Cold Steel: Canadian Journal of Surgery Podcast

This week's guest is Dr. Bishal Gyawali. Bishal is an oncologist at Queen's University and a policy researcher. His focus as a researcher has been both sensational and at the same time extremely fundamental. Bishal has been asking questions around how we decide which drugs are approved for funding by the government, as well as how we might best allocate resources to help cancer patients around the world. Bishal has been an integral part of the "Common Sense Oncology" movement, which will promote interventions that measurably improve the lives of patients, promoting effective treatments but  also challenging interventions that might cause more harm than good.
Our conversation focused around Bishal's training, how he became interested in cancer health policy and his thoughts around the idea of value in cancer care. We also discussed Bishal's thoughtful use of technology, blogs, and social media.

Links:
Grounded in Groundshot Podcast – Dr. Bishal Gyawali

BG lab: Dr. Bishal Gyawali

Common Sense Oncology: Home - Common Sense Oncology

Mittal A, Kim MS, Dunn S, Wright K, Gyawali B. Frequently asked questions on surrogate endpoints in oncology-opportunities, pitfalls, and the way forward. EClinicalMedicine. 2024 Sep 13;76:102824. doi: 10.1016/j.eclinm.2024.102824. PMID: 39764569; PMCID: PMC11701476.

Surrogate Endpoints: The 15 Most Common Misunderstandings in Oncology

Cancer groundshot: Access to proven treatments must parallel development of new therapies

Do Oncology Board Exams Make Us Better Doctors?

Ending Medical Reversal: Ending Medical Reversal | Hopkins Press

In 2013, when I was a medical student, I wrote an essay entitled, #nomoretextbooks? for the Canadian Undergraduate Surgical Education Committee essay competition. In the essay I wrote, “Tomorrow, I start my vascular surgery rotation. Before bed tonight, I will watch a YouTube video of a femoral-popliteal bypass surgery, review the surgical anatomy from Zollinger’s Atlas of Surgical Operations on my iPad while waiting for my car tires to be changed, listen to a podcast on peripheral vascular disease while riding my exercise bike, and perhaps tweet about my new rotation.” At the time, I really felt strongly that the future of surgical textbooks would be virtual. 
To explore that future, I spoke with Tanner Schrank, the head of impact for the Journal of Medical Insight (also called JOMI). JOMI is a website that showcases a wide range of operations across multiple disciplines. What I really like about JOMI is the in-depth interviews that are done with surgeons before the operation, where the surgeon will describe their thought process and indications for the operation. The videos are also extraordinarily well filmed, often from multiple camera angles and with great detail. JOMI clearly offers a fantastic resource for residents and attendings to learn new surgical techniques.
Tanner and I discuss the implications for a transition to a “virtual” textbook that is more reliant on video than an actual written textbook. I must caveat this episode by saying that I think there is pretty good evidence that reading something and actively trying to absorb information is more effective than passively viewing it. In other words, I am not totally convinced that you can effectively learn something by passively watching video. I think it’s important, especially for trainees, to learn actively.  As the great expert on performance, Anders Ericsson said, deliberate practice, not just practice, is required to really acquire mastery. However, there is no question in my mind that video needs to augment the learning that we do as surgeons. At Queen’s, we use video review on a weekly basis to give residents and fellows feedback on how they can improve their technique. 
We would love to hear your thoughts. Do you think videos are the way of the future for surgical textbooks? Shoot us an email at podcast.cjs@gmail.com. 

Links:
AMBOSS: Beyond the Textbook: amboss.com/int/internationalpodcast
JOMI: https://jomi.com/
#nomoretextbooks: https://www.canjsurg.ca/content/57/4/E119

In honor of National Nursing Week in Canada, which is May 11th to May 17th, we are re-releasing an early episode with Lauren Kiwan, nurse clinician for general surgery at the Foothills Medical Centre. Lauren shares what surgeons can do to improve the OR. 
Revisit this important episode with us.
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Lauren Kirwan is the nurse clinician for general surgery at the Foothills Medical Centre. She is currently finishing up her nurse practitioner degree. 
We wanted to ask Lauren her thoughts about what it means to be an OR nurse and what she wishes surgeons would do to make the OR environment better. We also hear about the impact of COVID19 on our nursing colleagues. We’d love to hear from our nurse listeners – what are some things that make your day or make you mad in the operating room? Email us at podcast.cjs@gmail.com with your thoughts and comments. 
Links:
1. Melinda Davis on the Anesthetist - Surgeon relationship: https://soundcloud.com/cjs-podcast/e40-melinda-davis-on-career-counseling-and-the-anesthetist-surgeon-relationship
2.  Atul Gawande paper on Safe Surgery Checklist implementation in South Carolina. Perception of Safety of Surgical Practice Among Operating Room Personnel From Survey Data Is Associated With All-cause 30-day Postoperative Death Rate in South Carolina. https://journals.lww.com/annalsofsurgery/Abstract/2017/10000/Perception_of_Safety_of_Surgical_Practice_Among.14.aspx

I have a confession to make. I kind of felt that to talk about money or to be really into financial planning was akin to being the Wolf of Wall Street, where the only real principle was how much money I could make. After this week’s conversation with Dr. Mark Soth, I think of financial planning in a completely different way. In fact, I would argue that Dr. Soth provided on this episode some of the best advice on how to live in a truly fulfilling way.
Dr. Soth is an intensivist at McMaster University. He has done significant work in the space of physician financial independence. He has a website called The Loonie Doctor as well as a limited run podcast called The Money Scope podcast. In this episode I basically ask Mark all the finance related questions I could think of, ranging from the utility of professional corporations in 2026 to tools for financial tracking. Most importantly, Mark explores how financial planning can help us all to life “the good life”. 
Check out all the resources and links from Mark in the show notes. 

Links:
The Wealthy Barber
The Money Scope Podcast 
The Loonie Doctor's Bookshelf : Mark’s favorite finance books
beyond MD podcast with Dr. Yatin Chadha
Breaking Bad Debt - Dr. Steph - YouTube
Reboot Your Portfolio by Dan Bortolotti

While we hope that none of  us “botch a surgery”, medico-legal concerns are issues that affect most surgeons at some point in their careers. Previously on the podcast, Dr. Richard Mimeault and Liise Honey spoke to us about the landscape of medico-legal concerns in surgery, and the anatomy of a lawsuit. In this episode, we talk about the CMPA's innovative approach to try to prevent errors from happening in the first place. Richard Mimeault and Elisabeth Normand join us to talk about "Theatre Arts", a workshop developed by the CMPA to help OR teams improve the quality of the care, and most importantly, improve the culture and dynamics of the team. In this episode we talk about the Theatre Arts workshop and how improving culture may have profound impacts on patient safety and satisfaction. 
Links:
Theatre Arts workshop: https://www.cmpa-acpm.ca/en/education-events/workshops/workshop-theatre-arts
CMPA x Cold Steel on Medicolegal risks for surgeons: https://www.youtube.com/watch?v=7Mkw68prEP0
CMPA x Cold Steel – the Anatomy of a Lawsuit: https://www.youtube.com/watch?v=LRUh95LauFw 
Contact the CMPA: https://www.cmpa-acpm.ca/en/connect/contact-us