Summary
Dr. Paul Greig is an icon of surgical education, transplantation, hepatobiliary surgery and Canadian surgery. Dr. Greig has trained experts in these fields all over the world and is regarded as one of the most important surgical educators in the past 25 years.
On March 6, 2020, just as the COVID-19 pandemic started to disrupt the world as we knew it and just before the world went into lockdown, we hosted a celebration of Dr. Paul Greig’s career. Former fellows from the University of Toronto hepatopancreatobiliary (HPB) and transplantation fellowship program, along with friends from the greater HPB surgical community, gathered for dinner, drinks and stories at the Delano Hotel in Miami Beach, Florida, during the annual meeting of the Americas Hepato-Pancreato-Biliary Association (AHPBA) to celebrate and mark the remarkable career of Paul, as he is fondly known to all those in attendance.
Paul had been the program director for almost all the former fellows in attendance. He has acted as a confidante, mentor, career planner, reference and friend. This relationship usually started with an early morning breakfast at the Chelsea hotel when out-of-town applicants came to interview for the fellowship. Paul would meet you at the hotel, give you the rundown of the city of Toronto, the University of Toronto, the Department of Surgery, the fellowship and the various people you would interview with over the next 24 hours, as well as generally get to know you. As eager and nervous applicants, little did we know that this would be the start of an important lifelong friendship for those fortunate enough to become fellows in the University of Toronto HPB and transplantation program.
Paul Greig grew up in Toronto and did his undergraduate degree at the University of Waterloo in mathematics. He eschewed a career in music and went on to complete his degree in medicine at the University of Toronto, and then entered into the university’s Gallie residency program in general surgery. Paul was taken under the wing of Dr. Bernard Langer. Dr. Greig went to Columbia University in New York, where he completed a research and clinical fellowship in nutrition, total parenteral nutrition and surgery for portal hypertension. After completing his residency and fellowship, his career plan was to return to the University of Toronto as a general surgeon with an interest in surgery for portal hypertension and nutrition. He took up a position at the Toronto General Hospital, joining the impressive HPB team of Bernie Langer, Bryce Taylor and Steven Strasberg. At this time, Dr. Langer was working on the technique of liver transplantation in the animal laboratory and sent Paul to the University of Pittsburgh to observe Dr. Thomas Starzl and his burgeoning liver transplantation program. After much preparation, the first liver transplant was performed at the University of Toronto, with Dr. Greig a key member of the team. With the original team of Drs. Langer, Taylor, Strasberg and Greig, the program started slowly and took some time to increase in volume over the course of the next decade. Over the ensuing 15 years Drs. Mark Cattral, David Grant, Allan Hemming and Stephen Chung were added to this formidable team. Drs. Greig, Cattral and Grant helped the program evolve into a true multiorgan unit, with the help of transplant hepatologists, Dr. Gary Levy and Dr. Les Lilly. During this time, the volume of hepatobiliary and pancreatic surgical resections also grew exponentially, with Dr. Steven Gallinger as a key leader in developing HPB surgical oncology at the University of Toronto. Dr. Greig was one of the few North American surgeons who successfully straddled the fields of transplantation and HPB surgery, with expertise in both domains acknowledged at the national and international levels. The University of Toronto fellowship in abdominal transplantation, hepatobiliary and pancreatic surgery was one of the first true hybrid programs that trained fellows in high-volume transplant and complex HPB surgery. In addition, the fellowship program offered a unique bond between the resection and transplantation programs at the Toronto General Hospital and Mount Sinai Hospital. Paul was the program director of the fellowship from 1995 to 2016, and was the driving force in merging these 2 programs and skills sets for all of the fellows who trained there.
His excellence in teaching and educating medical students, residents and fellows (often concurrently) has been recognized both formally and informally by the institution and the university, as well as internationally by numerous professional societies such as the AHPBA and the International Hepato-Pancreato-Biliary Association. He was a trailblazer in developing teaching curricula. Dr. Greig was truly in his element as a passionate, skilled, patient and trusted teacher in the operating room. He practised and espoused competency-based learning and entrustable activities decades before these were widely acknowledged by the surgical education community. Put simply, Paul always taught from the left-hand side of the table, broke down every step of every operation into small, precisely defined tasks and was able to guide even the most inexperienced trainee through complex operations by discrete and patient instruction. He brought an enthusiasm and positivity to his teaching in the operating room that registered at the same inspirational level whether its was during a 2 am liver transplant or a 9 am Whipple. Remarkably, this verve remained from his first year on staff to his last case before retirement in 2019. Outside of the operating room, Paul was well balanced. In particular, his love of music permeated into the operating room with thoughtfully selected playlists ranging from jazz to alternative to progressive rock, as well as a steady diet of classic rock. He blew off steam as the lead guitarist for a group of musicians comprising fellow transplanters, aptly named The Marginal Donors.
Outside of the University of Toronto, Dr. Greig is most widely recognized for being the driving force behind the creation, definition, standardization and credentialling of HPB surgery fellowship training in North America. Through his work with the AHPBA and the Fellowship Council, Paul helped create and define the principles, curriculum, assessment and operative case volume standards that formed the foundation of our current HPB fellowships.
There have been many widely recognized and beloved surgical educators over time. All of those who gathered to recognize his career agree, what set Paul Greig apart was his enthusiasm, unselfishness and humanity — he truly cared about his fellows as surgeons and as people. While most toiled in the pyramidal hierarchy of surgery and surgical training, Paul treated you as an equal from your first day of fellowship. He became a close confidant and mentor to all who passed through the program. When one reviews the list of surgeons who Dr. Greig has trained and realizes the resulting collection of deans, department and division chairs, and past presidents of societies, the impact that he has had on HPB and transplant surgery across North America and the world becomes readily apparent. Most of those trainees made the trip to Miami to gather, celebrate and pay tribute to Paul Greig and his career. Although embellishment and hyperbole are common among surgeons recounting their escapades, in this instance, the underlying theme that emerged from our gathering was of Paul Greig’s benevolence and passion. We, his former fellows, will be forever grateful to have trained with such an amazing surgical educator and human being.
Footnotes
Competing interests: None declared.
Contributors: All of the authors contributed to the conception and design of the work, drafted the manuscript, revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.
- Accepted October 12, 2022.
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