reliable andregular opportunity for onlineCPD. As our web site hasmatured the initial bugs in thisprocess have been workedthrough. If you haven’t tried itlately, ASAP is accessedthrough the web site andprovides accredited CPDactivity for our members.
The CAGS Exam is beingpromoted this year (see“President’s Challenge”), notas test with a pass/fail—but asa means of comprehensive self-assessment and an opportunityfor members to self identifyunexpected areas of weakness.This concept of “unperceivedneeds”— not realizing that anarea of practice may haverecent nuances or subtlechange — is of great concernto our Royal College assessors.While our individual scopes ofpractice may vary— taking thisexam is an opportunity to
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GENERAL SURGERY MATTERS
Continued from page 1
CAGS membership has its benefits cont’d
measure our understandingagainst a national standard, anda chance to recognize specificareas were we may needindividual (or collective) atten-tion in our ongoing education.A sample study guide is pro-vided on our website (ESPs –Exam Study Preps) throughwhich members can cover theexam content through free web-based content chosen to coverthe areas of assessment. TheESPs guide will be annuallyupdated to cover exam topics(or even a specific personallearning project) that can bereadily identified and retrievedby our members.
On-line Journal Subscrip-tions: Our point of care accessto Journals and material throughthe CAGS and CMA websites isan important opportunity forpersonal learning projects.Using these materials on line foran immediate clinical problemor question should be recordedon your Royal College CPD fileas a personal learning project,also eligible for MOCOMPcredit.
The Canadian SurgicalForum is working hard to meetthe needs of our membership,with a variety of forums andcourses. New this year will be a
general review course andopportunity for an ultrasoundcourse geared for generalsurgical practice. The ProgramCommittee is exquisitelysensitive to the suggestions andevaluation of our attendees andis continually molding the forumto include emerging issues suchas advanced laparoscopy andobesity surgery.
Provincial Representation:Through the restructuredCAGS Board, the provincial andregional representation hasbecome a powerful force forchange within CAGS, seen mostclearly through the expandingattention to advocacy issues.The Provincial reps are tacklingeverything from a unified feeschedule to retirement issues.Our web site already containsvaluable position statement s oncall, the acquisition of new skills,and endoscopy. Watch for thisadvocacy movement to grow inCAGS as it is being fostered andpromoted in our new structure,and make sure our reps knowthe issues in your daily practice.
CAGS also supports a vibrantresident section and haspublished a resident guide (thatreally has sage advice for us all).This section along with theboard and regional representa-tion is following the trainee
hour restriction issues withinterest and accumulating dataand responses to address theimpacts on surgical training.Through the Research fund wesupport Canadian researchactivity, and through a variety ofcommittees we contribute to theroles and issues surroundingprofessionalism, ethics, programdirectors, site specific surgery,and are looking at the evolvingrole of acute care surgicalmodels.
CAGS Membership has a lot tooffer…and as we move on nowas a fully independent organiza-tion with a new governancestructure, take advantage ofwhat it can offer and make sureCAGS knows your issues andconcerns.
If so moved, look into the opennomination process for ourExecutive (president electsecundus on-line nomination),or contact a committee chair ifthere is an area in which you’dlike to contribute ([email protected]).
See you in Calgary at theSurgical Forum and at the CAGSExam this September,
Ralph GeorgeCAGS President
PAGE 3SPRING 2012
Guyana Surgery Award Presented to CAGSDr. Brian Cameron presented CAGS President, Dr. Ralph George with an awardof appreciation from the Guyana Institute of Health Science. The awardrepresents recognition of the significant contribution made by CAGS in training28 surgical Faculty in Guyana between 2005 and 2011. Dr. Cameron is pastChair of the CAGS International Surgery Committee and has been instrumentalin bringing the surgical training program to Guyana. Congratulations toDr. Cameron for this outstanding achievement.
Dr. Brian Cameron presents Guyana surgeryaward to Dr. Ralph George March 4th, 2012.
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GENERAL SURGERY MATTERS
Join CAGS President, Dr. RalphGeorge as he challenges the CAGS in-training exam at this year’s CanadianSurgery Forum in September. Dr. Georgecan be followed on Twitter and Facebook as
Undergraduate General Surgery AppA series of podcasts have beendeveloped called ‘Surgery 101’,which provide short overviewsof common surgical topics formedical students. The first 10 ofthese are focused on General
Surgery topics and have beenfeatured recently on the peer-reviewed site MedEdPortal -theyare also available free on theiTunes Music Store and atsurgery101.org . The link can
be found at: http://itunes.apple.com/ca/app/surgery-101/id390445770?mt=8 , and formore information please visit:http://surgery101.libsyn.com/
CAGS Exam Challenge now livehe prepares for the exam – Follow hisTweets and share on Facebook! The exampreparation process is estimated to be worth60 -70 MOCOMP credits, so join him andlive the CAGS exam challenge!
Last year, the CanadianAssociation of General Surgeonspublished a position paper onEndoscopy services in Canada.One component of this paperrelates to the responsibility ofGeneral Surgeons to participatein Quality Assurance. This isalso consistent with expectationsthat most surgeons are facingfrom their hospital departmentheads and boards to participatein regular practice audits. TheCanadian Association ofGastroenterology has generouslyagreed to provide members ofCAGS with access to the CAGQuality Audit Tool forcolonoscopy.
Colonoscopy Audit Tool
I received my username andpassword from CAG. The toolhas a trial component so thatone can become familiar withthe screens prior to using it livefor a real patient.It can also be loaded on yoursmartphone or iPhone forconvenience.
It has been recommended toenlist the assistance of theEndoscopy nurse to enter thedata in real time. Whendiscussing this with theendoscopy staff, they arefamiliar with the tool and will behappy to assist me when I startto use the program. CAG has a
listing of all of the Endoscopycenters in the country thathave experience with the tool,so surgeons may find their unitshave seen the tool previously.
When I started to use thedemo, it became evident thatthe tool requires an update as Icould not enter dates beyondthe year 2009. I have beenassured by CAG that this willbe updated and rectified. Thisalso tells me that the membersof the CAG are not activelyusing this tool at this time.
I will send another updatewhen I am able to trial it onreal patients!
by Dr. Susan Reid
PAGE 5SPRING 2012
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GENERAL SURGERY MATTERS
The new Canada Not-for-profitCorporations Act (CNCA), which receivedRoyal Assent on June 23, 2009, has beenproclaimed in force effective October 17,2011. The new legislation is the final step ina long process of modernizing Canada’sfederal not-for-profit legislation, and willapply to nearly 19,000 active not-for-profitsin Canada. The CNCA will provideopportunities for not-for-profits to takeadvantage of many of the moderngovernance and procedural activities thatare closely modeled to the Canada BusinessCorporations Act.
CAGS has a three (3) year period fromOctober 17, 2011 to apply for a certificateof continuance under the CNCA and willbegin by amending the bylaws that needchanging in order to comply with the newact. The guiding principles that will affectthe bylaw revisions concern the following:1) There will be no further ex-officiopositions on the CAGS Board; 2) There willbe no further voting by proxy and all new
A New Home for CAGSCAGS now has a new office downtown Ottawa! It is located at 421Gilmour St. in Ottawa, ON K2P 0R5 which can be used to send anycouriers. Please continue using the mailing address for regular mailat PO Box 1428, Station B Ottawa, ON K1P 5R4. The CAGS phonenumber will remain (613) 882-6510.
New Canada Not-for-profit Corporations Act willbring bylaw changes for CAGS
matters must be received in writing 14 daysprior to a meeting; 3) The only ‘Member’category of membership will be votingmembers; and 4) CAGS will no longer needto seek the Minister of Industry’s approvalfor any bylaw amendments proposed bythe members.
CAGS will ask members to approve severalamendments to the bylaws at the nextAGM, held Saturday September the 15th,2012 at 4:30 PM in Exhibit Hall E of theCalgary Convention Centre. Theamendments are attached in a separatedocument. If you have any comments orquestions regarding the amendments to thebylaws, please submit your concerns inwriting to [email protected] by August30th, 2012.
To vote on the amendments, you mustbe at the AGM. This is a fundamentalchange to CAGS governance and wehope to see as many members aspossible at the meeting.
421 Gilmour St in Ottawa, ON
PAGE 7SPRING 2012
BY-LAW NO. 3being a by-law amending
By-law No. 2of
THE CANADIAN ASSOCIATION OF GENERAL SURGEONS(the “Corporation”)
BE IT ENACTED as By-law No. 3 that By-law No. 2 is amended as follows:1. By replacing all references to “Secretary” and “Treasurer” with “Secretary-Treasurer”.2. By amending Section 5.1 to Article V, the following:
5.1 There shall be one category of (voting) membership:(i) Active Members;
5.1(1) There shall be six categories of affiliates (non-voting):(i) Residents;(i) Senior Fellows;(iii) Honorary Fellows;(iv) International Affiliates;(v) Allied Health Affiliates and;(vi) Medical Students
3. By deleting a portion of Section 8.14 of Article VIII which reads:“Ex-officio directors may be included in the determination of the quorum.”
4. By deleting Section 9.4 of Article IX in its entirety which reads as follows:“Upon the election of the President-Elect secundus, the existing President-Elect secundus, shallautomatically become the President-Elect. Upon the election of the President-Elect, the existingPresident-Elect shall automatically become the President, the existing President shall automaticallybecome the Immediate Past President and the existing Immediate Past President shall retire as anelected officer and as a director, provided however he shall be eligible for re-election.”
5. By deleting a portion of Section 9.4 of Article IX which reads:“If at the termination of the term of the Secretary-Treasurer a Secretary-Treasurer-Elect, as the casemay be, is then in office, upon the retirement of the Secretary-Treasurer the Secretary-Treasurer-Elect shall become the Secretary-Treasurer in office.”
6. By deleting a portion of Section 9.7 which reads as follows:“The President-Elect shall assume the office of President when his successor takes office.”And“The President-Elect Secundus shall hold office for a 1-year term and will ascend to President-Electwhen his successor takes office as President. He will also serve a term as Vice-chair of membershipcommittee.”
7. By adding the following to Section 12.4(1):Notices for introducing new matters, other than the matters of privilege, shall be sent in writing tothe President at least 14 days before a meeting of the members of the Corporation.
8. By deleting Section 12.9 in its entirety, and replacing it with the following:Each member present at the meeting shall have the right to exercise one vote and all questionsshall be decided by a simple majority vote of the members present, unless otherwise specificallyprovided by the Canada Corporations Act or by the By-Laws of the Corporation. Voting by proxyis not allowed.
ENACTED by the board this day of , 2012.
WITNESS the seal of the Corporation.
President Secretary-Treasurer
CONFIRMED by the members entitled to vote on the matter this day of , 2012(Corporate Seal)
PAGE 8
GENERAL SURGERY MATTERS
CAGS is proud to presentThe National LaparoscopicSkills Competition Finalswhich will be held at theCanadian Surgical Forum inCalgary at the opening of theexhibits, Thursday September13th 2012 at 19:00. This eventhas had outstanding success inpast years and this yearpromises to be equally asexciting! The competition isdesigned to promote technicalskills training throughsimulation across the countrywhile encouraging participationin CAGS and interest inlaparoscopic surgery. Winnerswill have the glory of beingcrowned “Canada’s NationalChampion”.
Trainees who will be PGY1-5 inSeptember 2012 are eligible toparticipate (no laparoscopicfellows please). We propose that
2012 Suturing Competition!each program have localpreliminary rounds to pick theirrepresentatives. The residentsshould be chosen on the basis oftheir ability to performintracorporeal suturing in alaparoscopic box trainer. For anyprogram without access to alaparoscopic trainer, this may bea good opportunity to acquirethe Fundamentals ofLaparoscopic Skills (FLS) system,which includes a trainer box,available to North Americanresidency programs through aneducational fund at SAGES. Moreinformation about this programis available at the SAGES website(http://www.flsprogram.org/brochure.php).
To make this event a success,please arrange a local event thisspring to identify your “best”resident laparoscopic suturer andreward him or her with a trip to
the CSF in September.
Members of the CAGSlaparoscopy/endoscopycommittee include Drs Ellesmere(Halifax),Bendavid (U de Montreal),Bergman (McGill), Boushey(Ottawa), Okrainec andGrantcharov (Toronto),Meneghetti and Patton (UBC),and Karmali (U of Alberta).
We hope as many programs willbe able to participate as possible.Please contact Dr. Okrainec orBergman with any questions.
Allan OkrainecChair, CAGS Laparoscopy and
Endoscopy [email protected]
Simon [email protected]
Applications that focus on research in the area of Minimally Invasive Surgery and/or colorectal surgery arerequested for operating grants from the Canadian Surgical Research Fund.1. The deadline for receipt is June 30, 2012.2. There is $25,000 in funding which may be applied towards two separate grants.3. Applicants must be CAGS members. Residents are encouraged to apply with a CAGS member as
supervisor.
The application should include:1. A title page with information regarding all co-applicants and contact information for correspondence.2. A summary of the application (max. 1 page).3. A detailed description of the proposed research including references and a detailed budget (max. 6 pages).4. A curriculum vitae of the principal applicant (max. 3 pages).5. A letter of support from the Head of the Department of Surgery. For further information please contact:Dr. Lorenzo FerriResearch Committee Chairman:McGill University Montreal General HospitalRoom L9-112, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4phone 514 934 1934 ext [email protected]
$25 K Grant Offered in Minimally Invasive and/or Colorectal Surgery
PAGE 9SPRING 2012
Executive CommitteePresidentDr. Ralph [email protected]
President Elect:Dr. Garth [email protected]
President Elect Secondus:Dr. Elijah [email protected]
Past-President:Dr. Susan [email protected]
Treasurer:Dr. David [email protected]
Clinical Practice Committee:Chairman:Dr. Shahzeer [email protected]
Continuing ProfessionalDevelopment Committee:Chairman:Dr. Oliver [email protected]
Membership Committee:Chairman:Dr. Elijah [email protected]
Nominating Committee:Chairman:Dr. Susan [email protected]
Postgraduate EducationCommittee:Chairman:Dr. Mark [email protected]
Program Committee:Chairman:Dr. Sean [email protected]
Dr. Morad [email protected]
Research Committee:Chairman:Dr. Lorenzo [email protected]
Residents’ Committee:Chair:Dr. Chloe [email protected]
Regional Representatives:Chairman:Manitoba/SaskatchewanDr. Brent [email protected]
British Columbia/YukonDr. Raymond [email protected]
Alberta/Northwest TerritoriesDr. Paul [email protected]
OntarioDr. Jeff [email protected]
QuébecDr. Roger C. Gré[email protected]
MaritimeDr. Dennis [email protected]
CAGS Committee Chairs andRepresentativesAcute Care SurgeryCommittee:Chairman:Dr. Fred [email protected]
Endoscopic & LaparoscopicSurgery Committee:Chairman:Dr. Allan [email protected]
Head and Neck / EndocrineCommittee:ChairmanDr. Todd [email protected]
Hepatobiliary-TransplantationCommittee:Chairman:Dr. Jeff [email protected]
Test Committee:Chairman:Dr. Roger [email protected]
International Surgery Committee:Chair:Dr. Gwen [email protected]
Local Arrangements Committee2012:Chairman:Dr. Don [email protected]
Oncology Committee:Chairman:Dr. Andy McFadden
Professionalism Committee(Medical/Legal):Chairman:Dr. Cliff [email protected]
Representative of the CSCRSPresident:Dr. Don [email protected]
Representatives to the AmericanCollege of SurgeonsAdvisory Committee for GeneralSurgeryDr. Gerry [email protected]
ACS Board of GovernorsDr. Christopher [email protected]
IFSES/SAGESDr Christopher M. [email protected]
Representatives of the Provinces:SaskatchewanDr. Paul [email protected]
New BrunswickDr. Chris [email protected]
Nova ScotiaDr. Dennis [email protected]
Prince Edward IslandDr. Phil [email protected]
Newfoundland and LabradorDr. Mark O’[email protected]
Your 2012 CAGS Board Members and Committee Chairs
PAGE 10 SPRING 2012
Lung cancer remains the leadingcause of cancer death in thedeveloped world. Surgery continuesto be the mainstay of curativetreatment in this disease. Whileappropriate surgery has resulted inimproved survival, unfortunately,most patients go on to developdisease recurrence in the form ofdistant metastasis. Furthermore, anenlarging body of evidence hasemerged which suggests that surgeryand post-operative infections may infact contribute to the developmentof metastasis and death. This isthought to be the result ofinflammation and widespreadactivation of the immune system.Neutrophil extracellular traps(NETs) represent a completely novelmeans by which immune cells, underconditions of stress, may trapcirculating cancer cells in distantorgans and lead to the developmentof metastasis. The initial resultsobserved in Dr. Ferris laboratory inthis completely unexplored field ofresearch are promising. Under hissupervision, we have demonstratedthe ability of NETs to capturecirculating tumor cells underconditions of systemic inflammationand promote the development ofliver metastases in a mouse model oflung cancer.
In collaboration with Dr. Kubes atthe university of Alberta theinteractions between NETs andcancer cells were visualized for thefirst time in vivo. Dr. Kubes hasextensive experience in high
Research Update from 2011 CSRF Winner – Dr. Jonathan Cools-Lartigueresolution in vivo microscopy andby collaborating with hisexperienced team at his imagingfacility the impact of our data wassignificantly increased, serving as aproof of concept for thiscompletely novel paradigm incancer biology.
Furthermore, as orally availablecompounds already exist whichdisrupt NET formation, wepostulated that NETs represent a
new drug target in the treatmentof cancer. Using high resolution invivo microscopy, we were able todemonstrate the NET formation inthe liver and lungs can beinhibited by pharmacologicintervention. In addition we wereable to show that this resulted indecreased cancer cell adhesionand metastasis formation. Withoutthe support of provided by CAGS,this novel research would not havebeen possible.