Passion for work and satisfaction helping patients also common

Lack of control over operating rooms and other resources as well as a lack of work-life balance are among the main reasons general surgeons may be dissatisfied with their jobs, a new study has found.

The study was led by Najma Ahmed, a Professor in the University of Toronto’s Department of Surgery, at a time when both the Association of American Medical Colleges and the Canadian Medical Association have reported a decline in the number of general surgeons due to low recruitment, poor retention and early retirement.

Ahmed, who is also a trauma surgeon at St. Michael’s Hospital, said that since the general surgery workload in North America is expected to increase over the next 20 years due to the aging population, it’s important to know why fewer physicians want to become general surgeons and why so many leave the field.

Her team’s findings were published yesterday in the journal Academic Medicine.

Interviews conducted with members of the Canadian Association of General Surgeons in 2010 found that surgeons get satisfaction from resolving patient problems quickly and effectively and they enjoy the social aspect of their work, such as interacting with supportive colleagues, trainees and patients.

“Surgeons we surveyed had a passion for their work that made the long hours involved inconsequential,” Ahmed said. “They described gratification in being able to take care of patients’ problems expeditiously, fixing things quite quickly and seeing the immediate outcome of a procedure and its impact on the patient’s quality of life.”

Contributing to career dissatisfaction were such things as insufficient access to and control over resources and a perceived disconnect between hospital administration and clinical priorities. This negatively impacted their morale and ability to provide timely and high-quality patient care, she said.

One participant in the study commented: “All that everybody wants to do is to cut operating time because it costs the system money to run the OR. Nobody looks and says, ‘It’s somebody’s mother or somebody’s daughter or husband or whatever.’ They just look at the accounting side of it and that’s it.”

General surgeons in urban areas cited in particular frustration due to lack of access to OR resources during daylight hours and the routine practice of delaying urgent operations. Rural general surgeons were frustrated by the large amount of time they were on call and the volume of patients due to the large geographic catchment areas their hospitals’ served.

Ahmed said many surgeons wanted more control over their work-life balance.

“The current generation is more family-centric and team-oriented and, while still achievement-oriented, is less interested in personal sacrifices to achieve career success or financial rewards,” she said. “These trends, combined with the sociologic realities related to the change in family structures such as single-parent families and two-professional-parent families, mean the protection of personal time and a more tangible way to achieve work-life balance is becoming an increasingly important pragmatic consideration for all professionals.”

Ahmed said a potential solution to some of the issues raised in her study may be the evolving model of acute care surgery. This model separates emergency and elective surgical care, thereby eliminating the competition between the two services for institutional and human resources and decreasing the burden of work on any one general surgeon. Other solutions could include making better use of primary care physicians, nurse practitioners, physician extenders and patient care navigators.

Between 1981 and 2005, the number of general surgeons in the United States dropped from 7.68 per 100,000 people to 5.69. The Canadian Residency Matching Service reported a decline in the number of first-choice applicants to general surgery between 1996 and 2001, as well as an increasing number of general surgeons pursuing surgical specialty fellowships. An increasing number of Canadian general surgery residents were also failing to complete their training programs.

The greatest impact of the looming shortage of general surgeons will be felt in rural areas. In some areas of the United States, the survival of local hospitals is at risk, because without general surgeons, emergency departments cannot remain open and family physicians are left without a means to secure even basic surgical consultations. General surgeons can also generate as much as 40 per cent of hospital revenue in the U.S.

A small instrument resembling a mini chocolate grater. An ordinary-looking catheter tube with extraordinary properties. They may not look like much to the untrained eye but to biomedical engineers objects like these represent the future of medicine.

On October 10th, as part of its 50th Anniversary Symposium, the Institute of Biomaterials and Biomedical Engineering (IBBME) is holding the "Tomorrow's Technology Showcase", a unique 'World's Fair' of biomedical engineering devices. The event is designed to give the public rare glimpse at the frontier of medicine and its roots in technological innovation.

The Showcase is part of a free, one-day international symposium called "Defining Tomorrow: Advancing the Integration of Engineering and Medicine".

With an emphasis on neurobiology and neuroengineering, international thinkers will present alongside University of Toronto leaders, including:

• Milos Popovic
• Molly Schoichet
• Derek van der Kooy
• Geoffrey Hinton

The  Symposium also features speakers such as James Fawcett (Cambridge University), a world-leading researcher on nervous system and spinal cord repair, and Miguel Nicolelis (Duke University) a pioneer in neural interfaces for overcoming paralysis.

But not everything about the day will be academic.

Sponsored by the Ontario Brain Institute (OBI), the Tomorrow's Technology Showcase is about exploring biomedical devices that will be defining our future. Companies such as GE Healthcare, STEM CELL, and Octane Biotech, as well as IBBME's commercialization partners, not-for-profit organizations CCRM and the University Health Network's Techna will display devices and explore the uses of this technology.

The Aggrewell, a gadget that looks like a cross between a penny holder and a grater, is one such device. (see image at right.)

Developed by a former IBBME research associate as a tool to grow stem cells in uniform colonies, the Aggrewell is currently produced by STEM CELL, a company that primarily sells products to scientists conducting stem cell research in areas such as cancer, heart disease, and more.

Another presenter will be Interface Biologics Inc. (IBI), whose biomaterial product, Endexo™, has recently been cleared by the U.S. Food and Drug Administration (FDA) for use in AngioDynamics’ catheter, the BioFlo PICC, in the United States. The catheter is manufactured using a biomaterial developed by IBBME's Director, Professor Paul Santerre. The biomaterial reacts to the catheter in such a way that it prevents blood coagulation, virtually eliminating the risks of blood clots—a serious danger for kidney dialysis patients—without drug additives.

Event details:

Location:

Chestnut Conference Centre (89 Chestnut St.), University of Toronto

Date:

October 10th, 2012

Registration deadline:

Space is limited for this free event, so register early and before October 1st.  Registration and further information can be found on IBBME's website: http://ibbme.utoronto.ca/50th_Anniversary.htm.

For more information, please contact:

Erin Vollick, Communications Officer
Institute of Biomaterials and Biomedical Engineering, University of Toronto
comm.ibbme@utoronto.ca
(416) 946-8019

Memory loss caused by inflammation in the brain may be treatable and reversible, a new study has found.

The study, led by Professor Beverley Orser (Departments of Anesthesia and Physiology), and Dr. Dian-Shi Wang, research associate in the Department of Physiology, found memory loss in mice could be reversed by using drugs to target “memory-blocking” receptors in the brain.

"When inflammation occurs after an infection, injury, stroke, or a surgical procedure, the resulting memory loss can be serious and prolonged. This type of inflammation in the brain has been linked to memory loss and cognitive disorders, including Alzheimer's disease,” says Orser, staff anesthesiologist at Sunnybrook Health Sciences Centre and Canada Research Chair in Anesthesia. “Currently, there is no treatment for post-surgery memory loss."

Orser's team found that mice experienced memory loss when inflammation activated “memory-blocking” receptors in a specific part of their brain. This memory loss was reversed when the mice were treated with drugs that stopped the receptors.

“These results provide insights into the cause of memory loss and great promise for possible treatment associated with inflammation,” says Orser.

Orser hopes the findings will be applied to a clinical trial in the near future, with a study focusing on those who have experienced memory loss after surgery.

The study, published online in the journal Cell Reports, was funded by the Canadian Institutes of Health Research.

This month, as part of the launch of the Fraser Mustard Institute for Human Development, the University of Toronto is bringing together world-renowned experts to explore hot topics in early childhood development.

Dr. David Barker—a physician and  epidemiologist at the University of Southampton—is one of the experts taking part in U of T’s Connaught Global Challenge International Symposium “Investing in Mothers and Children.” Twenty years ago, Barker showed that people with low birth weight are at greater risk of developing coronary heart disease, hypertension, stroke and diabetes—a breakthrough discovery the British Medical Journal dubbed the “Barker Hypothesis.”

On Thursday September 27, Barker will give a free public lecture that explains how our early development in the womb establishes our vulnerability to negative things we encounter as well as our ability to cope with these external influences.

What was the initial inspiration for your research that eventually led to the ‘Barker Hypothesis’ – that chronic adult diseases are "programmed" by malnutrition in the womb?
It is a paradox that while coronary heart disease rises as nations become more affluent, the disease has its highest rates among poorer people in poorer parts of a western country. This cannot be explained by the lifestyles of the poor and suggests that they are more vulnerable to the western lifestyle. Vulnerability is acquired during development.

How is research on human development affecting clinical practice?
The prevention of chronic disease depends on improving development, especially development in the womb.  A baby is nourished by its mother’s lifetime nutrition. Improving the nutrition of girls and young women therefore has to become the focus of public health activity. The rates of chronic disease are rising rapidly in North America. It is projected that by the year 2050, one in three Canadians will have diabetes. Genetic research will not solve this; neither will a continued focus on adult lifestyles.

We hear a lot about what mothers can do to increase optimal development for their child, but what about fathers? Do they play a role?
Little is known about this. The growth of a baby in the womb is largely controlled by the mother. It has to be, for otherwise many mothers and babies would die during child birth.

How is U of T’s Fraser Mustard Institute for Human Development positioned to advance research in this area?
The institute is well-positioned, having a combination of talented and experienced researchers from a wide range of disciplines. To improve early human development will require this range of expertise. Chronic diseases are unnecessary. They are not mandated by the human genome. We could readily prevent them, had we the will to do so.

The “Investing in Mothers and Children” symposium runs from September 27 to 29 at the MaRS Discovery District.

Media Advisory

Toronto, ON — The University of Toronto’s Faculty of Medicine will launch a new fundraising campaign on Thursday, September 13, 2012. It will help the Faculty deliver on its promise of improving health in Canada and around the world.

EVENT DETAILS:

WHAT: Launch of the Faculty of Medicine’s fundraising campaign

WHEN: Thursday, September 13, 2012, 6 p.m. to 8 p.m.

WHO: Dr. Catharine Whiteside, Dean, Faculty of Medicine & Vice-Provost Relations with Health Care Institutions, to host benefactors, volunteers, faculty, staff and students

WHERE:  Donnelly Centre Atrium
             160 College Street, main floor atrium
              University of Toronto
              Toronto, Ontario

Follow us on Twitter: @uoftmedicine with the hashtag #UofT
For more information, please contact:

(or to RSVP)

Nicole Bodnar
University of Toronto Faculty of Medicine
416-978-5811
nicole.bodnar@utoronto.ca

A group of Toronto scientists, led by University of Toronto Faculty of Medicine Professor Grant Brown, have discovered new ways that cells respond to the damage caused by chemotherapy, a finding that could improve treatments for patients. While chemotherapy can kill cancer cells, it can also harm healthy cells. This leads to side effects such as hair loss, fatigue, nausea and a weakened immune system.

Understanding how both normal cells and cancer cells deal with DNA damage is instrumental in improving patient treatment. “In a cell there’s never only one response but a multitude of responses,” says Brown, a principal investigator at the Terrence Donnelly Centre for Cellular and Bimolecular Research and an associate professor in the department of biochemistry. “Understanding these responses can tell us how normal cells counteract the damaging properties of cancer drugs and can show us targets that could make cancer cells more sensitive to chemotherapy.”

In this Canadian Cancer Society–funded study, Brown’s team used a microscopic screening technology to study cell proteins and their responses to specific chemotherapy drugs.

This is the first time cell proteins have been studied in this way, allowing scientists to better understand what happens inside a cell during chemotherapy. Brown’s group found that, during chemotherapy, hundreds of proteins move to new locations in the cell or multiply. They studied how the cellular proteins move in real time by tagging them with a fluorescent molecule. The research team then treated the cells with different chemotherapy drugs and monitored them for changes in the location and abundance of the glowing proteins. They found that sets of proteins respond differently to chemotherapy drugs and that there are many ways that the cell tries to combat DNA damage. Brown hopes others will use a similar screening technique to study all types of cancer drugs. This will help scientists and clinicians make more informed decisions about drugs and improve therapy options for many types of cancer. The study was released on nature.com and will be published in the September 2012 issue of the journal Nature Cell Biology.

Professor Mary Gospodarowicz (Department of Radiation Oncology) has made history after being named the first-ever female – and first-ever Canadian – to lead the Union for International Cancer Control (UICC).  Gospodarowicz’s appointment as President of the UICC was announced recently at the World Cancer Congress in Montreal, Quebec.

Founded in 1933, UICC is the largest cancer fighting organization of its kind, with more than 400 member organizations from around the world. The international organization’s mission is to eliminate cancer as a life-threatening disease for future generations.

A member of the University of Toronto medical faculty since 1981, Gospodarowicz has  held many leadership positions in the cancer care sector, including regional vice-president of Cancer Care Ontario. She has authored more than 250 peer-reviewed articles and book chapters, with her research interests including clinical trials evaluating radiation therapy in cancer treatment, image-guided precision radiotherapy, and survivorship.

One of Gospodarowicz’s main goals for the UICC is to achieve greater health equity on a global level.

“There is a huge gap between what we can achieve today and what is actually being achieved, especially in low- and middle-income countries,” she said in an interview with CBC Radio’s Metro Morning.  A child with Acute Lymphoblastic Leukemia in Canada has over 90 per cent chances of cure, she said, whereas in low- and middle-income countries those chances are as low as 10 per cent.

In addition to cancer treatment, Gospodarowicz says it’s important to focus on palliative care and pain control.  “There are countries in the world that have no access to morphine which means patients are dying in terrible pain,” she says.

In order to address these inequities, Gospodarowicz says it’s vital to foster connectivity—between different healthcare sectors, generations and basic, clinical and implementation sciences. The UICC is striving to make these connections happen. “All of our programs, including those on cancer registration, cervical and childhood cancer and pain relief, are about equity and connectivity.  Ultimately, we want to provide a clear, trusted and aligned voice for cancer care and control around the world,” says Gospodarowicz.

Improving the lives of people with diabetes through cross-disciplinary research is the driving force behind a renewed partnership between the University of Toronto’s Banting & Best Diabetes Centre (BBDC) and the University Health Network (UHN).

The five-year renewed commitment will enable experts from diverse backgrounds from both organizations to continue to work together on cutting-edge prevention and treatment strategies for people with diabetes.

“This collaboration significantly enhances our ability to achieve global impact in the areas of diabetes research, education and clinical care,” says Gary Lewis, director of the BBDC and a professor of Medicine who holds the Drucker Family Chair in Diabetes Research.

“By bringing people together – across our health network and from a variety of backgrounds – we’re better able to develop new treatment paths to cure diabetes and prevent its complications, while figuring out new ways to improve the lives of people already living with diabetes.”

The BBDC-UHN partnership continues a long-standing legacy of diabetes research and care that dates back to the 1921 discovery of insulin by Drs. Frederick Banting and Charles Best – Nobel prize winners who conducted their research at U of T and treated patients at Toronto General Hospital. The BBDC-UHN partnership was initially struck in 2007 with a focus on searching for a cure for diabetes through islet cell biology and stem cell research.

Today, more than 9 million Canadians have diabetes or pre-diabetes. Worldwide, 285 million people worldwide are affected by diabetes.

Related Links

Banting & Best Diabetes Centre (BBDC)
University Health Network (UHN)

The groundbreaking research of two U of T professors has been recognized with the 2011 NSERC John C. Polanyi Award, which honours an individual or team whose Canadian-based research has led to a recent outstanding advance in the natural sciences or engineering. Prof. Benjamin Blencowe of the Terrence Donnelly Centre for Cellular and Biomolecular Research, and Prof. Brendan Frey of The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, were honoured for their contribution to understanding of a gene regulatory code hidden in DNA that allows a relatively small number of genes to be transformed into hundreds of thousands of variations in a process called alternative splicing.

Related Document(s)

Read Full Press Release (PDF)

Related Links

Read Full Press Release
External Link: Video - A conversatin with Ben Blencowe & Brendan Frey
 

Professor Stephen Lye will serve as the inaugural executive director and Professor Marla Sokolowski as the inaugural academic director of the University of Toronto’s newly established Institute for Human Development. The announcement came jointly from Professor Julia O’Sullivan, Dean of the Ontario Institute for Studies in Education, and Professor Catharine Whiteside, Dean of the Faculty of Medicine, following a competitive search led by an interdisciplinary Appointments Committee.

Related Links

External Link: Stephen J. Lye, Marla B. Sokolowski to lead U of T's Institute for Human Development