E109 CaRMS General Surgery Residency Program Highlights!
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Chad Ball 00:12
Welcome to the Cold Steel podcast, hosted by Ameer Farooq and myself, Chad Ball. We consider it an absolute privilege to bring you guests from around the world who are truly experts in their craft. Our mission is to offer you a combination of not only master classes on clinical surgery topics, but also insights into achieving personal growth, productivity, and fulfillment as a surgeon, and perhaps more importantly, as a human.
Ameer Farooq 00:42
We're very pleased to bring you this special episode of Cold Steel. So, this year, we recognize that this has been a very hard year for all the med school applicants who are applying to residency as, again, it was a virtual year. Many of the programs have done a really excellent job of trying to hold virtual info sessions and things like that. We wanted to try to also facilitate that a bit more for our future colleagues and all the medical students who are applying, specifically, to general surgery this year. What we did for this episode is to actually interview most of the programs across the country to ask them a bit about the program. It was quite neat to do this episode, hey Dr. Ball? Because I think doing this actually brought back a lot of memories for me about what it was like to go through CaRMS.
Chad Ball 01:28
Yeah, I think that's true. You know, some of the program directors were so eloquent in terms of the benefits and some of the neat things within their program, within their city, being around their colleagues. And it certainly brought back trying to think about all those things as you apply, for sure. It was a real privilege to invite all the programs across the country, most of which were able to be included, and we hope it helps a lot.
Ameer Farooq 01:52
Yeah, absolutely. And while we're on the subject, Dr. Ball, you've obviously been on both sides of that equation. I think it is worth just talking a little bit about maybe some tips and tricks for people who are applying for their residency, as well for their interviews. Do you have any little tips and tricks that you tell people who are applying? And are going to, particularly now, I guess, with virtual interviews?
Chad Ball 02:16
Yeah, that's a great question. I certainly don't have much in the way of advice to our national applicants, in terms of virtual interviews, because it's a hard thing to do and it's certainly not something that you or I had to go through at that stage. Fortunately, and unfortunately for the candidates now. I think whether you apply for medical school, and certainly when you apply for residency and/or fellowships, really, the truth is on the other side of the curtain, almost all of the reference letters are good to excellent. They're all quite good. Otherwise, I think most of our medical student and resident colleagues would know not to ask for a poor letter. So, that probably holds a little bit less weight than some of the other elements of the application. I think you should be true to yourself. And in many ways, as you know, you're interviewing the program as much, if not probably more than the program that's really interviewing you. And these programs across the country, I think, as our listeners and applicants will hear in this podcast, although they have the solid core of Canadian general surgical training, without doubt across the board, they really are unique in terms of flavour and some of their strengths. They differ substantially, wouldn't you say?
Ameer Farooq 03:38
Yeah, I completely agree to you. Not to get too Shakespearean, but that advice holds true, "To thine own self be true." And I think you don't realize this when you're going through it, but the programs want to recruit their best possible applicants too. And more than one program director says on the interview that what they're really looking for is fit. And that goes both ways, I think. And I think hopefully, that comes across virtually as well, too. You get a sense of who the people are, you get a sense of whether you would fit with that group. And not all personalities fit with all groups, in all cities. So, I think figuring out where you would jive and where you would thrive is so important. And this is the part of that interview where it's really hard to be objective about it. There's some little gut feeling that goes deep within you and you kind of realize, I think that's the place where I want to go and where I'm gonna fit in. You should just trust that voice inside your head that tells you that. I think that that's the way to go. And again, I didn't do a virtual interview either, but I think all the usual things about dressing professionally, looking into whatever you can do to make yourself look as good as possible on your virtual interviews, is going to go in a long stead. Because again, the programs only get to see that one little snapshot of you. So do whatever you can to make sure that you look the best that you can on the interview day, is going to go a long way. And we'll post some links in the show notes to some really good advice that I've seen online about how to make yourself look good virtually. It is kind of a neat feeling to look back on that. I know I met many of my friends that I have today on my CaRMS tour. So, I hope that can be the experience for applicants this year as well, too.
Chad Ball 05:24
Yeah, the last thing I would say is support what you just mentioned. I liked that very much. Essentially, trust your intuition. It's probably the best barometer of the fit to a program. My only other comment would be, and it probably sounds a little bit old school to, perhaps, some of the applicants listening to this would be that volume of cases in terms of procedurally based residency is critical. So, try and go to the places where you get the sense that you have a lot of opportunity with regard to seeing cases, thinking about cases and, fortunately, as a result, operating on cases. So, trust your intuition and go where the volume is. I think there's a lot of programs across the country that are wonderful. And the truth is, everyone wants to be a superstar. And you can really be a superstar, both clinically and academically, in any of the programs across the country.
Ameer Farooq 06:23
I couldn't have said it better myself, Dr. Ball. To all of our listeners, please enjoy our 2022 CaRMS residency interview highlights. Dr. Mathieson, thank you, again, for joining us on Cold Steel. We really appreciate you taking the time, especially so late, out on the East Coast. And again, hats off to you and all the dedicated program directors who really go to the ends of the world to take care of their residents really well.
Alex Mathieson 06:51
Thanks very much. It's great to be talking to you.
Ameer Farooq 06:52
We'd just like to start by asking you to tell us a bit about your program.
Alex Mathieson 06:57
Yeah. So, we think we got a good program. We take four people a year. We've been steady at that for a long, long time. And we think it's a really good program. There's some things that we do a little different, which I'll get to in a second. But obviously, it's sort of five years, we're in the CBD, like the rest of the world now. At the end, we really think we produce a good surgeon. Our goal is at the end of five years, you finish on June 30. On July 1st or 2nd, you should be able to walk into just about any hospital, community hospital, in this country and start working and take call. Whether that means you're doing laparotomies in the middle of night or scoping people, or whatnot, we think you're ready to go. This comes from sort of with us, a couple things we do differently. So, we don't really have a senior/junior setup. We have chief-year residents who are not on the regular call schedule, but available most of the time. And then, everybody else gets their own team when they're on general surgery. So, we think this really gives people lots of early experience. And we put about 50% of people out into fellowships and 50% of people finish, they go straight into work. So, we think it is a nice balance.
Ameer Farooq 08:25
Yeah, I think that's a really unique training model. Probably, really allows for some really good, early and ongoing, operative exposure. I guess, you've touched upon that strength of the program. Are there any other strengths or highlights you'd want to talk about for the Newfoundland program?
Alex Mathieson 08:44
Yeah, so we definitely do early operative exposure. So, because you're in, even in PGY1, you might be leading a team. The one sort of exception to the senior/junior is on our acute care service at the busier hospital. There's a PGY3 and a PGY1 together. So that, then the PGY1 plays a sort of junior role. Just because it's so busy. But in all the other teams, we sort of throw you in and let you run a team, even straight out of med school. And I tell the residents when they start out that, basically, what we're going to do is we're going to throw you into the deep end of the pool but then all the faculty are going to stand on the side of the pool with life preservers and ropes, ready to throw to you when you need it. I think this is, it really is just like that. We throw you in the deep end, but virtually everybody is capable of doing this, whether they realize it or not. And we're there to help out. I think one of the things that we culturally accept is that the staff are used to doing a bit more micromanagement, a bit more helping out. So, you're on a team with a PGY1 or a PGY2, you're probably doing a little bit more micromanagement of floors, you're doing things a bit differently than if you've got a PGY4 or if you're in a big center where you got a senior and a junior on every team. So, we just accept that, and we're used to it.
Ameer Farooq 10:15
Yeah, I think that one of the unique things about having that setup is, and again, trusting people with responsibility early, is that usually people are able to rise to that expectation a lot more often than that person thinks, or sometimes even outside people think. So, I think that's really helpful, and I think it builds a lot of confidence. And having worked with some of your trainees, you can see that confidence right from the get-go. You mentioned that about 50% of your graduates go on to do fellowships. What kind of fellowships are people typically doing or where are people often, those who aren't doing fellowships, where are they going off to practice?
Alex Mathieson 10:53
It's a bit of a mix. So, the fellows, this year, one guy's going to thoracics, another one's going to Surge Onc in the US, actually. Last year, the graduates who just finished in spring 2021, both went to community jobs. Both are sort of locum right now. But one has, probably, a long-term job out west, Alberta, BC. Stretching back before that, from the fellow point of view, we've sent people to peds surgery, thoracics, good number of MIS. We just hired a guy who did advanced endoscopy. So, it's a bit of a mix. Trying to remember where the last few people who went to the community, a couple of them are in the province of Newfoundland working. We sent, three or four years ago, a guy to coastal BC. He was from Alberta and decided to move to the coast of BC. A couple hours north of Vancouver. So, it's a real mix where people end up.
Ameer Farooq 12:07
What are the strengths and qualities that you're looking for in a prospective applicant?
Alex Mathieson 12:11
I'm never sure how to answer this question. I think we're definitely looking for team players. We debate this a lot at rank meetings and current interview time, what are the qualities we're looking for? But definitely, we want people who are personable, team players, and easy to get along with and work with. And we think these are qualities that both make a good resident. They're essentially a sort of, colleague for five years. And these are definitely qualities that are good in the world of treating patients and doing surgery. I think that brings a personability to patient care that is really important.
Ameer Farooq 12:56
Well, I think you have to be a personable person to live in such a lovely city such as St. John's, with such lovely people. Can you tell us a little bit about what St. John's is like as a city and what residents get up to outside of the hospital?
Alex Mathieson 13:12
Yeah, so, St. John's has become more and more vibrant over the last couple of decades. It's a very busy downtown restaurant and club scene. So that's the evenings. One of the strengths of this place is outdoors and hiking. So, it's rustic, it's rugged, and it's bare rock-exposed stuff everywhere. But on a sunny day, it's gorgeous. There are trails all over the place. There's a long trail that goes a couple hundred kilometers weaving along the coastline, which is used by all kinds of people. And a lot of the residents get out and hike these on weekends and whatnot. So that's definitely one of the things that's going for it. Our usual detractor is the weather. We don't really have spring. So, it's like cold and wintery from December until the middle of April. And then it's, sort of, foggy for a while. And then summer comes sometime in June and lasts till the middle of September. And then, fall is nice. One of the things that a lot of people do, especially if they hear five years, is that they can actually buy houses. So, if you're here long enough, people invest and make that purchase, which I think is probably a bit different from other places.
Ameer Farooq 14:36
Well, that's fantastic. I will say, anecdotally, that it is just an absolutely beautiful city and the colors and the vibrancy of the buildings downtown are just gorgeous. In closing, Dr. Mathieson, thank you again for spending the time with us. Is there anything about the program that you think people wouldn't know that would be surprising to prospective applicants? And is there anything else that you would want our med student listeners to know?
Alex Mathieson 15:06
So, I'll spin back, to quick things. We do take pride in the endoscopy curriculum that we have, which is, sort of, four months of dedicated endoscopy. And I think we aim for people to come out with good skills and that one of the advantages we have here is that there's only a couple of surgery training programs. There's general surgery, orthopedics, and there's no fellows in anything, right? So that keeps people out of your way when you're getting operative experience. Like I said before, we sort of jump in right away, but everybody, we're there to help you. And it's a small group. In the last 5, 6, 8 years, there's been really great camaraderie amongst the residents. They get along, they spend time outside the hospital together, and there's support for each other that, sometimes, really impresses me. Knowing that I wasn't that it's so much better than it was 20 years ago. Not that it was bad 20 years ago, but they really help each other out. And it's a team and a family.
Ameer Farooq 16:10
That's absolutely wonderful. Thank you again, Dr. Mathieson, for joining us. Have a great night. Dr. Helyer, thank you so much for joining us on Cold Steel today. We really appreciate you taking the time to tell us about the Dalhousie General Surgery Program for our upcoming CaRMS season. We'd just like to start by asking you to tell us a little bit about the Dalhousie program. And what are some of the strengths and weaknesses of the program?
Lucy Helyer 16:47
Well, thanks a lot for asking me to participate, this is great. So, Dal has a five year, like everybody else across the country, General Surgery Program. We are situated in Halifax, but we have rotations in New Brunswick and, possibly, Prince Edward Island and other communities outside in Nova Scotia. We take five residents a year. We have a compliment of anywhere from 25 to 30 residents in our program. I think the strength of our program happens to be the early onset of operating and independence. Residents are encouraged to use a skills lab and we have ongoing skill sessions all the way through the five years, to build on those surgical skills. I think that another strength would have to be the Maritimes. Maritime people are known to be warm and generous, and I think that resonates through our program and the rotations around the Maritimes. Everybody's always very happy to have residents and they have excellent experiences in the community.
Chad Ball 18:03
That's so true. You never hear anyone say anything negative about Dalhousie, and it's always a beautiful stop on the CSF tour over the years. We're curious, what is the typical breakdown of what your residents go on to do after graduation?
Lucy Helyer 18:20
Great question, Chad. It varies. We have traditionally tried to train community surgeons, but we've had many subspecialties come out of our program this year. We have a resident going into MIS, one going to HPB transplant and another one going to thoracics. Last year, we had one go to surgical oncology. So, subspecialty success rate to fellowship is very, very high.
Ameer Farooq 18:52
How many applicants do you take annually? And what are the traits and characteristics of an applicant that you'd be interested in?
Lucy Helyer 19:00
Every year, we have many applications, but we generally interview 60. And of that, five positions are filled. We occasionally have an externally funded grad every other year. What I'm looking for in a surgery resident is someone who is self-motivated. Who has great communication skills, as a good team player, and has enthusiasm for life. Someone who works well with others and is generally easy to get along with.
Chad Ball 19:38
That's such a good point. The match with the program and the residents clearly is so important to ensure success. You commented about the friendliness of the Maritimes and what a wonderful city Dalhousie resides in, and that you get to work in. Tell us a little bit more about what a resident's life looks like, what some of the things available to them, outside of work, would be in the city. For those who haven't been there.
Lucy Helyer 20:04
So, I think that Halifax has changed over the last 20 years. Halifax is now much more of a multicultural city. We have great restaurants and a good social life. There's lots of universities, so there's bars, activities, restaurants, all that sort of things. We have theater and concerts. So that's after hours. We have really short commutes to being outside and doing outdoors, such as hiking, kayaking. We don't have any downhill skiing, that would be you guys out west, but we have a lot of cross country and snowshoeing. The Maritimes has become a bit of a winery place. So, we have lots of wine tours, we have little farms, and generally, outside excursions. I think that's probably what has changed most. We, of course, have whale watching and being on the Atlantic gives a great chance to go sailing, scuba diving, if you like the cold water.
Ameer Farooq 21:12
And don't forget the lobsters in the airport.
Lucy Helyer 21:17
That's right.
Ameer Farooq 21:18
The last two questions we had for you are: one is, if prospective applicants were interested in doing research, what kind of opportunities are there for them to do that? And then the last question we have is, is there anything else you'd like prospective applicants to know and is there anything surprising about the program that they should know, but might not know?
Lucy Helyer 21:41
So, for your first question on research, every resident, when they come into the program, is given a list of research topics which are aligned with [inaudible] people and Dr. Newman is our research coordinator. And she mentors people all the way through their five years. You have to hopefully have an outline in your first year, present your working plan in the second, and have data collection in your third. We also have the path for people who want to go on to do more of a concentrated research time, a Clinical Investigator Program, which is two years, fully funded from the department of surgery. Then they are off of all clinical duties and usually have secured funding. And that can be taken anywhere from second to fourth year. I have residents in fourth year who are just going into CIP now. And then you come back in after your two years, generally, with a master's. I've had residents do Master of Education, Master in Pathology, CIP. So, it's very varied. We've also had some residents take a three-month block to really do a focused project. And everybody's encouraged to have an abstract presentation at a national meeting, or CAGS, which we fully fund the residents to go to that meeting. So, I think researches are supported and successes are celebrated. The last question is, what would people be surprised? Well, Halifax has a full complement of subspecialties. We have a Multi-Organ Transplant Program and this year we're looking at over 30 liver transplants. The residents all rotate on transplant in their second year. They do eight weeks where they go for donors and look after these transplant patients. We also have quite a busy Surgical Oncology Program, where we're doing cytoreductive and intraperitoneal chemo. We have liaison with medical oncology where we're looking after a lot of advanced melanoma patients. And we generally take from across the Maritimes and sometimes including Newfoundland, the Atlantic provinces. We would include quite a busy MIS Program and colorectal surgery. The last thing, we only have one fellow, two fellows right now, one in HPB and one in MIS, so the residents all are the primary caregivers and the assistants in all these large surgeries. And they also have a great exposure to access surgery. So, when they want access surgery as a PGY4, you are the fellow. So, you're doing all of the cases, seeing patients, and running the team. So, I think that's quite a unique focus, currently, across the country.
Ameer Farooq 24:46
Well, thank you so much for joining us. Dr. Liberman, thank you so much for joining us today on the Cold Steel podcast. Could you tell us a little bit about the Montreal General Surgery Residency Program?
Sender Liberman 25:10
Our program is a quite a large program, maybe not the biggest in Canada, but we have a fairly good-sized program with between eight and ten new first-year residents each year. We span a pretty good swath of Montreal's teaching hospitals. Although we're not the only teaching center in Montreal. We have very big university centers, we have affiliated teaching hospitals, and we have some community hospitals that really make up the clinical side of our program. And we have a pretty long history of excellent graduates and excellent teachers as well. And quite a bit of strong research, both output and opportunities for trainees to partake in. And it's a great place. I trained at McGill many, many years ago. And it's been a lot of fun coming back as program director, almost 20 years later. And so, I'm very excited to play a part in this program.
Ameer Farooq 26:24
Well, McGill has a very good reputation nationally and, I might even add, internationally. So you talked a little bit about the research, the breadth of different environments where trainees work. What are some other highlights or strengths that you want to talk about for the McGill General Surgery Program?
Sender Liberman 26:42
One of the things that our residents always comment on, and something that we noticed, but also foster in the program, is that despite being a fairly large program, we really have a family feel to the program. All the residents know each other. The majority of attendings and residents really have a close relationship in terms of knowing each other and knowing each other's background, but also skills and capabilities. And we're really the type of program where, if you have a problem, and everyone has problems from time to time, and every program has issues, it's the type of program where you can bring those issues to us, or to the general surgery resident's committee. And we really take those things seriously and look at how we can improve things for residents. And so, people always ask about strength of a program. Well, I think our biggest strength is the ability to deal with problems when they happen. And also, at the same time, serving out an excellent teaching program that really leaves nothing left to guess about when you're heading towards your exams five years later or so.
Chad Ball 28:02
Yeah, it sounds fantastic. But you know, there's no question, I think all the Canadian programs can put graduates in any fellowship or job that they probably desire. But I'm curious, when it comes to McGill, what is the flavour? What have your graduates gone on to do, in general? What's that fellowship versus direct entry into their first job mix?
Sender Liberman 28:22
So, we have always made sure that anyone graduating could just go work in a general surgery position somewhere. We make sure that they have all the skills that a community general surgeon or even an academic general surgeon would need. That being said, we do have a lot of fellowships at McGill. And so, the residents are often exposed to those things. It's very few of our residents that don't go on to fellowship afterwards. Partly because, maybe, the strong research component, which really fosters an academic flavour to the program. And so, the residents, when they're going through our training, will often really start to seek out fellowship training opportunities. And while I don't know if it's a strength or a weakness, it's just how it is. We make sure that everyone has the training that they need and our royal college requirements for graduating residents that are competent and safe. Definitely, we do that. But because there's such a high exposure to a lot of very subspecialized work, I think that piques the interest of a lot of the residents who can see themselves in careers in more subspecialized areas that fellowships would offer them. And so, I looked recently back at our last 10 years of graduates, and I would say there's maybe only been about two or three graduates over those 10 years that have gone directly into general surgery practice. So, although we're definitely open to someone who wants to do general surgery, and many who have come into the program have said that as well, the output at the end is often the fellowship route. There's not really one type of fellowship that our residents go into. There's a huge variety, year after year. Some years, a little bit more into one versus another. But just as an example, in the last year or two, I mean, we've had people go into colorectal, thoracic, surgical oncology, MIS. And I'm probably skipping a few. There's been some ICU, critical care people, one or two have gone into trauma. Really, a bit of everything. We have those specialties at McGill. So, a lot of the services that the residents will rotate on, are usually either a mix of community type general surgery, and some of the subspecialized programs. Or sometimes a purely subspecialized area like hepatic biliary and transplant, or colorectal surgery, and things like that. And so, that tends to be the route that most of our residents take.
Ameer Farooq 31:20
What's the ideal applicant or candidate look like to you? What kind of strengths and abilities, or what types of characteristics are you looking for in a prospective applicant?
Sender Liberman 31:29
So, we have a pretty limited ability in terms of the number that we can hire. Because in Quebec, this is regulated by the government. So, each of the medical schools and their residency programs, numbers are dictated by the government. So, for example, in the coming year, we only have three spots that we can offer through CaRMS. So, the question you ask is very critical in terms of figuring out who would like to come to our program, and also what we'd like from those people. The best applicants are probably the ones who have showed the most interest in general surgery. Have very supporting letters of recommendation from the people that they worked with, especially from surgeons. And also, the ones who have come across in an interview as the type of people that we'd like to work with. So, people that, at the same time, are driven and interested in general surgery, but also have a personality that we find easy to get along with. Someone that we love to have call us at three or four in the morning to discuss a case with us. When you're talking about just admitting a few people, and these things are really critical, because we know that we're limited a little bit by the numbers that we're allowed to take into the program. But we also feel it's extremely important to be fair to everyone who's applying, and really make sure that the ones who are the most interested and the ones who will probably get the most out of our program, are the ones that we match. So, it's a combination of things. It's really what you've done leading up to the program, and also the type of interaction and communication skills and things like that, that we would see as you go through the program. You know, in the year after or so.
Chad Ball 33:40
I think we all know, having been, a lot of us, to Montreal many, many, many times what that absolutely beautiful city you live in has to offer. But from maybe a 30,000-foot perspective, what are some of the extracurricular or nonhospital-based activities and opportunities that your residents get into, typically?
Sender Liberman 34:00
On a normal, nonpandemic year, obviously, we have a much better variety and offering of events. Montreal, as I hope you all know, is the coolest place in Canada. Not just the coldest, but also the coolest. And we're a city of festivals, we're a city of good food, we're a city of outdoor events, both in the summer and in the winter. And, because our residents also are quite friendly with each other, they tend to organize some of these events too amongst themselves. They have a strong residency committee that plans extracurricular things, in addition to academic retreats and things like that. We do biking in the summer, we do skiing in the winter, and everything in between. We're home to a hugely popular restaurant scene with very exciting types of restaurants. Obviously, this year, a lot of us are eating at home alone. We're with our families quite a bit. But the second we're allowed to; we always break out and book a couple of good restaurants. And for those who like skiing, I mean, we're definitely not gonna ski like at Whistler, or out west, but we have a lot of skiing that's really close to the city. So, in the winter, they're skating in the Old Port and things like that. And then, like I said, about the festivals, we have the Jazz Fest, and the different types of music festivals. It's really a cool city to live. And those of us who live here, are here for a reason. And that's because of all these things. And the quality of life is generally quite good for a reasonably priced city as well, compared to a couple other places in the country. And so, the residents, usually, really enjoy that.
Chad Ball 36:10
I think cool and funky are definitely understated descriptors of Montreal. So good, good for your descriptor there, for sure. And I think the last thing we'd like to ask in respect of your time and your program is, if you could tell our applicants and our listeners, maybe one or two things that might surprise them about the McGill program. Usually in a positive light, but really any light that you see fit.
Sender Liberman 36:39
I think, coming right out of medical school, especially if you weren't at McGill for medical school, you'd probably be a little bit surprised by the level of independence that residents have when they start in their training. I don't mean independence like just go and do stuff, but independence that, with the supervision and teaching and everything that they acquire early on, they get to do quite a lot with the patients that they see, both in the emergency room, the operating room, clinics and things like that. I don't have a lot of experience with other programs in the country. But, when you look at what our residents are able to do quite early in their training, it's actually quite incredible. And I think it's because we put a lot of trust and faith in the residents that allows them to be able to get to that skill level very quickly. The other thing is, I think that the family feel of the program will be quite surprising to someone who really hasn't been in the program for very long or wasn't at McGill and did a lot of rotations in ours services, for example. The residents really are a friendly bunch, and they get along well. That's so important to their well-being and, really, making people happy in the program. I think those are probably the two, if you're asking about surprises, the two biggest surprises.
Ameer Farooq 38:15
Well, thank you again, so much, Dr. Lieberman, the one question I thought we would quickly sneak in there is, I'm sure it's a common question that you get, do applicants need to know how to speak French?
Sender Liberman 38:27
They do not. As I mentioned before, we take about 10 residents per year, and only three of them are through CaRMS. So, the others are all basically from the Middle East. And so, the majority of our program, actually, do not speak French. That being said, there is an obligation to serve patients in their language, especially if they don't speak English, a language that they understand. And so, we rely on translators, we rely sometimes on family members, but also some of the other health care professionals to translate. So, it is very important that people know how to get the word through to their patients that they're trying to explain. McGill does offer courses through Rosetta Stone and some others. Lately, they've been free, and a lot of the residents do take up these opportunities. It's always great to learn an extra language, but spending 5, 6, 7, years in a place, it is really nice to learn some of the language. So, most of the residents do use that opportunity to learn some French. But it's not mandatory. You also have to remember that Montreal is an extremely cosmopolitan and international city. And so, about 40% of our patients speak French as the first language, about 40% speak English as a first language, and the other 20% speak a variety of other languages. So, there's an equally important emphasis on speaking with those patients, with their translators, and things like that. So, no, it's not obligated that anyone speak French. It's helpful, like if I was to go somewhere else in Canada, if I didn't speak English, I'd probably pick up some of it pretty quickly, as well. And that goes the same for any other country.
Ameer Farooq 40:25
That's very well said. Thank you so much, Dr. Liberman. Dr. Ott, thank you very much for joining us today on the Cold Steel podcast. It's really a pleasure to have you and all the really hard-working program directors join us for such a session for incoming applicants. I know you've just been on a 3-hour session for incoming residents as well. Thank you again for joining us.
Michael Ott 40:58
Well, thanks very much for having me. I think this is going to be really exciting to have this go out on the podcast.
Ameer Farooq 41:03
Can you start by telling us a little bit about the Western Residency Program, please?
Michael Ott 41:07
Sure. I would describe us as a medium sized program, we take five residents each year. So, a total of 25 plus or minus one or two, depending on how things work out every year for our Residency Training Program. We're in southwestern Ontario. London, as a city, is about 400,000 to 450,000 people, but we serve a really large catchment area. I've been the program director for about 10 years. So, I'm not new at this, as far as program directorship goes. I think we have a really, really strong program as far as training excellent surgeons, and allowing people to get the jobs and/or fellowships that they're interested in doing.
Ameer Farooq 41:48
Yeah, Western has such a great reputation. Can you tell us a little bit about some of the strengths, in your mind, of the Western Program?
Michael Ott 41:48
Yeah, so I think that over the years, I've kind of come to realize there are 3 important components to any training program. One is clinical volume. One are educational experiences outside of clinical volume, and the other is what I call, mentorship or collegiality. I think we excel in all of those. As far as clinical volume goes, for those of you that may or may not be aware, southwestern Ontario is a large area. Even though London itself is a smaller city in comparison to some of the very large cities in Canada. Our catchment area is massive, so everything west of Hamilton, all the way to the border. So, even though London's 400 some odd 1000 people, our catchment area is about 1.5 to 2 million people, and there's no tertiary care level or level 1 trauma centers, other than London, serving all of southwestern Ontario. So, we have a very large catchment area and a very large clinical volume of tertiary care. Within that clinical volume, we don't have a tremendous number of fellows. So, our residents get a lot of experience in looking after patients with both simple disease that are from our local area, and then complex disease from within the region. We have all the services of a large tertiary care hospital and service, a population that's bigger than some of the major metropolitan areas like Montreal, Toronto, or Vancouver, because they have to divvy up their clinical volumes between multiple hospitals. The various education programs, we have a lot of things outside of work or clinical volume that I think allows residents to achieve their goals of being excellent surgeons. We have really organized and well-run Research Training Program by Dr. Kelly Vogt. We have a lot of productivity in our program and opportunities for research, if that's what people want to do with their career. We have a lot of communities that are local to London, as I said, our catchment area is quite large, it spans as far as 3 hours away in Owen Sound. And so, we have a lot of community partners where residents can go and work in these smaller communities that range anywhere from 30,000 up to 40,000-50,000 population base. So that's really exciting. We have a large amount of money that's available for residents, or residents when they present at meetings, get paid to go to meetings. Prior to COVID, we were spending anywhere between $60,000 to $75,000 a year on residents traveling to research meetings. That gets their work out there, that gets them introduced to mentors and to see how things are done in other parts of the country or the world, depending on where they're presenting their work. We have a very innovative Trauma Simulation Program run by Dr. Rob Leeper. That includes video feedback, and play by play, and discussions. Our residents, as they come into the program, get added to a team. They stay in that team throughout their 5 years of residency, so people are added and subtracted, but the core of the team, throughout your training, stays the same. And it's kind of a fun competition amongst the different teams. You stay with that group of individuals through your trauma simulation throughout the five years, and that creates some really good relationships. And then, we have a really strong general club program that includes going to restaurants. I think the cornerstone of why our program is really successful in the Royal College Exam is that we have, probably, the best exam preparation program where our faculty spend a tremendous amount of time, on their free time, with no arms twisted, to prepare our residents for the examination. And the final part of training programs, which I think is really important and often overlooked, is that mentorship or collegiality. Our program is not that big. We have 25 residents, and we have somewhere in the neighborhood of just over 30 faculty involved. We have two main training sites. And even though we're a big hospital that does a lot of important work, everyone knows each other, everyone cares about each other. Our residents often describe it more as a family relationship than really being a work relationship. And our faculty are very, very invested in our residents. Education is one of the pillars of our training, of our program. That's in the Division of General Surgery, in the Department of Surgery. It's a very important thing to our program. It's something that we pride a lot of. And so, it's easy to find mentors, it's easy to find friends. A lot of our faculty treat our senior residents more like peers. There's independent operating that occurs as you get into later stages of your career. I think that people find that it's a very comfortable place to work. If you work really hard and do a lot of hard work, and no one appreciates the work you do, then you get burned out pretty quickly. When you're in a place where you might work hard, but everyone really appreciates what you do and demonstrates that appreciation by investing in you or buying lunches, buying drinks, going out places together, doing things together, caring about your life outside of work, that makes you feel very important and it creates this sense of belonging, which I think we have. And so, I think those 3 areas. The clinical volume, the programs outside of just the clinical work, and then that feeling of belonging and collegiality, makes us an excellent place to train. And that's why, to be honest, in the 10 years that I've been a program director, no one really has left the program. We don't fail people out of the program, we bring people up to where they need to be. People don't transfer out. In fact, we've had more people transfer in, in the 10 years, than we've had transfer out of the program. And I think that really speaks to the feeling that once you're in, you're in and you belong, and everyone's gonna invest everything in you, to make sure that you're an exceptional surgeon by the time we're done. So, I think those are the main things that I would highlight about our program.
Chad Ball 47:28
You know, Mike, I think that's beautifully said. And I think from the outside, it sure seems like that. The collegiality and the tightness of your group, both on the trainee side, as well as the faculty side in London, is clear, I think, to the rest of the country. Beyond that, though, you guys have really graduated some real icons and some true giants in surgery over many, many decades. More recently, you reintegrated a lot of these really great graduates back into your own faculty, in your own program. Curious if you could give some of the applicants a sense of what your graduates, on average, go on to do fellowships, community jobs, direct entry work, whatever that would be.
Michael Ott 48:13
So, I think if you were to look over, again, the 10 years that I've been involved, and to say, "Well, how many of you go on to fellowship and how many work in the community?" It's probably somewhere in a neighborhood of 60% to 70% would do fellowship, and about 30% to, maybe, 40% would go into work directly in the community when they're done. It changes every year. Some years, we have two or three that want to work in the community and not do extra training. So then, when someone does fellowship, that doesn't always mean that they're going to go on to do an academic job. So, we have a number of individuals that have done extra training in the area of critical care, colorectal, even HPB, and then I've decided not to work in academic centers but work in large community hospitals. So that's always a great thing too. Our residents are highly competitive. For sought-after fellowships, they do very well, because not only do they get a lot of great references, and we have a lot of connections, but they are given the freedom to do the things that they need to do, within their training program, to make them strong applicants. Our residents populate all kinds of things. We have a number of individuals that have taken jobs in Stratford and St. Thomas, which are local towns that are not that far from London, that have anywhere between 50,000 to 100,000 people. Then, Sarnia or Windsor, which are slightly bigger cities. Then, I've been very proud that we've populated a bunch of academic spots across the country. There are individuals that work in Calgary. We've had individuals take jobs in Saskatchewan, Ottawa, some have come back to London and contributed to our faculty. We're slowly starting to infiltrate in a bunch of different areas. And so, I think the main thing about our program is that we don't have a prototypical graduate. Where we say, "if you come to Western, this is what you're going to be." Rather than, we work with our learners to decide, what is their career goals? And sometimes, that takes a year or two for them to figure that out. Then we figure out how we're going to make that happen. The only thing that we demand is that people be exceptionally good surgeons by the time they're done their training, and we make sure of that. But, as far as what their career goals are, we're interested in supporting them to be the best, wherever they're going to be. So, they're going to go to a community hospital and they're not going to be the best surgeon that community hospital's ever had. They're going to be an academic surgeon, then they're going to be highly functional, not just in surgery, but in all the other components of academia, administration, research, and otherwise. I think we have the building blocks to create a successful career for whatever someone wants to aim for. And I think that's the nice thing about our program. This is a little bit different than some other programs, is that there's flexibility built in the system. We don't have, if you will, what a Western graduate is, other than an exceptional surgeon. The rest of it is really, what do people want to do? We spend a lot of time trying to figure out what's important to our learners, and then figuring out and tracking a mechanism for them to achieve that success over their time with us and after us. So, I'm very, very proud of the graduates we have. We have some pretty exceptional people working in London and some pretty exceptional people working both in Canada and in the United States. And I think are some of the leaders, will be some of the leaders moving forward in Canada, in surgery.
Ameer Farooq 51:30
Dr. Ott, one of the, I think, the unique things I think about Western is some of the research opportunities. And I think, correct me if I'm wrong, residents can actually take a year off during their residency to pursue research like a formal researcher, can you tell us a little bit about that?
Michael Ott 51:48
Yeah, so we have a very extensive research program. We recognize that not everyone wants to do a ton of research or have an academic career, this focuses on research. However, we believe that it's very important if you're going to be a surgeon, particularly practicing in North America or anywhere in the world at this point, that you need to be facile with how research is done and to interpret research properly. And part of that is being engaged in research. So, we kind of have 3 different streams for people who are meeting their research requirements to learn the basics of what they need in order to interpret the literature and to be exceptional. Surgeons that understand how the world is changing, because the practice changes. All the way up to people that are aiming for academia and want to do, for example, a randomized control trial. And so, we have different streams, and residents kind of choose which of those three streams they want to be in. We have an exceptional research director, Dr. Vogt, who's very involved in research, nationally, and trauma. She makes sure that everyone is doing what they need to do, when they need to do it, and get some support, when they need to do it. But as far as taking time out, it's really quite flexible. We've had residents take a year to do, we have a local program, it's a Master of Surgery, it's a thesis-derived degree through the university. It's a one-year program. It's meant to be done during some of the clinical work. So, fellows and residents will often engage in that. We've had residents take 2 years out to do a more formal master's, whether that be basic science or otherwise. And then we even have a resident who's just returned after 4 years of completing their PhD in epidemiology at Harvard University. So again, there's no real formula. It's more about what career you're wanting to do. If you come to Western, you're going to be engaged in research. If you say you're not interested, that doesn't matter. That's a requirement of our program and we don't make any excuses for that. But the level of which your engagement is in research is going to be variable depending on your career goals. We design our training program with a lot of flexibility to meet a learner's needs. And so, if they're wanting to aim for extended time and doing extra degrees, or whatever it is that they want to achieve, we're willing to work with them to make it achievable. So, we definitely have flexibility in that manner.
Chad Ball 54:19
That's super, Mike. I think we all know that the London area is a lot of fun. There's a lot that that region, in general, offers to folks outside of medicine. In particular, we're wondering, maybe for some of the applicants, what some of your residents get up to outside of the hospital. What some of the things they can do are and what their living looks like in general.
Michael Ott 54:45
London is a nice place to live because it's exceedingly affordable. So, a large proportion of residents will even actually purchase small homes as opposed to rental properties or rent an apartment. Some don't choose to, but some will. And that's completely affordable on a resident's salary, with the salary structure through PARO, an Ontario organization that structures the payments. So, that's definitely doable. I think that that is the nice thing. That doesn't exhaust all of their income, so residents still have money to travel and do other things that they want to do. You know, London's kind of nice because it's sandwiched in between Lake Huron and Lake Erie. So, within an hour to an hour and a half, you can be on one of the Great Lakes. There's lots of great beaches, and camping, and other things, and outdoor activities. There's lots of hiking. That's something that I really appreciate and enjoy. The Bruce Trail runs all the way from Tobermory, which is the northern part of southwestern Ontario, all the way down to Niagara. So, you can engage in that. We have a local hockey team that everyone's excited about. It's an OHL team, so it's juniors. But the arena is built downtown, and it's really become a thing that people do. So, we have 8000 or 9000 people that show up to a London Knight's hockey game. There's all kinds of bars and restaurants that people go to before and after the game. So that's quite an event. We have a pretty decent art community. There's a local theater that puts on some great productions. We have a local art gallery, as well. And then Stratford, Ontario, which has world class theatre is like 40 minutes away. So, you can drive down to go see some of the greatest Shakespearean actors that you ever want to see, plus non-Shakespeare as well. But it's kind of worldwide known as an exceptional place. So, there's lots of activities to do and I think that our residents have the time to do it. The other thing is they have the disposable income, because our cost of living is actually pretty good when you compare it to places like Vancouver, Toronto. Even Calgary, I think, is pretty expensive now. Our residents have a pretty good salary and have money to do things with. They do a lot of things together, which makes me pretty proud. When the cohort spends time together, vacations together, things like that, again, just speaks to our motto, which is: we work hard, and we play hard. I think that there's lots of good opportunities. If people want to travel, we have an airport in London that you can get to Toronto or to Detroit pretty quickly. Then, if you want to drive to Toronto and to Detroit, is 2 hours either way. So, we're kind of nicely nestled in this part of southwestern Ontario that has a lot to offer, and everything's close by. So, I think it's a great place to live. It's been a great place for me to raise my family.
Ameer Farooq 57:33
That sounds absolutely lovely. Dr. Ott, in closing, we were wondering if you could tell prospective applicants something that they might find surprising about the program. Also, if there's any other things that you would like prospective applicants to know about Western?
Michael Ott 57:51
I think the most surprising thing is that, and this has been something that's long standing, but often Western has a reputation of being very, what people would describe as a hard program. I'm not sure how that became or why it became. But certainly, residents or students often come and ask about that. I'm not sure where that's come from. I certainly think we have a lot of expectations of our trainees, and we give them a lot of autonomy. We want them to be decision makers with backup, obviously. But this idea that it's a cold place to work, if you ask our residents, that's not the case. They feel very well cared for. We've had lots of residents engage in all kinds of activities with our faculty, we really treat them more like, if you will, family or children in a sense, as opposed to residents. And so, if you come and spend time in London, and unfortunately, because of COVID, the applicants aren't gonna be able to spend time in London. But over and over and over again, residents that are not from London will tell me they were a bit fearful of coming, but when they came, they were hooked, and they decided to stay. And we have residents from all across the country. So that's, I think, something that's a bit surprising. That this reputation that it's a difficult program or a tough place to train isn't really true. It's definitely a place where you're going to be pushed to be your absolute best, but you're going to have a lot of support or caring. I think the things that are most helpful to applicants, I think the thing that I always try and tell students, and I know they don't believe in when I say it, but the algorithm is built for you to get what you want more than me, as a program director, to get what I want. So, think of your training as a Christmas list or birthday wish list. Start from the top, down to the bottom. Rank the things that you really want. Don't worry about playing games with your rank list. If you had your ideal place you wanted to go, rank it. Don't try and overthink it. The people that try and overthink it, or play the games with the algorithm, sometimes end up losing out because they've overthought the thing too much. So that's my biggest piece of advice. And then, I really think it's important for people to figure out whether they feel comfortable in a place, training. The reality is, like I said, I've been doing this for 10 years, I know all the programs across the country. I've been involved in some of the accreditations of the programs across the country. There isn't a bad program in Canada. You're going to get well-trained no matter where you go. But each one has a different flavour. It has some pros, it has some cons. And the reality is, is it the right fit for you as an applicant? We're trying to look for if you're a right fit for our program, you need to figure out whether the program is the right fit for you. And don't be afraid to pick something that you think isn't the most prestigious or seems crazy to go to this place. If you feel it's the right fit for you. If you're in a program where you fit well, you will excel. If you go to a program where you don't think you're going to fit well, but somehow it will change while you're in your training, that never happens. So, I think it's really important to feel comfortable with where you go. And to really choose what you think is best for you and not to overthink the whole ranking thing. I've seen all kinds of disasters over the years when people try and overthink it. Just go with what your heart tells you is the best place and the best fit. That would be my most salient advice, if I could.
Ameer Farooq 1:01:33
Dr. Marcaccio, thank you so much for joining us today on Cold Steel. Could you start us off by telling us a bit about the McMaster program, please?
Michael Marcaccio 1:01:41
Okay. Well, I always say that there's 17 good training programs in Canada. And the good thing is, we do things a little differently. So, there's diversity. So, the things we think that we do that are important and define us is, number one, every resident, we help them find their career path in general surgery, and then make sure that their training prepares them for that path. We think it's very important since Canada needs all kinds of general surgeons and we need to be sure we're producing all the kinds that Canada needs. So that something we spend a lot of time at. Our program is relatively fixed in first and second year. And we ensure exposure to all the subspecialties in general surgery. And we have endoscopy fundamental training in PGY2, so that residents can continue to expand on that for the rest of their training. And so, we graduate very strong endoscopists. And then PGY3, PGY4 and PGY5, is where all the flexibility is to help you explore, then ultimately prepare yourself for your career.
Chad Ball 1:02:46
There's no question, Mike, the Hamilton Program is known to be really strong. I'm curious what, if you take a 30,000-foot view, what you're looking for in your resident applicants.
Michael Marcaccio 1:02:58
I think, one of the things I've learned, and this is my 10th year in this job, is we look at where, and we've been interested in attrition in those who choose general surgery. And I think one of the things we're most interested in, and focused on, is how well you've explored general surgery and how well you understand it as a career, and how that fits with your own values and your strengths, right? Can you relate that to the things that really get you interested, and excited, and that you excel at? And how does that match up with what general surgery demands? So, I think, the more you really have that understanding, the better we'll see you as a candidate. Because we think a lot of people choose general surgery or any medical discipline based on a romantic notion or an event. Often, a mentor who inspired them. They were more inspired by the mentor than the actual subject. And, when they started to live the subject, they found that really didn't fit with them. So, we really want you to understand general surgery. We want individuals that believe collaboration, supporting each other, and helping each other, even though at times you're going to compete with each other, that you'll all get further ahead by supporting each other. So, it's okay to compete in a supportive way. Being supportive. And then, the third thing we really are interested in, people who want to help us make us better. We're not going to stay a good program and get better by ourselves. We need our residents to be involved in that process of improving the program. So, those are some of the things that are really important to us, as we look. We don't worry about what kind of general surgeon you want to be. We don't have any preference. We want people who understand general surgery and truly want to be a general surgeon.
Ameer Farooq 1:04:47
That's really sage and insightful kind of criteria. Because, when you're elbows deep in someone's belly at 3 in the morning, then you really have to know that what you're doing is what you really love doing.
Michael Marcaccio 1:04:58
Right. A good general surgeon never complains or is never not excited about being in somebody's belly at 3 in the morning. They may not be overly excited about seeing constipation in the emergency room, nor should they be. But, if you're really meant for general surgery, that will always be a positive experience.
Ameer Farooq 1:05:16
100%. What do your residents typically do after graduation? Are they going for fellowship or community?
Michael Marcaccio 1:05:23
So, I believe that we live what we say. If we say that's what we're looking for, we actually produce that. So, if I analyze 10 years of graduates, we have people across the entire spectrum of general surgery. From single surgeon in remote hospitals, to high level academic health sciences centers and academic careers. I'd say the distribution of our residents follows the distribution of general surgeons in Canada. About a third in academic practice, a third in large urban community hospitals, where they're doing complex surgery, but just don't have that added component of spending a third or more of their time. And then, a third in smaller, medium to small, hospitals. That's pretty well the distribution of general surgeons in Canada and most are graduates. Many of those that end up in those large urban hospitals, even though they're not academic health sciences centers, have done clinical fellowships.
Ameer Farooq 1:06:20
Is there any opportunity for doing research for residents?
Michael Marcaccio 1:06:24
Yes, there is. And I'm just negotiating that because we've been very successful. So, we have all the options. Everybody has to do some research and residency; the Royal College requires it. They require one project, we require two. That's to help everybody understand how to approach and use information that's going to guide their clinical practice. For those that feel research is going to be a part of their career, we have multiple different opportunities. The most common two are, we have a full-fledged Clinical Investigator Program. McMaster has six positions that are the Royal College Clinical Investigator Program. We have a surgeon scientist streaming inside the department of surgery. Selects and helps residents prepare and compete for those six positions. So, McMasters got about 200 residents in each year, training. Somewhere around 1000 residents, total. This year, two of those six positions across all of McMaster went to General Surgery residency. We're really proud of that. The second option, a lot of residents will take a year leave of absence to do a one-year master's. For McMaster, Harvard's been extremely popular, although we've had residents go around the world. I just had one return, who spent a year in France studying economics of health care. So, they've done all kinds of diverse things. But at least 50% of them that have done that have gone to Harvard to the School of Public Health and done their one-year MPH. our program owns an endowment that is competitive. About every year, that endowment provides funding for one resident, for the salary of a resident. So, if you take a leave of absence, you can still get your salary if you win the endowment fund. It's very competitive. I think we've got four applications this year and one of them will get that. But we own that. And it's a huge benefit to be able to do that, not have to stitch together five different types of funding to try and get by for that year. But, again, about 30% of our residents have done an advanced degree in training, but we don't try to combine that with our clinical time. So, you still do five full years of clinical training if you do that.
Chad Ball 1:08:44
That's an amazing opportunity, there's no doubt. I've spent a lot of time in Hamilton over the years and I love that city dearly. I'm wondering, for somebody who maybe hasn't spent much time in Hamilton, how you would describe it. And what are some of the things that your residents get up to, on days off?
Michael Marcaccio 1:09:03
So, if you look at our Instagram, and I don't run that because I have no social media skills, but I think the big things are, one, it's easy to get around. We've got 3 main teaching hospitals, plus the pediatric hospital. You can get from hospital to hospital in 15 minutes. Most of our residents live within 15 minutes, they don't have long commutes in. I think that we're 10 minutes from green space and we've got a huge multitude of green spaces. So, people who like green spaces, there's no shortage and they're easy to get to. It's a very livable city. Raising a family. Many of our residents end up buying a house because, if well, nothing's affordable, they find it manageable and possible. So, they do that and then they can sell it when they leave and make a profit. Many of them actually live in houses or in the downtown core. There's lots of high-quality living spaces. And then, the big things in Hamilton, lots of cultural things. But the last 10 or 15 years, food is the rage, and really a good eclectic mix of food. Microbreweries are big here; we've got lots of really excellent ones. So, food and beverages is a favorite pastime of my residents, as well as outdoor activities and just chilling out. Finally, if you really need to go to the big city, you can hop on the GO Train and be in downtown Toronto in about 53 minutes, without the hassle of parking. So, access to Toronto, the Niagara Peninsula and wine country, and the United States. If the borders let you in, that's your thing. So, it's a pretty easy place to get to other places from. And our residents do all kinds of things.
Ameer Farooq 1:10:59
Yeah, having lived in Hamilton a little while, I can totally vouch for everything that you're saying. In closing, and thanks again, Dr. Marcaccio, for spending the time. What's one thing that you think people would find surprising about the program? Is there anything else that you would want future applicants to know about the program?
Michael Marcaccio 1:11:16
Hard to know how to answer that. I don't think there's anything particularly surprising. I think our graduates are ambassadors. So, I don't think there's anything really surprising about it. I think the one thing is that we really do value diversity, and inclusiveness, and that we welcome all those that truly want to be a general surgeon. And we are committed to making sure that your training prepares you for what you want to do.
Ameer Farooq 1:12:03
Dr. McKay, thank you so much for joining us on the Cold Steel podcast. Can you tell us a little bit about the Winnipeg Program, please?
Andrew McKay 1:12:10
Yeah, thanks. Happy to be here. We have a fairly small program, kind of, small to medium program. We take about 3 residents a year, from the CaRMS interviews. It's a 5-year program, with the option to do either a 1-year master's in surgery research here or a 2 year Clinical Investigator Program research track. So, anywhere from 5 to 7 years. Two main teaching sites in Winnipeg with contacts with a bunch of community centers nearby or across the province. We have a huge catchment area. We service all of Manitoba, part of Nunavut, Northwestern Ontario. So, we see absolutely everything. Lots and lots of volume. Lots and lots of teaching. You know, the small atmosphere, I think, really helps.
Ameer Farooq 1:13:27
Yeah, absolutely. Winnipeg is well known for all the crazy cases and high volume that you get. Certainly, I've talked to some of your residents and seen some of their pictures on their phone, so I can attest to the sheer volume and interesting cases that residents must see. Can you tell us a little bit about some of the highlights and strengths of the program?
Andrew McKay 1:13:47
I think the biggest strength of the program is the size. It's that sweet spot with, you know, just big enough that you will see and do everything, but it's still nice and small that very early on, the staff will get to know all of the residents. You don't get buried in 50 or 60 other residents. So that's really a good thing. By getting to know our residents early, building that trust, which gives them increased responsibility and roles. So, operating early, getting to do more cases sooner. Also recognizing if somebody does need a little bit of help, or a little bit of extra attention, they don't fall through the cracks.
Ameer Farooq 1:14:44
Yeah, absolutely. I think that's such a nice thing to have, where the residents and staff really all get to know each other and there's a real level of trust and camaraderie there. What do your residents typically do after graduation? Are most of them going into community practice or fellowships? What has been the split?
Andrew McKay 1:15:03
That's a good question. I think, the short answer is that our residents have been very successful in getting the careers that they want. It has traditionally been about a 50/50 split between fellowships versus community. A bunch of recent grads have all gotten nice community jobs. Everybody who, at least in recent memory, that has gone after a fellowship, has got it in some very competitive fellowships. Our residents, I think they've really been doing well after they've been finished.
Ameer Farooq 1:15:45
There's an opportunity for residents to take a year off to do their master's. Is that the main opportunity for residents to do research? Or are there any other opportunities for residents to participate in research or other scholarly activities?
Michael Ott 1:15:59
There are lots of research opportunities in the program. Taking the year off, or the two years off for the CIB program is really for master's level research. So, you know, big projects, lots of studying. We have requirements in our program that every resident do two research projects in their five years. You know, we specify that they need to present at our research day at least twice and really encourage presentations at conferences and things. So, everybody's been able to meet those requirements. Some people have certainly done more. But anybody who's wanted to do a research project has always found one.
Ameer Farooq 1:16:46
I think Winnipeg is very similar, I think, from what I've heard, to where I grew up in Edmonton. But can you tell me and our listeners a little bit about what the city of Winnipeg is like and what residents get up to, typically, after hours and outside of the hospital?
Andrew McKay 1:17:06
So, it's a good question. I think Winnipeg gets a bad rap. I think it's a great city. I will say that I'm biased. So, my advice to all the applicants when it comes to interview day, talk to our residents, get the real deal. But there is lots going on in the city. There's a great restaurant scene. NHL hockey has been back for a while. Personally, my favourite is the summer, there's so many outdoor activities, parks, lakes, campgrounds, all very close to the city. So, I think we have just fantastic summers and you gotta embrace the winter, you got to enjoy the winter. Lots of festivals. Our residents are a really pretty tight knit group, and they do actually spend their own personal time together too, I think. I think they do a lot of activities. I think they make the most of the city
Ameer Farooq 1:18:19
That really speaks to the camaraderie again, among the residents, when people spend time together outside of the work. Yeah. I guess what you're saying is, buy a warm coat and then enjoy the city.
Andrew McKay 1:18:31
That's good advice.
Ameer Farooq 1:18:33
Do you have any tips for prospective applicants, in terms of, first of all, what kind of applicants you're looking for? And also, any tips and tricks for having a successful CaRMS interview day? And I know that it's all virtual. So, do you have any tips regarding that?
Andrew Ibrahim 1:18:50
Yeah. So, what we're really looking for is people that we think are going to be a real good fit. A real good part of the team. I think all of our applicants are going to be smart, they're going to be capable. We're really looking for the right mix who are going to really fit in. In terms of tips on the interview day. You know, it's easy to say, "Hey, relax and just be yourself." You know, although some of the questions are tough, nobody's out to trick you. Just be open and be honest. It's a hard process. I remember going through all that. I just wish everybody... wish you all the best.
Ameer Farooq 1:19:54
In closing, I'd just like to ask, is there anything surprising about the program that you'd want applicants to know about that they might not already know? And is there anything else that we haven't asked you about Winnipeg that you think prospective residents would like to know?
Andrew Ibrahim 1:20:08
I think that, probably, the things that I'm the most proud of, that we've really developed over the past few years, is a huge increase in the quantity and quality of the teaching. There's one good thing that came out of COVID, so many bad things, but when we were shut down and had nothing to do. We said, we're just going to, teaching sessions, lots and lots of teaching sessions. Now that things have kind of ramped up again, well, we've kept that. So, I think we've made really, really, nice improvements. I think the quantity and quality of the teaching is now just fantastic. In terms of what else to know about Winnipeg, the advice that I always gave to medical students thinking about a residency program is, get a chance and talk to the residents. Find out, are the residents happy? That really tells a lot about a program. So, I'd absolutely encourage people to reach out. We have a few meetings, obviously in CaRMS interview day, lots of chances to do that.
Ameer Farooq 1:21:42
Dr. Rochon, thank you for joining us on Cold Steel today. Can you start by telling us a little bit about my alma mater, the University of Calgary Residency Program?
Ryan Rochon 1:21:52
So, the University of Calgary is a midsize general surgery residency program. The program offers all general surgery subspecialty services with the exception of lung and liver transplantation. There are five sites in Calgary, including the Children's Hospital, Foothills Hospital, Peter Lougheed, the Rockyview, the South Health Campus. We're also supported very well by a number of community rotations, which gives the residents a lot of opportunity to explore things outside the academic world. We also have a very engaged faculty and resident group. I think that's really the strength of where our program lies.
Ameer Farooq 1:22:24
Well, not to bias listeners too much, but I agree with many of the points that were said about... Can you tell us a little bit about the strengths of the Calgary Program?
Ryan Rochon 1:22:34
Sure. So, one of the first things that I think about now with our program is our simulation program. You know, when I was a resident a number of years ago, it was really in its infancy. And we've had a couple of very astute medical leaders develop the simulation program, it's something that's probably one of the better ones in the country. We have four to five porcine labs yearly. That's in addition to the monthly labs that we run for the more junior residents. It really gives our residents an opportunity to improve their tissue handling, decision making, in a really less stressful environment. It also gives our more senior trainees an opportunity to teach in a less stressful environment. To tell them, you know, their tricks and tips on how to manage the tissue and how they manage surgical problems. We're a high-volume center. Although Calgary seems like a smaller place, when you fly into it, it's actually a large place in Canada. We support a lot of our surrounding areas. So, we probably look after between 1.5 and 2 million people. We have an outstanding faculty that's nationally and internationally recognized. This is not only helpful for our residents, but also helps them when deciding on fellowships. It gives them a lot of support throughout North America, especially. But, really, the true strength of program is our residents. We're really fortunate to have attracted an incredibly talented, caring, supportive group of people, that really showcase what the culture of Calgary general surgery is, and the type of people who go on to recruit. I'm really fortunate to be able to lead this group.
Ameer Farooq 1:24:15
I think that's very accurate. All the things that you said. You touched on it a little bit, that many applicants go on to do fellowships. Can you just break down, I can tell you what my year was, but historically over the last few years, what have Calgary residents gone on to do after graduation?
Ryan Rochon 1:24:35
Sure. So historically, it's pretty close to 50/50. Looking at the last 20 years. This year, we have four chiefs, one's going to vascular surgery, one's doing an access global health fellowship, one's doing an upper GI bariatric fellowship, and one's going to locum for a year before going into a fellowship the following year. The previous year was more heavily weighted towards fellowships, as well. Then, your year was 50/50, where four of you went into community and four of you went into a fellowship. I suspect, looking back at our more junior trainees is going to carry along those 50% lines. I think really the pride of the surgery program here in Calgary is that no matter what you choose, you're going to be competent when you leave here at the end of your fifth year. Whether that's going to be to go on to further training in a fellowship, or to go into a community independent job.
Ameer Farooq 1:25:27
Ryan, how many applicants you typically take in a year?
Ryan Rochon 1:25:31
We typically see between 100 and 130 applicants. This year, we've increased the number of Canadian medical graduates, we're going to be enrolling to five. I think that's a better number for Calgary. We had been dropping our enrollment due to workforce issues. But I think there's a lot more opportunity in general surgery coming forward in our country. And I think five really provides a very good balance for not only our program, but also is enough of a service gap that we'll be able to supply general surgeons in areas of need in the next five years.
Ameer Farooq 1:26:05
Ryan, there's lots of opportunities for residents to get involved in research. Can you highlight some of the opportunities that if someone was interested in doing research, how they might pursue that?
Andrew McKay 1:26:17
Sure. So, like many places across the country offer a CIP and a surgeon scientist stream, if you were actually doing some more formal education. But we also have an expectation of all residents to be involved in research. Whether that's clinical or basic science or some combination of both of those, I expect all first-year residents to be involved in a research project and present a proposal, at least in the next three out of four years, I expect you to present a new data and take at least one project to completion, including publication. I also have a background in quality improvement and patient safety and through a group of us here at the university, we're planning on putting on a more formal Quality Improvement program with the expectation that every general surgery resident, really, every surgical resident in Calgary, will have been involved or completed a quality group project before graduation. I think that's a skill set that's going to be very much in need going through the future.
Ameer Farooq 1:27:15
Yeah, that's fantastic. I couldn't agree more. Having lived in Calgary, I can tell you that, and I'm sure you're going to talk about this, what a great city it is. You can't come to Calgary and not be inspired a little bit by all the fit cyclists, and skiers, and things like that. But can you talk a little bit about what Calgary has to offer and what residents typically get up to outside of the hospital?
Ryan Rochon 1:27:40
Sure. Calgary is a terrific city. It's definitely an international city. I knew very little about the city before moving to Calgary. My only real experience was coming here on a yearly basis with UBC football, to get beat. But once moving here, I really realized what an outdoor city Calgary is. We're situated very close to the Rocky Mountains. Banff and Canmore. The two main areas that we have access to for hiking. The outdoor activities are abundant throughout the year. Whether it's in downhill skiing or cross-country skiing, snowshoeing, or just hiking. There are some terrific lakes in that area, as well. I know that my family takes advantage of that often. But beyond that, the stampede is probably what the city is best known for. It's in the early part of July. It's a heavily attended outdoor festival. Historically, last year, we came back after a year hiatus due to COVID and was extremely well done. It's definitely the highlight of the summer for Calgary. It really puts us on the map. The winter months, they're definitely cold today with the windshield, -25. But they're sunny. Again, growing up on the mainland, I was used to very dreary, wet, winters. Although they're cold and snowy, the sunshine makes it a lot easier to get through. We have an exceptional zoo. I have four children and we utilize the zoo frequently. We'll be going to ZOOLIGHTS in the next week or so, which is a really well-done live show the that the zoo puts on in the evenings. We're getting a new rink, which is well overdue. The Calgary Flames are definitely overachieving currently. That new rank will hopefully give you a little bit better arena to play in. We have very manageable traffic. But again, growing up in the Vancouver area it's not something that I'm used to and so it's easy to get around the city. And we also have a very active arts community. There are several excellent museums and we have visiting shows that come frequently to the city.
Chad Ball 1:29:36
We wanted to finish with one final question which was essentially surrounding if you were going to give advice to potential applicants in terms of, maybe, one or two things that would surprise an applicant that they wouldn't know about the Calgary Program, what would you say?
Ryan Rochon 1:29:53
So CaRMS, I would say, is my favorite time of the academic year. I get to meet some incredible applicants and I get to talk about the program. My goal at the end of the day is to match the best applicants to my program. And by best applicant, I mean, the people that fit in with our resident group the best that are going to probably thrive in our city and in our program. Now, my main tip is for the medical students to be themselves, don't try to promote yourself as somebody you're not. The second part is being honest with themselves, really knowing who they are and what they want to do. The worst thing that can happen is to oversell or undersell, or really not recognize what you want to do or what you want to be and end up in the wrong program in the wrong city. So, this CaRMS tour, this CaRMS Program is all about figuring out what's best for the applicant. The programs benefit greatly, but it's really both the applicants. So, knowing themselves and being honest themselves. I think that's where you find out who you are, and you end up in the right place.
Ameer Farooq 1:31:04
Dr. Mapiour, thank you very much for joining us today on Cold Steel. We really appreciate your time and for making the effort to tell all the prospective applicants more about the University of Alberta General Surgery Program. So, can you start off by telling us a bit about your program?
Deng Mapiour 1:31:21
So, my name is Deng Mapiour and I'm a co-program director of general surgery at the University of Alberta. My other colleague is Dr. Athena Bennett. The both of us are directors in the program. So, at U of A, we take about six residents a year. It's a big program, we train in about four different hospitals, four different main hospitals. We do send some of our residents to a rotation in Grand Prairie. Some of them go to Lethbridge or Red Deer. But the main four hospitals are based out here in Edmonton. The two main sites are the University of Alberta Hospital, and the Royal Alex hospital, what we consider the trauma center. Then, we have the Grey Nun as well as the Misericordia. So definitely, big program, a lot of challenges in terms of coverage, but you do get exposed to a lot of things. That's kind of the upside of it. You get to see a lot from the bread and butter of general surgery, from all the different sides, to more of the specialized sides. You see hepatobiliary, vascular, you see minimally invasive surgery, acute care surgery. We do have also high-volume breast surgeries at the Misericordia. So, you get exposed to a lot of the general surgery with, not only just the bread and butter, but also the subspecialty that will hopefully help guide you in your career. And the other thing that we don't highlight as much is the University of Alberta offers a rural stream. Which means that, for example, if you decided that during your residency here, that you want to do work in a smaller community, then we'll try to facilitate that. So, you spend more time in some of the rural areas of, mainly, Grand Prairie. But then, we get to make sure that you have some chance to expand your surgical capacity and surgical knowledge to include things that you might offer. It might not necessarily be in the realm of general surgery in the big cities, but definitely, if you work in a smaller center, things like C-sections, a few plastics procedures, and things like that. So, we try to facilitate that. And usually, that happens in your R3 years and up. That's briefly what the University of Alberta has to offer.
Chad Ball 1:34:16
That's great. The U of A Program, obviously, has been such a strong Canadian program for so many decades. You almost don't have to sell anything. But I'm curious, or we're curious, where do a lot of your residents, once they're graduating, go? In terms of fellowship versus, maybe, straight into a community job sort of mix, and what does that look like?
Deng Mapiour 1:34:39
Yeah, that's actually a good question Dr. Ball. Just one thing that I forgot to highlight. Then I'll answer this question. We do have a strong research infrastructure here at the University of Alberta. A lot of our residents actually go on and do the CIP Program, the Clinical Investigator Program. Usually, one or two per year go into that program. But back to your question, Dr. Ball. In terms of where our residents go. Over the years, there's been like, 80% will go into fellowship, and about 20% will go straight into community. That's the average over the last few years. In terms of fellowship, we have people going into fellowship across the country, in the States. And a lot of them are going to be successful in attaining their fellowship. We have people going into hepatobiliary, colorectal, trauma, breast. And then, we have some people who wanted to go straight into community and they're successful in that, as well. So, it's a mix of both. But I'll say probably 80% will go into fellowship and about 20% will go straight into community practice.
Chad Ball 1:35:59
Yeah, that is always a great mix, the 80/20 split, for sure. I think Amir and I have to be honest and disclose, as we have before on this podcast, that being both Edmonton born boys and having grown up in Edmonton, we really do love the city. But for those folks who maybe haven't visited Edmonton or spent much time there, tell us what your impression of the city is like and, maybe even beyond that, the other things that residents can get involved with, within Edmonton, when they're not at the hospital working.
Deng Mapiour 1:36:28
I moved to Edmonton in about 2014. So, I didn't know exactly what to expect, you know? But I have to say that I came to love Edmonton, I grew to love Edmonton. Because the city actually has a lot to offer, whether it's during the wintertime, during the summertime. Whether you're an indoor type of person or outdoor type of person, you will find a lot to do in Edmonton. For example, if you do a lot of outdoor stuff, Edmonton is very famous for their River Valley trail, which is one of the longest, it's probably, in North America, if not, the world. It's well-maintained during summer and winter. So that's one of the highlights that the city has to offer. As you know, people who like to go do indoor stuff and shopping, we're famous for the West Edmonton Mall. And the great thing with Alberta, you don't have to pay the GST. So that's a bonus for people who like those kinds of activities. But not only that, but there's a lot of festivals that happen here. Unfortunately, with COVID, you haven't seen a lot of action over the last couple years, but before COVID time, there's a lot of festivals all throughout the summers. Different types of festivals, from music festivals to cultural festivals. So, there's almost every weekend there's something happening in Edmonton. So definitely, you will not be bored outside the hospital. Same thing, winter, there's a lot of winter festival activities that are happening. One thing that I need to highlight is there's this street called Candy Lane. A street where they have a bunch of Christmas decorations, that's happening right now. It's a very well-known Edmonton attraction. Whether it's summer, winter, you're gonna find something to do in Edmonton. Jasper is not too far away, it's only a few hours' drive, so you can make that drive and you can go enjoy the mountains and all that. There's a lot of other places around Edmonton, within driving distance, if you like nature and the outdoors, you can go enjoy yourself there. So, you're not just in the hospital, on-call, all the time.
Ameer Farooq 1:38:49
Good old E-town, you gotta love it. Dr. Mapiour, what are the qualities that you're looking for in an applicant to the U of A Program?
Deng Mapiour 1:38:59
The main thing in any applicant, especially for general surgery, is to be passionate about surgery. You have to have that passion about surgery. Because the training for general surgery is quite tough. For all surgery, but for general specifically, it's quite tough. You get to sometimes have long hours. You do many calls. You're dealing with sick patients. Sometimes you lost a patient. So, it's definitely required, you have to have that passion to push you through some of those tough days. Okay? But at the same time, we want you to have somewhat of a balanced life. Even though you work very hard during residency, we still want you to maintain the social lives, maintain your hobbies, your activity that you do outside of the hospital. Make sure that you have time for your friends and your family. We want a well-rounded person. Yes, we want you to work very hard and be passionate about surgery. But at the same time, we want to make sure that you also balance your life outside of medicine, outside of work. So, you want to make sure that you have time to exercise, exercise the body. Make sure that you look after your mental health. Make sure that you have strong social connection with your family, and your peers, and your colleagues, and people outside of work. So that's what kind of thing that we're looking for in applicants. Someone who is willing to work hard, but also someone who is also able to take care of themselves and make sure that they have a life outside of the hospital and outside the residency.
Ameer Farooq 1:40:47
Our last question for you, Dr. Mapiour. Is there anything about the program that might be surprising to applicants? And are there any other things that we haven't asked about, that you'd like to add about the U of A Program?
Deng Mapiour 1:41:01
Like I said, it's a strong program. Whether you want to go into community practice, you can have that. Or you want to go into academics, you can have that. But the thing that I like about Edmonton and the residency here, is just the collegiality, right? Amongst the residents themselves, between the residents and the staff. There's a strong period of, we're in it together and look after each other as best as we can. That's one of the things that kept me in Edmonton, and hopefully for the foreseeable future. But that's one of the things I like about Edmonton is your sense of collegiality and sense of like, we're in this community together, and we're gonna support each other.
Ameer Farooq 1:42:02
Dr. Scott, thank you so much for joining us on Cold Steel today. We really appreciate you taking out the time and taking out the time to highlight the University of British Columbia General Surgery Residency Program. Can we just start by asking you to tell us a little bit about the UBC Program?
Alex Scott 1:42:16
Sure. Well, thanks for having me today. UBC is, I think, a great program. Mostly because of the residents and the faculty we have. It's really a, truly, provincial program. We have over 40 sites for our residents to come to work, live, and play in. We have a mix of common general surgery, we have trauma, we have complex surgical oncology. There's hepatobiliary, thoracics, pretty much anything you can think of, to do surgery wise, we have here. So, we're really excited to be able to give our residents that experience. One of our other key factors is, we have a longitudinal endoscopy program. So, we have a really good relationship with GI and our general surgeons that do colonoscopy. So that's really exciting for our general surgery residents. And then, beyond the clinical expertise, we really have time for residents to do research and to do their academics. We have innovative programs that they do each year. So, in every year residents come, they do a different course. So, in first year, they have CRASH, in second year, they have an innovation week, third year, they have RISe. They also have a cultural safety course. So, we're really excited about what we're able to offer our residents.
Chad Ball 1:43:29
You know, Dr. Scott, UBC general surgery has been known for being very dynamic and innovative of the past. At least 10 years and probably longer. I'm curious, based on the culture of that innovation and the culture of that sort of forward thinking, where most of your residents end up once they're done, in terms of fellowship versus community practice. As well as the mix of those of those scenarios.
Alex Scott 1:43:56
I would say it changes, kind of, on a yearly basis. But if you look at it overall, about half of our residents go into fellowship, and that could be in anything all across North America. Then about half of them go into practice right away. That could be at an academic center or in a community site. So, I would say it's about half and half.
Ameer Farooq 1:44:20
Dr. Scott, how many applicants do you take a year and what are the qualities of prospective applicants that you're looking for?
Alex Scott 1:44:27
We normally get about somewhere between 100 to 130 applications, depending on the interest in general surgery, in a year. We really want to have residents that are interested in general surgery and have a growth mindset. So, we use the term "zone of proximal development" a lot. So, we want people that have curious minds that are going to be coachable and that really want to learn how to be an excellent general surgeon.
Chad Ball 1:44:56
That's such a great outlook. I think, so important, obviously, in surgical training, there's no doubt. I think probably all of us across the country, all the applicants know a fair bit about Vancouver. But I'm curious what your thoughts on your city are, number one. And, number two, what some of the things available to prospective residents would be, on days where they're not working in the hospital, for example.
Alex Scott 1:45:21
I think that's a really great question. I come from Newfoundland. So, I was totally enamored with Vancouver when I came. Just having the ability to be in the city. But in 20 minutes, you could be in the mountains, you could be in the ocean, you could have summer, you could have winter, all close around you. Then also have all the elements of city life. So, you can go to a play, you can go out for dinner, you can go shopping. So, I just love that you have such a variety of things, no matter what you're interested in.
Ameer Farooq 1:45:46
What opportunities are there for research, for future applicants?
Alex Scott 1:45:51
Some of our residents will actually take a research year, and that could be multiple years. We actually have a couple of residents that are doing their PhD right now within their residency program. But even if you don't want to do a dedicated research time, we do have a lead surgeon who gets involved with all the residents in their first year and really finds out what is their baseline of research, and they need to complete at least three research projects over their time here. So again, we want to make sure that people have that intellectual curiosity and can follow through with a plan, and make sure they can read the literature. So, you can kind of do as little or as much as you want, as long as you get through the baseline. But it's an important part of our program.
Chad Ball 1:46:34
That's great that you guys have that flexibility in general. It's wonderful. I think our last question for you, Dr. Scott, is, for the prospective applicant, once again, what's the one thing or a few things that maybe would surprise them, that, really, they wouldn't know about, in terms of coming to Vancouver and in particular, to the UBC Program?
Alex Scott 1:46:58
I think the one thing that we always like residents to know is that this is a very resident focused program. So, all of our innovation, and our evaluations, and our assessments, are done as a team. So, we always think that our residents are the strength of our program. We do a lot of feedback sessions, and we get a lot of information from them. So, the program that you see now is not going to be the program you're going to see in five years. Because we like to change with the residents that are here and the residents that are coming in and making sure that we can make it the best residency for each individual resident. And I know that you're going to get good training no matter where you go across Canada. So, I really think that the residents need to find the right fit for them. So, talk to the residents that are at the program that you're at and see, can you actually stay at that program for five or more years? Surgical residency is long. And if you're happy in it, then it'll make it so much better. If you're really unhappy in the location that you're at, it's going to make it so much harder. So, I think you really need to find the right fit. And I think that's something that our residents really like to talk about, as well. We really think of UBC as a family. And so, we want to make sure that everybody comes in with that same attitude that they're going to support each other.
Ameer Farooq 1:48:21
You've been listening to Cold Steel, the official podcast of the Canadian Journal of Surgery. If you've liked what you've been listening to, please leave us a review on iTunes. We'd love to hear your thoughts, comments or feedback. Send us an email at [email protected] or tweet at us @CanJSurg. Thanks again.