CAGS-International Surgery Committee
Minutes January 28, 2009 Page 1 of 6
Canadian Association of General Surgeons
Minutes
CAGS International Surgery Committee
January 28th, 2009 4:00 p.m. EST Teleconference
Invited Committee members:
Alex Mihailovic (resident, Toronto),
Jon Just (Kamloops),
Morad Hameed (Vancouver),
Fady Balaa (Ottawa),
John Barnhill (Nepal/Newfoundland),
Massey Beveridge (St. Anthony),
Brian Cameron (Chair, Hamilton),
Gwen Hollaar (Calgary),
Geoff Ibbotson (Nepal/Alberta)
Allan Okrainec (Toronto)
Brian Ostrow (Guelph),
Bill Harris (Thunder Bay)
2008-2009
2006-2009
2006-2009
2007-2010
2007-2010
2007-2010
2007-2010
2007-2010
2007-2010
2008-2011
2008-2011
2008-2011
Invited guests:
Tarek Razek (Montreal)
Allison Mciver (CAGS Resident Committee)
Robert Taylor (UBC Branch for International Surgery)
1.
regrets
regrets
present
no response
present
present
present
present
regrets
regrets
present
present
regrets
present
present
Adoption of Minutes from September 13, 2008 confirmed.
2.
CSF International Surgery Symposium 2008:
The debate format at CSF 2008 was well received. The room was too large to allow
intimate discussion; next time prefer a room to accommodate 50-100.
(from CAGS newsletter:)The well-received 2008 International Surgery symposium at the
CSF included debates about features of successful projects, international electives for
surgical residents, and preparation of Canadian surgeons for war surgery.
3.
CSF 2009
We heard that the Residents education symposium will focus on international surgery
electives. Also there is a PG program on ‘War Surgery’ scheduled. We discussed the
history of the international surgery symposium at CSF beginning in 2000 recognizing
there was no other forum at the time, and whether we should consider not having one
this year. There was no immediate volunteer to organize it.
Decision: The Committee decided to NOT hold an international surgery
symposium at the 2009 CSF for the following reasons:
a. The 2008 symposium had a successful format with a lot of positive feedback, and
reasonably good attendance up to 50 maximum. However, we don’t want to keep
repeating the same presenters and topics.
b. There is already scheduled for CSF 2009, a War Surgery course and the
Resident’s symposium is planning to focus on international surgery electives. Our
committee will support those programs.
c. Dr. Haile Debas was unavailable again as our invited guest, but remains
interested … maybe we can get him committed for 2010.
CAGS-International Surgery Committee
Minutes January 28, 2009 Page 2 of 6
d. It is a challenge to mount a symposium when there are several other conflicting
activities – perhaps we can discuss the appropriate scheduling for the international
surgery symposium in 2010 to allow as many interested CAGS members as possible
to attend.
This decision was conveyed to Dr. Urbach and Suzanne Leblanc by email.
4.
Business Arising
a.
CAGS Website (B Cameron)
Committee members were asked to contribute to the News, Publications, and Links
pages.
b.
‘Surgery in Africa Monthly Reviews’ (B Ostrow)
The expanding affiliation affiliation with CJS was noted. Beginning April, each online
CJS edition (6x/yr) will have a link to Surgery in Africa. One Review will be peer
reviewed and published in each edition, producing an indexed citation, which will attract
more submissions from academic centres. Committee members may be asked to be
reviewers. The Committee had committed to submit 4 reviews; only 2 were completed
in 2008. SIA is receiving an increasing number of submissions, but Brian Ostrow
requests 3-4 more submissions from Committee members in 2009.
c.
Archiving ISC report forms for Participants and Overseas Hosts (R Taylor)
Bob Taylor has begun archiving a list of CAGS surgeons who have been involved with
CAGS-affiliated international projects, with some of their reports up to 2005. He
requests that copies of reports since 2005 from Uganda (Brian O.) and Guyana
(Brian C.) be submitted for the archive.
d.
Guidelines for International Surgery projects
These were initially drafted in 2005 and were reviewed again. The purpose of the
guideline is to provide direction for the Committee when responding to requests for a
project to have the ‘official’ CAGS imprimatur. An example of such a possible request
regarding The Gambia was discussed, and a formal request is pending. Brian C. will
revise the guidelines and recirculate to the Committee members.
e.
UBC guidelines for surgical resident international electives (R Taylor)
These are undergoing revision/approval at UBC and Bob Taylor will share with the
Committee when they are ready.
f.
Resident representation on the Committee. Allison Maciver will be meeting with
the CAGS resident committee in February and then will suggest a resident member
for our Committee to start in September 2009 for 2 years.
CAGS-International Surgery Committee
5.
Minutes January 28, 2009 Page 3 of 6
Project updates:
a.
Uganda (B Ostrow). CNIS is running ESS in Gulu and needs 2-3 visitors per year
from CAGS who are qualified instructors, each for a minimum of 2 month visit. Ghee
Hwang and Barb Leblanc will be going in 2009, possibly Jon Just as well.
(from CAGS newsletter:) The CAGS-Uganda collaboration had its most successful year
with 4 visitors in 2008 also instructing the ESS course. CAGS-Uganda visitors 20022008 were: Drs. Nicholas Baumann, William Fitzgerald, Ghee Hwang, Bernard Lawlor,
Barb LeBlanc, Brian Ostrow, Robert Schwarz, Robert Taylor, Steven Untracht, and Eric
Webber.
b.
Guyana – (B Cameron – report attached). There are still needed CAGS
volunteers to teach a hepatobiliary module (2 weeks, May-July) and visit the regional
hospitals (3-6 weeks in Sept-Oct).
Bill Harris reported on efforts to organize a 2-3 month endoscopy fellowship in Thunder
Bay for Guyana surgical graduates. He has support from the hospital, medical staff and
medical school and is awaiting confirmation from Guyana.
c.
Member projects.
(from CAGS newsletter:) Other member projects include CAGS surgeons in Malawi,
Somalia, Nepal, Guatemala, and Botswana and working with MSF and CNIS. CAGS
members are encouraged to share reports of their activities for inclusion on the
international surgery pages of the CAGS website, as well as upcoming events.
6.
New business:
John Barnhill suggested submitting a questionnaire to the CAGS membership to
identify those who would be willing to mentor other surgeons or residents.
Decisions: Send a questionnaire through the CAGS newsletter/e-blast (Brian C.).
Maintain a ‘mentor’s list by province/region on the website specifically for
residents interested in international surgery.
Identify a contact person at each academic centre as a resource person for
resident electives (Morad offered to take this to the PG Ctte).
7.
University reports:
a.
UBC Vancouver (Bob Taylor). The postgraduate course in international surgery
prepared by Bob is before the UBC Senate for approval.
b.
Calgary (Gwen Hollaar). There is an Office of International Surgery at the
University of Calgary, with Gwen the Director and an Advisory Committee that meets
quarterly. They are hosting the ESS Instructor Course in March, and maintain a liaison
with Awassa Ethiopia through CNIS to teach ESS. A website is in progress.
c.
Edmonton (Allison Maciver) Not sure if there is an international surgery group or
office. There is a strong international health centre with weekly rounds.
d.
Hamilton (Brian Cameron): Will be hosting the CNIS SSS course May 25, 2009.
CAGS-International Surgery Committee
Minutes January 28, 2009 Page 4 of 6
8.
Review of Short-term goals for 2008 and Long-term 3-year goals:
Goals were not specifically addressed during the meeting but the progress is
summarized below:
a.
update and move the Committee website to the CAGS homepage and
server. (done)
b.
contribute 4 articles to the Surgery in Africa Monthly Reviews. (2 contributed)
c.
organize the International Surgery Symposium for the 2008 CSF. (done)
d.
continue to encourage and support the member projects currently underway,
particularly the CAGS collaborations in Uganda and Guyana. (ongoing)
e.
expanding the collaboration with ‘Surgery in Africa’ and the Canadian Journal of
Surgery.(underway)
f.
supporting the development of Offices/Branches of International Surgery in
academic centres across the country. (needs further discussion/action)
9.
Next meetings:
May 22-23, 2009
September 2009
Bethune Round Table, Toronto
Canadian Surgery Forum, Victoria
Minutes prepared by Brian Cameron
cameronb@mcmaster.ca
CAGS-International Surgery Committee
Minutes January 28, 2009 Page 5 of 6
To: CAGS International Surgery Committee
From: Brian Cameron MD, co-ordinator of CAGS-Guyana project.
In December 2008, the training program at Georgetown Public Hospital graduated its first
5 surgeons, who were awarded a Diploma in Surgery by the University of Guyana. (report to
CAGS newsletter attached)
There were eight CAGS visits to Guyana this year: Dr. Peter Willard, Dr. Wally
Yakimets, Dr. Bill Harris, Dr. Ghee Hwang and I each tutored a two-week module at GPHC. Dr.
Robin Fairfull-Smith and Dr. Bob Taylor were external examiners in April. Dr. Jon Just spent 3
weeks at the regional hospitals with the senior residents, and Dr. Ghee Hwang spent an additional
4 weeks at the regional hospitals. Since the CAGS-Guyana affiliation began in 2005, CAGS has
sent 14 surgeons to Guyana on 20 teaching visits totaling 45 weeks.
The first cohort of 5 graduate surgeons have received their hospital postings and are
contracted to spend a minimum of another year in the employ of the Ministry, promoted to senior
registrar level. Dr. Allan Tinnie is at Linden, Dr. Shawn Legall at West Demerera, and Drs.
Carlos Martin, Shilindra Rajkumar, and Navindra Rambaran are at GPHC. The 2nd cohort of 4
residents (Drs. Cheetanand Mahadeo, Ravi Motilal, Chris Prashad, and Rajendra Sukhraj) began
their training in May 2007 and a 3rd cohort of 3 residents (Drs. Bob Ramnauth, Roy Samlall, and
Kishore Persaud) began in May 2008. All residents were interviewed and an external review was
presented to Dr. Rambaran and the Surgical Postgraduate Education Committee in November
2008 (attached). This Committee has agreed to meet more regularly to assume stronger
oversight of the program.
Ongoing CAGS involvement has been requested, including preparing the final exams,
providing an external examiner (Dr. Robin Fairfull-Smith in April 2009), continuing 5 CAGS
visits each year (4 2-week modules and one 3-4 week regional hospital visitor), and revamping
the curriculum. We have also discussed offering short Canadian Fellowships for graduates. Dr.
Bill Harris (Thunder Bay) has obtained a funding commitment ($6000) from his medical staff to
support a 2-3 month fellowship in endoscopy. Dr. Robin Fairfull-Smith and I have been so far
unsuccessful in identifying fellowship funds in Ottawa and Hamilton. Prof. Ivor Crandon in
Jamaica has offered to accept graduates for unfunded elective fellowships, but could not give
them advanced standing in the University of the West Indies training program. The consensus in
Guyana seems to be that Diploma in Surgery graduates will require additional training and likely
some overseas experience, before they will be promoted to consultant level. Sustainability of the
program is a concern, and visiting faculty will still be needed for at least the next 5 years. An
MOU has been drafted and agreed to in principle by Dr. Rambaran and Dr. Ron Lett. (attached).
CIDA’s Canadian-Caribbean Cooperation Fund (CCCF) agreed to extend the project
budget to May 2009. A further budget request has been made to extend funding to March 2010
which is when the CCCF ends. If there are no more CIDA funds, CAGS visitors will have to be
asked to pay their expenses through a CNIS Member’s Project and receive a tax receipt. Dr. Jon
Just did this in 2008 to cover his airfare.
CAGS-International Surgery Committee
Minutes January 28, 2009 Page 6 of 6
Future CAGS visits are scheduled as follows:
Jan 09:
Dr. Brian Ostrow (vascular module)
Feb 09:
Dr. Brian Cameron (clinical pediatric surgery – ?CNIS Member’s Project}
Early April 09:
Dr. Felicia Huang (thyroid, endocrine module, practice orals) - confirmed
Late April 09:
Dr. Robin Fairfull-Smith (external examiner) - confirmed
May-June 09: Hepatobiliary module (noone confirmed)
July-Sept 09: Wounds/Burns/Plastics module (Dr. Yvonne Ying?)
Aug-Oct 09: Regional hospital visitor (3-4 weeks, noone confirmed)
Oct-Dec 09: Pediatric surgery (Dr. Brian Cameron)
Additional Canadian surgical projects underway:
a.
Diabetic Foot Sepsis prevention. Dr. Brian Ostrow has obtained funding through CCCF
to set up a clinic and educate health professionals about wound care and diabetic foot infection.
(Ostrow B, Martin C, Rambaran M. Clinicians work to enhance diabetic foot program in
Guyana. Adv Skin Wound Care. 2007 Dec;20(12):640-1. )
b.
Fundamentals of Laparoscopic Surgery. Dr. Allan Okrainec is using Skype software to
teach the FLS course to Guyanese surgical residents and faculty, and plans a visit in March to
complete their exam and certification.
c.
Plastic Surgery. Dr. Tim Sproule is taking a team to GPHC in February 2009, and is
discussing offering a plastic surgery fellowship to one of the surgical graduates.
Presentations and Publications:
Dr. Rambaran presented a paper on the training program at the 2008 Bethune Round Table
meeting (CJS 2008; 51(4):313), and a manuscript has been accepted for publication in the
Canadian Journal of Surgery.
Two surgical residents made presentations at the first Guyana Medical Scientific Conference in
November, and abstracts will be submitted for the 2009 BRT.
Respectfully submitted.
Brian Cameron MD
Co-ordinator, CAGS-Guyana project