Deepak Dath | McMaster University (original) (raw)

Papers by Deepak Dath

Panminerva medica, 2001

BACKGROUND No safe technique of subarachnoid perfusion during thoracoabdominal aneurysm surgery h... more BACKGROUND No safe technique of subarachnoid perfusion during thoracoabdominal aneurysm surgery has been described. We tested the hypothesis that in cold cadavers, perfusion of the subarachnoid space at the lumbar level with warm solution is feasible and increases the temperature at the thoracic level without an increase in cerebrospinal fluid (CSF) pressure. METHODS Six cadavers were used. A 5 Fr silastic catheter in the subarachnoid space between the second and third lumbar vertebra (L2-3) was used as an inflow and a 16-gauge catheter at L4-5 as an outflow. Normal saline at 38 degrees C was infused at 999 mL/h. Temperatures of inflow and outflow, of the thoracic subarachnoid space (T8), and of the cisterna magna, were recorded. CSF pressures were measured from the outflow catheter. RESULTS Outflow temperature was 9+/-1 degrees C at 10 minutes. At 15 minutes it was 27+/-4 degrees C, and thoracic subarachnoid temperatures was 22+/-5 degrees C. There was no statistical difference bet...

Canadian Medical Education Journal, 2016

Clinician Educators (CE) have numerous responsibilities in different professional domains, includ... more Clinician Educators (CE) have numerous responsibilities in different professional domains, including clinical, education, research, and administration. Many CEs face tensions trying to manage these often competing professional responsibilities and achieve “work-work balance.” Rich discussions of techniques for work-work balance amongst CEs at a medical education conference inspired the authors to gather, analyze, and summarize these techniques to share with others. In this paper we present the CE’s “Four Ps”; these are practice points that support both the aspiring and established CE to help improve their performance and productivity as CEs, and allow them to approach work-work balance.

Leadership in Health Services, 2018

Purpose This paper aims to describe the evolution of Sanokondu, highlighting the rationale, achie... more Purpose This paper aims to describe the evolution of Sanokondu, highlighting the rationale, achievements and lessons learnt from this initiative. Sanokondu is a multinational community of practice dedicated to fostering health-care leadership education worldwide. This platform for health-care leadership education was conceived in 2014 at the first Toronto International Summit on Leadership Education for Physicians (TISLEP) and evolved into a formal network of collaborators in 2016. Design/methodology/approach This paper is a case study of a multinational collaboration of health-care leaders, educators, learners and other stakeholders. It describes Sanokondu’s development and contribution to global health-care leadership education. One of the major strategies has been establishing partnerships with other educational organizations involved in clinical leadership and health systems improvement. Findings A major flagship of Sanokondu has been its annual TISLEP meetings, which brings var...

BMJ Leader, 2019

Power and leadership are intimately related. While physician leadership is widely discussed in he... more Power and leadership are intimately related. While physician leadership is widely discussed in healthcare, power has received less attention. Formal organisational leadership by physicians is increasingly common even though the evidence for the effectiveness of physician leadership is still evolving. There is an expectation of leadership by all physicians for resource stewardship. The impact of power on interprofessional education and practice needs further study. Power also shapes the profession’s attempts to address physician and learner well-being with its implications for patient care. Unfortunately, the profession is not exempt from inappropriate use of power. These observations led the authors to explore the concept and impact of power in physician leadership. Drawing from a range of conceptualisations including structuralist (French and Raven), feminist (Allen) and poststructuralist (Foucault) conceptualisations of power, we explore how power is acquired and exercised in heal...

HPB, 2018

post-operative pancreatic fistulae or delayed gastric emptying. There were no differences in medi... more post-operative pancreatic fistulae or delayed gastric emptying. There were no differences in median OS (32 vs 48 months, p = 0.86), median RFS(16 vs 36 months, p = 0.17), or patterns of recurrence (local, regional, or distant) between MD and PD tumors. Conclusions: Poorly differentiated PDAC is characterized by more frequent or persistent perineural invasion relative to moderately differentiated tumors following preoperative therapy. However, tumor differentiation has no impact on postoperative patterns of local or distant tumor recurrence or the incidence or severity of post-operative complications.

Gastroenterology, 2017

On a national level, rates of SSI after MIPD have not been reported. With the new availability of... more On a national level, rates of SSI after MIPD have not been reported. With the new availability of pancreatectomy-specific outcomes in NSQIP, we hypothesized nationwide SSI would also be reduced with MIPD. METHODS The procedure-targeted NSQIP participant user file (PUF) from January 1, 2014 through December 31, 2015 was queried for PD. Patients were then divided into open, laparoscopic, and robotic cohorts, excluding hybrid or converted procedures. For each group, demographics, treatment parameters, and surgical considerations known to affect SSI were evaluated. χ 2 test was used to determine correlation of SSI with operative approach, and linear regression was used to determine correlation of clinical characteristics with infection by approach. RESULTS Over this time period, 296 patients underwent MIPD out of the total 6,882 PD evaluated. The majority of patients underwent open procedures (n=6,346, 92%). In contrast, 1.8% (n=125) were wholly laparoscopic and 2.5% (n=171) wholly robotic. The remaining 240 were hybrid or converted to open procedures; these patients were excluded from the analysis. In the open group, 24.2% (n=1,536) of the patients developed SSI. In the minimally invasive groups, SSI rates were 15.2% (n= 19) in laparoscopic approach and 21.6% (n=37) in robotic approach. The overall rate of SSI in all three groups was 24.0%. Compared to laparoscopic approach, both robotic and open procedures had higher rates of infection (p=0.03 and 0.001, respectively). SSI were comparable between open and robotic approaches (p=0.6). Preoperative stenting (p=0.003), duct size (p=0.007), gland texture (p<0.001), and presence of drains (p=0.001) increased SSI in laparoscopic procedures. Events were too few to evaluate type of SSI by approach. CONCLUSIONS In this nationwide analysis, wholly laparoscopic approach to PD was associated with reduced rates of SSI. In accordance with previous single-center studies, stenting, duct size, gland texture, and drains increased SSI. This study, despite a greater overall rate of infection than previously reported in PD, even within NSQIP, suggests that outcomes in high-volume centers may be applicable nationwide. The comparable SSI rate between robotic and open procedures possibly reflects the former's ongoing learning curve, and it is consistent with single-center experiences. It is unlikely due to the exclusion of converted and hybrid procedures, as there were fewer robotic converted/hybrid cases than laparoscopic (7.5% vs 29.0% of all attempted/hybrid MIPD).

Leadership in health services (Bradford, England), Jul 4, 2016

Purpose This paper aims to highlight the importance of leadership development for all physicians ... more Purpose This paper aims to highlight the importance of leadership development for all physicians within a competency-based medical education (CBME) framework. It describes the importance of timely international collaboration as a key strategy in promoting physician leadership development. Design/methodology/approach The paper explores published and Grey literature around physician leadership development and proposes that international collaboration will meet the expanding call for development of leadership competencies in postgraduate medical learners. Two grounding frameworks were used: complexity science supports adding physician leadership training to the current momentum of CBME adoption, and relational cultural theory supports the engagement of diverse stakeholders in multiple jurisdictions around the world to ensure inclusivity in leadership education development. Findings An international collaborative identified key insights regarding the need to frame physician leadership e...

HPB, 2016

Background: Pancreatic neuroendocrine tumors (PNET) are rare neoplasms with various subtypes. Non... more Background: Pancreatic neuroendocrine tumors (PNET) are rare neoplasms with various subtypes. Nonfunctioning tumors are usually incidental with increased incidence in the last decades. Insulinomas are the most frequent functional tumors that present benign behavior in up to 90% of cases. We aimed to evaluate aspects of diagnosis and results of pancreatic resection of nonfunctioning (NF) tumors compared to insulinomas. Methods: We retrospectively evaluated the medical records and electronic data from 103 patients submitted to pancreatic resection at our Institutuion. Patients with small liver metastasis resected during the same surgery were included. Results: Thirty-four patients had NF pancreatic tumors and 69 insulinomas, 56% were women with 44.51 AE 17.27 years. Age was decreased and BMI increased in Insulinoma group compared to NF (p < 0.05). Enucleation was performed in 44.93% of insulinomas and pancreatoduodenectomy in 50.0% of NF tumors (p < 0.001). Tumor diameter was greater in NF group (p < 0.0001) with a trend to present positive lymphnodes (p = 0.0843). Insulinoma group showed higher number of patients with postoperative complications (p = 0.0025). Follow-up time was 7.71 AE 6.39 years in NF and 14.0 AE 10.52 years in Insulinoma (p = 0.0038). The 10-year actuarial survival was 94.95% in Insulinoma and 83.32% in NF group, without significance. Conclusions: Nonfunctioning tumors are diagnosed later than insulinomas showing greater size at surgery, however there was no significant difference in survival between these two groups of patients. Interestingly resection of insulinomas was associated with more complications, probably related to high incidence of pancreatic fistulae after tumor enucleation.

Canadian journal of surgery. Journal canadien de chirurgie, 1999

To determine if intraoperative instillation of bupivacaine would decrease early postoperative pai... more To determine if intraoperative instillation of bupivacaine would decrease early postoperative pain after laparoscopic cholecystectomy, if the patients would consequently require less narcotic postoperatively and if such patients would elect to be discharged on the day of operation if given the choice. Double-blind, randomized, controlled trial. A tertiary care hospital in Hamilton, Ont. Fifty patients underwent laparoscopic cholecystectomy. Day-surgery patients had the choice of staying overnight for discharge the following day. They were compared with a control group of 47 patients who had laparoscopic cholecystectomy but did not receive bupivacaine. Instillation of 20 mL of 0.5% bupivacaine with epinephrine into laparoscopic cholecystectomy port sites intraoperatively before closure. Visual analogue scale (VAS) pain scores assessed 4 times postoperatively, the choice of patients to leave hospital the same day or to remain in the hospital overnight; the level of postoperative narco...

Journal of Graduate Medical Education, 2014

Background: The Royal College of Physicians and Surgeons of Canada (RCPSC) will launch CanMEDS 20... more Background: The Royal College of Physicians and Surgeons of Canada (RCPSC) will launch CanMEDS 2015 after a 3year process to revise and refine the CanMEDS 2005 Framework. To engage multiple stakeholders, the RCPSC distributed an online survey to its fellows, trainees, and other interested stakeholders in 2013. Methods: Educators at the RCPSC developed a survey using an iterative, reflective process. The mixed methods survey, administered electronically, consisted of open-and close-ended questions related to the 7 CanMEDS Roles. The results were analyzed by 2 RCPSC clinician educators and 2 RCPSC education scientists. Results: Of 1204 respondents, 60% were fellows and 19% were trainees, representing all but 2 disciplines within the RCPSC. Forty-seven percent were university-based and 64% considered themselves to either know the framework or be an expert in applying 1 role. The depth and breadth of responses varied greatly and qualitative analysis revealed 5 overarching themes: simplify the descriptions of roles; clarify the roles; reduce overlap between roles; assist with implementation; and include patient safety. Conclusions: Stakeholders are very interested in participating in the revision and renewal of the CanMEDS Framework. Responses align with themes found through other consultation methods and validate the importance of reaching out to stakeholders in the process of framework revision.

Medical Teacher, 2010

With the introduction of Tomorrow's Doctors in 1993, medical education began the transition from ... more With the introduction of Tomorrow's Doctors in 1993, medical education began the transition from a time-and process-based system to a competency-based training framework. Implementing competency-based training in postgraduate medical education poses many challenges but ultimately requires a demonstration that the learner is truly competent to progress in training or to the next phase of a professional career. Making this transition requires change at virtually all levels of postgraduate training. Key components of this change include the development of valid and reliable assessment tools such as work-based assessment using direct observation, frequent formative feedback, and learner self-directed assessment; active involvement of the learner in the educational process; and intensive faculty development that addresses curricular design and the assessment of competency.

Medical Teacher, 2010

Although competency-based medical education (CBME) has attracted renewed interest in recent years... more Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership-the International CBME Collaborators-to examine conceptual issues and current debates in CBME. We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals. In this paper, we describe the evolution of CBME from the outcomes movement in the 20th century to a renewed approach that, focused on accountability and curricular outcomes and organized around competencies, promotes greater learner-centredness and de-emphasizes time-based curricular design. In this paradigm, competence and related terms are redefined to emphasize their multi-dimensional, dynamic, developmental, and contextual nature. CBME therefore has significant implications for the planning of medical curricula and will have an important impact in reshaping the enterprise of medical education. We elaborate on this emerging CBME approach and its related concepts, and invite medical educators everywhere to enter into further dialogue about the promise and the potential perils of competency-based medical curricula for the 21st century.

Medical Education Online, 2010

Background: The increasing complexity of medical training often requires faculty members with edu... more Background: The increasing complexity of medical training often requires faculty members with educational expertise to address issues of curriculum design, instructional methods, assessment, program evaluation, faculty development, and educational scholarship, among others. Discussion: In 2007, The Royal College of Physicians & Surgeons of Canada responded to this need by establishing the first national clinicianÁeducator program. We define a clinicianÁeducator and describe the development of the program. Adopting a construct from the business community, we use a community of practice framework to describe the benefits (with examples) of this program and challenges in developing it. The benefits of the clinicianÁeducator program include: improved educational problem solving, recognition of educational needs and development of new projects, enhanced personal educational expertise, maintenance of professional satisfaction and retention of group members, a positive influence within the Royal College, and a positive influence within other Canadian academic institutions. Summary: Our described experience of a social reorganization Á a community of practice Á suggests that the organizational and educational benefits of a national clinicianÁeducator program are not theoretical, but real.

The Journal of Urology, 2010

Journal of the American College of Surgeons, 2011

... Vinay T. Fernandes BSc, MD a , Kerry M. Graybiel BSc, MD a , Jen Hoogenes BS, MS, PhD(c) a an... more ... Vinay T. Fernandes BSc, MD a , Kerry M. Graybiel BSc, MD a , Jen Hoogenes BS, MS, PhD(c) a and Deepak Dath MD ... 3, Supplement 1, September 2011, Page S122 Surgical Forum Abstracts - 2011 Clinical Congress, The 66th Annual Sessions of the Owen H Wangensteen ...

Background Trigger videos have occasionally been used in medical education; however, their applic... more Background Trigger videos have occasionally been used in medical education; however, their application to surgical faculty development is novel. We assessed whether workshops designed to improve surgeons’ intraoperative teaching (IOT), anchored by trigger videos, were useful and effective in inspiring surgeons to improve their IOT.Methods Surgeons from multiple specialties attended one of six faculty development workshops where IOT trigger videos were shown and discussed during break-out sessions. Participants completed questionnaires to 1) evaluate videos via survey and feedback, and 2) identify adoptable and discardable IOT techniques. Teaching techniques were collated to identify planned IOT changes and survey data and feedback were analyzed.Results A total of 135 surgeons identified 292 adoptable and 202 discardable IOT techniques based on trigger videos and discussions, and 94% of participants reported that the trigger videos were useful and encouraged them to discuss and consi...

Additional file 2: Appendix 2. Likert-style questionnaire data for evaluation of; the trigger vid... more Additional file 2: Appendix 2. Likert-style questionnaire data for evaluation of; the trigger videos (A), presentation (B), quality of the session (C), and usefulness of the session (D).

The American Journal of Surgery, 2013

BACKGROUND: Motivation in teaching, mainly studied in disciplines outside of surgery, may also be... more BACKGROUND: Motivation in teaching, mainly studied in disciplines outside of surgery, may also be an important part of intraoperative teaching. We explored techniques surgeons use to motivate learners in the operating room (OR). METHODS: Forty-four experienced surgeon teachers from multiple specialties participated in 9 focus groups about teaching in the OR. Focus groups were transcribed and subjected to qualitative thematic analysis by 3 reviewers through an iterative, rigorous process. RESULTS: Analysis revealed 8 motivational techniques. Surgeons used motivation techniques tacitly, describing multiple ways that they facilitate resident motivation while teaching. Two major categories of motivational techniques emerged: (1) the facilitation of intrinsic motivation; and (2) the provision of factors to stimulate extrinsic motivation. CONCLUSIONS: Surgeons unknowingly but tacitly and commonly use motivation in intraoperative teaching and use a variety of techniques to foster learners' intrinsic and extrinsic motivation. Motivating learners is 1 vital role that surgeon teachers play in nontechnical intraoperative teaching.

Panminerva medica, 2001

BACKGROUND No safe technique of subarachnoid perfusion during thoracoabdominal aneurysm surgery h... more BACKGROUND No safe technique of subarachnoid perfusion during thoracoabdominal aneurysm surgery has been described. We tested the hypothesis that in cold cadavers, perfusion of the subarachnoid space at the lumbar level with warm solution is feasible and increases the temperature at the thoracic level without an increase in cerebrospinal fluid (CSF) pressure. METHODS Six cadavers were used. A 5 Fr silastic catheter in the subarachnoid space between the second and third lumbar vertebra (L2-3) was used as an inflow and a 16-gauge catheter at L4-5 as an outflow. Normal saline at 38 degrees C was infused at 999 mL/h. Temperatures of inflow and outflow, of the thoracic subarachnoid space (T8), and of the cisterna magna, were recorded. CSF pressures were measured from the outflow catheter. RESULTS Outflow temperature was 9+/-1 degrees C at 10 minutes. At 15 minutes it was 27+/-4 degrees C, and thoracic subarachnoid temperatures was 22+/-5 degrees C. There was no statistical difference bet...

Canadian Medical Education Journal, 2016

Clinician Educators (CE) have numerous responsibilities in different professional domains, includ... more Clinician Educators (CE) have numerous responsibilities in different professional domains, including clinical, education, research, and administration. Many CEs face tensions trying to manage these often competing professional responsibilities and achieve “work-work balance.” Rich discussions of techniques for work-work balance amongst CEs at a medical education conference inspired the authors to gather, analyze, and summarize these techniques to share with others. In this paper we present the CE’s “Four Ps”; these are practice points that support both the aspiring and established CE to help improve their performance and productivity as CEs, and allow them to approach work-work balance.

Leadership in Health Services, 2018

Purpose This paper aims to describe the evolution of Sanokondu, highlighting the rationale, achie... more Purpose This paper aims to describe the evolution of Sanokondu, highlighting the rationale, achievements and lessons learnt from this initiative. Sanokondu is a multinational community of practice dedicated to fostering health-care leadership education worldwide. This platform for health-care leadership education was conceived in 2014 at the first Toronto International Summit on Leadership Education for Physicians (TISLEP) and evolved into a formal network of collaborators in 2016. Design/methodology/approach This paper is a case study of a multinational collaboration of health-care leaders, educators, learners and other stakeholders. It describes Sanokondu’s development and contribution to global health-care leadership education. One of the major strategies has been establishing partnerships with other educational organizations involved in clinical leadership and health systems improvement. Findings A major flagship of Sanokondu has been its annual TISLEP meetings, which brings var...

BMJ Leader, 2019

Power and leadership are intimately related. While physician leadership is widely discussed in he... more Power and leadership are intimately related. While physician leadership is widely discussed in healthcare, power has received less attention. Formal organisational leadership by physicians is increasingly common even though the evidence for the effectiveness of physician leadership is still evolving. There is an expectation of leadership by all physicians for resource stewardship. The impact of power on interprofessional education and practice needs further study. Power also shapes the profession’s attempts to address physician and learner well-being with its implications for patient care. Unfortunately, the profession is not exempt from inappropriate use of power. These observations led the authors to explore the concept and impact of power in physician leadership. Drawing from a range of conceptualisations including structuralist (French and Raven), feminist (Allen) and poststructuralist (Foucault) conceptualisations of power, we explore how power is acquired and exercised in heal...

HPB, 2018

post-operative pancreatic fistulae or delayed gastric emptying. There were no differences in medi... more post-operative pancreatic fistulae or delayed gastric emptying. There were no differences in median OS (32 vs 48 months, p = 0.86), median RFS(16 vs 36 months, p = 0.17), or patterns of recurrence (local, regional, or distant) between MD and PD tumors. Conclusions: Poorly differentiated PDAC is characterized by more frequent or persistent perineural invasion relative to moderately differentiated tumors following preoperative therapy. However, tumor differentiation has no impact on postoperative patterns of local or distant tumor recurrence or the incidence or severity of post-operative complications.

Gastroenterology, 2017

On a national level, rates of SSI after MIPD have not been reported. With the new availability of... more On a national level, rates of SSI after MIPD have not been reported. With the new availability of pancreatectomy-specific outcomes in NSQIP, we hypothesized nationwide SSI would also be reduced with MIPD. METHODS The procedure-targeted NSQIP participant user file (PUF) from January 1, 2014 through December 31, 2015 was queried for PD. Patients were then divided into open, laparoscopic, and robotic cohorts, excluding hybrid or converted procedures. For each group, demographics, treatment parameters, and surgical considerations known to affect SSI were evaluated. χ 2 test was used to determine correlation of SSI with operative approach, and linear regression was used to determine correlation of clinical characteristics with infection by approach. RESULTS Over this time period, 296 patients underwent MIPD out of the total 6,882 PD evaluated. The majority of patients underwent open procedures (n=6,346, 92%). In contrast, 1.8% (n=125) were wholly laparoscopic and 2.5% (n=171) wholly robotic. The remaining 240 were hybrid or converted to open procedures; these patients were excluded from the analysis. In the open group, 24.2% (n=1,536) of the patients developed SSI. In the minimally invasive groups, SSI rates were 15.2% (n= 19) in laparoscopic approach and 21.6% (n=37) in robotic approach. The overall rate of SSI in all three groups was 24.0%. Compared to laparoscopic approach, both robotic and open procedures had higher rates of infection (p=0.03 and 0.001, respectively). SSI were comparable between open and robotic approaches (p=0.6). Preoperative stenting (p=0.003), duct size (p=0.007), gland texture (p<0.001), and presence of drains (p=0.001) increased SSI in laparoscopic procedures. Events were too few to evaluate type of SSI by approach. CONCLUSIONS In this nationwide analysis, wholly laparoscopic approach to PD was associated with reduced rates of SSI. In accordance with previous single-center studies, stenting, duct size, gland texture, and drains increased SSI. This study, despite a greater overall rate of infection than previously reported in PD, even within NSQIP, suggests that outcomes in high-volume centers may be applicable nationwide. The comparable SSI rate between robotic and open procedures possibly reflects the former's ongoing learning curve, and it is consistent with single-center experiences. It is unlikely due to the exclusion of converted and hybrid procedures, as there were fewer robotic converted/hybrid cases than laparoscopic (7.5% vs 29.0% of all attempted/hybrid MIPD).

Leadership in health services (Bradford, England), Jul 4, 2016

Purpose This paper aims to highlight the importance of leadership development for all physicians ... more Purpose This paper aims to highlight the importance of leadership development for all physicians within a competency-based medical education (CBME) framework. It describes the importance of timely international collaboration as a key strategy in promoting physician leadership development. Design/methodology/approach The paper explores published and Grey literature around physician leadership development and proposes that international collaboration will meet the expanding call for development of leadership competencies in postgraduate medical learners. Two grounding frameworks were used: complexity science supports adding physician leadership training to the current momentum of CBME adoption, and relational cultural theory supports the engagement of diverse stakeholders in multiple jurisdictions around the world to ensure inclusivity in leadership education development. Findings An international collaborative identified key insights regarding the need to frame physician leadership e...

HPB, 2016

Background: Pancreatic neuroendocrine tumors (PNET) are rare neoplasms with various subtypes. Non... more Background: Pancreatic neuroendocrine tumors (PNET) are rare neoplasms with various subtypes. Nonfunctioning tumors are usually incidental with increased incidence in the last decades. Insulinomas are the most frequent functional tumors that present benign behavior in up to 90% of cases. We aimed to evaluate aspects of diagnosis and results of pancreatic resection of nonfunctioning (NF) tumors compared to insulinomas. Methods: We retrospectively evaluated the medical records and electronic data from 103 patients submitted to pancreatic resection at our Institutuion. Patients with small liver metastasis resected during the same surgery were included. Results: Thirty-four patients had NF pancreatic tumors and 69 insulinomas, 56% were women with 44.51 AE 17.27 years. Age was decreased and BMI increased in Insulinoma group compared to NF (p < 0.05). Enucleation was performed in 44.93% of insulinomas and pancreatoduodenectomy in 50.0% of NF tumors (p < 0.001). Tumor diameter was greater in NF group (p < 0.0001) with a trend to present positive lymphnodes (p = 0.0843). Insulinoma group showed higher number of patients with postoperative complications (p = 0.0025). Follow-up time was 7.71 AE 6.39 years in NF and 14.0 AE 10.52 years in Insulinoma (p = 0.0038). The 10-year actuarial survival was 94.95% in Insulinoma and 83.32% in NF group, without significance. Conclusions: Nonfunctioning tumors are diagnosed later than insulinomas showing greater size at surgery, however there was no significant difference in survival between these two groups of patients. Interestingly resection of insulinomas was associated with more complications, probably related to high incidence of pancreatic fistulae after tumor enucleation.

Canadian journal of surgery. Journal canadien de chirurgie, 1999

To determine if intraoperative instillation of bupivacaine would decrease early postoperative pai... more To determine if intraoperative instillation of bupivacaine would decrease early postoperative pain after laparoscopic cholecystectomy, if the patients would consequently require less narcotic postoperatively and if such patients would elect to be discharged on the day of operation if given the choice. Double-blind, randomized, controlled trial. A tertiary care hospital in Hamilton, Ont. Fifty patients underwent laparoscopic cholecystectomy. Day-surgery patients had the choice of staying overnight for discharge the following day. They were compared with a control group of 47 patients who had laparoscopic cholecystectomy but did not receive bupivacaine. Instillation of 20 mL of 0.5% bupivacaine with epinephrine into laparoscopic cholecystectomy port sites intraoperatively before closure. Visual analogue scale (VAS) pain scores assessed 4 times postoperatively, the choice of patients to leave hospital the same day or to remain in the hospital overnight; the level of postoperative narco...

Journal of Graduate Medical Education, 2014

Background: The Royal College of Physicians and Surgeons of Canada (RCPSC) will launch CanMEDS 20... more Background: The Royal College of Physicians and Surgeons of Canada (RCPSC) will launch CanMEDS 2015 after a 3year process to revise and refine the CanMEDS 2005 Framework. To engage multiple stakeholders, the RCPSC distributed an online survey to its fellows, trainees, and other interested stakeholders in 2013. Methods: Educators at the RCPSC developed a survey using an iterative, reflective process. The mixed methods survey, administered electronically, consisted of open-and close-ended questions related to the 7 CanMEDS Roles. The results were analyzed by 2 RCPSC clinician educators and 2 RCPSC education scientists. Results: Of 1204 respondents, 60% were fellows and 19% were trainees, representing all but 2 disciplines within the RCPSC. Forty-seven percent were university-based and 64% considered themselves to either know the framework or be an expert in applying 1 role. The depth and breadth of responses varied greatly and qualitative analysis revealed 5 overarching themes: simplify the descriptions of roles; clarify the roles; reduce overlap between roles; assist with implementation; and include patient safety. Conclusions: Stakeholders are very interested in participating in the revision and renewal of the CanMEDS Framework. Responses align with themes found through other consultation methods and validate the importance of reaching out to stakeholders in the process of framework revision.

Medical Teacher, 2010

With the introduction of Tomorrow's Doctors in 1993, medical education began the transition from ... more With the introduction of Tomorrow's Doctors in 1993, medical education began the transition from a time-and process-based system to a competency-based training framework. Implementing competency-based training in postgraduate medical education poses many challenges but ultimately requires a demonstration that the learner is truly competent to progress in training or to the next phase of a professional career. Making this transition requires change at virtually all levels of postgraduate training. Key components of this change include the development of valid and reliable assessment tools such as work-based assessment using direct observation, frequent formative feedback, and learner self-directed assessment; active involvement of the learner in the educational process; and intensive faculty development that addresses curricular design and the assessment of competency.

Medical Teacher, 2010

Although competency-based medical education (CBME) has attracted renewed interest in recent years... more Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership-the International CBME Collaborators-to examine conceptual issues and current debates in CBME. We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals. In this paper, we describe the evolution of CBME from the outcomes movement in the 20th century to a renewed approach that, focused on accountability and curricular outcomes and organized around competencies, promotes greater learner-centredness and de-emphasizes time-based curricular design. In this paradigm, competence and related terms are redefined to emphasize their multi-dimensional, dynamic, developmental, and contextual nature. CBME therefore has significant implications for the planning of medical curricula and will have an important impact in reshaping the enterprise of medical education. We elaborate on this emerging CBME approach and its related concepts, and invite medical educators everywhere to enter into further dialogue about the promise and the potential perils of competency-based medical curricula for the 21st century.

Medical Education Online, 2010

Background: The increasing complexity of medical training often requires faculty members with edu... more Background: The increasing complexity of medical training often requires faculty members with educational expertise to address issues of curriculum design, instructional methods, assessment, program evaluation, faculty development, and educational scholarship, among others. Discussion: In 2007, The Royal College of Physicians & Surgeons of Canada responded to this need by establishing the first national clinicianÁeducator program. We define a clinicianÁeducator and describe the development of the program. Adopting a construct from the business community, we use a community of practice framework to describe the benefits (with examples) of this program and challenges in developing it. The benefits of the clinicianÁeducator program include: improved educational problem solving, recognition of educational needs and development of new projects, enhanced personal educational expertise, maintenance of professional satisfaction and retention of group members, a positive influence within the Royal College, and a positive influence within other Canadian academic institutions. Summary: Our described experience of a social reorganization Á a community of practice Á suggests that the organizational and educational benefits of a national clinicianÁeducator program are not theoretical, but real.

The Journal of Urology, 2010

Journal of the American College of Surgeons, 2011

... Vinay T. Fernandes BSc, MD a , Kerry M. Graybiel BSc, MD a , Jen Hoogenes BS, MS, PhD(c) a an... more ... Vinay T. Fernandes BSc, MD a , Kerry M. Graybiel BSc, MD a , Jen Hoogenes BS, MS, PhD(c) a and Deepak Dath MD ... 3, Supplement 1, September 2011, Page S122 Surgical Forum Abstracts - 2011 Clinical Congress, The 66th Annual Sessions of the Owen H Wangensteen ...

Background Trigger videos have occasionally been used in medical education; however, their applic... more Background Trigger videos have occasionally been used in medical education; however, their application to surgical faculty development is novel. We assessed whether workshops designed to improve surgeons’ intraoperative teaching (IOT), anchored by trigger videos, were useful and effective in inspiring surgeons to improve their IOT.Methods Surgeons from multiple specialties attended one of six faculty development workshops where IOT trigger videos were shown and discussed during break-out sessions. Participants completed questionnaires to 1) evaluate videos via survey and feedback, and 2) identify adoptable and discardable IOT techniques. Teaching techniques were collated to identify planned IOT changes and survey data and feedback were analyzed.Results A total of 135 surgeons identified 292 adoptable and 202 discardable IOT techniques based on trigger videos and discussions, and 94% of participants reported that the trigger videos were useful and encouraged them to discuss and consi...

Additional file 2: Appendix 2. Likert-style questionnaire data for evaluation of; the trigger vid... more Additional file 2: Appendix 2. Likert-style questionnaire data for evaluation of; the trigger videos (A), presentation (B), quality of the session (C), and usefulness of the session (D).

The American Journal of Surgery, 2013

BACKGROUND: Motivation in teaching, mainly studied in disciplines outside of surgery, may also be... more BACKGROUND: Motivation in teaching, mainly studied in disciplines outside of surgery, may also be an important part of intraoperative teaching. We explored techniques surgeons use to motivate learners in the operating room (OR). METHODS: Forty-four experienced surgeon teachers from multiple specialties participated in 9 focus groups about teaching in the OR. Focus groups were transcribed and subjected to qualitative thematic analysis by 3 reviewers through an iterative, rigorous process. RESULTS: Analysis revealed 8 motivational techniques. Surgeons used motivation techniques tacitly, describing multiple ways that they facilitate resident motivation while teaching. Two major categories of motivational techniques emerged: (1) the facilitation of intrinsic motivation; and (2) the provision of factors to stimulate extrinsic motivation. CONCLUSIONS: Surgeons unknowingly but tacitly and commonly use motivation in intraoperative teaching and use a variety of techniques to foster learners' intrinsic and extrinsic motivation. Motivating learners is 1 vital role that surgeon teachers play in nontechnical intraoperative teaching.