Sean C. Grondin, MD MPH FRCSC FACS
2016 James IV Traveling Fellow

It was with great excitement that I learned that I had been selected as the 2016 James IV Traveling Fellow. I want to thank the former Head of the Department of Surgery at the University of Calgary, Dr. John Kortbeek, for nominating me for this prestigious award. I would also like to thank Dr. Janice Pasieka, a James IV Traveler from Calgary in 2006, and Dr. Vivian McAlister, Canadian Honorary Secretary for the James IV Association of Surgeons, for their advice and mentorship in the planning of my trip.

I divided my travel into two tours, the first to Australia and China, and the second to the United Kingdom (England and Scotland). Throughout my travels, my hosts and their colleagues were very warm, welcoming, and generous with their time. I am very grateful for the hospitality shown to me during my visits.

Australia

Sydney

I began my visit in late October 2016 in Sydney, Australia after a 16-hour flight from Canada. I spent the first day in this beautiful city touring the iconic Sydney Opera House, the Harbor Bridge and Botanical Gardens. I thoroughly enjoyed walking the neighborhoods and meeting friendly city residents.

The next day I began the medical portion of the trip by visiting Mr. Tristan Yan at the Royal Prince Alfred Hospital. Mr. Yan is a renowned cardiothoracic surgeon who has expertise in minimally invasive thoracic surgery (MITS). Mr. Yan provided an interesting tour of the Royal Prince Alfred Hospital facility. I also visited with several members of the cardiothoracic care team before meeting with Mr. Paul Bannon, a cardiac surgeon with a strong interest in surgical education. Mr. Bannon and I spent a relaxed lunch discussing the pros and cons of various international healthcare systems. Later, Mr. Bannon took me for a tour of their new, very impressive, simulation facility. A highlight of the day was meeting with Dr. James Crista, a cardiothoracic resident at the Royal Prince Alfred Hospital. Dr. Crista is an enthusiastic young resident who provided interesting insights into cardiothoracic residency training in Australia. The day was capped off with a very enjoyable evening with Mr. Yan, Dr. Crista, Mr. Holden, and Prof. Brian McCaughan where I listened to a lively discussion regarding the history of cardiothoracic surgery in Australia.

The following day, Mr. Yan and I visited Sydney Adventist Hospital, a private care facility originally opened in 1903 as a quarantine hospital for new immigrants to Australia. The efficiency of the surgical suites was remarkable with Mr. Yan completing five video-assisted thoracoscopic surgery (VATS) lobectomies in addition to several other thoracic cases in one day. Although the day was busy, Mr. Yan demonstrated his superb technical skill while maintaining a relaxed atmosphere in the operating room. During the lunch break, I had the opportunity to meet hospital administrators to discuss the business aspects of healthcare delivery in the private practice setting. The day finished with a delicious supper with the anesthesia team.

On the final day, I visited world famous Bondi beach and completed the Bondi to Bronte ocean coast walk. The city and ocean views were fabulous and the people were very friendly. The day finished with a tour of the campus at the University of Sydney. I left Sydney in the evening taking a short flight to Melbourne.

Tips for future Travelers: I highly recommend a visit to Sydney. The city is truly one of the most beautiful that I have visited and the people are warm and welcoming. The public transportation system was easy to navigate and the restaurants were excellent. I recommend staying at a centrally located hotel such as Sheraton on the Park given its easy access to the airport train and short walking distance to the Sydney Harbor.

Melbourne

On November 3, I met Mr. Philip Antippa at the Royal Melbourne Hospital. Mr. Antippa is a Senior Lecturer in the Department of Surgery at the University of Melbourne with a special interest in medical informatics. He is also an active musician and viola player, and runs the highly acclaimed doctors’ orchestra in Melbourne, Corpus Medicorum.

After a brief tour of this facility, Mr. Antippa hosted me as I participated in multi-disciplinary rounds (MDR) at Peter MacCallum Cancer Centre. The MDR provided a wonderful opportunity to discuss interesting cases and debate treatment options for patients. I enjoyed the strong evidence–based discussions highlighted by opinions from experienced clinicians. After the MDR, I toured the modern cancer center facility. I was fortunate to meet several surgical colleagues during my tour. The many similarities between the Canadian and Australian healthcare systems were highlighted in the many discussions with various providers throughout the day.

The following morning, I attended an informative lecture on safety with members of the Department of Surgery followed by a visit to the physician offices and clinics. During this visit, I was able to view the lung cancer research database created by Mr. Antippa. This database was truly remarkable and is an enviable tool for analyzing patient demographics and treatment results. The afternoon was spent observing Mr. Antippa performing consultations and reviewing challenging thoracic surgery cases. Mr. Antippa is a skilled communicator and it was inspiring observing him at the bedside relate to patients and families. The day finished with a lovely Asian Fusion dinner with Mr. Antippa and Mr. Gavin Wright.

The next day, I watched Mr. Antippa perform a VATS lobectomy with smooth surgical skill. Later in the day, we toured the Melbourne cultural district followed by lovely supper at his house with family and friends. The local ice cream and Moscato wine for dessert were a real treat.

Tips for future Travelers: Melbourne is the coastal capital of the southeastern Australian state of Victoria. At the city’s center is the modern Federation Square development with several bars and restaurants situated on the Yarra River. The Southbank area is home to the impressive Arts Centre Melbourne and the National Gallery of Victoria. Hotels in Old (Downtown) Melbourne are very affordable and offer easy access to a number of great shops and restaurants that are open late into the night.

Brisbane

On November 6, I flew to Brisbane and was met at the airport by Prof. David Gotley and his son Ben. Prof. Gotley is an upper gastrointestinal surgeon who is a member of the James IV Association of Surgeons. Interestingly, he visited a thoracic surgeon, Dr. Richard Finley, in Vancouver Canada during his James IV Traveling fellowship in 1997. After settling into my apartment, I enjoyed a lovely supper hosted at Prof. Gotley home with his sons James and Ben, and wife Trish.

The next morning, I toured the Princess Alexandra Hospital accompanying Prof. Gotley and his team on ward rounds. Later, I visited the Translational Research Institute. After a lunch with house staff, I was fortunate to watch Prof. Gotley perform two surgical procedures (Heller myotomy and Toupet fundoplication) at the Mater Private Hospital. His attention to detail during the procedure was remarkable. Later that night I toured the bustling Brisbane waterfront.

Most of the following day was spent observing a complex colon interposition. The team approach of the surgeons in performing this challenging case was exemplary. Following the case I was treated to a wonderful steak dinner with Prof. Gotley. The discussion on mentoring trainees as well as career development strategies was excellent as was the tutorial on how to choose a good Australian steak.

Tips for future Travelers: Brisbane is the capital of Queensland and is the third largest city in Australia (population approx. 2 million). I recommend the river walk downtown with excellent views and a vibrant food scene. I stayed at an inexpensive apartment complex close to the hospital which afforded me an opportunity to do laundry in preparation for the next portion of my trip.

China

On my first morning in Shanghai, I was picked up at my hotel by Drs. Timmy Yang and Alan Sihoe. We navigated the busy streets to the Shanghai Pulmonary Hospital where we were hosted by Prof. Jiang, Chief of Surgery. During the morning surgical rounds over 50 lung cancer cases were efficiently reviewed in preparation for surgery. The day was spent moving freely between the 15-dedicated thoracic surgery operating rooms observing major thoracic cases (e.g. uniport and substernal VATS resections, VATS segmentectomies, etc). The technical skill of the surgeons and work ethic of the entire operative team was impressive.

The following morning, I presented Surgical Rounds on the current state of thoracic surgery in Canada. My talk was followed by an inspiring presentation by Prof. Murakaya from Japan on thoracic surgery simulation with soft 3D models. The remainder of the morning was spent watching multiple operations (57 booked cases) performed by Dr. Jiang and his colleagues. Later in the day, I transferred to a hotel close to the Bund in preparation for the ATEP (Asian Thoracoscopic Surgery Education Program) conference. A faculty dinner that night was entertaining with lively discussion with Profs. Date, Khan, Kyoto, Sihoe, and others.

The next day, I attended the ATEP meeting presenting talks such as “MITS training in North America” and “How to write a scientific paper”. I was also privileged to participate on several panel discussions including the role of stereotactic body radiation therapy and the future of lung cancer surgery. The conference was excellent and afforded a great opportunity for international collaboration and exchange of ideas. On November 13, I returned to Canada for a brief stay to see my family and prepare for the second leg of my travels.

Tips for future Travelers: Shanghai is a very large city (population approx. 15 million) so having great hosts like I did to assist in planning the trip and navigating the city is highly beneficial. I suggest a visit to the Bund for great downtown city views (especially at night). Also, I would recommend embracing the local culinary cuisine in order to maximize the cultural experience. Importantly, travel visas to China require a fair amount of paperwork and time to obtain, so I recommend applying a few months before your travel.

United Kingdom

London

I arrived in London and stayed at the historic Royal College of Physicians and Surgeons of England medical building. This complex is home to several significant paintings and surgical artifacts. In addition, the adjacent Hunterian Museum boasts an amazing collection of human and non-human anatomical and pathological specimens, models, instruments, and paintings. My first full day was spent touring London and visiting several well-known landmarks such as Big Ben and the Tower of London.

Middlesbrough

On November 20, I took a train from London to Middlesbrough to visit Mr. Joel Dunning. Mr. Dunning is a young innovative thoracic surgeon at James Cook University Hospital who is leading the way in the development of new MITS techniques such as micro lobectomy. I was fortunate to observe Mr. Dunning excellent surgical skill when he performed two micro lobectomy procedures. Postoperatively, I enjoyed a detailed discussion on his ERAS (early recovery after surgery) protocols. The evening was capped off with a lovely dinner after which Mr. Dunning interviewed me for a video about my James IV Traveling Fellowship experiences. (https://www.ctsnet.org/article/experiences-thoracic-travelling-fellowship)

Tips for future Travelers: Staying at the Royal College in London is affordable and allows a centrally located “home base’ close to major tourist attractions. Travel in London using the tube is safe and easy to navigate. Railway travel in England is suggested as it is relatively inexpensive and a relaxed way to see the countryside. While in the United Kingdom, I highly recommend attending a professional football match – it is a fantastic experience.

Edinburgh

After spending a day touring Edinburgh, I visited the Royal Infirmary where I met with Mr. Richard Skipworth, a consultant GI surgeon, and Prof. Steve Wigmore, a hepatobiliary/transplant surgeon. Both meetings were very informative as we exchanged thoughts on the challenges of providing excellent clinical care in different health care models. A visit with Prof. Rowan Parks provided a great opportunity to discuss the organization of medical education in Scotland.

In the afternoon, a visit to the Medical Research Council (MRC) Laboratory for Inflammatory Research was hosted by Dr. Kevin Dhaliwal. The facility infrastructure and research personnel were inspiring. In particular, the work known as PROTEUS was impressive. This home-grown technology allows the user to visualize cellular changes arising from diseases of the lungs in real time. This multiplexed optical molecular imaging unit demonstrated how collaborative multi-disciplinary teams can have great success. The day wrapped up with a delicious supper with Prof. Wigmore, Prof. Parks, Mr. Skipworth, and Dr. Dhaliwal.

The next morning, I met with several surgical trainees at the Royal Infirmary who presented their research projects. Informative discussions on their research methodology and future ideas for investigation were outlined. Later, I met with the warm and welcoming Regius Professor O. James Garden. We went for lunch at the impressive ESSQ (Edinburgh Surgical Services Qualification) offices where staff demonstrated the advances made in online distance learning and their international surgical education programs. In the afternoon, Prof. Garden toured me through the historic streets of Edinburgh and showed me several noteworthy landmarks. In the late afternoon, I visited the University of Edinburgh campus and then joined Prof. Garden and colleagues for supper at the New Club.

On the last day of my visit, I met with renowned thoracic surgeon, Prof. William (Bill) Walker. Prof Walker has trained numerous accomplished thoracic surgeons around the world. Prof. Walker insights into the use of the posterior approach for VATS lobectomy were fascinating. I particularly enjoyed our conversations as we shared his wonderful memories of my mentor and mutual friend, Dr. F.G. Pearson.

Tips for future Travelers: Staying at a nice hotel in downtown Edinburgh is very affordable and allows easy access to restaurants and historic landmarks by foot. A visit to the Surgeons’ Hall Museum and the University of Edinburgh campus is highly recommended.

Conclusion

I wish to first thank the James IV Association of Surgeons for selecting me as the 2016 James IV Traveling Fellow. I am truly honored. I am also incredibly indebted to my local hosts in Australia, China, and the United Kingdom who gave so generously of their time and knowledge. Their hospitality was unforgettable and a special part of an outstanding experience.

This Traveling Fellowship was an incredible opportunity that allowed me to develop new professional relationships and friendships, broaden my understanding of other health care systems, and enhance my thoracic surgery knowledge base. I look forward to future collaborations and exchanges with several of the visited sites and am sure that many of the individuals that I met will remain influential to me personally and professionally.