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president’sperspectiveSurgeonsof the 21stCenturyProfessionals or Tradesmen?This is perhaps the most importantquestion facing surgeons at thisstage of the 21st century. It isa topic that I have spoken about bothin Australia and New Zealand andinternationally with resonance fromcountries as diverse as Poland and India,Japan and Argentina. It is an issue to beconfronted proactively and fully.I declare that my starting premise isthat professionals are good for Society.In this I am supported by Professor LordRalf Dahrendorf, previously the Directorof the London School of Economicswho said “the independence of theMichael GriggPresidentprofessions is perhaps the best indexof the personal freedoms of individualswithin Society”. He went on to warn, “butthe winds of change are blowing”.So what is the difference betweenprofessionals and tradesmen? Both areknowledgeable and highly skilled andfocused on doing a great job. AgainDahrendorf assists, “the professions attheir best: oriented to expertise ratherthan commercial interest, bound byself-imposed rules of behavior, they basetheir status on the unwritten agreementwith the public of which the professionalorganisation is the guardian”.So professionals are deemed to have themotivation and the autonomy to place theinterests of their patients above all otherconsiderations. In return they are grantedthe privilege of autonomy (and monopoly)and the responsibility of self-regulationby Society with subsequent benefits. Butis this autonomy still valued by Society?Is the self-regulation and accountabilityunderstood by the profession and ourprofessional organisations? The 21stCentury question could perhaps berestated – how do we reflect our autonomyin our accountability?Setting standardsIn 1776, Adam Smith, a Scottish moralphilosopher, who has also been describedas the father of modern economics,published ‘The Wealth of Nations’.In this treatise he established both adefinition of professionals and the socialcontract between doctors and Societythat continues today. Dr Thomas Percival,an English physician was among thefirst to invoke Smith’s social contractdocumenting this within one of themodern codes of medical ethics in 1794.Smith proposed that a hallmark ofprofessionalism was the necessity of beingable to act in a patient’s best interest, freeof both State and Church control. Smithwas no fool and he foresaw the risk thatindependence might degenerate intoan exploitive monopoly. He sought tobalance the privilege of autonomy with theresponsibility of self-regulation. It was nothis intention to legitimise idiosyncraticindividualistic behavior, but rather toimpose this responsibility on professionalpeer groups i.e., professional organisations.The Royal Australasian Collegeof Surgeons, formed in 1927, is anorganisation of surgical professionals.A catalyst for its formation was a lettersigned by three prominent surgeons ofthe time that expressed concern at thedegradation of the high standards ofthe surgical profession and proposedthe formation of a College of Surgeonswhose members would conform tocertain standards. I believe Adam Smithwould have approved. Today, 87 yearson, professional standards remains thecornerstone of all College activities.Practical manifestations include surgicaltraining, certification, Code of Conduct,professional development courses, peerreview and even Continuing ProfessionalDevelopment.Professional standards, determined bythe profession, are the manifestation of“self-regulation” allowing us to fulfill ourpart of the social contract and to continueprofessional life as we know it. This is onereason that I believe professional organisationsare essential in the 21st Century.Professional standards need to bedetermined by the profession. Thisenables the autonomy necessary to bea professional rather than being subjectto the different types of accountabilityconfronted by tradesmen. I am oftenasked, “What is the role of professionalorganisations?” The answer is easy for theCollege of Surgeons – it exists to ensureand to protect the professional standingof surgeons for the benefit of Society.The embodiment of Adam Smith’sviews of the relationship betweenProfessionals and Society was the ‘Doctor– Patient’ relationship that has rightlybeen held in high regard by both themedical profession and Society. It is thevalue placed on this relationship thathas until recent times provided almostcomplete protection to the professionfrom the State. The social contract wasbetween Professionals and Society – itnever involved the State.Royal AustralasianCollege of Surgeons$10,000 Convention Travel Grant2015 SubmissionsNow InvitedProfessor Michael GriggPresident, Royal AustralasianCollege of SurgeonsAutonomy under threatGovernment, bureaucracy,instrumentalities and even politiciansmake up the State, an inherent andunifying characteristic of which isa desire for control. The Professionstherefore represent an anathema to theState and we should not forget that weare constantly at risk. In the event thatSociety comes to doubt the value ofautonomy of medical professionals, orthe ability of the medical profession toself-regulate it is predictable that Societywill turn to the State for the remedy.Internationally there is evidence that thisis already happening.In a world where the individualrelationship between doctor and patientis often within larger organisationalstructures such as hospitals, the dilemmathat comes to mind is apparent in thequestion, “Can employed doctors beprofessional?” The answer of courseis “yes”, provided the standards ofprofessional behaviour are determinednot by the employer or by the State, butby a strong independent professionalbody. It is also apparent that it is desirablethat the body determining professionalstandards is separate from the bodynegotiating pay and conditions.Unlike other professional groups,such as university academics, the medicalprofession still enjoys relative autonomy.However, this is under threat withincreasing intrusions of accountabilityimposed by the State, occurring becauseof the perception of failure ofself-regulation.This failure is portrayed in many ways– avoidable medical harm, exploitive fees,suspect relationships with third partyproviders, “closed shop” turf protection,rogue behaviour to name but a few.Ultimately, however, the challenge for theState is the increasing cost of healthcareand the need for reform. Alas theautonomy of healthcare professionals isperceived to be an impediment, indeed asubstantial impediment.We live in an era of increasingaccountability, but we can survive asprofessionals provided we nurture ourprofessional organisations and they inturn retain the trust and support ofSociety. As President of this College,I know this is vitally important to eachand all of us. It is the differentiator, thekey difference between a tradesman anda professional.The annual Convention Travel Grant – run under the auspices ofPerth Convention Bureau’s Aspire Program – is a fine initiativethat is open to all Fellows, Trainees and International MedicalGraduates on a pathway to Fellowship. The grant offers therecipient the chance to broaden their networks and horizonsand bring kudos to themselves, the College and the widercommunity. I encourage all Fellows and Trainees to embracethe Aspire Program.Applications close 28 February 2015To obtain application guidelines and apply, contactDr John M Quinn FRACS, FACSExecutive Director for Surgical AffairsRoyal Australasian College of SurgeonsTel: +61 (0)3 9249 1203John.Quinn@surgeons.org6 Surgical News november / december 2014Surgical News november / december 2014 7

Relationshipsand AdvocacyThe value invaluesDo you know what your own values are or even those of the hospital you work at?Have you agreed corporate values define and inspire your own private practice?David WattersVice PresidentWhy do organisationssuch as the College needvalues? Does anyonereally pay any attentionto them?I believe we need values, because theydefine who we are and what we aspireto be. They emanate from our innerbeliefs and make a statement about whatmotivates our actions and underpin theway we behave towards each other.Most companies have values, eventhose whose principle motivationmight be profit for their shareholders.If you take a few moments to search theweb you will likely find many espousecommon values. For example, Coca-Cola’s seven corporate values includequality, passion, leadership, collaborationand integrity. Medibank Private hasfour values including customer focus,integrity and respect. BHP has sixvalues which include integrity, respect,sustainability and accountability.Corporations often go to greatlengths to ingrain their values intotheir corporate culture. They rewardexceptional display of values andcontinuously train staff to encouragebehaviour that reflects the desiredcorporate values.There has been much research over thelast few years about the ‘value of values’in organisations and whether valuescan predict such things as performance,emotional intelligence and compliancewith occupational health and safetystandards.The experts in these fields of studysay that although personality traits arelargely inherited, values can be learned.Values then influence behaviour andare found to be significant predictors ofpositive and negative work outcomes.Furthermore, in the field of HumanResources, assessments that look atboth personality and values havegreater accuracy in predicting emotionalintelligence, success in customer focusedroles and safety compliance. 1Shalom H. Schwartz, an academic inSocial Sciences, developed a ‘Theory ofBasic Values’ based on studies of over60,000 people from 82 countries. 2 Heidentified ten basic personal values thatare emotionally distinct, are recognisedacross cultures, and determined how theyare derived. It is interesting to note thatwhilst the values are structured in similarways across culturally diverse groups,particularly as to conflict and congruencebetween values, individuals and groupsdiffer substantially in the relativeimportance they attribute to the values.So as individuals and groups in society,we do have different value ‘priorities’ or‘hierarchies’. Are we able to be collectivein our thinking as surgeons, and asa College, about the priority of ourvalues? Do our values drive us toaction? Do they define our actions?Schwartz makes the connection that“Values are beliefs linked inextricablyto affect. When values are activated,they become infused with feeling.”These feelings then lead us to action.Our College values have been onthe minds of Councillors recently,particularly because the developmentof our communication strategieshighlighted the importance of beingable to articulate ‘what we stand for’.The current College values,applicable to Fellows, Trainees andstaff, were first introduced in 2000and comprise four pairs and onesingleton: Service and Professionalism Integrity Respect and Compassion Commitment and Diligence Collaboration and TeamworkIn reflecting on these values, themembers of the Governance andAdvocacy Committee, chaired by theVice-President, believed it was time tosimplify them into five key values toenhance impact. So which values bestapply to us as surgeons and Fellows ofthe College?The committee and otherCouncillors favour the followingfive values: Service Respect Integrity Compassion CollaborationAs you can imagine, getting consensuson these was a challenge and generatedmuch interesting discussion! Somewas about semantics, but we definitelywanted to include values each Fellowwould think were important. I ampleased to say that ‘service’ was highon the list. As one Councillor said, “Itis outward looking, patient and societyfocussed and a prime motivation andreason for our existence as individualprofessionals and as a representativeprofessional organisation.”I trust that our values will be worthyof what you aspire to be as a surgeon.Our values should inspire behaviourthat is worthy of the trust placed inus by the public and describe themotivation behind our actions.Each of our values are manifestin recent areas of College activity:advocacy on appropriate traininghours for Trainees [service, respect andcollaboration], safe surgical care andglobal health [service, collaborationand compassion], the unacceptability ofexcessive fees [service, compassion andrespect]; promoting professionalism[all our values], collaborating withothers to mitigate the effects of alcohol,tobacco and obesity on our patients andthe community [compassion, service,collaboration].Integrity should drive us to willinglyparticipate in Continuing ProfessionalDevelopment (CPD), by which I meanlifelong learning related to our scope ofpractice, reflection on our performancethrough audit, peer review and othertypes of feedback [collaboration],participation in clinical governance[service and collaboration], anddocumentation of our CPD compliance[respect and integrity]. Common valuesassure us we should work together. As afellowship that is the unifying voice forsurgery we can have much more effectthan the sum of our individual efforts.References1. Griffin, M. A., Neal, A. (2006) Alongitudinal study of the relationshipsamong, safety climate, safety behaviour,and accidents at the individualand group levels. Journal of AppliedPsychology, 91, 946-9532. Schwartz, S. H. (2012). An Overview of theSchwartz Theory of Basic Values. OnlineReadings in Psychologyand Culture, 2(1).I would be pleased to hear your thoughts about our College values and theirimportance. Email me at college.vicepresident@surgeons.orgFOLLOW US today@RACSurgeons/RACSurgeons8 Surgical News november / december 2014 Surgical News november / december 2014 9

surgicalsnipssurgicalsnipsRevived heartsgive hopeAnatomy course in demandA three day anatomy course held at James Cook University and accreditedby the College gives aspiring surgeons hand-on experience.Now in its second year, JCU Associate Professor of Surgery AlanDeCosta has said there is high demand for the course.“Most of our Trainees are very good at keyhole surgery, but theyhave very little experience with open surgery,” he said.“Open surgery is still very necessary … especially in emergencysituations.”Cairns Post, 2 NovemberNeighbourly helpThe College continues to build its relationship with Pacificcommunities with assistance in the development of newpostgraduate surgical program in Fiji. While the programwas suspended in 2013, new facilities and staffing hasallowed the program to grow. Fiji National UniversitySchool of Medicine Dean Professor Ian Rouse has saidthat all Pacific Islands will benefit from the program.“The recently opened world-class operating theatres atCWM Hospital mean that we now have quality facilities toensure the best possible training for regional surgeons,”Mr Rouse said.The Fiji Times, 6 NovemberAudit participation commendedThe Western Australian Audit of Surgical Mortality, coordinated by the College,is ensuring continuing improvement in the treatment of patients.The latest report shows surgical deaths continue to fall, at a rate of 22 per centbetween 2009 and 2013. Encouraging is the level of participation among surgeons,Acting-Director General of the Department of Health Bryant Stokes has said.“This demonstrates that the surgical community wants to learn from mistakes andimprove clinical practice,” Professor Stokes said.PSNews.com.au, 21 OctoberSurgeons have opened newpossibilities after restartinghearts for transplantsurgery in a world first.The dormant hearts wereflushed with saline solutionbefore being removed frombodies, then connected to amachine that supplied newblood and kept them pulsing.Cardiothoracic surgeonEmily Granger hopes thenew method will go someway to relieving wait listpressure.“I carry around a briefcasethat seems to be gettingheavier by the day andthat’s just the transplantwait list,” Dr Granger said.Sydney Morning Herald,25 OctoberSPECIALIST MARKETING SERVICESFOR MEDICAL PROFESSIONALSCJU Medical Marketing are leadersin providing a comprehensive rangeof marketing services and businessdevelopment programs designed togrow your specialised business.For a healthy start to the newfinancial year call 1300 941 250www.cju.net.au16 Mitchell Street Camden 2570Level 1 Octagon, 110 George Street Parramatta NSW 2150Level 2, 710 Collins Street, Docklands VIC 3008CJU Medical Marketing services include:• Strategic Medical Marketing• Medical Referral Services• Practice Review• Competitor Reviews• Staff Development• Online Medical Marketing• Segmented Strategies• Social Media Programs• Public Relations• Direct Marketing• Creative Services• Brand Consultation and Development10 Surgical News november / december 2014 Surgical News november / december 2014 11

38 SURGICAL NEWS SEPTEMBER 2014Opus OPXIII XXXIVLetters tothe EditorRelationshipsand AdvocacyMUNCHAUSENSYNDROMEButtons and genderIn my story about Buttons and Bows(‘Surgical News’, September 2014), thereare a few points I would have liked to add forcompleteness sake and the first is, why I usedthat title in that article.Bob Hope is one of my favourite comediansand this was the song, ‘Buttons and Bows’, ofhis Oscar winning film, ‘Paleface’, with JaneRussell, produced in 1947. One of his famousquotes that stick in my mind relating to theageing population is embraced by his words,“You know you are old when the cost of thecandles costs more than the cake.”The second point of interest relates to thereason why ladies’ buttons are on the lefthand side of their garments. It harks back toSURGICAL SKETCHESAND SILHOUETTESBUTTONS & SURGICAL BOWSn this, another letter from SpringStreet, I note the feature of Curmudgeon’sCorner in Surgical NewsIis always stimulating. Originally Ihad to use the OECD to find this meaning(churlish or miserly), but it is really a collectionof cantankerous idiosyncrasies – ofa bad tempered old man.This is a 16th century word.Incidentally the composer Wolf Ferrariwrote a comic opera in the 1900s calledthe ‘Four Curmudgeons’, but he was morefamous for his piece ‘The Jewels of theMadonna’.In his diatribe in the June 2014 issue,I find Professor Grumpy is bugged bybuttons, on tailored shirts, spare partshidden under contour shapes and missingfrom the cuffs. He did not mentionA protean perspectiveFrench cuffs (the Francos call them foldedcuffs) nor cufflinks, which mirror ourdress style.This brings me to a little pearly vignetteabout Don Hossack, a man of artisticbackground who loved to drive a yellowSilver Dawn (Benny Rank drove the samemodel in black).Don was a surgeon at Prince Henry’sin the 1980s who sometimes wore abowtie (now almost an edict fromInfection Control Departments). He wasalso the Victorian State Police Surgeon.One evening going to an emergency atPrince Henry’s and while driving alongthe St Kilda stretch, he was surprisinglyintercepted at the red light intersection bya street courtesan.The appeal of the car must have beenthe 18th century when the mistress of the household in the wealthier classeswas dressed by her ladies-in-waiting. They would insert the buttons into thebuttonholes with a pincer grip using a right hand dominant gesture, as weknow 90 per cent of the population is right handed. This meant les boutonswere attached to the left hand side of the tunic. And some say the reasons whymen’s clothing has buttons on the right was the fold of the coats etc. meanteasy access to the sword on the left hip in the days of Dick Turpin etc.It is interesting to note how someone explained, when working in an op shopwhere bundles of clothing are given en masse that when one has to decide theirgender to place them on the appropriate rack, one just looked at the buttonorientation and stacked them accordingly. I presume the same principle wouldapply to clothing with zip fasteners.Statistically female surgeons in the UK amount to 9.7 per cent, whereasentering a medical course in their undergraduate years they comprise 55 percent. In Australia and New Zealand the figure comes out at just under 11 percent for female surgeons. Imagine the logistics in having male and femaletheatre gear governed by button orientation. Thankfully we use slip on theatregarb and pyjama cords.Finally another pearl about pearls: along the Dampier coast of northernWestern Australia near the 80 mile beach, pearl luggers would retrieve from theoyster reefs beyond, enough shells to supply 90 per cent of the world’s pearlbuttons in the 1890s.Felix BehanVictorian FellowPub: CMC TOTS Page: 40 Date: 27-SEP-2009 Plate:CMYKFactitious disordersMusings about Munchausen Syndrome, are there three types?later that evening discharged herself. This clinicalhistory stimulated me to recount the storyof some of my other Munchausen experiencesover the last three and a half decades, and threeFelix Behancases in particular spring to mind – I wonderVictorian FELIX Fellow BEHANif this is the statistical average (one every tenVICTORIAN FELLOWyears and I would welcome other comments).n a recent theatre list I had an interestingclinical experience even at narrative, in the 1980’s. In those days the medi-The second case makes an interestingOmy age. In the Anaesthetic room a cal administrator allowed us to transfer insurancepatients to the private domain. Over a twopatient was awaiting surgery. My registrar wasnot there with me to present the details on his month period a general surgeon and I operatedline of management. He had mentioned beforehandthat this lady had presented for removal sustained abdominal injuries in a motor vehi-on this young man a number of times. He hadof something off her leg.cle accident, a perfectly credible story until IWhen I addressed the patient in this later questioned the multitudinous maturecontext, my question was “now what am I abdominal wall scars – another warning sign.removing today?” She said “I have a scar on theleg at a skin graft site and I was told you couldpossibly fix it”. Previous attempts at serial scarrevision had been unsuccessful. People knewI have successfully closed similar defects inmelanoma patients with the usual keystonetechnique.Like any experienced surgeon, I exposed Three days before discharge he asked athe whole lower limb to examine it and found, young nurse for $15 so that his clothes couldto my horror, she had a donor site dressing on be dry-cleaned. I asked the young lady someher upper thigh. On further questioning, it months later whether she had ever received hertranspired, this had been there for six months. money. She was never paid.I then glanced at her notes on the anaesthetic Some years later, I was doing Mondaybench. There were five volumes, each about five morning rounds when I encountered theinches thick – “a warning sign”. At this stage the same individual, recently admitted againalarm bells were ringing and I asked her “why with abdominal trauma. Needless to say hehave you been in hospital so often?” suspectingsome major clinical catastrophe like neph-confronted him.signed himself out within the hour when Irotic syndrome. She gave a history of repeat A further story relates to a nursing aideirresistible to her. overdose She was needing en grande ICU admission. It transpired who burnt her finger on a steriliser. The registrarin the Emergency Department referredtenue, yet a little she deshabillé was seen if in not our risqué unit six months earlier and– she opened the it front was door found of that the Rolla she has been putting oven her to me for grafting (which failed), whichand positioned herselfcleanernexton theto him,skin graft donor site.was repeated and failed a second time beforeobviously with professionalI took herintent.into theatreDon’sand manually debridedthe wound under general anaesthesia and finger years later resulted in a ray amputationdoing a cross finger flap. The resultant stiffimmediate response – while still stationedat the red light – was that he just showeddressed it with the usual donor site techniques, of the middle finger, by another specialist, asher his Police Association cufflinks andreinforced with soft topical non-removable I discovered when she came back to me for amade one remark, “You understand Idressings, and signed it “not to be removed medico legal report seeking compensation foram the Victorian State Police Surgeon.”without my permission”. I heard that she had this work related injury.Without hesitation she retreated back intothe shadows of the SURGICAL night. NEWS P40 / Vol:10 No:8 September 2009In London, one of the buttons of myreefer jacket became detached and hereis the genesis of another story. I needed a3.0 silk on a Keith needle which was onlyavailable from the thoracic departmentstores and the sister-in-charge had the keyto the stock cupboard.Airline industry couldlearn from us“As one of my mentors and later colleagues saidyears ago “Plastic surgeons are sometimes describedas psychiatrists with knives” – but not always.”All deserve praise in Wong caseTAs we know musing is gazing meditativelyhe President, and reflectively in a literary context. This Michael led Grigg, mentionsme to ponder the Munchausen syndrome.Whether by proxy or direct involvementin the public or the private sectors, thisin his psychiatric President’s disorder is classified as a factitioussequence of clinical episodes - fancied,Perspective: “How tofeigned or self-inflicted-. It is interesting howthis eponym arose: Richard Asher in 1951 wasbe alert the like first to describe the such self-harm, airline recallingBaron Munchausen in an article in theindustry” (‘SurgicalLancet. He mentioned how the Baron had alist of fantastic stories, beyond belief, reflectingdaring exploits, quite unbelievable. In hisNews’, October 2014) his interest in DVTobituary in the British Medical Journal, it wasmentioned how Asher respectfully dedicatedthis syndrome to the Baron(Deep Vein Thrombosis) prophylaxis.My interesting in DVT stems fromThe Baron served in the Russian militaryforces against the Ottoman Empire andthe 1960-70’s acquired a reputation when for witty and exaggeratedtales and became the subject of numerousI began to usetexts published in 1862 by Gustav Doré, fromballoon flights, to taming wolves to shootingsubcutaneous flocks of ducks and being mauled heparin by bears (en. pre and postopin major particular person general who also wrote about surgery to preventwikipedia.org).However the idea occurred to me thatthis recollection had a similar ring to anotherfictional and fanciful adventures. He was farmore readable and he became the second mosttranslated author of all time, (second only topulmonary Agatha Christie). embolism Having written Journey to (PE). Othersthe Centre of the Earth in 1864, then 20,000Leagues Under the Sea in 1869, and Around theWorld in 80 days in 1873 – none other than thegreat Jules Gabriel Verne (1828-1905)followed, but orthopaedic surgeons wereHe lived along the Loire Valley. At theschool of St Donation College, one of histutors in drawing and mathematics was possiparticularlywary because of the risks ofbleeding. One particularly well-known O &G surgeon had bilateral hip replacementswithout prophylaxis and died of PE.Over the years since, I thought DVTprophylaxis had become routine, butapparently not, from the President’s article.Then, when laparoscopic cholecystectomy(LC) came in, it was thought by some thatthe rapid ambulation would negate theneed for prophylaxis: forgotten was theabdomen filled with gas slowing flow in theinferior vena cava and predisposing to DVT.The modern trend for early discharge aftermajor surgery was found to necessitate theuse of DVT prophylaxis for a period aftergoing home. One of my own patients diedof a PE after discharge.Then in the airline industry itself, the longflights taken commonly today expose passengersto DVT/PE because of the long period ofinactivity – have they learnt from us?President Grigg’s idea of an industrywidealert in matters involving patientsafety is emphasised in the history of DVT/PE prophylaxis!Kevin B. OrrNSW FellowRe. Michael Wong (‘Surgical News’, October 2014).He suffered a terrible attack and ghastly injuries in February. He is fortunateto have survived and fortunate to be making a great recovery, thanks toevery single person involved in his care. But most of the congratulations go to notonly to these wonderful team members, but to Michael himself who tried so hardbut then said we must think more of the three-year-old with a brain tumour!Well done everyone!Donald BeardSouth Australian FellowNew Councillors to serve youFellowship ElectedCouncillorsThere were four Fellowship ElectedCouncillor positions to be filled.Re-elected to Council are:Phillip Carson (General, NT)Lawrence Malisano (Orthopaedic, QLD)Newly elected to Council are:Andrew G Hill (General, NZ)Jonathan Serpell (General, VIC)CONTROVERSIESIN GENERALSURGERYResults of elections to councilSpecialty Elected CouncillorsRe-elected to Council are:Cardiothoracic Surgery – Julie Mundy (QLD)Otolaryngology Head & Neck Surgery – NeilVallance (VIC)Paediatric Surgery – Anthony Sparnon (SA)Plastic & Reconstructive Surgery – DavidTheile (QLD)Newly elected to Council are:General Surgery – David Fletcher (WA)Vascular Surgery – John Crozier (NSW)The results will be tabled at the Annual General Meeting in Perth on Thursday, May 7, 2015 when newly elected Councillors take office.New Zealand Association of General SurgeonsNZAGS 2015NEW ZEALAND ASSOCIATION OFGENERAL SURGEONS ANNUAL CONFERENCE14–15 MARCH 2015 • NOVOTEL ROTORUA LAKESIDE HOTEL, ROTORUA, NEW ZEALANDFor further conference information visit http://www.nzags.co.nz/events/2015-nzags-asm/.WWW.NZAGS.CO.NZCongratulations to the successfulcandidates and sincere thanks to allcandidates who nominated.The pro bono contribution ofFellows has been, and continuesto be, the College’s most valuableasset and resource. We are gratefulfor their commitment. We are alsograteful to the voting Fellows (22per cent) who demonstrated theirengagement with the governance ofthe College.The poll results are verified byMr Ralph McKay of BigPulse.12 Surgical News november / december 2014Surgical News november / december 2014 13

Fellowsin the NewsRecognition forbrain tumour workAfter being shortlisted, Queensland NeurosurgeonDr Sarah Olson became a finalist to receive anational award for her work to establish a braintumour bank and her extraordinary fund-raising effortsto support brain tumour research.In the past two years, Dr Olson has raised more than$300,000 for brain tumour research and has established aQueensland brain tumour bank through the John TrivettFoundation with the support of neurosurgeons acrossthe state.She is now in the process of extending the tumour bankacross the country and raising further funds to supportresearch throughout Australia in a bid to extend survivalFellow Sarah Olson is drivingawareness on brain cancerto find a cure, becoming afinalist for a national awardin the processLEFT: Sarah with husband Brad Armstrong,daughters Ingrid and Charlotte and son Sam.rates for patients with brain tumours, which currentlyhave some of the lowest survival rates of any cancer.Dr Olson was announced as a finalist for a Pride ofAustralia Medal in October, an award offered by NewsCorp Australia to recognise and reward outstandingAustralians.She was nominated earlier this year in the Care andCompassion category by the Princess Alexandra Hospitalin Brisbane that specifically commended her selflessnessin offering to pay for the maintenance of the tumourbank if enough funds could not be raised and forchoosing to forgo private patient fees in lieu ofcharitable donations.Dr Olson has a public appointment at the PrincessAlexandra Hospital and private practice through the Materand Greenslopes Hospitals.She has particular interests in minimally invasive brainsurgery, pituitary disorders, trigeminal neuralgia and inrecent years she supervised the introduction of deep brainstimulation into the public sector in Queensland.She said she became motivated to raise money to boostbrain cancer research and establish the tumour bank whenshe could no longer tolerate going into the brain cancerclinic knowing there had been little advance in treatmentoptions for decades.“Like most surgeons, I spent all my time working tobecome better and better at what I did, but then one day Ihad this horrible moment when it struck me like a sledgehammerthat no matter how good I became at this, I stillwon’t be able to save my patients,” she said.“Glioblastomas have only a 10 per cent five-year survivalrate; they are the biggest killer in people under 40 and yetstill so little is known about them and I got sick of goinginto clinic knowing that the treatment I could offer nowwas no better than it was 10 years ago.“The treatment of breast, prostate and bowel cancershave been almost revolutionised in that time – fromdetection, to removal, to remission or cure – yet braincancers still remain as lethal as they were.“The difference is, of course, that those diseases have thefinancial resources available to support and advance thenecessary research.“So I decided to do something about it and while I dideverything I could think of to raise money, I also beganwork on the brain tumour bank to allow scientists toconduct DNA profiles of the pathology.”To do this, Dr Olson first approached brain tumourresearchers across Queensland to ask them what theyneeded; she reached agreement with her neurosurgicalcolleagues willing to process the tumour samples andfound a laboratory equipped to conduct the work atWesley Hospital.She then won support and funding from the John TrivettFoundation to pay for the annual running costs of thetumour bank.Since then, she has also forged links with both the CureBrain Cancer Foundation and the Brain Foundation.“When I first started fund raising for this I thoughtabout setting up a stand-alone charity, but it wasn’tpractical because of the costs involved in meeting legal andadministrative requirements, so instead I am working withother brain cancer charities,” she said.“It’s important, though, to remain focused and committedtoward particular goals that in my case is to support thegenetic profiling of as many tumour samples as possible.“That might sound straightforward, but it isn’t. I spenta great deal of time winning ethics approval for the projectand working out the logistics of how to store and transportsamples so they are of maximum value for the researchscientists.“The good news is, though, that now that all this hasbeen done, there is no reason we cannot standardise theproject across Australia and I am now meeting with likemindedpeople from other states to work on this.“We are also in discussions about extending the bank totake in tumour samples of all metastatic tumour samplessuch as those from the pituitary, lung and breast.”Dr Olson’s fund-raising campaign now sees hercompeting marathons, pushing raffle tickets, attendingcharity balls and dinners and speaking at public functions.Working as a teamDr Olson thanked her neurosurgical colleagues for theirsupport of the tumour bank.“All of us have similar feelings about the poor outcomesour patients face and they are also keen to advocate and getout there to push the case for our patients,” she said.“We all know that the days of throwing tumours in thebin belong to history now that scientific advances meanthey can be used as a resource to advance our knowledge.“It’s taken quite a bit of effort getting everyone from themajor charities, to the neurosurgeons, to the brain cancerresearchers all on the same page and while it’s a work inprogress we are getting there.“No glioblastoma is the same, so genetic profiling iscrucial if we are ever going to come up with personalisedtreatment plans.”Dr Olson, a mother of three, has a range of appointmentsoutside her surgical practice including Chair of themultidisciplinary brain tumour clinic at the PrincessAlexandra Hospital, surgical advisor to the AustralianPituitary Foundation and Senior Lecturer at the Universityof Queensland.Dr Olson said she was taken aback to hear of hernomination and short-listing for the award.“I’m a little embarrassed about the nomination, but if itraises awareness and therefore funding to boost research tohelp our patients then I’m happy to go along with it,” she said.“I would dearly love to see better treatment optionsand better outcomes for our patients during the course ofmy working life and I believe that is possible if all of usinvolved in this field work together and find the money topush the research forward.”With Karen MurphyFor more information visit www.curebraincancer.org.au14 Surgical News november / december 2014Surgical News november / december 2014 15

Trauma andIndigenous HealthYes, I would like to donateto our Foundation for SurgeryAll donations are tax deductibleYour passion.Your skill.Your legacy.YourFoundation.Name:Address:Email:ComingtogetherThe attendance of Indigenous health leaders at the2014 Trauma Symposium, ‘Indigenous Injury –learning from each other’ to discuss injury andtrauma in the Indigenous community should beconsidered a positive step forward, according to the Chairof the College Indigenous Health Committee, AssociateProfessor Kelvin Kong.The Symposium, which coincided with the 50thanniversary conference of the PSA, also brought togethermembers of the College Trauma Committee, Indigenoushealth leaders from Australia and New Zealand, internationaltrauma experts from Canada and India, politicians and localdoctors.Held in Darwin in August, the meeting was designed notonly to discuss ways to lower mortality and morbidity ratesin the Indigenous community caused by injury and trauma,but to hear first-hand from Indigenous health leaders aboutthe underlying factors behind the statistics.Speakers at the conference included Ms Donna AhChee from the Central Australian Aboriginal Congress, DrStephanie Trust from the Australian Indigenous Doctors’Association, Mr John Paterson from the Aboriginal MedicalServices Alliances of the Northern Territory and Dr HinemoaElder from the Health Research Council of New Zealand.Associate Professor Kong said the presence andSpeciality:Enclosed is my cheque or bank draft (payable to Foundation for Surgery) for $ .Please debit my credit card account for $ .Mastercard Visa AMEX Diners Club NZ BankcardCredit Card No: Expiry /Card Holder’s Name - block letters Card Holder’s Signature DateI would like my donation to help support:General Foundation ProgramsInternational Development ProgramsScholarship and Fellowship Programs Indigenous Health ProgramsI have a potential contribution to the Cultural Gifts ProgramI do not give permission for acknowledgement of my gift in any College publicationPlease send your donation to:AUSTRALIA & OTHER COUNTRIESFoundation for Surgery250 - 290 Spring StreetEast Melbourne , VIC 3002AustraliaNEW ZEALANDFoundation for SurgeryPO Box 7451Newtown, 6242 WellingtonNew ZealandTelephone:Tripartite meeting signalscommitment to issues for Trauma,Indigenous and Rural healthinvolvement of such health leaders indicated a growingawareness within the Indigenous community that theCollege was deeply committed to improving outcomes forIndigenous patients.“The presence of the Indigenous speakers changed theentire tone of the meeting allowing all of us to get a deeperunderstanding of the issues behind the high rates of injury andtrauma that we see in the Indigenous community,” he said.“While the College has recognised for some time thattrauma statistics are just one way of understandingIndigenous health issues, this meeting allowed for a widerdiscussion around trauma such as spiritual and emotionaltrauma and social dislocation.“The fact that such respected Indigenous health leaderswere keen to participate, I think, indicates that theyunderstand that the College wishes to walk beside them toimprove the care and well-being of Aboriginals, Torres StraitIslanders and Maoris whether they live in the city or remotecommunities.“The College has a long and proud history in advocatingfor social change to create safer communities – like the workdone to reduce drink-driving and the legislative requirementto wear seat-belts – and this meeting represented anopportunity for us to learn from those leaders about how wecan best help their communities.“Sometimes I think we forget how powerful the Collegecan be, yet I think in the past we haven’t really known whereour voice as surgeons belongs in the debate about Indigenoushealth. This meeting represented a change in that.”Associate Professor Kong said the College was nowactively lobbying the Northern Territory Governmentagainst unlimited speed limits, promoting improved accessto telehealth to treat severely injured remote patients whilethey wait for transport and pushing for limitations on thesale of alcohol to benefit the entire Australian community.He said the meeting also discussed the need for moreliaison officers to work with Indigenous patients and theirfamilies as they navigated the health system.Shared aspirationsThe first Aboriginal doctor in Australia to become asurgeon, Associate Professor Kong said the three daysof discussions and presentations helped consolidate agrowing sense of trust and shared aspirations betweenIndigenous leaders and the College.“The presence of the Indigenous health leaders meant agreat deal to me because in years past they would not havebelieved that the College was deeply interested in the issuesaffecting their communities,” Dr Kong said.“This meeting was very moving to me, then, because itbrought together not just Indigenous leaders and surgeons,but three Committees of the College, which indicates greatcommitment to tackling the issue as well as great collegiality.“I think sometimes people don’t realise how passionatesurgeons can be, not only about the welfare of their ownpatients but also the wider community.”The co-convenor of the Symposium, Mr David Read,said central issues addressed at the meeting included thedisproportionately high road death toll in the NorthernTerritory, injuries caused by alcohol and interpersonalviolence and the time taken to transport and transferseverely injured patients.A general surgeon and the Director of Trauma and Burnsat the National Critical Care and Trauma Response Centreat the Royal Darwin Hospital, Mr Read said members ofthe Indigenous community were over-represented in mostindices of trauma and injury.He said Aboriginal and Torres Strait Islander patientsnow represented 40 per cent of the Royal Darwin Hospitalcase load while representing only 29 per cent of the over-allpopulation in the NT.Latest statistics also show that the Northern Territorynow has the highest road toll in Australia at 17.31 deaths per100,000 people compared with 5.04 for the rest of Australia.“There are a number of very basic reasons why Indigenouspeople are over-represented in terms of injury and traumacaused by motor vehicle accidents,” Mr Read said.“There are often vast distances to travel, the variablequality of roads and cars, and the lack of public transportare all factors. The distance from pointof injury to definitive care is also oftensignificant.“The mean time now at the Royal DarwinHospital for severely injured patients to getinto a resuscitation bay is six hours comparedto other major trauma units in southernstates that can be as low as 30 minutes.“All of these issues affect Indigenous peopledisproportionately because they are morelikely to live in remote areas and they are morelikely to have to drive significant distances forcultural reasons or to access services.“The Symposium gave us the opportunityto not only look at the epidemiologybehind trauma in the Indigenous community,but to discuss ways we could improve outcomesthrough creating stronger links between traumaunits and remote medical centres to provide teleconsultationsto help stabilise severely injuredpatients while they wait for transport.”“We also discussed alcohol-related violenceand injury based around the RACS policy calledHours, Outlets and Taxes (HOT), an importantadvocacy initiative of the College.”Mr Read also described the presence ofIndigenous health leaders as a highlight of themeeting and said that their input would be usedto further refine the College’s Indigenous Healthpolicy.In particular, he said the call by Indigenous healthleaders for an increase in the number of Aboriginaland Torres Strait Islander liaison officers in hospitalsacross Australia should be promoted so that suchassistance becomes a core standard of care. uabove:From left: WarrenSnowden and CoconvenorDavidRead.inset: KevinKong16 Surgical News november / december 2014Surgical News november / december 2014 17

Trauma andIndigenous HealthRuralHealtho donatefor SurgeryHe said many surgeons would find sucha cultural and health resource invaluable.“The Indigenous health leaders werethe shining light of the Symposium,” MrRead said.“They were realistic, they wereforthright about what works and whatdoesn’t and they were generous with theirknowledge.“I think their presence made theSymposium unique and I think in timetheir contributions will help Fellows whowork within Indigenous communitiesto discern where gains can be made toimprove outcomes for Indigenous patientsacross the trauma spectrum.“One of the most profound statementsI heard during the conference came fromMs Ah Chee who said that Indigenouspeople did not want paternalism, butthe assistance to bring themselves out ofdisadvantage.“To me, that comment emphasisedthe need for us to keep in mind that anystrategy we adopt must be implementedin conjunction with, and with the supportof, the Indigenous community if it is tohave any meaningful impact.”With Karen MurphyWe would like to thank the following sponsorswho generously supported the Symposium:The Foundation for Surgery is the philanthropic armof the Royal Australian Telephone: College of Surgeons whoseSpeciality: support includes pioneering research into newmedical treatments, addressing the health inequitiesyable to Foundation for Surgery) for $ in Australia and New Zealand’s . Indigenous, remoter $ and . rural communities and supporting the expansionof medical capacity in the Asia Pacific region.Diners Club NZ BankcardExpiry /The National CriticalCard Holder’s SignatureDate Care and Traumahelp support:Response Centre whichamsInternational Development Programs ensures Australia andip Programs Indigenous Health Programs Royal Darwin Hospitaltion to the Cultural Gifts Programcan respond swiftlyr acknowledgement of my gift in any College publication and effectively to major:incidents in AustraliaNEW ZEALANDand South East Asia.Foundation for SurgeryPO Box 7451Newtown, 6242 WellingtonNew Zealand18 Surgical News november / december 2014Convenors Mahiban Thomasand Sarah WeidlichPSA MeetingGood feeling pervaded at meetingCarolyn VaseyThe Provincial Surgeons of Australia (PSA) meeting is onethat stands apart from any other; I remember the feelingas an intern at my first meeting of being among friendsopenly sharing surgical experiences with a sense of honesty andhumility, and that feeling has extended to the current day withthe 50th anniversary meeting of the PSA in Darwin being myfirst PSA as a newly graduated Fellow.Buoyed on by positive training experiences in regionalAustralia, it is heartening to see such a swell of youngerdelegates attending the PSA. The Rural Coach program,headed by Sally Butchers and supported by Trish Meldrum,is having a positive effect in supporting these Trainees.Nevertheless, the more mature age groups did not gounrepresented, with a well-attended session on retirementand the Jim Prior Begonia Prize (for the most original surgicalinnovation) this year going to Peter McNeil from WaggaWagga who accepted his award in full song!This year the scientific program focused on managing traumain regional areas. Guest speakers included Dr Grant Christeywho provided insights into trauma systems in regional NewZealand, Professor Ranijinkanth J from Christian MedicalCollege Vellore, India, who spoke about neck trauma andDr Rajiv Choudhrie from Padhar Hospital in Central andextremely rural India, who spoke on his moving personalexperiences with the separation of two conjoined twins in India.Carolyn Vasey and Phil Carson.ReviewLocal Territorian and master surgeon Assoc ProfessorPhil Carson spoke on a diverse range of topics fromthe history of surgery in Darwin through to thoracicsand hand surgery in regional practice. The free paperssection demonstrated the breadth and depth of researchbeing produced from regional units, with the best paperawarded to Dr Tara Luck on her study of neurosurgicalmanagement in the Northern Territory (NT).For the first time the PSA partnered with the RACSTrauma Committee meeting, which culminated inthe Saturday symposium on ‘Injury in IndigenousPopulations’, with many experienced practitionerscontributing to a discussion platform from which manyforward steps will be taken to better tackle longstandingissues facing indigenous populations in rural and regionalareas.Many thanks to the two conveners Mahiban Thomasand Stephanie Weidlich, who complemented each otherso well in organising both the scientific program and allof the fabulous dinners, each with a perfect dry-seasonDarwin sunset as a backdrop to the festivities.The personalised touches that pervaded the conference(from the hand painted gold crocodiles through to thethoughtful Territory style gifts for the guest speakers) didnot go unnoticed. Thank you also for the support providedby the College events team to bring this all together.We look forward to the 51st PSA meeting from October28 to 31, 2015 – with a particular invitation extended toany surgeon or Trainee working in provincial Australiaand New Zealand, regardless of specialty, to come along toLismore next year and see what the PSA is all about.Rural healthoutcomes will benefitfrom conferenceMedical student Jerry AbrahamAlex writes of his experience atthe PSA ConferenceAs a medical student wanting to pursue a careerin rural surgery, I was privileged to be sponsoredby the College Rural Surgery Section to attendthe PSA Conference 2014. With trauma and Indigenoushealth as the main themes, the list of guest speakers wasnothing short of phenomenal. The program covered allaspects of trauma from emergency department to headand neck, upper and lower limbs, thoracic, abdominaland pelvic injuries. It offered multiple sessions of shortduration, keeping the audience spell bound as thevarious specialists discussed some of their harder andobscure clinical vignettes.As the Co-Chair of the National Rural HealthStudents’ Network, I was able to represent theNRHSN, which acts as a national voice for all ruralhealth students to help address the disparity in healthoutcomes among Indigenous and non-Indigenouspopulations and between rural and metropolitanAustralia. The NRHSN supports students in ruralschools considering health careers and encourages themto return to rural areas. The meeting with the PSA isa significant milestone, as RACS is the first specialistcollege within the discipline of medicine to expressits support in partnering with the NRHSN to helpaddress the dearth of medical specialists in rural andremote Australia. It provides networking opportunitiesfor students to engage with potential mentors as theynavigate their way to specialty training.Managing a trauma scene competently requiresknowledge, experience, great teamwork and nerves ofsteel. Listening to the management of rural trauma inAustralia, Canada, New Zealand and India has helpedme understand how rural surgeons often utilise limitedresources to save lives. Innovation lies within the heartof rural Australia, as the economy of this nation wasonce dependent on this sector. Although we do notobserve much of that today, one thing is certain – thebrain power I witnessed at the PSA conference amongthese rural surgeons is a force, I believe, able to set inmotion ground-breaking work to dramatically improvehealth outcomes of rural and remote Australians inyears to come.With thanks also to Stephanie Weidlich and MahibanThomas for their kind invitation to attend.Surgical News november / december 2014 19u

RuralHealthAudits of SurgicalMortalityMotivatedby the PSA ConferenceFour Trainees tell of their PSA 2014 experiencesFindings presentedI was fortunate the abstract deadline forPSA 2014 coincided with me completinga small review project regarding theintroduction of acute general surgeryunit in Bendigo Hospital, Victoria. Iwas overjoyed when I was given theopportunity to present my findings to anaudience whom the results are relevant to.The sight of surgeon mentors andthe kind introduction afforded by BrianKirkby, who I have worked with, easedme into my oral presentation, which Iam glad was well received. I would liketo thank the GSA for the grant whichsupported my attendance at the PSA.Wei Ming Ooi,Rural TraineeInspirationalThe academic and social programs ofthe PSA ran like clockwork thanks to thehard work and planning of the organiserswho even managed to arrange balmy 25degree days and pleasantly cool nights.Inspirational presentations were givenby surgeons undertaking humanitarianwork, and I don’t think I was alone as Isurreptitiously wiped away tears whenRajiv Choudhrie described the lives andseparation surgery of conjoined twins athis rural hospital in Vellore, India.The rural coach project Traineeswere encouraged to use the conferenceto establish relationships and makeour interest clear at an early stage. Thecamaraderie between the older PSAmembers was evident, but youngermembers were seamlessly included. I waswelcomed in true country hospitality andwould like to thank the College, RuralCoach Project and the GSA for fundingmy attendance.Julie Flynn,Rural TraineeHigh quality careLocal Darwin surgeons presented at thePSA on their extensive experience inthe surgical management of mandiblefractures, neck and chest trauma. Ofparticular interest was the session fromthe National Critical Care and TraumaResponse Centre outlining its supportfor victims of Typhoon Haiyan. Anotherhighlight was the Jim Pryor Begoniaprize for ‘surgical innovation’, which washotly contested. Entries included a heatedponcho styled to fit under a surgicalgown, innumerable methods of gainingpneumoperitoneum, but the prize waseventually awarded for a modifiedwooden spoon designed for thoracicaortic compression.As my first visit to a PSA conference,I developed a better appreciation of thebroad, high quality surgical care beingdelivered in the provincial setting acrossAustralia and New Zealand and alsothe significant role rural and regionalsurgeons play in surgical training. Iwould like to acknowledge the support ofGSA and encourage any Trainee lookingto enrich their rural surgery trainingexperience or considering any future roleas a regional surgeon to get involved inthe rural coach project, apply for the GSAgrant and attend the PSA conference inLismore 2015.Jesse Beumer,Rural TraineeA bright futureThe first two days at the PSA were filledwith engaging talks related to ruraltrauma – from the approach to preventionof a frozen ‘open’ abdomen fromOllapallil Jacob to large mammal-relatedtrauma in the Yukon, Canada by AlexPoole. My interest in surgical history waspiqued with a thorough and insightfulnarrative of the history of rural surgery inDarwin by Phillip Carson.The strong attendance and multiplepapers suggest a bright future for Ruraland Trauma Surgery. The eveningscomprised of fantastic activities andvenues such as the Mindil Beach Markets,Parliament House and even encounterswith crocodiles and lions at CrocodylusPark. I would like to thank the GSA forthe grant which supported my attendanceat the PSA.Gausihi Sivarajah,Rural TraineeCase Note ReviewAn elderly patient fell, resultingin a fracture of the left proximalhumerus and a sub-capitalfracture of the left femur. When retrievedby the ambulance, the patient was fullyconscious and there was no evidence of ahead injury (or other injuries).The patient was admitted tohospital and operated on (under thesame anaesthetic) for both fractures(stabilisation of a two-part proximalhumerus fracture with a locked fixationdevice and a hemiarthroplasty of theintra-capsular fracture of the left hip). Theoperation report suggests minimal bloodloss and surgery time was not excessive.The patient had significant medicalcomorbidities including chronicrenal failure, mild chronic obstructiveA simple fall isnot so simpleairways disease (COAD), and previousgastrectomy with associated anaemia,gastritis and congestive cardiac failure.These comorbidities do not contraindicatethe appropriate surgicalstabilisation of these fractures. Indeed, ina patient of this nature it would have beenextremely difficult, if not impossible, tomanage them without fracture fixation.The patient had a cardiac arrest onday three post-operation and died. Thepatient was ‘not for resuscitation’ as per anadvanced health directive.CommentThe treating surgeons had little choice, butto perform the surgery that was undertaken.Early internal fixation of multiplefractures is indicated even when multipleGuy MaddernChair, ANZASMcomorbidities are present. This may verywell allow for best nursing care and reducedpain, even though a frail patient does nothave a long life expectancy.Although the patient had a difficultpostoperative course as a consequenceof the comorbidities, the assessor couldnot see anything in the medical record tosuggest that the postoperative course wascompromised by any area of management.There was nothing to indicate excessiveintraoperative or postoperative blood lossor other complications of surgery whichmay have worsened the situation.The assessor could see nothing ineither the decision to undertake suchsurgery or subsequent treatment that wasundertaken that would have prejudicedthis patient’s outcome in any way.Advance your careerwith Sydney Medical SchoolStudy the Graduate Certificateof Advanced Clinical Skills (SurgicalAnatomy) or the Master of Surgery,designed by respected academicsand clinicians. Improve your knowledge,connect with an influential networkand stand out from your peers.sydney.edu.au/medicine14/4504C CRICOS 00026A20 Surgical News november / december 2014Surgical News november / december 2014 21

Educationand trainingFellowshipServicesCourt of Examinersfor the FellowshipExaminationApplications from eligibleFellows willing to serveon the Court should beforwarded to the Departmentof Examinations of theCollege no later than Friday,30th January 2015 forappointment in 2015.Fellows are asked to notethe following vacancieson the Court, in thespecialties of:• General Surgery• Neurosurgery• Orthopaedic Surgery• Paediatric Surgery• Urology• Vascular SurgeryShould you wish to apply to be anExaminer/member of the Court ofExaminers, please forward yourapplication form with yourcurriculum vitae to:examinations@surgeons.orgor post to:Department of ExaminationsRoyal Australasian Collegeof Surgeons250 - 290 Spring Street,EAST MELBOURNE VIC 3002> Application forms are available fordownloading via the College websitewww.surgeons.org> The policy in respect toAppointments to the Court ofExaminers and Conduct of theFellowship Examination can befound on the College website.For inquiries, please emailexaminations@surgeons.orgExams now onlineThe first ever computer based RACS GenericSurgical Science Examination is a major milestoneRichard Wong SheChair, SSE&CE CommitteeOn October 9 and 10 this yearthe Generic Surgical ScienceExamination (GSSE) wasdelivered to more than 100 candidatesdistributed across seven locationsin Australia and New Zealand viacomputers based in a number ofexamination centres.Until now, all College examinationshave been paper based; the move to anelectronic format via the web for theGSSE heralds the first time a majorCollege examination has been deliveredin this way.The examination, which is arequirement for all SET Trainees, isrun over two days and tests basicknowledge of surgical Anatomy,Physiology and Pathology. In additionto MCQ type questions, the GSSE alsoincludes short answer questions (SpotTest Questions). These questions haverequired manual marking of eachpaper. This is labour-intensive and timeconsuming for the Anatomy Committeemembers, and a major barrier tooffering the GSSE beyond currentcapacity. This technology will supportthe delivery of the examination to manymore candidates, allowing access fornon-Trainees. The opportunity to sitthe examination prior to entry into SETwill enable the GSSE to become part ofpre-vocational training and in time, apre-requisite for application and entryinto SET.Work to establish a secure platformby which to deliver the exam and aprocess for collating and markinganswers was developed in-house by theIT staff with the support of the CollegeExaminations Department.This is a major milestone, not just inthe way the examination is delivered,but in building our capacity to offer theGSSE to a wider audience. Importantly,many improvements planned for thenear future will be supported throughthis initiative.Benefits associated with thisdevelopment include:• An improved exam experiencefor candidates; feedback from thecandidates was very positive.• More efficient marking that willsupport a faster turnaround ofresults.• Integration of examination deliverywith College plans for improveddigital interaction with Fellows andTrainees.• Paves the way for the GSSE tobecome widely available priorto entry to SET and ultimatelyto become a prerequisite for SETselection.The College is now looking forwardto expanding computer delivery toother examinations starting withSpecialty Specific Surgical Scienceexams in 2015. The written componentsof the Fellowship Examination are alsobeing considered for computer deliveryin the future.I would like to thank the CollegeExaminations and IT Departmentsfor their assistance in developing anddelivering the examination system.Thank you also to College Regionaloffice staff for their assistance onsite atthe examination venues across Australiaand New Zealand.Cathy FergusonChair, FellowshipServicesYour College serviceFind a Surgeon and Practice Card services updatedFind a Surgeon is a free to usedirectory listing service for allFellows of the College who are CPDcompliant.It is the most visited area of the website(after the College library), so it presents agreat opportunity to help your patients andreferring GPs to find you.The service has recently been givena refresh to make records more visuallyappealing and easier to understand, andthose Fellows who have a Practice Cardwill also now have their image shown intheir listing.To opt in to be displayed on Find aSurgeon, or to update your details, visit theMy Account section of My Page.Practice cardPractice Card is an extension of the Finda Surgeon facility that creates a page allabout you on the College website. It’sessentially a professional online businessbrochure that encourages both GP referralsand, if you choose, increased engagementwith prospective patients.Following feedback from our Fellows, theCollege has recently made improvements tothe Practice Card service to make it easiersetup and use.Firstly, your Practice Card can now befound via a more user friendly web addresswith your name or other text insertede.g. http://www.surgeons.org/profile/drgeneric-surgeonThis is a big improvementover the numeric URL used before; you cancertainly select your own words, but it willbe subject to approval before going live.Also, it’s now also easier to setup yourPractice Card. Your profile’s image can beresized and cropped online to save youtime, or if preferred, you can import yourheadshot from LinkedIn. Additionally, youcan now list up to three separate practices.Your Practice Card will now print neatlywhen required, so it’s useful for creatingpatient handouts.Why not check out the new and improvedFind a Surgeon and Practice Card areas nexttime you visit the College website.22 Surgical News november / december 2014Surgical News november / december 2014 23

inmemoriamOur condolences to thefamily, friends and colleaguesof the following Fellowswhose death has beennotified over the past month:Richard Wingate,NSW FellowClaude Mann,Qld FellowKenneth James Brown,Qld FellowGarth Powell,New Zealand FellowAlan Poole,NSW FellowEarl Owen,NSW FellowMark, McGree,Qld FellowDonald Golinger,WA FellowIain Macfarlane,New Zealand FellowMalcolm Stening,NSW FellowWe would like to notify readersthat it is not the practice ofSurgical News to publish obituaries.When provided they are publishedalong with the names of deceasedFellows under In Memoriam on theCollege website www.surgeons.orgInforming the CollegeIf you wish to notify the College ofthe death of a Fellow, please contactthe Manager in your Regional Office.They areACT: Eve.edwards@surgeons.orgNSW: Allan.Chapman@surgeons.orgNZ: Justine.peterson@surgeons.orgQLD: David.watson@surgeons.orgSA: Meryl.Altree@surgeons.orgTAS: Dianne.cornish@surgeons.orgVIC: Denice.spence@surgeons.orgWA: Angela.D’Castro@surgeons.orgNT: college.nt@surgeons.orgCurmudgeon’sCornerThe problemwith LycraWhy are they in such a rush?There is one thing that reallyannoys me and that is bicycles.It is not so much the machinebut the users and their attitude. Wecurmudgeons like to walk sometimesand some of the nice paths along theriver or beach are described as ‘sharedpaths’. The attitude of the cyclists is,“Yes, we will share our path with youas long as you get out of our way.” The‘Slow’ sign is interpreted as 1-2 kmsper hour less than maximum speed. Acyclist passing within 2cms at 60 kmsper hour is rather startling. If I wasquick enough my walking stick mightget stuck in their spokes.In my city we had a very good roadthat enabled a driver to get away fromthe CBD quite quickly– two lanes in eachdirection anda clearway. Sowhat have thenincompoops atthe city councildone? Theyhave amputateda lane in eachdirection for a fewparking spacesinterspersed withgarden and a bikelane on the innerby professor grumpymost portion of the road. An excellentCBD escape turned into a parking lot!In the many minutes that I have beenstuck there, how many bikes have Iseen? Not one!Why is it that some cyclists are alwaysin lycra and some look so, so – well,slim and gorgeous? (Some, however,reveal way too much information thatwould be better covered). How comethey don’t have sore backs that preventthem from leaning over the handle bars?Just because they are slim and gorgeousor think that they are slim and gorgeousdoes not mean they can cut in front ofcars or make rude gestures when wequite legitimately nick into the bike lanefor a few seconds to get past that slowcar ahead. We curmudgeons pay thetransport taxes of various sorts and thecyclists pay nothing – not a brass razoo!We pay for the bike lanes so on theprinciple of equity they are ours to doas we wish. I would turn them all backinto car lanes.The latest concession to these cyclingcommandos is special traffic lights forthem. At some intersections the busseshave a special green light, then thepedestrians and then the cyclists andat last a few seconds for the motorists.That way they can get in front againand congest the next set of lights withtheir metal monsters.The only cyclist that I would allowis my three year-old granddaughterand she would only be allowedon the back patio. As for therest of the lycra set I wouldsay to them, “On yourbike!”Don’t become a puddingSurgeonHealthHave a Healthy & Merry Christmasby Dr BB G-loved the case series of useless, readily discarded So what of King John’s list? Crackers –gifts from our family members over the maybe, if not too salty. Candy – bad, definitelya sugar fix. Chocolates – dark choco-years – driven by guilt, obligation andThe festive season heralds joy and advertising-induced commercial pressure. late has antioxidants and flavanols whichgaiety, but is laced with toxicity. Tom Lehrer aptly sang: ‘Angels from the improve cognition and cerebral perfusion,Christmas parties and family realms on high, tell us to go out and buy’! promote vasodilation, reduces blood pressure,gatherings, sparkled by the excitementof children and grandchildren, belie therisk of ulcerating atheromatous plaques,increased platelet adhesiveness andinflammation across the foregut.The Yuletide can be lethal. In theNorthern Hemisphere mortality ratesare highest in December and January.Downunder and in the Antipodes, whereChristmas may be spent lazing about onthe river, the beach or cowering from theheat in wafting vents of an airconditioner,mortality rates rise with the temperature,as do road fatalities with the festive season.Dr Chris Toomas has struggled with theusual features of impending metabolicsyndrome – hypertension (BP 160/105), hyperlipidaemia(Cholesterol 7.6mmol/l) andincreasing adipositiy (BMI 28). Chris is notcurrently diabetic, but could well developit over the next decade or so. So what cheer(advice) could I offer this busy and stressedEat well. Turkey is a lean meat sotradition is a healthy option. Cranberriesare rich in antioxidants, so a tick forthe sauce. Christmas pudding is, likeChristmas, a mix of the good, the badand the ugly. The pudding is high infibre, B vitamins, potassium, calciumand rich in antioxidants that emergefrom the raisins and sultanas, but alsopotentially glycaemic due to its sugarand carbohydrate load. The traditionalistwho smears or dowses it in brandybutter (1 tablespoon 15g = 81kcal, 5.8gfat, 3.9g saturated) and/or cream (2tbspor 30g of double cream has 133kcal,14.2g fat, 8.9g saturated) should ratherconsider vanilla custard or GreekYoghurt instead. And for those of youwho like brandy butter orcream, since when haveyou limited it to one ortwo tablespoons?inhibits platelet activity and decreasesinflammation. Wow! Enjoy in moderation.Avoid milk and white chocolate.Oranges are rich in flavanols as well asVitamin C, an antioxidant that reducesplasma lipid peroxidation – so idealfor stockings, even for grandparentswhose memories and mood will onlybenefit. Nuts are rich in magnesium,which reduces risk of hypertension,hyperlipidaemia, metabolic syndromeand obesity. The traditional Brazil nuts(410mg/100g) almonds (260mg/100g) andwalnuts (130mg/100g) are all good sourcesof magnesium and also provide zinc, forthose of you who think zinc after lastmonth’s column.I must admit I cannot recommend‘a pocket knife that cuts’, not even forKing John to commemorate the 800thanniversary of the signing of theMagna Carta next year. That pocketsurgeon for the on-rushing Christmas?knife portends alcohol fuelledMinimise stress that increasesviolence between relatives who’d ratherinflammatory markers. Free radicals should The traditionalnot congregate, but pretend they must;stocking wantsnot be allowed to play havoc with youror children playing with sharp knives (oras requested by AAneuroendocrine system. Relax, take aMilne’s King John:adults with chain saws) suffering fingerbreak, avoid last minute shopping and dolacerations requiring surgeons to spendnot enter a shopping mall. Providing you I want some crackers,Christmas managing wounds.are exercising, shop online; in time for yourpresents to be gift wrapped at source anddelivered without scuffing your shoes.Though it might be tempting to shoptill you drop, the malls are crowded withAnd I want some candy,I think a box of chocolates wouldcome in handy;I don’t mind oranges,I do like nutsAnd what of that red india-rubber ball?Whatever shape you like your balls, playingwith them is good for you. You and the kidscan be out in the park, or playing on thebeach, avoiding obesity. Chris Toomas can bedesperados and the prices are high. Last I haven’t got a pocket knife,stretching and strengthening back, buttockminute buys are usually poorly matched not one that cuts,and abdominal muscles across one of thoseeven when for a newborn. ‘Bearing gifts And Oh if Father Christmas had big gym balls which, providing there iswe trespass too far’.loved me at all,sobriety, won’t normally cause an injury. AndIn Oceania’s Orient we may not be He would have brought a big, on that note of sobriety – drink alcohol inKings; wisdom forsakes us when out of our red india-rubber ball.moderation, don’t drink and drive, and enjoycomfort zone Christmas shopping. Witnessa healthy and merry Christmas.24 Surgical News november / december 2014Surgical News november / december 2014 25

Audits of SurgicalMortalityProfessionalStandardsSurgical MortalityAn international perspectiveJohn NorthClinical Director,QASM and NTASMCPD VerificationIt’s not as hard as you think!Julie MundyChair, ProfessionalStandardsIn September 2014, I visited the RoyalCollege of Surgeons (Edinburgh)at the invitation of Mr Ian Ritchie(College President).During my visit, the College Vice-President and Director of the ScottishAudit of Surgical Mortality (SASM),Professor James Hutchison, organised agroup of interested parties to meet. Thisgroup discussed why the QueenslandAudit of Surgical Mortality (QASM) andwhy the Australian and New ZealandAudits of Surgical Mortality (ANZASM)successfully continue, whereas the SASMceased to audit in May 2014.Professor Hutchison described the slowand progressive reduction of surgeons’participation in SASM. This lack ofsurgeon support was the final blow towhat was initially seen as a golden age ofsurgical mortality audits in Scotland.Prior to May 2014, health bureaucratsin the United Kingdom’s NationalHealth Service (NHS) viewed the auditas a worthwhile activity. Unfortunately,the protection afforded surgeons inAustralia (that is, qualified privilege:the Commonwealth legislation thatprotects release of any information inany form) did not exist in Scotland. Formany reasons, over time, the surgeonsin Scotland lost enthusiasm aboutresponding to and being participants intheir surgical mortality audit.Elegant Specialistrooms for lease in Hawthorn.Available for lease 2 days per week (Wed & Thurs).Price on application. Professional consulting suiteswith fully equipped procedure room and lovelywaiting area for patients. On site parking close topublic transport.For enquiries please call 1300 073 239.When Dr James Aitken moved fromScotland to Australia and established theaudit process in Western Australia in 2001,the Scottish audit was functioning well.Sadly, SASM no longer exists.Senior health administration inScotland and the Executive ClinicalDirector of Health Improvement Scotland(HIS), Dr Brian Robson, joined ourEdinburgh-based meeting and expressedhis regret that the SASM had failed. Hesuggested that a morbidity and mortalityaudit for Scotland was his vision. Hesought advice on how to emulate thesurgeon participation/volunteerism thatwe know in Australia (and especiallyin Queensland with 100 per centparticipation of public and privatehospitals, and 100 per cent surgeonparticipation).There is no doubt that Australiansurgeons have been incredibly positiveabout and supportive of their surgicalmortality audits. They continue to bediligent in their returning of surgical caseforms, first-line assessments and secondlineassessments.This kind of surgeon involvement hascreated an extremely useful and robustdatabase. From this database, aggregatedde-identified data can be extracted bysurgeons and health care providers. Manylessons can be learned from this data atall levels of surgical care.Australian surgeons who areparticipating in their state-based surgicalmortality audits need to be congratulatedon their enthusiastic volunteerism.To Australian surgeons, I would say thatthis is your audit. This data is your data.You can learn from this data and you canuse this data to present, to publish and tochange practice that will improve surgicalhealthcare delivery across our nation.To know that the SASM has ceased isdisappointing, but we hope that out ofthe ruins of that establishment might risea ‘phoenix’ that will improve both themorbidity and mortality audit process inScotland. And thereby create a learningarena as strong as ours.My thanks to the Vice-President of theRoyal College of Surgeons, Edinburghand to the Executive Clinical Director ofHealth Improvements Scotland as wellas other participants; Dr Frank Dunn,President RCPSG, Dr Derek Bell, PresidentRCPEd and Surgical Vice-Presidents IanColquhoun and Mike McKirdy for theirenthusiastic participation when I joinedthem at Surgeons’ Hall in Edinburgh,Scotland.I would like to thank Professor GuyMaddern, Mr Gordon Guy and Ms ThereseRey-Conde for their assistance at thismeeting by teleconference.Looking for new rooms?Your chance now exists to secure a quality medicalconsult tenancy in a premier location of Glen Iris.The suites are being fitted out to the higheststandard with state of the art facilities.Price available upon application.For more information please contactROOMS WITH STYLE 1300 073 239If you are one of the seven per cent ofFellows who are asked to verify theirContinuing Professional Development(CPD) participation – don’t panic! It’s notas hard as you think!In November each year, notification issent to Fellows who have been randomlyselected to provide evidence of their CPDparticipation for that year.If you have been selected to verify youractivities in 2014, it is mandatory for youto complete your CPD online diary andprovide your verification evidence online.How do I use theOnline Diary?In four easy steps you can finalise yourCPD participation and upload evidence ofattendance:Step 1Logon to your Online Diary to check youroutstanding requirementsStep 2Enter any remaining activities relevant foryour practice typeStep 3Add supporting documents to anyactivities that are not College-runStep 4When you have entered your activities andattached evidence of participation, submityour diary by clicking the ‘Finalise my2014 CPD’.The College continues to refine theCPD program to improve usability forFellows. This includes a recurring eventstool for activities you regularly attend andthe ability to upload, store and retrievedocuments throughout the year as yougo. The more information you provide foractivities you attend throughout the year,the easier it is to verify your participationif you are randomly selected.What evidence can I useto support my CPD?The College accepts a wide range ofevidence to support your participationincluding:Surgical Audit and ANZASM(mortality audit)• A letter from your head of departmentconfirming your participation• A copy of the audit presentation• Certificate of participation for CHASM**The mortality audit is automatically verified for all statesother than NSW. This is not a requirement in NZClinical Governance• A letter from the Chair or Head of Unitconfirming your attendance• The first page of meeting minutes withyour name on the attendees listPerformance Review• Letters from head of unit/directorconfirming multisource feedback• Copy of learning plan• Letter from peer confirming practicevisit with details of the evaluation andaction plan• Summary and action plan of patientfeedback report• Letter from peer confirming they peerreviewed three of your medico-legalreportsMaintenance of Knowledge and Skills• Certificate of attendance for workshopsand scientific meetings• List of journals/articles read, copy ofreceipt for journal subscription• Letters to confirm teaching andsupervision• Copy or links to publications• Letters to confirm volunteer positionFor information on what documents areacceptable, please see the CPD Guidewhich can be found on the Collegewebsite: http://www.surgeons.org/policies-publications/publications/HELPFUL HINTSCheck your practice type to make sure itstill best reflects your current situationand review any activities that are alreadyin your CPD Online Diary, includingthose populated by RACS.Activities that have been automaticallypopulated through your attendance atCollege-run events do not need to beverified.For Fellows in operative practice, youneed to provide evidence to verify:Surgical Audit and Peer Review– If participating in a specialtygroup audit, ask theadministrators to provide youwith a certificate of participationANZASM– Only Fellows in NSW need toprovide evidence of participationin CHASM. All other Fellows(including NZ) do not needto enter an activity or provideevidence of participationClinical Governance Meetings– Set regular meetings (i.e. M&M)up as a recurring event in yourdiaryActivities that are not College run– The Head of Unit, Chair orDirector can provide youwith a letter confirming yourparticipation in a range ofactivities including Surgical Auditand Peer Review, attendance atClinical Governance meetings andTeaching/Supervision dutiesThe CPD Team is available to support youin completing your CPD and verificationrequirements. Please don’t hesitate tocontact the Fellowship and VerificationOfficer on +61 3 9276 7474 orcpd.verification@surgeons.org.28 Surgical News november / december 2014Surgical News november / december 2014 29

SectionsCTEC CADAVERIC WORKSHOPS 2015Experience Surgical Skills Training at its BestCTEC welcomes you to Perth for the ASC in May 2015 and invites you to attend SpecialistSurgical Skills Workshops at its leading facility at The University of Western Australia.Binational ColorectalCancer AuditChanges to make contributing to the audit easierAlexander HeriotChair, Colorectal CancerAudit CommitteeMatt RickardChair, Colon and RectalSurgery Section, RACSThere are around 18,000 new casesof colorectal cancer diagnosedin Australia and New Zealandeach year and it remains the secondmost common cause of cancer death.There have been many advances in themanagement of colorectal cancer over thepast decade including chemotherapy andscreening, but the primary treatment forbowel cancer remains surgery.The RACS Annual Scientific Congress(ASC) in Singapore highlighted theimportance of quality in surgery andthe integral role of audit in undertakinga continual evaluation of the work thatindividual surgeons undertake. It providesthe ability to both assess how we areperforming as surgeons and also theopportunity to identify areas where wecan improve our individual and hospitalpractice. A comprehensive binationalaudit provides the ability to benchmarkan individual’s personal results againstan appropriate comparative group.Collecting data in an efficient manner hasalways been a challenge for surgeons withincreasing demands on their time.The Binational Colorectal Cancer Audit(BCCA) was set up in 2006 under theauspices of the Colorectal Surgical Society(CSSANZ) and the Research, Audit, andAcademic Surgical Division of the Collegeto facilitate surgeons undertaking surgeryfor colorectal cancer to record and audit32 Surgical News november / december 2014their patients and benchmark their resultsagainst a large number of colorectalcancer cases across Australia and NewZealand. The audit was initially runthrough both the College and throughBioGrid Australia, with data being ableto be submitted on both paper forms andelectronically, uploading from hospitalbased servers. The BCCA database hasrecently been upgraded to allow onlinesubmission of data through a secure webportal, hence facilitating data input fromanywhere with Internet access.What does this meanfor me?The new database provides a numberof advantages to surgeons submittingpatients to the BCCA. Data can besubmitted from any computer withInternet access at any time. Any patientdata submitted by a surgeon remainsunder the ownership of the surgeon,or their supporting hospital if a publicpatient. A summary of all the datasubmitted by an individual surgeon, orby a hospital with appropriate approval,can be obtained at any time throughthe BCCA portal on the web. As well asan easy way to collect data on all thecolorectal cancer cases operated on bythe surgeon, the audit will also allowreal time benchmarking of the surgeon’spractice to the rest of the patients on thedatabase to be obtained at the same time.What do I need to doto get involved?All surgeons treating patients withcolorectal cancer are encouraged tocontribute patients’ data to the BCCA.This includes both general surgeons andcolorectal surgeons. It is necessary toobtain registration and ethical approvalat each centre and this will be facilitatedby the BCCA if it has not already beenundertaken. In order to maintain therunning of the audit, there is an annualfee of $100 for each surgeon submittingdata to the database.Continuing ProfessionalDevelopment (CPD)programParticipation in approved auditscontributes CPD points used in issuingof College CPD Certificate. Fellows willbe aware that in their annual AHPRAregistration they must state that theyare compliant with the CPD program.James Aitken recently outlined in thearticle ‘Value your Audit’ (‘Surgical News’,July 2014) that AHPRA itself will nowbe auditing 15 per cent of registrations.BCCA is an approved audit for CPDpurposes and participation assistscompliance with the CollegeCPD program.The Binational Colorectal Cancer Auditis an easy and convenient way to auditand benchmark the workload of surgeonstreating colorectal cancer across Australiaand New Zealand. Participation isvoluntary, but surgeons and hospitals areencouraged to get involved. For enquiries,contact Michaela O’Regan, BCCA projectmanager; telephone +61 3 9853 8013or email at bcca@cssanz.orghttps://bcca.registry.org.auCLAREMONT10 minsto Subiaco& LeedervillePosterior Spinal Pain WorkshopSaturday 2 May 2015 (8am-1pm)Suitable for Spine Surgeons,Radiologists, Registrars, Pain SpecialistsFee: $600Cardiothoracic SurgeryWorkshopSaturday 2 May 2015 (8am-5pm)Suitable for Cardiothoracic Consultantsand TraineesFee: $600Courses include• Fresh Frozen human cadaveric dissection• Didactic Sessions• All meals and refreshments• Limited places to maximise practical learningUWACTECHackett DriveSUBIACO(Entrance No.2)KINGSPARKMounts Bay RoadSWAN RIVERPlease support our Sponsors:PCECPERTH CITYSOUTH PERTHGetting to CTEC:10 min taxi drive from Perth CBD toThe University of Western Australia,Entrance No. 2 Hackett Drive, CrawleyBariatric Surgery WorkshopSunday 3 May and Monday 4 May 2015(8am-5pm both days)Suitable for Bariatric Fellows and TraineesFee: $300Note: Non-cadaveric simulation stationsRetroperitoneoscopicNephrectomy and LaparoscopicKidney Transplant WorkshopSunday 3 May 2015 (8am-5pm)Suitable for Transplant Fellowsand SurgeonsFee: $900Contact CTEC for further information and course content:www.ctec.uwa.edu.aulorna.christie@uwa.edu.auMain +61 (0)8 6488 8044Level 2 OncoplasticSurgery WorkshopMonday 4 May 2015 (8am-5pm)Suitable for Oncoplastic BreastSurgeons, Plastic Surgeons, SET 4-5Trainees and FellowsFee: $900Advanced Course inNeck Dissection forThyroid CarcinomaFriday 8 May 2015 (8am-5pm)Suitable for Fellows and JuniorConsultants in ENT/Endocrine SurgeryFee: $975Register online:www.ctec.uwa.edu.auCourse dates subject to change without notice. Course content, dates and convenors may be subject to change due to unforeseen circumstances.UniPrint 116911

Audits of SurgicalMortalityAutomatic ANZASMentry into CPD OnlineThe College is committed to strengthening and streamlining the CPD Program.Ian BennettChair, Research,Audit and Academic SurgeryIt is important that Fellows candemonstrate they meet the RACSstandards without the need foronerous record keeping. Participation inthe Australian and New Zealand Auditof Surgical Mortality (ANZASM) is aContinuing Professional Development(CPD) Program requirement that is nowautomated to save you time and effort.This improvement also increases therigour of the CPD Program.ANZASM is an independent peerreviewaudit of patient deaths thatcurrently takes place in all Australianstates and territories. Fellows inoperative practice must participatein the audit annually, irrespective ofwhether they have a patient death ornot. Participation relates only to thosein hospitals where the audit is availableto them. Fellows residing in NewZealand do not currently participatein ANZASM, but are expected toparticipate in other mortality reviewssuch as those run by their employingDistrict Health Board.Each audit of surgical mortality(ASM) is managed by a local office. InNew South Wales (NSW), however,the Collaborative Hospitals Audit ofSurgical Mortality (CHASM) is managedseparately by the Clinical ExcellenceCommission and provides de-identifieddata to ANZASM annually for nationalreporting.ANZASM aims to improve qualityof practice, highlight system errors andidentify trends in surgical mortality.Independent peer review takes place inthe form of first line and (if required)second line assessments. The audit isintended to be an educational ratherthan a punitive process and individualfeedback on clinical management from apeer promotes reflective learning.Case formsTo meet the CPD Program requirements,Australian Fellows who experience apatient death and receive a surgical caseform (SCF) must complete and returnthe form to their local ANZASM officewithin three months of receiving the SCF.As of 2014, Fellows who have met thisrequirement will have their ANZASMparticipation automatically populatedin their personalised CPD Online Diary.The diary will display the number ofoutstanding SCFs (for the period October1, 2013 - September 30, 2014) that need tobe completed and returned to ANZASM.Fellows selected to verify their CPDactivities are no longer required to providesupporting evidence for this activity.This improvement will ensure that onlyFellows who have met the ANZASMrequirement are eligible to receive theCPD Program Statement of Participation,which is required for ongoing medicalregistration. An ANZASM electronicinterface is available to assist Fellows tocapture audit information directly into asurgical case form template.Fellows who reside in NSW willcontinue to self-report their ASMparticipation through the CPD Program.NSW Fellows will receive a letter fromCHASM in January 2015 providinginformation regarding their participationfor the period October 1, 2013, toSeptember 30, 2014.If you have any questions about yourANZASM participation or requireassistance completing a surgical caseform, please contact your local ASMOffice. Further information about ANZASMis available at www.surgeons.org/anzasmStunning Specialist SuitesCollins Street Specialist Suites is a brand newconsulting centre in the heart of Melbourne’s CBDavailable for sessional or longer lease with allamenities included. Beautifully appointed - space,style and innovation exceeding every expectationin our purpose-built consulting and proceduralsuites furnished to the highest standards.• On-site undercover patient parking or 4 minute walk fromFlinders Street Station• Seminar area with built-in presentation facilities• Fitted with all latest technological support systemsincluding wireless Broadband and desktop computers• Secretarial support includedContact 03 8658 9529www.collinsstreetspecialistsuites.com.auConsulting RoomsSouthbank Melbourne CBDSpecialist consulting rooms lease opportunityavailable in GP clinic in Southbank MelbourneCBD, main road City Rd ground floor,great visibility amongst thousands of newapartments and 40000 cars daily, easy parking,massive potential.Email medidock.health@gmail.comEducational opportunities in 2015THE AUSTRALIAN SCHOOL OF ADVANCED MEDICINEMaster of Advanced Surgery in Craniomaxillofacial SurgeryBased in Adelaide at the Australian Craniofacial Unit, this degree can betailored to the individual surgeon. Candidates should have a postgraduatequalification in one of the following:- Plastic and Reconstructive Surgery- Neurosurgery- Oral and Maxillofacial Surgery- OtolaryngologyMaster of Advanced Surgery in Breast and Endocrine SurgeryBased at multiple sites across Sydney, this degree focuses on OncoplasticBreast Surgery and Minimally Invasive Thyroid/Parathyroid Surgery. Therewill be opportunities for clinical involvement at Liverpool Hospital’s EndocrineSurgical Unit and the Westmead Breast Cancer Institute.Graduate Diploma of AnatomyBased in Sydney this program is delivered primarily online and includes a16-day intensive focused on whole body dissection in our state-of-the-artanatomy laboratories. It offers ideal preparation for the SET Surgical ScienceExamination.For more information:T: +61 2 9812 3527E: asam.education@mq.edu.aumedicine.mq.edu.au/programsCRICOS Provider 00002J34 Surgical News november / december 2014Surgical News november / december 2014 35

SuccessfulScholar“This added to the value of my Fellowship because it allowed menot only to learn the techniques of functional neurosurgery andDBS, but to apply them across a range of complex cases”SmarttravelA College scholarship has helped Kristian Bulluss expand his skillsThe 2013 recipient of the Stuart MorsonScholarship in Neurosurgery, Mr KristianBulluss, used the stipend provided to undertakea 10-month Fellowship in Functional Neurosurgery atthe Radcliffe Hospital in Oxford, UK, one of the largestspecialist neurosurgical units in the United Kingdom.Functional Neurosurgery is a growing subspecialtythat seeks to modulate brain function either throughthe use of electrical stimulation or by destroying thoseparts of the brain that are misfiring or over-stimulated.In Australia, Functional Neurosurgery is used totreat movement disorders such as Parkinson’s disease,essential tremor, dystonia and the movement disordersassociated with multiple sclerosis.However, an increasing number of neurosurgeonsare now expanding their use of Deep Brain Stimulation(DBS) to treat such disorders through the use ofimplanted electrodes designed to alter brain activity.Mr Bulluss said DBS was also useful in thetreatment of some forms of epilepsy and was beingused by British surgeons to treat particular forms ofchronic pain.He said that the Fellowship in Oxford had allowedhim to work alongside experts such as Professor TipuAziz, Mr Alex Green and Mr James Fitzgerald at one ofEurope’s pre-eminent DBS units.“As this subspecialty has grown, many small functionalneurosurgical units have started around the UK that inturn has resulted in the Oxford unit being referred themore complex and complicated cases,” he said.“This added to the value of my Fellowship becauseit allowed me not only to learn the techniques offunctional neurosurgery and DBS, but to apply themacross a range of complex cases, disorders and for avariety of therapeutic uses.“I gained an insight into rare movement disordersthat we would be unlikely to see in Australia as well asthe ability to manage complex complications that canonly be seen in a unit with a large caseload such as theone at the Radcliffe Hospital.“I now have the skill set to supplement an existingDBS program as well as the ability to start a unit withina hospital that has not previously offered this type ofsurgical therapy.”All SoulsCollege,Oxford,EnglandMr Bulluss said the use of DBS had grownrapidly following the publication of a majortrial in the US six years ago, which wonthe procedure FDA approval for the use inmedical refractory focal epilepsy. Europeembraced the therapy the following year whileAustralia was now rapidly catching up.“This surgical therapy can be extremelyeffective for a range of disorders includingfor those patients with epilepsy that cannotbe treated surgically and those people withParkinson’s disease that are suffering from theside-effects of their medication,” he said.“The management of pain is the other bigarea of utility and in the Oxford unit about40 per cent of the caseload was using DBS forthe management of chronic pain, particularlyfor returning soldiers with wounds involvingsevere nerve damage.“However, given that is an expensiveprocedure, it is not approved for painmanagement in Australia.”Now back home in Melbourne, Mr Bullussis now providing DBS surgery at St Vincent’s,the Austin and Cabrini Hospitals.He said that each surgery took about threehours and involved the placement of electricalwires into the brain that are attached toan implanted device known as a brainpacemaker.He said he conducted such surgery a fewtimes each month, working closely withNeurologist Dr Wesley Thevathasan whocompleted a PhD at Oxford.Mr Bulluss said that one of the greatbenefits of the Fellowship in Oxford wasgaining the knowledge to assess whichpatients would have the most to gain by DBSas well as spinal cord stimulation.“Working closely with Dr Thevathasan,we assess the patient and take very detailedscans so we can see exactly which parts ofthe brain are misfiring or overstimulated,”he said.“In theatre, the patients are awake for about60 per cent of the procedure while we placethe wires, conduct tests and ask questions toensure the wires are positioned correctly.“The DBS therapy does not cure movementdisorders, but it can dramatically reducetremors and the side effects caused bymedication because the patient requires lessto manage their condition.“In Australia, over 95 per cent ofpatients having this treatment suffer frommovement disorders while we are planningto implant patients with medical refractoryfocal epilepsy.“DBS can make a great difference to thequality of life for the majority of thesepatients, which makes it an extremelyrewarding surgical service to offer.”International linksMr Bulluss said that one of the majorbenefits of his Fellowship in Oxford wasthe chance to develop strong links betweenUK and Australian Neurosurgeons andNeurosurgical Trainees keen to undertakereciprocal Fellowships in Melbourne.“I have retained those links with mycolleagues in the UK and Dr Thevathasanand I are also closely connected to our localcolleagues so we can extend this subspecialty,refine the technology and surgical placementand targeting of the electrodes and also topromote and conduct research,” Mr Bullusssaid.“In Australia we are now doing worldclass DBS surgery and research is nowbeing conducted at the Bionic Institute inMelbourne into neuro modulation.“Professor Mark Cook is also conductingresearch in the use of DBS for the treatmentof epilepsy by using DBS to remove seizuresin animal models at the Royal Melbourneand Austin hospitals.”Mr Bulluss thanked the College forits support in awarding him the travelscholarship.“I took my wife and children withme and the funds provided through theScholarship were greatly appreciatedbecause Fellowships such as the one inOxford aren’t greatly remunerated,” he said.“However, most of all I appreciatedthe opportunity to expand my skills andknowledge and develop links with such arenowned international institution.”The Stuart Morson Scholarship inNeurosurgery was established followinga donation by Mrs Elisabeth Morson inmemory of her husband. It is designedto assist young Neurosurgeons to traveloverseas to further their trainingor research.KristianBulluss:Career highlights2012 – 2013Neurosurgical FunctionalFellow, West Wing, JohnRadcliffe Hospital,Oxford, UK2012RACS Fellowship, RoyalAustralasian College ofSurgeons2012Doctor of Philosophy: “Earlygene expression followingperipheral nerve injury,” TheUniversity of Melbourne2012Royal Australasian Collegeof Surgeons Stuart MorsonScholarship in Neurosurgery2008Royal Australasian Collegeof Surgeons Foundationfor Surgery Scholarship($40,000AUD)Oxford oldcollegebuildings36 Surgical News november / december 2014Surgical News november / december 2014 37

ProfessionalStandards“The College will continue to review and enhancethe services that it offers to Fellows and advocateon issues that matter to the Fellowship”the highest standardsin surgical practiceJulie MundyChair, ProfessionalStandardsIn 2014 the Professional Standardsportfolio has been actively involved ina diverse range of consultations andpolicy initiatives aimed at promoting thehighest standards in surgical practice. Wehave keenly promoted and represented theviews and opinions of Fellows, ensuringthat the voice of surgeons is heard onmatters ranging from engagement withregulatory authorities to improvingpatient outcomes.Responding to KeyConsultationsThe College has participated in anumber of government and regulatoryconsultations and policy reviews over thepast 12 months. Responding to the MedicalBoard of Australia (MBA) consultationA busy and productive year in Professional Standardson standards regarding ContinuingProfessional Development (CPD), Recencyof Practice and Personal IndemnityInsurance, the College emphasised theimportance of close consultation withColleges and Speciality societies inproposals around CPD and revalidation.The College, recognising that CPD is arapidly evolving area, also recommendedthat standards be reviewed every threeyears rather than the proposed five years.The Prevention of HealthcareAssociated Infection (PHAIC) Committeereviewed and endorsed the ‘TherapeuticGuidelines: Antibiotic Version 15’ as asource of comprehensive information anda framework for medical practitioners toutilise in their management of antibioticprophylaxis and post-operative care.The guidelines highlight the continuingevolution of antimicrobial diseasemanagement that necessitates a proactiveand consistent approach from allstakeholders. The College recognises theimportance of these developments andthe PHAIC committee will be consideringfurther how it can actively promote theprinciples of antimicrobial stewardship inthe near future.The College has given its endorsementto ‘The Australian and New ZealandGuideline for Hip Fracture Care’, beingrepresented on the review committeeby Professor Ian Harris. The guide isdesigned to assist professionals providingcare for people with a hip fracture todeliver consistent, effective and efficientcare. Every person with a hip fractureshould be given the best possible chanceof making a meaningful recovery from asignificant injury and strategies should beput in place to reduce the occurrence offuture falls and fractures.The College responded to the‘Review of the National Registrationand Accreditation Scheme (NRAS)’ forhealth professions. While recognising thesignificant achievements of AHPRA andthe national scheme since its inceptionin 2010, there was some disappointmentregarding the scope and content ofthe review. The College suggestedthat a key focus for the review shouldbe an evaluation of notifications andcomplaints processes and strengtheningthe uniform standards and processesthat were established in the nationalscheme. Concern was also expressed at aproposal to introduce additional layers ofbureaucracy to address scope of practicedeterminations. The College believesthat the key issues of transparency,natural justice, timeliness and bettercommunication and support to all partiesare the core issues that AHPRA shouldwork towards improving.Policies andPosition PapersLong Elective Surgery ListsThe College responded to concerns overthe length of some elective operatinglists, developing a position paper thathighlights the inherent dangers associatedwith operating lists that exceed 12 hours.Issues discussed include the effect offatigue on psychomotor performance andcognitive awareness, strains placed uponstaff when operations conclude late atnight and the diversion of resources andcapacity away from emergency surgery.The College recommends that electiveoperating lists should be performedduring routine hours with appropriatefatigue management employed whena single elective case is expected to lastmore than 12 hours.Informed Consent & InformedFinancial ConsentThe College has been engaged inon-going consultations in reviewingits position on informed consentand informed financial consent. TheCollege recognises the autonomy ofpatients to make their own decisionsabout treatment pathways and theimportance of appropriate and readilyunderstandable information abouttreatment options, associated risk, costsand expected outcomes. The paperalso acknowledges that it is not alwayspossible to provide complete informationor predict outcomes with absolutecertainty, highlighting the importanceof communicating to patients anyuncertainty where possible. The positionpapers should provide both cliniciansand the public with a clear understandingof the responsibilities of all parties andthe elements that an informed consentprocess should involve.Elective SurgeryFollowing partnership with the AustralianInstitute of Health and Welfare (AIHW)in 2013 on elective surgery categorisation,the College has revised its position paperon Elective Surgery and incorporateda number of the accepted principlessuggested in the consultation. The workundertaken by College Fellows in thisarea has provided a solid foundationfor renewed advocacy that encouragesgovernments to further invest inelective surgery and for the continueddevelopment of sustainable and effectiveelective surgical waiting list schemesthroughout Australia and New Zealand.Excessive FeesThe College continues to engage inon-going discussions on excessive feeswith the President recently presentingat an Australian Medical Association(AMA) forum to convey the College’sposition. The College acknowledgesthat the majority of its Fellows chargeappropriate fees, but is also cognisant ofits obligations to champion standards inrelation to those surgeons who chargeexcessive and/or extortionate fees andthe risk this poses to the good standingof the profession. In 2015 the Collegewill continue to explore and respond tothis issue and we welcome the input ofFellows in shaping our ongoing response.Compliance in the CPD ProgramCompliance with the 2013 CPDProgram currently stands at 99.4 percent, the highest level of compliancewith the program since the Collegestarted reporting CPD in the annualworkforce data reports. With Councilsupport, non-compliance is nowmanaged as a breach of the Code ofConduct. A small number of Fellowsremained non-compliant and inSeptember were requested to completea statutory declaration reaffirming theircommitment to CPD and the College’sCode of Conduct. As has been statedin previous communications, failureto comply with CPD is considered abreach of the Code of Conduct withthe ultimate sanction being loss ofFellowship.Continuing Medical Education (CME)– Making CPD Participation EasyThe College approved over 250CME activities in 2014, providingan exceptionally diverse range ofopportunities for Fellows to completetheir CPD requirements across theRACS competencies. The ProfessionalStandards Committee have overseen theendorsement of a number of new CMEactivities, evaluating proposals againstrobust criteria that ensures the contentand educational value of the activitiesis relevant, up-to-date and in line withindustry best practice. From 2015College sponsored CME activities willalso be auto-populated into your CPDOnline Diary.Moving ForwardThe College will continue to reviewand enhance the services that it offersto Fellows and advocate on issues thatmatter to the Fellowship. As a memberdriven organisation, we invite you tocontact us on any matters you feel weshould address as your representatives.On behalf of the Professional StandardsCommittee, I wish you all the best forthe coming year and look forward toworking together with you on promotingthe highest standards in our profession.38 Surgical News november / december 2014Surgical News november / december 2014 39

AcademicSurgeryDeveloping a Careerin Academic SurgeryResearch from the CollegeBJSVenous issue• New evidence on treatments for varicose veins(this article is free online)• Systematic review, network meta-analysis andexploratory cost-effectiveness model of randomizedtrials of minimally invasive techniques versus surgeryfor varicose veins• Patient-reported outcomes 5–8 years after ultrasoundguidedfoam sclerotherapy for varicose veins• Short-term complications and long-term morbidity oflaparoscopic and open appendicectomy in a national cohort• Small bowel obstruction, incisional hernia and survivalafter laparoscopic and open colonic resection (LAFA study)www.bjs.co.ukSystematic reviewAugust 2014 Volume 101 Number 9BJSiPhoneAppAVAILABLE NOW“Surgical simulation:Efficient, safe and available.”Dawe, S. R., et al. (2014).“Systematic review of skills transferafter surgical simulation-based training.”British Journal of Surgery 101(9): 1063-1076.Systematic review of skills transfer after surgicalsimulation-based trainingS. R. Dawe 1 , G. N. Pena 1,2 , J. A. Windsor 4 , J. A. J. L. Broeders 2 , P. C. Cregan 3 , P. J. Hewett 2 andG. J. Maddern 1,21 Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), Royal Australasian College of Surgeons, and2 Discipline of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia, and 3 Department of Surgery, University of Sydney,Nepean Clinical School, Penrith, New South Wales, Australia, and 4 Department of Surgery, University of Auckland, Auckland City Hospital, Auckland,New ZealandCorrespondence to: Professor G. J. Maddern, Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S), RoyalAustralasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia 5006, Australia (e-mail: asernips@surgeons.org)Background: Simulation-based training assumes that skills are directly transferable to the patient-basedsetting, but few studies have correlated simulated performance with surgical performance.Methods: A systematic search strategy was undertaken to find studies published since the last systematicreview, published in 2007. Inclusion of articles was determined using a predetermined protocol,independent assessment by two reviewers and a final consensus decision. Studies that reported on theuse of surgical simulation-based training and assessed the transferability of the acquired skills to apatient-based setting were included.Results: Twenty-seven randomized clinical trials and seven non-randomized comparative studies wereincluded. Fourteen studies investigated laparoscopic procedures, 13 endoscopic procedures and sevenother procedures. These studies provided strong evidence that participants who reached proficiency insimulation-based training performed better in the patient-based setting than their counterparts whodid not have simulation-based training. Simulation-based training was equally as effective as patientbasedtraining for colonoscopy, laparoscopic camera navigation and endoscopic sinus surgery in thepatient-based setting.Conclusion: These studies strengthen the evidence that simulation-based training, as part of a structuredprogramme and incorporating predetermined proficiency levels, results in skills transfer to the operativesetting.Paper accepted 30 January 2014Published online 15 May 2014 in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.9482IntroductionSimulation-based training allows trainees to learn technicaland non-technical skills without risking patient safety 1,2 .It is increasingly being incorporated into surgical trainingor mandated by registration bodies 3 . Before simulation isincorporated into training curricula, important questionsmust be answered: does it work (train the appropriateskills) and how well does it work (does it improve skillsperformance in the patient-based setting and how strongis the evidence 4,5 )?A systematic review 6 published in 2007, which included12 randomized clinical trials (RCTs) and two nonrandomizedcomparative studies, found that surgicalsimulation-based training appeared to result in skillstransfer to the patient-based setting. However, the included40 Surgical News november / december 2014studies were limited by design and variable quality whichreduced the strength of the conclusions. The emergenceof new information is important 7 and the publication ofstudies in the past 6 years, during which there have beenimprovements in simulation-based training programmes,may have modified this conclusion. An important aspecthas been the requirement to reach a predetermined level ofproficiency in simulation-based training (often related tothe ‘expert’ surgeon’s level) 8–11 before the trainee proceedsto the patient-based setting.Whether the skills learnt by a trainee in surgicalsimulation-based training transfer to performance inthe patient-based setting must be tested for compliancewith standards to meet patient need. Recent studiesacknowledge the importance of objective assessment for© 2014 BJS Society Ltd BJS 2014; 101: 1063–1076Published by John Wiley & Sons LtdSLAv259n2-Cover_SLA 12/24/13 12:44 AM Page 1Volume 259 ● Number 2 ● February 2014 ISSN 0003-4932ANNALS OFSURGERYA Monthly Review of SurgicalScience and Practice Since 1885www.annalsofsurgery.comSimulation of cholecystectomyand endoscopy works!Dawe, S. R., et al. (2014).“A systematic review of surgical skills transferafter simulation-based training: Laparoscopiccholecystectomy and endoscopy.”Annals of Surgery 259(2): 236-248.REVIEWA Systematic Review of Surgical Skills Transfer AfterSimulation-Based TrainingLaparoscopic Cholecystectomy and EndoscopySusan R. Dawe, MSc, ∗ John A. Windsor, MBChB, MD, FRACS, FACS,† Joris A.J.L. Broeders, MD, PhD,‡Patrick C. Cregan, MBBS, FRACS,§ Peter J. Hewett, MBBS, FRACS,‡ and Guy J. Maddern, MBBS, PhD, FRACS ∗ ‡Objective: A systematic review to determine whether skills acquired throughsimulation-based training transfer to the operating room for the procedures oflaparoscopic cholecystectomy and endoscopy.Background: Simulation-based training assumes that skills are directly transferableto the operation room, but only a few studies have investigated the effectof simulation-based training on surgical performance.Methods: A systematic search strategy that was used in 2006 was updated toretrieve relevant studies. Inclusion of articles was determined using a predeterminedprotocol, independent assessment by 2 reviewers, and a final consensusdecision.Results: Seventeen randomized controlled trials and 3 nonrandomized comparativestudies were included in this review. In most cases, simulation-basedtraining was in addition to patient-based training programs. Only 2 studiesdirectly compared simulation-based training in isolation with patient-basedtraining. For laparoscopic cholecystectomy (n = 10 studies) and endoscopy(n = 10 studies), participants who reached simulation-based skills proficiencybefore undergoing patient-based assessment performed with higher global assessmentscores and fewer errors in the operating room than their counterpartswho did not receive simulation training. Not all parameters measured wereimproved. Two of the endoscopic studies compared simulation-based trainingin isolation with patient-based training with different results: for sigmoidoscopy,patient-based training was more effective, whereas for colonoscopy,simulation-based training was equally effective.Conclusions: Skills acquired by simulation-based training seem to betransferable to the operative setting for laparoscopic cholecystectomy andendoscopy. Future research will strengthen these conclusions by evaluatingpredetermined competency levels on the same simulators and using objectivevalidated global rating scales to measure operative performance.Keywords: endoscopy, laparoscopy, simulation, surgery, systematic review,training(Ann Surg 2014;259:236–248)From the ∗ ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, SouthAustralia, Australia; †Department of Surgery, Middlemore Hospital, Auckland,New Zealand; ‡Discipline of Surgery, University of Adelaide, The QueenElizabeth Hospital, Adelaide, South Australia, Australia; and §The Universityof Sydney, Nepean Hospital, Penrith, New South Wales, Australia.The ASERNIP-S project is funded by the Australian Commonwealth Departmentof Health and Ageing and the South Australian Department of Health. TheASERNIP-S project receives no support by commercial sponsorship.Disclosure: Professor John Windsor is director and educational advisor, SimticsLtd. No authors declared any relevant financial interests. Other authors have noconflicts of interest.Reprints: Guy J. Maddern, MBBS, PhD, FRACS, Australian Safety and EfficacyRegister of New Interventional Procedures—Surgical (ASERNIP-S), RoyalAustralasian College of Surgeons, 199 Ward St, North Adelaide SA 5006,Australia. E-mail: asernips@surgeons.org.Copyright C 2013 by Lippincott Williams & WilkinsISSN: 0003-4932/13/25902-0236DOI: 10.1097/SLA.0000000000000245Surgical simulators have an increasing role in the instruction andtraining in surgical skills, and simulation-based training with lifelikeexperiences has the potential to make a significant contributionto evolution of the surgical curriculum. 1 A surgical training programshould combine training for technical and nontechnical skills, andfor working as part of a team in the operating room, to make themost effective use of available resources and to maximize patientsafety. Although simulation-based training programs were initially“add-ons” to traditional surgical training, simulation-based trainingis increasingly being incorporated into curricula or even mandated byregistration bodies, such as the American Board of Surgery that hasrequired Fundamentals of Laparoscopic Surgery (FLS) certificationsince 2009. 2In 2007, our group published a systematic review which concludedthat simulation-based training seemed to result in skills transferto the operative setting. 3 However, it was noted that the includedstudies were of variable quality and design that limited the strengthof this conclusion. Since then, the number of studies addressingtransferability of simulation-based skills to the operative setting hasincreased. 4 There have been improvements in simulation-based trainingprograms.The methodology of recent studies has improved by acknowledgingthe importance of objective assessment when measuringcompetence in the operative setting to make valid comparisons betweensimulator-based and/or patient-based training. A number ofprocedure-specific objective global assessment scales that can beused in operative settings have been developed and validated. Theseinclude the Anaesthetist’ Nontechnical Skills global rating scale, 5Global Objective Assessment of Laparoscopic Skills (GOALS), 6Objective Structured Assessment of Technical Skills, 7 OrthopaedicCompetence Assessment Project, 8 and United Kingdom (UK) JointAdvisory Group on Gastrointestinal Endoscopy Direct Observationof Procedural Skills assessment form. 9 Other studies modify globalrating scales developed by others 10 or developed their own. 11,12The aim of this systematic review was to determine whetherskills acquired through simulation-based training are transferable tothe operating room for the procedures of laparoscopic cholecystectomyand endoscopy.METHODSThis systematic review was limited to the literature relatingto laparoscopic cholecystectomy and endoscopy (colonoscopy,sigmoidoscopy, or esophagogastroduodenoscopy). The comprehensiveAustralian Safety and Efficacy Register of New InterventionalProcedures—Surgical reports 61 3 and 80, 4 which include additionalprocedures investigated, and can be found online at http://www.surgeons.org/asernip-s/.Literature Search StrategyAll randomized controlled trials (RCTs) and nonrandomizedcomparative studies (non-RCTs) reporting on the use of236 | www.annalsofsurgery.com Annals of Surgery Volume 259, Number 2, February 2014Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.© 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd © 2013 by Lippincott Williams and Wilkins.Monday 4 May 2015, 7:00am - 4:00pmPerth Convention and Exhibition CentrePerth, AustraliaProvisional ProgramSession 1 A Career In Academic SurgeryWhy every surgeon can and should be an academic surgeonWhere do good research questions come from?Clinical effectiveness researchTechnology enhanced learning in surgeryEducational researchHot Topic in Academic Surgery: NanotechnologySession 2 Presenting Your WorkWriting an abstract, choosing your journalSubmitting and revising your manuscriptPresenting your workPanel discussionKeynote Presentation: How to be awarded a Nobel Prize in Medical ResearchProfessor Barry Marshall, Nobel LaureateSession 3 Concurrent Academic WorkshopsWorkshop 1: Tools of theTradeBuilding a careerpathway: opportunities,obstacles and gettingpast themGetting started as anacademic surgeonWhy a Trainee shouldconsider fulltimeresearchSession 4Workshop 2: Residents /RegistrarsIs a higher degree worthpursuing? Which one?When?Overseas experience –clinical or research andwhen?A Career In Academic SurgeryFinding and being a mentorLocal research changing local practiceThe future of academic surgeryWho should attend?Surgical Trainees, research Fellows, earlycareer academics and any surgeonwho has ever considered involvementwith publication or presentation of anyacademic work.If you have been to a DCAS coursebefore, the program is designedto provide previous attendees withsomething new and of interest eachyear.Presented by:Association for Academic Surgeryin partnership with theRACS Section of Academic SurgeryWith special guest speakerNobel Laureate Professor Barry MarshallWorkshop 3: CareerAcademicsBuilding a career pathway:opportunities, obstaclesand getting past themGrants/funding/writingsessionAcademic surgery inprivate practice2014 comments“Incredibly thorough and worthwhile day.Inspirational as a young Trainee on anacademic path, it was good to bereinvigorated.”“Thank you for organising this. It was verysmoothly run and a valuable and veryuseful overview of how surgical practiceand research interact.”Royal Australasian College of SurgeonsSection of Academic SurgeryInternational Faculty include:Anthony Gallagher, UniversityCollege, Cork, IrelandAssociation for AcademicSurgery invited speakers:Justin Dimick, University of Michigan,Ann Arbor, Michigan, USAAmir Ghaferi, University of Michigan,Ann Arbor, Michigan, USACaprice Greenberg, University ofWisconsin, Madison, Wisconsin, USAMuneera Kapadia, University ofIowa, Iowa City, Iowa, USAJohn Mansour, University of TexasSouthwestern Medical Center, Dallas,Texas, USACarla Pugh, University of Wisconsin-Madison, Wisconsin, USAJulie Ann Sosa, Duke UniversityMedical Center, Durham, North Carolina,USAInvited speakers will also include highlyregarded faculty from Australia andNew Zealand.DCAS course registrationCost: $220.00 per personRegister on the ASC registration form oronline at asc.surgeons.orgThere are fifteen complimentary spacesavailable for interested medical students.Medical students should register theirinterest to attend by emailingdcas@surgeons.org.Further informationConferences and Events ManagementRoyal Australasian College of SurgeronsT: +61 3 9249 1273F: +61 3 9276 7431E: dcas@surgeons.orgProudly sponsored by:NOTE: New RACS Fellows presenting for convocationin 2015 will be required to marshal at 3:45pm for the Convocation Ceremony.CPD Points will be awarded for attendance at the course with point allocation to be advised at a later date.Information correct at time of printing, subject to change without notice.As per Regulation 4.9.1a for the SET Program in General Surgery, Trainees who attend the RACSSurgicalDevelopingNews novembera Career/ decemberin Academic2014 37Surgery course may, upon proof of attendance, count this course towards one of the four compulsory GSA Trainees’ Days.

ProfessionalDevelopmentA productive yearAcademy of Surgical Educators reflect on 2014Julian SmithChair, Professional DevelopmentChair, Academy of Surgical EducatorsStephen TobinDean of EducationThe Academy of Surgical Educators(ASE) has enjoyed anotherproductive year in 2014 with theestablishment of a membership baseof over 550 and around 1100 attendeesparticipating in our surgical educatorrelated activities and courses.The Academy was established tosupport, enhance and recognise surgicaleducators within the College. Since itsinception, it has evolved into an activecommunity of practice and this yearhas started to reward and recognisethe contributions of its surgicaleducators. The inaugural winners ofthe Educator of Merit – Supervisor/ International Medical GraduateClinical Assessor of the Year Awardrecipients are Prof Phillip Walker forQLD and Prof David Hardman for theACT. The Educator of Merit Award –Professional Development Facilitatorof the Year award has been won by MrDavid Birks of Victoria. The AcademyAward winners were presented withtheir awards at the Academy Forum onNovember 13, 2014.The Academy also recognises all servingSupervisors and Professional Developmentfacilitators with the Educator ofCommitment Awards. Upon acceptance asa supervisor or facilitator for professionaldevelopment courses a certificate is issued.Then a bronze lapel pin and certificate willbe awarded at three years, a silver lapel pinand certificate at six years and gold lapelpin and certificate after nine years. Thisrecognition of service will commence inearly 2015.As part of the Academy’s publicawareness campaign, the Dean ofEducation has been presenting aboutthe Academy of Surgical Educators andits educational products such as theFoundation Skills for Surgical Educatorscourse. Presentations have beendelivered at the RACS Annual ScientificCongress, International Conferenceon Surgical Education and Training(ICOSET), Australian and New ZealandAssociation for Health ProfessionalEducators (ANZAHPE), InternationalConference on Residency Education(ICRE) and the Australian and NewZealand Medical Education TrainingForum (ANZMET) incorporatingthe National Prevocational MedicalEducation Forum.The Academy offers a range ofeducational activities, resources andrecognition to its members in order tosupport them in their role as a surgicaleducator. Educational activities deliveredthis year have included the ConjointMedical Education Seminar, AcademyForum, National Simulation HealthEducator Training program (NHETSim), Foundation Skills for SurgicalEducators, Supervisors and Trainers forSurgical Education and Training (SATSET), Keeping Trainees on Track (KTOT),Surgical Education and Training SelectionInterviewer Training (SET SIT), Non-Technical Skills for Surgeons (NOTSS),Surgical Teachers Course, GraduateDean of EducationStephen Tobin withRACP President LesBolitho at the 2014Conjoint MedicalEducation Seminar on‘Revalidation’.Programs in Surgical Education and theEducator Studio Sessions.The 4th International MedicalSymposium on ‘Revalidation’ was held onFriday, March 14, at Hilton on the Park,Melbourne. It was hosted by the RoyalAustralasian College of Surgeons, theRoyal Australasian College of Physiciansand Royal College of Physicians andthe Surgeons of Canada and involvedinternational and domestic presentersincluding Sir Peter Rubin, Dr John Adams,Mr Barry Beiles, Dr Craig Campbell,Dr Linda Snell, Dr Joanna Flynn, ProfLiz Farmer, Dr Jocelyn Lockyer and DrWilliam Pope. Next year the topic is the‘The Future of the Medical Profession’ andwill again involve the three colleges, aswell as the Australian and New ZealandCollege of Anaesthetists and the RoyalAustralian and New ZealandCollege of Psychiatrists.The Academy hosted its second Forumin Adelaide with presentations fromAssoc Prof Alison Jones on ‘DevelopingProfessionalism in Trainees’ and Assoc ProfDavid Hillis on ‘Surgeons are role modelsfor professionalism’. This was deliveredin association with the Surgical ResearchSociety and Section of Academic Surgeons.The National Health Education andTraining in Simulation is a program forsurgical educators who use or intend touse simulation as an educational methodto support the education and training ofsurgeons. Unfortunately the funding hasceased for this program so it will not beoffered in 2015; however, this year we wereable to offer five courses – four in basictraining and one advanced, qualifying 82surgeons over the course of the programas accredited NHET Sim graduates.The Foundation Skills for SurgicalEducators has been successfully pilotedin Noosa – prior to the QueenslandASM, Queenstown – prior to the NZASM, Ballarat and in Perth – prior to theGSA ASM and eight to ten courses arescheduled for delivery around Australiaand New Zealand in 2014.The SAT SET and KTOT educationalprograms have been in circulation for anumber of years now and are in need ofreview. This work is currently underwayand the new programs and correspondingonline programs will be rolled out in 2015.The Educator Studio Sessions showcasepresentations from renowned medicaleducators on topics of interest to members.Six sessions* were delivered in the 2014period including: A/Prof Victoria Brazilin Melbourne; Dr Sarah Yardley in GoldCoast; Dr Gabrielle Reddy in Melbourne;Dr Nick Sevdalis in Adelaide; Dr SimonPatterson Brown in Melbourne and ProfBrian Jolly in Melbourne. 243 membershave participated in the sessions this year.The Graduate Programs in SurgicalEducation offered jointly by the Universityof Melbourne and the College offer a suiteof programs that address the specialisedneeds of teaching and learning in a modernsurgical environment. Congratulationsmust be extended to our first cohort offive Masters graduates who complete theirstudies at the end of this year.The Academy is supported by aninteractive online learning communitywhere members can gather ideas, shareinterests and research, find resources andkeep abreast of upcoming events. Theenvironment is supportive, collaborativeand fosters enthusiasm in surgicaleducation. It includes: a discussion forum,resources, links to articles, e-newsletters,grant information and researchopportunities, listings of workshops andcourses, pathways to become trainers andsupervisors and award information. Pleaselet us know your thoughts about the styleand content of the online approach.Membership of the Academy is open to allFellows and Trainees and external medicaleducators who have strong educationalinterests and expertise. For moreinformation on getting involved in Academyactivities or how to become a memberplease contact Kyleigh Smith on+61 3 9249 1212 or ase@surgeons.org* To access the vodcasts for the abovesessions, login to the College website,go to My Page, eLearning, Academy ofSurgical Educators, Resources.InternationalThe Future of the Medical ProfessionRoyal Australasian College of Surgeons Royal College of Physicians and Surgeons of Canada The Royal Australasian College of Physiciansin association with Australian and New Zealand College of Anaesthetists The Royal Australian and New Zealand College of PsychiatristsSymposium OrganiserE: ims@surgeons.orgT: +61 3 9249 1260Medical Symposium. . .Friday 13 March 2015 Sofitel Melbourne On Collinshttp://tinyurl.com/IMS201542 Surgical News november / december 2014Surgical News november / december 2014 43

LibraryReportHeritageand ArchivesDonations and new itemsOn leave in Egypt - surgeons, William Kay (second from left) and Hugh Poate (at right). Credit: AWM C02157Some excellent additions to the library collectionMarianne VonauTreasurerThe library is extremely grateful fordonations from the authors of thefollowing new books, which arenow included in the collection.W. Bruce Conolly and others. AHistory of the Sydney HospitalHand Unit 1972-2012Sydney Hospitalis Australia’sfirst hospitaland membersof the hand unitparticipated inthe world’s firsthand transplantin France in 1988.They have contributed extensively toresearch on surgery and rehabilitationof the hand and have provided supportto many developing countries. Theirteaching model has been internationallyrecognized and emulated in othercountries.The book includes a brief history ofthe hospital itself along with chapterson the history of hand surgery and handtherapy in the unit as well as nursingand social work. Brief patient testimoniesaccompany these chapters and giveinsight into the benefits that have accruedto a range of patients (including a formerAustralian rugby captain).Chapters on research, publicationsand achievements as well as projects indeveloping countries are included.Overall, the book gives testament tothe author’s words that “In my worldwidetravels I had never seen a hand unit likethe one at Sydney Hospital”.Prof. Conolly AM has been a Fellowof RACS since 1965. His awards includeExcellence in Surgery (RACS) PaulHarris International Rotarian Fellowship,Pioneer in Hand Surgery (IFSSH).He holds academic positions at theUniversity of NSW, University of Sydneyand University of Notre Dame. He hasauthored or co-authored seven books and70 other publications on Hand Surgeryand Rehabilitation.John C Hall. From ColonialSurgeons to Royal Fellows: thecontext and social history ofsurgery in Western Australia1829-1958.The author emphasisesthat the book “is nota ‘scholarly’ work”and has been “writtenfor people who areinterested in surgery”.Before moving ontosurgery the bookdevotes a chapter onthe Swan River Colony which sets thecontext for the chapters to follow.The next chapters then provide anarrative of the path of surgery andsurgeons in the west up until 1958.Details of the careers of a numberof early surgeons are provided in thechapter on colonial surgery. Subsequentchapters move through the landmarks ofAustralian history; settlement, federation,the world wars and post-war recovery.Along the way, we are reminded thatSimpson (i.e. John Kirkpatrick, famousfor his and his donkey’s efforts atGallipoli) was in Perth at the outbreak ofwar and embarked from Fremantle. Alsoof interest is the development of the RoyalFlying Doctor Service and its importancein a state which encompasses vastdistances and some of the most remoteplaces in the world.Less well known individuals and theirlives and times are also found in the pagesof this book which should appeal morewidely than just those with an interest inthe west of the continent.Prof. Hall has been a Fellow of RACSsince 1976 and has received awards (JohnMitchell Crouch Fellow) and medals (SirLouis Barnett Medal) for his researchand contributions to surgery. He was alsoInterim Dean of Education for RACS.The following new book was purchased forthe collection and is also available for loan:Christopher Verco, AnnetteSummers, Tony Swain& Michael Jelly. Blood,Sweat and Tears: MedicalPractitioners and MedicalStudents of South AustraliaWho Served in World War 1.A hundred years afterthe commencementof ‘The Great War’,this title about thecontribution ofSouth Australiahas recently beenpublished. Themain focus is theprovision of over 200 biographies of onepage in length. The biographies are oftenaccompanied by excerpts from primarysources such as contemporary letters orspeeches. Each entry also contains a listof sources, often with URL hyperlinksincluded for further information availablein archives or libraries.Flicking through the work, onefinds many individuals who wereFellows of this College. Each had theirown experience of the war with somecontributing in large measure and othersto a lesser degree. Some never returnedto family and friends in South Australiawhile others survived into the latterdecades of last century. Among these,some achieved considerable professionalsuccess or became leaders in their fields.Apart from the biographies, the bookcontains chapters on military and navaldefence preparedness, the University ofAdelaide and Hospital Ships. A colour listof photos of medals issued to Australiansin World War I is also included.Please contact library staff to arrange fora loan of any of the above titles.Surgeons of GallipoliTo commemorate the ANZAC centenary, the College will be holding aspecial exhibition in its Museum in April 2015Elizabeth Milford,College ArchivistWhen the College wasformed in 1927, some of itsFounders and many of itsearly Fellows shared a common bond.As medical students, junior doctors orsenior surgeons, they had all served inWorld War 1. And around 120 of themwere involved in the Gallipoli campaign,serving in the field or on hospitalships. Some were also sent to hospitalsat Lemnos and others worked at basehospitals in Egypt, which had been setup to deal with the seriously wounded.Captain Hugh Poate, who was later aPresident of the College, volunteered inAugust 1914 and was posted to the 1stField Ambulance. He landed at Gallipoliwith his unit on April 25, but theextraordinary number of wounded meantthat he was soon posted to the hastilyconverted transport ship Itonus, ferryingthe wounded to hospitals in Egypt. TheItonus was one of the Black Ships, socalled because they were not protectedunder the Geneva Convention and couldbe subject to enemy fire. On April 27he wrote:The wounded on the Itonus were scatteredabout all over the ship being packed inand huddled together wherever they couldput them, irrespective of the character oftheir wounds… By the time we took overthe ship it was in an awful state – decksfilthy, patients in dirty blankets, fooddebris, bits of dressings, cigarette ends…Altogether we had seven deaths on boardbefore reaching Alexandria.The rugged terrain and issues withcommunication meant that thosewho landed on the Peninsula had adangerous and difficult job. AlexanderMarks was Regimental Medical Officerfor the 3rd Field Artillery Brigade.Landing at Anzac on April 25, Marksmoved up from the beach to GabaTepe and was constantly exposed toshellfire. His brigade was deployed inten camps and he had to try and visitthese each day:Sometime in June the hot weatherstarted, Diarrhoea and Dysentery setin and I found it impossible with suchscattered units to do much in regardto special feeding of the men. The bestI could do was issue the men smallquantities of oatmeal, milk, eggs orarrowroot…At the outbreak of war, medical studentsfuelled by ‘patriotism and a sense ofadventure’ rushed to join up. In August1914, 21 final year students from OtagoUniversity volunteered as medical officers.Second year student Montie Spencer alsovolunteered and was posted to the NewZealand Field Ambulance at Gallipoli:On Monday night [June 13] the Turks gotthe first of our medical students – youngPaterson of Gore. He was shot by a straybullet (or a sniper) right through the heartand only lasted a few seconds. He wasstanding not five yards from the door of ouradvanced dressing station up near the firingline, talking over news just received fromhome that afternoon; he’d been down to thebeach with me that afternoon for a swimand to get mail.In July 1915 all the students includingSpencer were ordered back to NewZealand to complete their medical courses.These excerpts from nearly 100 years agotouch on the experiences of the ‘ ANZACSurgeons of Gallipoli’. On April 23, 2015,the College celebrates the centenaryof Gallipoli with an exhibition in theCollege Museum and the launch of anaccompanying book. There will also becommemorative activities in New Zealand.44 Surgical News november / december 2014Surgical News november / december 2014 45

GlobalHealthbuilding internationalskillsA College award has allowed an Indonesian doctordevelop her skills with Australian peersThe College recently part-funded a visit to Australiaby a senior Indonesian ophthalmologist throughthe Surgeons International Award to help broadenher skills in the complex surgical treatment of glaucoma,now the second most common cause of blindness inIndonesia. Dr Nikompyang Rahayu arrived in Perthin August this year and spent four weeks undertakinga short Fellowship in glaucoma management andsurgery under the supervision of Professor Bill Morgan,Consultant Ophthalmologist at the Royal Perth Hospitaland Professor of Ophthalmology and Visual Science at theUniversity of WA.While in Australia, Dr Rahayu spent the bulk of hertime working alongside Professor Morgan at the Lions EyeInstitute, St John of God Hospital and Royal Perth Hospitalto expand her skills in trabeculectomy and glaucomadrainage device surgery, used to relieve pressure in the eye,as well as refining her gonioscopic skills.She also spent time working with Dr Philip House at hisprivate rooms and at the Perth Eye Centre, Dr Steve Colleyat the Perth Eye Centre, Dr Joshua Yuen at FremantleHospital and assisted Dr Anthony Giubilato in theatre atthe Royal Perth.During the trip, Dr Rahayu also attended the annualWA meeting of the Royal Australasian and NewZealand College of Ophthalmology (RANZCO) inKalgoorlie where she gave a presentation on eye healthdelivery in Bali.Upon her return home, Professor Morgan then tookone of his regular teaching trips to Bali in October towork with Dr Rahayu to conduct tube implant anddrainage surgery and to consult with her on complexpatients.A fully qualified ophthalmologist and experiencedteacher at the Australian Bali Memorial Eye Centre (alsoknown as the Indera Hospital), Dr Rahayu described theexperience she gained in Perth and the support of Australiancolleagues as “amazing”.“I came to Perth to learn more about glaucomaimplant surgery and finally I did,” she said.“I learned how to implant drainage tubes, theindications and complications involved and how tomanage those complications.“Basically, I learned how to manage glaucoma patientsproperly which means a great deal to me because I teachand train medical students and registrars for glaucomaand manual small-incision cataract surgery so now I amin a position to pass on the skills I have learned.“In Indonesia, many patients come to the hospitalin blind or severe stage probably because of a lack ofeducation about glaucoma.“These patients often need more complex care andsometimes have more complications so the skills Ilearned in Australia will help me a great deal.“I am particularly grateful for the support of ProfessorMorgan who allowed me to work with him in the eyeclinic and operating theatre in Perth.“He taught me how to diagnose early to advancedglaucoma, how to detect the progression and how totreat complications.“I also observed him doing some filtering and implantsurgery and when he visited me in Bali, we worked in theeye clinic and theatre and he supervised me while I didimplant surgery.“It was the best thing in my practice.”Improved eye careProfessor Morgan has been visiting Indonesia for thepast 15 years, teaching ophthalmologists and registrars inJakarta and Bali during twice-yearly trips.His work there is self-funded and coordinatedthrough the John Fawcett Foundation, a humanitarianorganisation which grew out of a number of Rotaryprojects best known for its Sight Restoration andBlindness Prevention Project.The Fawcett Foundation supported Dr Rahayu’s visit toAustralia through the provision of accommodation duringher stay.Professor Morgan saidthat while he began takingthe trips to teach cataractsurgery, Indonesian surgeonsnow had the skills andresources to undertakethe requiredcataract work.He saidglaucoma hadnow become themore pressingissue.“The standardof eye health caredelivery has improved dramatically in the past 15 years,particularly in Jakarta and Bali,” Professor Morgan said.“In Jakarta there are around 70 ophthalmologyregistrars in training at the very well-equipped six-storeystand-alone eye hospital there, while in Bali there are 35registrars training at the Bali Memorial Eye Centre.“This shows the great efforts they have made toprioritise this aspect of health care.“Then, however, the urgency was based aroundcataract blindness whereas now the issue is glaucoma.“This is because there are two broad categories ofglaucoma – open angled and closed angled glaucoma.“In South East Asia we tend to see more closed angleglaucoma, which is the more aggressive condition. Withthe increasing uptake of more Western diets, Indonesia isnow also seeing an increase in the rate of diabetes whichcan also lead to very aggressive forms of glaucoma.”Professor Morgan said it was these drivers that madethe core team of Perth ophthalmologists so keen to assistDr Rahayu during her visit.“Dr Rahayu’s main aims during the visit here were tolearn glaucoma draining device surgery and to refine hergonioscopic skills,” he said.“The art of gonioscopy revolves mainly around thetechnique, but also the interpretation of the findings andshe was able to distinguish between the key sub-typesof angle closure glaucoma including pupil block, ciliaryblock, plateau iris and the rarer causes with ease at theend of her Fellowship.“Many of the patients she saw in the LionsInstitute clinic were being followed post-surgery and sothat exposure, as well as the discussions she had withmyself, Dr House and Dr Giubilato added to her skillsin relation to post-operative management and thepre-operative assessment of patients requiringglaucoma surgery. uLeft:Dr Rahayuoperating;Dr Rahayuwith team.46 Surgical News november / december 2014Surgical News november / december 2014 47

2016 Rowan Nicks Pacific Islands Scholarship& 2016 Rowan Nicks International Scholarship2015 Rowan Nicks Australia & New Zealand Exchange Fellowship2016 Rowan NicksUnited Kingdomand Republic ofIreland FellowshipGlobalHealthThe Rowan Nicks Scholarships provide opportunities forsurgeons to develop their management, leadership, teachingand clinical skills through clinical attachments in selectedhospitals in Australia, New Zealand and South-East Asia.Application Criteria:Applicants for the Rowan Nicks International and PacificIslands Scholarships must:– commit to return to their home country on completion oftheir Scholarship;– meet the English Language Requirement for medicalregistration in Australia or New Zealand (equivalent to anIELTS score of 7.0 in every category for Australia, and 7.5for New Zealand);– be under 45 years of age at the closing date forapplications.In addition, applicants for the International Scholarship must:– hold a relevant post-graduate qualification in Surgery;– be a citizen of one of the nominated countries to be listedon the College website from December 2014.Applicants for the Pacific Islands Scholarship must:– be a citizen of the Cook Islands, Fiji, Kiribati, FederatedStates of Micronesia, Marshall Islands, Nauru, PapuaNew Guinea, Samoa, Solomon Islands, Tonga, Tuvalu orVanuatu;– hold a Masters of Medicine in Surgery (or equivalent).However, consideration will be given to applicants whohave completed local general post-graduate surgicaltraining, where appropriate to the needs of their homecountry.Selection CriteriaThe Committee will– consider the potential of the applicant to become asurgical leader in the country of origin, and/or to supply amuch-needed service in a particular surgical discipline.– The Committee must be convinced that the applicant is ofhigh calibre in surgical ability, ethical integrity and qualitiesof leadership.– Selection will primarily be based on merit, with applicantsproviding an essential service in remote areas, withoutopportunities for institutional support or educationalfacilities, being given earnest consideration.Value: Up to $50,000 pro-rata, plus one return economyairfare from home countryTenure: 3 - 12 monthsThe Royal Australasian Collegeof Surgeons invites suitableapplicants for the 2016 Rowan NicksInternational Scholarship and the2016 Rowan Nicks Pacific IslandsScholarship.The Royal Australasian College ofSurgeons invites suitable applicantswho are citizens of Australia andNew Zealand to apply for the 2016Rowan Nicks Australia and NewZealand Fellowship.These are the most prestigious of the College’s International Awards and are directed atqualified surgeons who are destined to become leaders in their home countries.The Rowan Nicks Australia and New Zealand Fellowship isintended to promote international surgical interchange at thelevels of practice and research, raise and maintain the profile ofsurgery in Australia and New Zealand and increase interactionbetween Australian and New Zealand surgical communities.The Fellowship provides funding to assist a New Zealander towork in an Australian unit judged by the College to be of nationalexcellence for a period of up to one year and an Australian towork in a New Zealand unit using the same criteria.Application Criteria:Applicants must– have gained Fellowship of the RACS within the previous tenyears on the closing date for applications.– provide evidence that they have passed the final exit exam toallow them to obtain a Fellowship of the Royal AustralasianCollege of Surgeons by the time selection takes place.Selection criteria:The Committee will– consider the potential of the applicant to become a surgicalleader and ability to provide a particular service that may bedeficient in their chosen surgical discipline.– assess the applicants in the areas of surgical ability, ethicalintegrity, scholarship and leadership.The Fellowship is not available for the purpose of extending acandidate’s position in Australia or New Zealand, either in theirexisting position or in another position.Value: Up to $50,000 pro-rata, depending on the fundingsituation of the candidate and provided sufficient funds areavailable, plus one return economy airfare between Australiaand New Zealand.Tenure: 3 - 12 monthsApplication forms and instructions will be availablefrom the College website from December 2014:www.surgeons.orgClosing date: 5pm Monday 4 May, 2015.Applicants will be notified of the outcome of theirapplication by 30 October 2015.Please contact: Secretariat, Rowan Nicks Committee,Royal Australasian College of Surgeons250 - 290 Spring Street, East Melbourne VIC 3002Email: international.scholarships@surgeons.orgPhone: + 61 3 9249 1211 Fax: + 61 3 9276 7431The Royal Australasian Collegeof Surgeons invites suitableapplicants who are citizensof the United Kingdom or theRepublic of Ireland to apply forthe 2016 Rowan Nicks UnitedKingdom and Republic ofIreland Fellowship.The Rowan Nicks United Kingdomand Republic of Ireland Fellowshipis intended to promote internationalsurgical interchange at the levels ofpractice and research, and increaseinteraction between the surgicalcommunities of Australia, NewZealand, the United Kingdom and theRepublicof Ireland.Application Criteria:Applicants must– hold his/her country’s postgraduatequalification in surgeryor its equivalent and must havecompleted his/her specialist surgicaltraining program within ten years ofthe closing date for applications.– provide evidence that he/shehas passed the final exit examwhich allows him/her to obtain aFellowship of one of the UnitedKingdom or Republic of IrelandColleges by the time selection takesplace.Selection criteria:The Committee will– consider the potential of theapplicant to become a surgicalleader and ability to provide aparticular service that may bedeficient in their chosen surgicaldiscipline.– assess the applicants in the areasof surgical ability, ethical integrity,scholarship and leadership.The Fellowship is not available for thepurpose of extending a candidate’sposition in Australia or New Zealand,either in their existing position or inanother position.Value: Up to $50,000 pro-rata,depending on the funding situation ofthe candidate and provided sufficientfunds are available.Tenure: 3 - 12 months“During one weekend in September she also attendedthe annual WA branch meeting of the RANZCOduring which she developed contacts with otherophthalmologists while one of the key-note speakersgave a presentation on gonioscopy which also added toher education.“It was clear this Fellowship would provide great valuenot just for Dr Rahayu, but for the people of Indonesiagiven her excellent surgical skills, intelligence andteaching responsibilities back in Bali.”Professor Morgan said that while great strides hadbeen made in providing complex eye care to glaucomapatients in Indonesia in recent years, the healthcare system and continuing poverty seen in somecommunities limited what could be surgically achieved.He said he was now working with internationalpartners to overcome one such problem.“The tubes we use in implant surgery cost around$700 each, which is very expensive within the Indonesiancontext so we now have a project underway in Jakartaworking with a Japanese company that makes lenses totry and create the tubes at a much lower cost,” he said.“We now have a prototype, but we are still some timeaway from conducting human trials.“Quite a few of us are very enthusiastic about this andhope that it works given the current and future needs ofglaucoma patients in Indonesia.”Professor Morgan said he also hoped to find thefunding to conduct a survey to measure blindness ratesover recent years, both to assess the success of Indonesianophthalmologists in treating cataracts and to measurethe disease burden caused by glaucoma.“Through the development of complex glaucoma careand surgery, we have halved the rate of glaucoma-relatedblindness in WA over the past 25 years and we hope thatpassing on these skills to Indonesian ophthalmologistssuch as Dr Rahayu will have a similar effect. We arefortunate to have a very cohesive group of Glaucomasurgeons in Perth, who are keen to teach overseascolleagues,” he said.“I thank the RACS for their generosity in donatingfunds to support her Fellowship.”The Surgeons International Award was established byProfessor Richard Bennett and his wife Enid in 1989 tofund short-term visits to Australia by surgeons, doctors,nurses or other health professionals from developingcountries.Aimed at helping to improve the standard and deliveryof health care in their home countries, the SurgeonsInternational Award has enabled more than 45 healthprofessionals from 14 countries access further trainingopportunities in Australia.With Karen Murphy48 Surgical News november / december 2014Surgical News november / december 2014 49

Research Scholarship& Fellowship Recipients2015 Scholarship and Grant RecipientsThe Board of Surgical Research thanks all applicantsand congratulates the following successful recipientsThe College wishes toacknowledge and thankour benefactors and sponsorsfor their generosity in fundingmany of the following scholarshipsand grants.There is a considerableamount of time and energyspent to properly evaluatethe extensive number ofapplications that we receive.The Chair would like tothank all those involved,and in particular, ProfessorJulian Smith, Dr Romidas Gupta, Professor PaulNorman, Associate ProfessorChristopher Young andProfessor Robert Fitridge,who all put in extra worktowards this result.Researchscholarshipand FellowshiprecipientsJohn Mitchell CrouchFellowshipProfessor Zsolt Balogh –NSWSpecialty: OrthopaedicFellowship Value: $150,000Professor Balogh is a clinicallyand academically activetrauma surgeon. The JohnMitchell Crouch Fellowshipfunding will enable him tocontinue his work on thecharacterisation and earlyrecognition of second hitsin major trauma patients toprevent multiple organ failureand mortality.Foundation for SurgerySenior LecturerFellowshipDr Sarah Aitken – NSWSpecialty: VascularFellowship Value: $132,000Topic: Epidemiology andoutcomes of vascular surgeryin elderly patients of NSW.Supervisor: AssociateProfessor VasikaranNaganathanSurgeon ScientistScholarshipDr Ryan Gao – New ZealandSpeciality: OrthopaedicScholarship Value: $77,000Topic: In vitro and in vivoevaluation of novel scaffoldsto improve bone healing.Supervisor: Professor JillianCornishFoundationfor SurgeryTour de CureCancerResearchScholarship –2014Dr Lipi Shukla – VicSpecialty: GeneralFellowship Value: $125,000Topic: Understanding the roleof fat grafting in radiotherapyinduced soft tissue injury,lymphedema and fibrosis.Supervisor: Mr Ramin ShayanFoundation forSurgery Tour deCure CancerResearchScholarship -2015Dr Andrew Gogos – VicSpecialty: NeurosurgeryFellowship Value: $125,000Topic: The role of the Hippo-YAP pathway in glioma stemcells.Supervisor: Mr AndrewMorokoffRaelene BoyleScholarship – Sponsoredby Sporting ChanceCancer FoundationDr Joseph Kong – VicSpecialty: GeneralScholarship Value: $66,000Topic: Exploiting geneticanalysis to predict responseand develop novel moleculartargeted therapies for rectalcancer.Supervisor: ProfessorAlexander HeriotEric Bishop ResearchScholarshipDr David Liu – VicSpecialty: GeneralScholarship Value: $66,000Topic: Investigating targetedmolecular therapies inoesophageal cancer.Supervisor: AssociateProfessor Wayne PhillipsFrancis & Phyllis ThornellShore Memorial Trustfor Medical ResearchResearch ScholarshipDr Andrew Cheng – VicSpecialty: CardiologyScholarship Value: $66,000Topic: Colchicine for theprimary prevention of atrialfibrillation after cardiacsurgery (Prevent AF).Supervisor: AssociateProfessor Bo ZhangMAIC-RACS TraumaScholarshipAssociate Professor EricChung – QldSpecialty: UrologyScholarship Value: $66,000Topic: Genitourinaryinjury, urinary and sexualdysfunctions following adultpelvic trauma: Clinicaloutcomes, healthcareadvocacy and guidelineimplementation.Supervisor: Dr Ross CartmillPaul Mackay BoltonScholarship for CancerResearchDr Heidi Cameron – QldSpecialty: GeneralScholarship Value: $66,000Topic: Towards thepersonalised management ofmetastatic melanoma.Supervisor: Professor NickHaywardSir Roy McCaugheySurgical ResearchFellowshipsDr Naseem Mirbagheri –NSWSpecialty: GeneralFellowship Value: $66,000Topic: Phenotypic variationsin the centre and peripheralmechanisms of sacralneuromodulation in faecalincontinence.Supervisor: Professor MarcGladmanDr Carlo Pulitano – NSWSpecialty: GeneralFellowship Value: $66,000Topic: Regulation ofhepatic microcirculationand patho-physiologicalrole of Endothelin-1 andstress-inducible vasoactivemediators in liver surgery.Supervisor: Dr NicholasShackelFoundation for SurgeryANZ Journal of SurgeryScholarshipDr Simon Tsao – VicSpecialty: GeneralScholarship Value: $66,000Topic: Functional and phenotypiccharacterisation ofmelanoma circulating tumourmarkers.Supervisor: ProfessorChristopher ChristophiFoundation for SurgeryCatherine Marie EnrightKelly ScholarshipDr Joshua Petterwood – VicSpecialty: OrthopaedicScholarship Value: $66,000Topic: A randomisedcontrolled trial measuringthree dimensional knee jointkinematics following totalknee replacement surgery.Supervisor: Professor PeterChoongFoundation for SurgeryJohn LoewenthalResearch ScholarshipDr Rajat Mittal – NSWSpecialty: OrthopaedicScholarship Value: $66,000Topic: Combined randomisedand observationstudy of Type B ankle fracturetreatment (CROSSBAT).Supervisor: Professor IanHarrisFoundation for SurgeryNew Zealand ResearchScholarshipDr Melanie Lauti– New ZealandSpecialty: GeneralScholarship Value: $66,000Topic: Better outcomes afterbariatric surgery (BOBS)Supervisor: ProfessorAndrew HillFoundation for SurgeryPeter King ResearchScholarshipDr William Shi – VicSpecialty: CardiothoracicScholarship Value: $66,000Topic: Clinical and molecularinsights into a personalised approachto heart transplantation:From rejection to protection.Supervisor: Professor IgorKonstantinovFoundation for SurgeryReg Worcester ResearchFellowshipDr Diana Kirke – SA (TBC)Specialty: OtolaryngologyFellowship Value: $66,000Topic: Differences in brain activationvia the utilisation of functionalmagnetic resonance imagingin patients with spasmodicdysphonia and voice tremor.Supervisor: Associate ProfessorKristina SimonyanFoundation for SurgeryRichard Jepson ResearchScholarshipDr Christopher Daly – NSWSpecialty: NeurosurgeryScholarship Value: $66,000Topic: Mesenchymal precursorcells, pentosan polysulphate andlumbar disc regeneration.Supervisor: Professor GraemeJenkinFoundation for SurgeryResearch ScholarshipsDr Anthony Glover – NSWSpecialty: GeneralScholarship Value: $66,000Topic: Adrenal corticalcarcinoma and non-codingRNAs: Unlocking themechanisms.Supervisor: Dr Patsy SoonDr Ruth Mitchell – NSWSpecialty: NeurosurgeryScholarship Value: $66,000Topic: The molecular biologyof epilepsy in low grade brainlesionsSupervisor: Dr AndrewMorokoffTravel Scholarship,Fellowship andGrant RecipientsHugh Johnston TravelGrantsDr James McKay – NewZealand|Specialty: GeneralValue: $10,000Dr Charlies Milne – VicSpecialty: VascularValue: $10,000Hugh Johnston ANZChapter AmericanCollege of SurgeonsTravelling FellowshipDr Anita Skandarajah – VicSpecialty: GeneralValue: $8,000Ian and Ruth GoughSurgical EducationScholarshipDr Rhea Liang – QldSpecialty: GeneralValue: $10,000John BuckinghamTravelling Scholarship –2014Dr Justin Chan – SASpecialty: CardiothoracicValue: $4,000John BuckinghamTravelling Scholarship –2015Dr Tarik Sammour – VicSpecialty: GeneralValue: $4,000Margorie Hooper TravelScholarshipDr Andrew Foreman – SASpecialty: OtolaryngologyValue: $75,000More than$1.5 millionawarded!Morgan TravellingScholarshipsDr Elizabeth Hodge – QldSpecialty: OtolaryngologyValue: $10,000Mr Timothy Lording – VicSpecialty: OrthopaedicValue: $10,000Murray and Unity PheilsTravel FellowshipDr Sameer Memon – NewZealandSpecialty: GeneralValue: $10,000Stuart MorsonScholarship inNeurosurgeryDr Johnny WongSpecialty: NeurosurgeryValue: $30,000Other ScholarshipsThe following lists externalawards that Fellows andTrainees of the College havebeen successful in attractingfrom other organisations.Sam Mellick TravelFellowshipDr Charles Milne – VicSpecialty: VascularAward Value: $5,000Mr Alan SaunderChair, Board of Surgical ResearchPreliminary Notice:Applications for 2016scholarships will open inMarch 201550 Surgical News november / december 2014Surgical News november / december 2014 51

$000’scollegebudget 2015RevenueExpenditureincreased funding for scholarships, fellowships and research Total Surplus grants and other philanthropic endeavours,resulting in a forecasted surplus of $2,463k (2014 – $2,682k).2015 College Finances and BudgetA report from the Treasurer, Marianne VonauThe College Budget for 2015 and theScholarship Program 2016 Budgetwere approved at the Octobermeeting of Council. The inclusion of theScholarship Program 2016 Budget ensuresappropriate funding is made available forthe ongoing commitment to the College’ssignificant research scholarships andgrants program. Prior to approval, thebudget progressed through an extensivereview by the governing committees andboards of the College.Fellows’ subscriptions and Trainees’fees fund the delivery of a broad range ofeducational and member related activitieswhich I will outline further in this report.The College activities are divided intothree separate “categories”.1. Activities related to your College’s corepurpose, namely education and training,professional development and standards,as well as regional and national advocacy.These resources are funded from yoursubscription and training fees.2. A growing program of research, aidand audit projects, externally fundedpredominantly by government agencies.These projects provide multiplehealth programs from specialisttraining, indigenous health, audit andinternational humanitarian assistance.3. Activities from our philanthropicendeavours. The College has receivedsubstantial generosity from benefactorsover many years including annualdonations from Fellows to fund researchactivities and international aid. In recentyears the College has continued todevelop a number of key corpuses fromany surpluses for designated activitiesand the current focus of these fundsare related to research scholarships,international development, ASC visitorsprogram, educational innovation andIndigenous health.52 Surgical News november / december 2014The College continues to maintaina strong financial position while stillensuring ongoing investment in initiativesthat deliver real value to our Fellows,and Trainees’ services are appropriatelyfunded. The Budget is set to achieve amodest surplus of $645k or 1.5 per centsurplus return on projected revenuefrom its core business activities anddemonstrates that the business planscontinue to be financially sustainable.Key attributes incorporated in thebudget strategy review and the budgetprocesses were to:• achieve a modest surplus return fromcore operations• set fees from Trainees, InternationalMedical Graduates and Fellows tosupport the costs of the infrastructureand governance of the College• increase subscription fees by CPI toensure all Fellow related activities arefully funded from fees charged• training, education and internationalmedical graduate fees to be increasedTotal College Budget 2015 - All Business Activities (2014 Budget Comparison)Main sources of revenue and expenditure are represeBudget 2015$000’sProperty rental andrecoveries1%Balance SheetMain sources of revenue and expenditure arerepresented in the chart display below:Budget 2014Investment incomeand bank interest8%Budget 2015:Budget Sources 2015 - Sources of Revenue of RevenueBudget 2015:Budget 2015 - Sources of ExpenditureSources of ExpenditureAs at 31 December 6% 2015, it is estimated that the Colle$67,906k). DepreciationVenue hire andCollege PropertiesmanagementThe College owns properties in Adelaide and 5% MelbouGrants - IncludesHospital Paymentsfor College offices in Adelaide, Sydney, Printing Brisbane, and general CaThe College Scholarships recently / sold the Wellington Computer property related in Nfellowshipscosts3%2%leased premises last year due to OH&S Travel and concerns.In Closing$000’sProject income andassociated fees28%Advertising androyalties1%Conferenceregistrations3%Sponsorship anddonations3%Increase / (Decrease)%(2014 - $4,046k) – associated with ourRevenue 61,276 7% Subscriptions andentrance fees21%• Property costs – $1,823k (2014 - $1,844k)Expenditure 57,750 8% Zealand and scheduled maintenanceTotal Surplus 3,526 (21%)Main sources of revenue and expenditure are represented in the chart display below:Property rental andrecoveries1%Investment incomeand bank interest8%Sponsorship anddonations3%• Consultants’ fees – clinical – $220k(2014 - $197k) – for clinical/medicalsupport and assessments, usuallyprovided by Fellows of the College.• Printing and general office supplies- $1,457k (2014 - $1,408k) includingthe very successful ‘Surgical News’,production of the ‘ANZ Journal ofSurgery’, and the Annual ScientificCongress.• Travel and accommodation – $4,220kcommittee, examination and skillscourses activities.– leasing of office premises in Sydney,Brisbane, Perth and Wellington – Newand service programs.• Specialty society funding – fees paidto specialty societies in accordancewith training partnership agreementsestimated at $3,851k.In addition to the delivery of coreFellowship services, training andeducation programs, the Budget alsoby the Education Price Index to ensureprovides significant funding of $965k toall related expenditure is fully fundedfurther invest in strategically important• review of all NZD denominated feesactivities including:to be charged at Budget AUD equivalent 2015 - Sources of Revenue• continuing to promote the FRACSto maintain equity in fee structurebrand as a quality mark standing forbetween the jurisdictionsexcellence in surgical care• project related activity Advertising should and beOther• ongoing development of onlineroyalties1%fully funded1%and Information Technology based• new key initiatives proposed will beresources to support Fellows andSubscriptions andassessed on the basis of adding valueentrance Trainees fees in education and CollegeProject to Fellows income and Trainees.related 21% activitiesassociated fees• further expansion of library resources28%for the eLibrary for Fellows and TraineesCategory 1In 2015 revenue from operationalactivities is budgeted to increase by 3per cent to $40,798k (2014 – $39,521k)while expenditure is budgeted toincrease by 4 per cent to $40,154k(2013 - $38,721k).Specific items of expenditure in category1 activities include:• Personnel costs –Conferenceincreased to supportthe roll out of the registrations Digital College andour increased advocacy3%role in Australiaand New Zealand jurisdictions.• continued investment to improve ITplatforms for the development anddelivery of the Fellowship and otherTraining, examinationand assessment fees34%examinations• active communication and advocacyinitiatives including broaderengagement into social mediacommunication channels• greater advocacy resourcing withfunding to appoint a policy andcommunications staff member forongoing initiation and co-ordination ofadvocacy issuesucatering5%18%Specialty SocietyFunding4%Other7%Associations andPublications1%Training, examinationand assessment fees34%As the year draws to a close Surgical the News College november / december continues 2014 53 toOther1%Property expenditure3%accommodation9%Personnel costs34%Consultants fees -clinical &office costs3%

collegebudget 2015Total College Budget 2015 - All Business Activities (2014 Budget Comparison)Budget 2015$000sBudget 2014$000sCategory 2In 2015 revenue for College project activities has increased by 13 percent to $19,099k (2014 - $16,897k) while expenditure is forecasted tobe $19,418k (2014 - $16,852k). The overall result is a projected deficit of($319k) which is primarily due to investment in further in-house ITresources to support the continual uptake and accessibility to the Fellowsinterface with IT Systems..The total contract value of currently operating projects is approximately$81 million and demonstrates continuing significant Commonwealthinvestment in specialist training programs, research, international aid andsurgical audit.Specific items of expenditure in category 2 activities include:• Personnel costs – $4,240k (2014 - $4,292k) represents ongoing level ofstaffing need• Consultants’ fees – $1,517k (2014 - $1,102k) – relates to professionalservices from external consultants for clinical / medical support andassessments provided to the College projects with increased activityunder the funding contract for the Timor Leste Program II• Grants – $10,549k (2014 - $7,160k) predominantly related to increasedspecialist training posts and rural loading hospital payments underthe Specialist Training Program contract.Category 3Revenue for all activities relating to the Foundation and Investments isbudgeted to increase 13 per cent to $5,493k (2014 - $4,858k) and mainlyrelates to the increased pool of fund holdings associated with stronginvestment returns achieved in the 2012 and 2013 years and build-upof College corpora funds newly established since 2013. Expenditure isbudgeted to be $3,030k (2014 – $2,176k) providing increased funding forscholarships, fellowships and research grants and other philanthropicendeavours, resulting in a forecasted surplus of $2,463k (2014 – $2,682k).Balance SheetAs at 31 December 2015, it is estimated that the College net assets will be$70,693k (2014 forecast - $67,906k).College PropertiesThe College owns properties in Adelaide and Melbourne in Australia.Accommodation is currently leased for College offices in Adelaide, Sydney,Brisbane, Canberra, Hobart, Perth and Wellington.The College recently sold the Wellington property in New Zealandhaving already relocated staff to new leased premises last year due toOH&S concerns.Increase /(Decrease) %Revenue 65,389 61,276 7%Expenditure 62,602 57,750 8%Total Surplus 2,787 3,526 21%➔➔➔In ClosingAs the year draws to a close the Collegecontinues to make significant progressregarding the key activities outlined in theStrategic Plan. The proposed initiatives,and challenges, for 2015, which I haveoutlined in my report, will ensure that theCollege continues to meet these challengesand progress in 2015.I would like to thank my DeputyTreasurer, Mr Andrew Brooks, for hiscontinued support during 2014 and hisoversight of property related matters.I would also like to extend my warmthanks to the Honorary Advisers of theCollege, Mr Brian Randall OAM, MrMichael Randall OAM, Mr AnthonyLewis, Mr Stuart Gooley, Mr Reg Hobbs,Mr John Craven, Mr Chesley Taylor,Mr Peter Wetherall and Mr GraemeHope, Investment Adviser of JBWerefor their ongoing support and excellentadvice, which over many years has beeninvaluable to the College and its Fellows.I would also like to thank the Resourcesstaff and the Director, Mr Ian T Burke,for their commitment, support andhard work in assisting me in my role asTreasurer.The budget has been set to continueto invest in core areas of service to ourFellows and Trainees with an ongoingcommitment to focus on matters ofstrategic priority. The financial position ofthe College continues on a solid base andis in sound shape for the year ahead.Marianne VonauTreasurerNovember 2014SUBSCRIPTIONS & ENTRANCE FEESAnnual Subscription - 2015 payable on 1 January 2015#$2,645 $3,180Fellowship Entrance Fee payable in full (10% discount applies) or over 5 years - no CPI increase $6,105 $7,340EDUCATION & TRAININGSurgical TrainingAdministration Fee - exam pending, interruption and deferral (SET) $345 $415Selection Processing Fee - (Note 6) $785 $945Selection Registration Fee $510 $610SET Training Fee - College Component - 2015 $3,150 $4,165International Medical GraduatesSpecialist Assessment Fee $9,045 N/ASupervision / Oversight Fee- onsite $7,325 N/ASupervision / Oversight Fee - remote $20,915 N/ADocument Assessment Fee - AoN subsequent to specialist assessment $1,370 N/ADocument Assessment Fee - College endorsement for AoN (Area of Need) $1,370 N/AIMG Administration Fee $905 N/AShort Term Specified Training Position Application Fee $1,095 N/AExaminationsClinical Examination Fee * * $2,085 $2,755Fellowship Examination Fee * * $7,550 $9,985Generic Surgical Science Examination Fee * * $3,635 $4,805Orthopaedic Principles & Basic Science Examination Fee * * $2,730 $3,610Paediatric Anatomy and Embryology Examination Fee * $3,445 N/A*Paediatric Pathophysiology Examination Fee $1,365 $1,805*Plastic and Reconstructive Surgical Science & Principles Examination Fee * $2,730 $3,610Cardiothoracic Surgical Sciences and Principles Examination Fee * $3,445 N/ASpeciality Surgical Science Examination Fee * $1,815 $2,400Pre Vocational Education and TrainingGeneric Surgical Science Examination Fee $3,995 $4,805OTHER FEESFEES FOR 2015Appeals Lodgement Fee $8250 N/AMOPS - Maintenance of Professional StandardsAustralia & New Zealand $2,990 $3,6001. All fees are payable in either Australian or New Zealand Dollars as invoiced.2. All New Zealand fees will be subject to GST of 15% unless marked with (**) which are not subject to New Zealand GST.3. All Australian Fees will be subject to GST of 10% except those approved Education courses marked with an asterisk (*)which are not subject to Australian GST.4. Examination & training fees for Australian based activities have been approved by the Australian Taxation Office asGST free for all courses relating to the awarding of the RACS Fellowship.5. Subscriptions and Fees marked (#) may be paid to the College by four equal instalments during the yearby AMEX, Visa or MasterCard credit cards only. Further details will be made available when fees are raised.6. Specialty programs may charge their own selection processing fees, these fees will be published by therespective Specialty Society.7. N/C relates to College services provided at no charge, N/A relates to College services not charged in stated currency.A full list of fees can be found on the College website.2015 AUST Fees 2015 NZ FeesAUD (Inc. GST)NZD (Inc. GST)#*54 Surgical News november / december 2014Surgical News november / december 2014 55

teryiality:Telephone:Thank you for donating tothe Foundation for Surgeryn for Surgery) for $ ..NZ BankcardVictoriard Holder’s SignatureExpiry /Mr Victor MarProfessor John Royle OAMDateEstate of the late Dr Lena McEwanPhryne Fisher Series 3International Development ProgramsIndigenous Health Programsral Gifts Programent of my gift in any College publicationDr Surgery42 WellingtonNSWDr Suchitra ParamaesvaranQLDMr Fred Leditischke AMAssoc. Prof. Julie MundyYes, I would like to donateto our Foundation for SurgeryWestern AustraliaMr Leslie StaggNew ZealandMr Harry SmithTotal: $532,594Royal Australasian ColleRoyal Australasian Members College of Save Surgeons up to 35% oMembers Save up to 35% Did you know on that all Royal Wiley Australasian Books! College of Surgoff Wiley’s general and professional titles, and 25% ofDid you know that Royal Australasian CollegetitlesofareSurgeonsexemptmembersfrom thisareoffer),entitledwhentoorders35%are plaoff Wiley’s general and professional titles, and 25% off our higher education titles (schooltitles are exempt from this offer), when orders You are can placed use your on member Wiley.com? discount to buy Wiley’s boo breast surgery general surgeryYou can use your member discount to buy Wiley’s books on: cardiac surgery plastic and reconstru breast surgery general surgery gastrointestinalsurgeryorthopedicssurgery cardiac surgery plastic and reconstructive surgical specialities gastrointestinal surgerysurgery vascular surgery.Or choose from the thousands more non-surgery-relatOr choose from the thousands more non-surgery-relatedFor more information,booksgopublishedto the RACSby Wiley.page on Wiley.coFor more information, go to the RACS page on Wiley.com at http://bit.ly/RACS_WileyAll donations are tax deductibleYour passion.Your skill.Your legacy.YourFoundation.Name:Address:Email:Speciality:Enclosed is my cheque or bank draft (payable to Foundation for Surgery) for $ .Please debit my credit card account for $ .Mastercard Visa AMEX Diners Club NZ BankcardCredit Card No: Expiry /Card Holder’s Name - block letters Card Holder’s Signature DateI would like my donation to help support:General Foundation ProgramsInternational Development ProgramsScholarship and Fellowship Programs Indigenous Health ProgramsI have a potential contribution to the Cultural Gifts ProgramI do not give permission for acknowledgement of my gift in any College publicationPlease send your donation to:AUSTRALIA & OTHER COUNTRIESFoundation for Surgery250 - 290 Spring StreetEast Melbourne , VIC 3002AustraliaNEW ZEALANDFoundation for SurgeryPO Box 7451Newtown, 6242 WellingtonNew ZealandTelephone:Don’t forget to stay up to date with the latestsurgery research at ANZJSurg.comSurgWiki focuses on general and specialitysurgery. Based on the bestselling Textbookof Surgery, each topic in SurgWiki has beenwritten by an expert in the field.SurgWiki has an abundance of information,but as new procedures and information come updateto light, users can log in, discuss, edit and commuupdate information. Users are the surgical and onDon’t community, forget to stay with up CVs to date required with at the registration latestsurgery and research only approved at ANZJSurg.com users allowed to edit.Live and interactive – be a part of SurgWiki’sevolution at www.surgwiki.comSurgWsurgeryof SurgwrittenSurgWbut asto lightLive anevoluti56 Surgical News november / december 2014Surgical News november / december 2014 53

Surgical News Index/Volume 15/2014Academic SurgeryCollaboration in AdelaidePg 22 No. 1Study surgeons’ non-technicalskills Pg 25 No. 1Feast of Academic EventsPg 28 No. 8Push to increase AcademicSurgery at tertiary levelPg 22 No. 9Research from the CollegePg 40 No. 10Annual ScientificCongressNot long now, Singapore ASCPg 20 No. 1Everything set for SingaporePg 12 No. 3A ‘Smart’ Congress Pg 17 No. 3Management of contaminatedwounds in disastersPg 20 No. 3Working together Pg 12 No. 4Standards of excellence,stewardship and self-actualisationPg 19 No. 5Orthopaedics at the CongressPg 22 No. 5From the ASC: Playing theMan Pg 16 No. 7From the ASC: The HumanFactor (Stavros Prineas)Pg 19 No. 7From the ASC: What do youexpect in a surgeon? (Carol-Anne Moulton) Pg 22 No. 7From the ASC: SurgeonophiliaPg 46 No. 72015 Annual Scientific CongressPg 30 No. 10Article of InterestA surgeon’s life: what do Iwant, need? How do I get it?Pg 24 No. 4Butting out behind barsPg 41 No. 4Managing boundaries Pg 50 No. 4Safety the top concern asregulator ponders RevalidationPg 38 No. 5Climate change Pg 30 No. 6Social Media in modernmedicine Pg 14 No. 7Remember your well-beingwhen discussing difficultnews Pg 42 No. 7Advance care planning andadvance care directivesPg 46 No. 8Do surgeons need a website?Pg 30 No. 9AuditsCase Note Review Pg 24 No. 1Evaluating the value andimpact Pg 37 No. 1Case Note Review Pg 29 No. 2Case Note Review Pg 40 No. 3Delay in Definitive TreatmentPg 21 No. 4MALT at full speed Pg 23 No. 4Adverse events: Systems orsurgeons? Pg 30 No. 4Valuable Data Pg 32 No. 4CNR: Good communication– good investment Pg 45 No. 5Case Note Review Pg 14 No. 6Morbidity Audit and LogbookTool Pg 18 No. 6Value your audit Pg 24 No. 6Continuing improvementPg 30 No. 7Case Note Review Pg 44 No. 7Case Note Review Pg 16 No. 8Doctors’ Handwriting Pg 34 No. 8Case Note Review Pg 19 No. 9Case Note Review Pg 21 No. 10Surgical Mortality: An internationalPerspectivePg 28 No. 10Automatic ANZASM entryinto CPD Online Pg 34 No. 10AwardsWork Awarded Pg 13 No. 1College AwardsRosenfeldt, Franklin Pg 40 No. 3Low, Gordon & Rosie Pg 41 No. 3Pfeifer, Murray V Pg 48 No. 4Anderson, Iain Pg 46 No. 5Richardson, Arthur Pg 46 No. 5Maddern, Guy Pg 36 No. 6Collins, John Pg 37 No. 6Martin, Jenepher Pg 48 No. 7North, John Pg 48 No. 7Mutimer, Keith Pg 49 No. 7Hill, Andrew Pg 42 No. 8Bolton, Damien Pg 43 No. 8Recognition paid to FellowsPg 13 No. 8Wall, Daryl Pg 26 No. 9College Budget 2015The College finances andbudget 2015 Pg 52 No. 10Curmudgeon’s CornerThat’s not nice at all Pg 14 No. 1Car-nage and choice Pg 13 No. 2The modern curse Pg 31 No. 3Not just any coffee Pg 17 No. 4The Question of ButtonsPg 23 No. 5Food Complexities Pg 15 No. 6No lift to heaven Pg 41 No. 7Old Timers! Pg 15 No. 8Nanna naps & Poppa pausesPg 14 No. 9The problem with lycraPg 24 No. 10EducationWe don’t shoot Pg 27 No. 1Bias in decision makingPg 30 No. 1Why social media mattersPg 39 No. 1The myths of surgical educationand training Pg 36 No. 4Working together onRevalidation Pg 36 No. 5Teaching surgery in the bushPg 32 No. 7John Corboy Medal Pg 40 No. 7Bio-reality simulation Pg 32No. 9Exams now online Pg 22 No. 10e-LearningResources ‘Gold’ for studyPg 42 No.4Fellows AbroadServing the Needy (WisamIhsheish) Pg 30 No. 8Fellows in the NewsWorking towards a full recovery(Michael Wong)Pg 10 No. 9Building community throughsurgery (James Leong) Pg 34No. 9Recognition for BrainTumour Work (Sarah Olson)Pg 14 No. 10Fellowship ServicesFellows in Need Pg 34 No. 1Your College Service Pg 23No. 10Foundation for SurgeryWhen ‘Sorry you have cancer’hits home Pg 26 No. 1From the ArchivesSurgery in Australia Pg 36 No. 1Henry Simpson Newland andthe Road to Sidcup Pg 42 No. 1The first medical x-ray?Pg 46 No. 2A glimpse of 18th centurysurgery Pg 50 No. 5Surgeons of Gallipoli Pg 45No. 10HeritageHeritage Report Page 40 No. 9Indigenous healthCall for Action Pg 28 No. 4Online Resources for Indigenoushealth specialists Pg49 No. 5In memoriamJan/Feb Pg 14 No. 1March Pg 14 No. 2May Pg 17 No. 4June Pg 23 No. 5July Pg 15 No. 6August Pg 38 No. 7September Pg 26 No. 8October Pg 14 No. 9November/December Pg 24No. 10International Development(Global Surgery)The best for burns Pg 10 No. 1Outcomes and Impacts(Rowan Nicks Scholarship)Pg 44 No. 2Myanmar specialists pass withflying colours Pg 22 No. 3Building Skills Pg 12 No. 4An unexpected experiencePg 24 No. 5New surgery for VanuatuPg 40 No. 5Sharing the Benefits Pg 10 No. 6Recognition for Project ChinaFounders Pg 10 No. 7PNG Neurosurgeon achievesoutstanding results Pg 20No. 8Twenty years of service forHangzhou Hospital Pg 36No. 8Leprosy’s Legacy Pg 16 No. 9Building International SkillsPg 46 No. 10InterplastIn his name (Sir BenjaminRank Scholarship) Pg 44 No. 8In the NewsDepression risk among TraineesPg 32 No. 1Alumni honoured Pg 28 No. 5Hybrid Theatre for Tassie Pg18 No. 8Letters to the EditorHealth Costs (Cashin, Paul)Pg 30 No. 2Early theatre return can avoidproblems (Wines, Robert D)Pg 52 No. 5Ulysses – I moan your passing!(Holling, Ray) Pg 52 No. 5ANZAC Article Postscript(Behan, Felix) Pg 52 No. 5‘Scrub-up?’ (Catchpole,Bernard) Pg 27 No. 7Simple to save Water (Petterwood,Joshua) Pg 9 No. 8More on Penicillin (Behan,Felix) Pg 9 No. 8A worthwhile, nobleprofession (Beard, Donald)Pg 45 No. 9All deserve praise in Wongcase (Beard, Donald)Pg 12 No. 10Airline industry could learnfrom us (Orr, Kevin B) Pg 12No. 10Buttons and Gender (Behan,Felix) Pg 12 No. 10Library reportImproving the CollegeLibrary Pg 37 No. 7Donations and New Items Pg44 No. 10Medical TourismA changing game Pg 26 No. 6Medico-LegalHow to avoid discriminationclaims Pg 32 No. 2Doctors: Advertising andSocial Media Pg 42 No. 3Privacy Reforms: Are youprepared? Pg 44 No. 4Winding down from MedicalPractice Pg 48 No. 5Health Policy ChangesPg 28 No. 6Informed financial consentPg 38 No. 7Doctors affected by bloodborne viruses Pg 41 No. 8Post OpA surgeon’s Guide toMelbourne… (Nicole Yap)(Summer) Pg 2 No. 1Following fortune (DerekBrockwell) (Summer) Pg 6 No. 1From the heart (AnanthaRamanathan) (Summer) Pg 8No. 1Pictorial records of War (RobertPearce) (Autumn) Pg 2 No. 3Fascinated by the AnimalWorld (David Hardman)(Autumn) Pg 4 No. 3A surgeon’s guide to Hobart(Carey Gall) (Winter) Pg 2 No. 6Indian Horizons (RobertCosta) (Winter) Pg 5 No. 6Remnants of War (BruceWaxman) (Winter) Pg 8 No. 6Adapting to retirement (JarvisHayman) (Winter) Pg 10 No. 6A surgeon’s guide to Lismore(Butchers, Sally) (Spring) Pg2 No. 9The Diggers’ Doctor (DonaldBeard) (Spring) Pg 4 No. 9Not just a rock (Ian Gough)(Spring) Pg 9 No. 9President’s PerspectiveGreetings from MyanmarPg 5 No. 1World War One – A centurylater Pg 5 No. 2Thank-you for the privilegePg 6 No. 3What is the direction for theCollege? Pg 6 No. 4Buzz in Singapore Pg 6 No. 5Leading, but not losingPg 5 No. 6Acting on our concernsPg 5 No. 7The ongoing discussionaround fees Pg 6 No. 8How to be alert like the airlineindustry Pg 5 No. 9Surgeons of the 21stCentury – Professionals orTradesmen? Pg 6 No. 6Professional DevelopmentActive learning with yourpeers Pg 16 No. 1Academy of SurgicalEducators Pg 40 No. 1Revalidation: The UKExperience Pg 18 No. 2Clinical Decision MakingPg 26 No. 2New course for Educatorsg 27 No. 4Safer Operative SurgeryPg 38 No. 4Success of Acute NeurotraumaPg 26 No. 7A Productive Year Pg 42 No. 10Professional StandardsAdvocating Best PracticePg 28 No. 1CPD and the Code ofConduct Pg 11 No. 2CPD Verification Pg 29 No. 10The Highest standards Pg 38No. 10RACS Trainees AssociationTraining fees increase Pg 26No. 4A word of thanks Pg 29 No. 4Technology, Social Media andTrainees Pg 44 No. 5Roundtable Pg 27 No. 9Recognition for ServicesJohn Mitchell Crouch FellowshipCitation (Russell Gruen)Pg 34 No. 22013 Sir Henry NewlandAward Pg 36 No. 2Regional NewsDiscussion and Consultation(Vic) Pg 28 No. 2News from the Tip (Tasmania)Pg 22 No. 4From the nation’s capital(ACT) Pg 43 No. 5Perioperative Mortality (NZ)Pg 28 No. 7It is all about the falls (Qld)Pg 33 No. 8The dos and don’ts of introducingnew technology (WA)Pg 28 No. 9Pacific Islands SurgeonsConference Pg 26 No. 10Relationships & AdvocacyThe HOT issues: Hours, Outletsand Taxes Pg 6 No. 1Workforce of the futurePg 6 No. 2Defining perceptions ofsurgery Pg 8 No. 3HOT Topics and the RegionsPg 8 No. 4Pledge for your foundationPg 8 No. 4Tell us how it is Pg 6 No. 6Time to get serious aboutalcohol Pg 16 No. 6Health advocacy Pg 6 No. 7Nominating for CouncilPg 13 No. 7New Zealand ‘Elliott House’for sale Pg 47 No. 7Election to Council Pg 10No. 8Alcohol-related harm Pg 17No. 8Pay online at the CollegePg 19 No. 8Likes, Tweets, Posts – You’veGot Mail! Pg 6 No. 9The value in values Pg 8 No. 10New councillors to serve youPg 13 No. 10Rural HealthServing rural needs Pg 31No. 9PSA Meeting Review Pg 18No. 10Motivated at the PSA ConferencePg 20 No. 10ScholarshipsBuckingham ScholarshipPg 21 No. 2Travel and research scholarshipsfor 2015 Pg 21 No. 2Senior Lecturer FellowshipPg 43 No. 2Opportunities Abroad Pg 22No. 62015 Scholarship and GrantRecipients Pg 50 No. 10SectionsBinational Colorectal CancerAudit Pg 32 No. 10Sharing the LoadTrauma, Rural and IndigenousHealth Pg 34 No. 5Coming Together Pg 16 No. 10Skills & Education CentreAn Oasis for OASIS Pg 34No. 4Speciality MeetingsGSA Annual ScientificMeeting Pg 32 No. 3Successful ScholarVather, Ryash (That Gut Feeling)Pg 38 No. 1Bennett, Iwan (Easing PatientExperience) Pg 36 No. 3Gruen, Russell (Makingsurgery safer) Pg 18 No. 4Palasovski, Tony (Educationfor Teaching) Pg 30 No. 5Read, Matthew (Improvingthe Odds) Pg 20 No. 6Ng, Kheng-Seong (Historicalfindings from research)Pg 34 No. 7Scholes, Corey (Helping othersstand tall) Pg 24 No. 8Bulluss, (Smart Travel) Pg 36No. 10Surgeon healthMind the gap? Yes we do!Pg 15 No. 1Exercise while you canPg 16 No. 2The hype on Hypo Pg 30No. 3When am I too old to operate?Pg 16 No. 4How do we assess? Pg 27No. 5IToddlers – Ikids UNOTPg 13 No. 6The full Brazilian Pg 15 No. 7How fast are you ageing?Pg 14 No. 8Think Zinc Pg 15 No. 9Have a Healthy and MerryChristmas Pg 25 No. 10Surgical Interest GroupsAustralasian Surgical LeadershipSymposium Pg 36 No. 9Surgical ServicesPoison’d chalice Pg 19 No. 1Poison’d chalice Pg 14 No. 2Poison’d chalice Pg 34 No. 3Surgical sketches andsilhouettesLetters from HeidelbergPg 44 No. 1Hors de Combat Pg 44 No. 3Empiricism Pg 32 No. 6Buttons and Surgical BowsPg 38 No. 8The surgeon’s dilemmaPg 38 No. 9Surgical SkillsScalpel Battles Pg 40 No. 2Younger FellowsBusy ASC Calender Pg 38No. 2Gathering on a TropicalIsland (Younger FellowsForum) Pg 20 No. 9By AuthorAitken, James Pg 24 No. 6Batten, John Pg 43 No. 4Behan, Felix Pg 44 No. 1Behan, Felix Pg 44 No. 3Behan, Felix (LtoE) Pg 52 No. 5Behan, Felix Pg 32 No. 6Behan, Felix (LtoE) Pg 9 No. 8Behan, Felix Pg 38 No. 8Behan, Felix Pg 38 No. 9Beiles, Barry Pg 37 No. 1Bell, Douglas Pg 36 No. 9Bennett, Ian Pg 43 No. 2Bennett, Ian Pg 23 No. 4Bennett, Ian Pg 18 No. 6Bennett, Ian Pg 34 No. 10Bird, Sara Pg 46 No. 8Bowles, Tom Pg 28 No. 9Broadley, Simon Pg 32 No. 7Burke, Peter F Pg 36 No. 1Cashin, Paul Pg 28 No. 2Campbell, Graeme Pg 28 No. 1Campbell, Graeme Pg 11 No. 2Catchpole, Bernard (LtoE)Pg 27 No. 7Close, Paul (LtoE) Pg 30 No. 2Crowe, Phil Pg 12 No. 4Day, Renee Pg 32 No. 7Evans, Andrew Pg 32 No. 7Ferguson, Cathy Pg 37 No. 7Ferguson, Cathy Pg 23 No. 10Flynn, Joanna Pg 38 No. 5Fraser-Kirk, Grant Pg 26 No. 4Fraser-Kirk, Grant Pg 29 No. 4Freeborn, Helen Pg 39 No. 1G-loved, Dr BB Pg 15 No. 1G-loved, Dr BB Pg 16 No. 2G-loved, Dr BB Pg 30 No. 3G-loved, Dr BB Pg 16 No. 4G-loved, Dr BB Pg 27 No. 5G-loved, Dr BB Pg 13 No. 6G-loved, Dr BB Pg 15 No. 7G-loved, Dr BB Pg 14 No. 8G-loved, Dr BB Pg 15 No. 9G-loved, Dr BB Pg 25 No. 10Gorton, Michael Pg 42 No. 3Gorton, Michael Pg 44 No. 4Gorton, Michael Pg 48 No. 5Gorton, Michael Pg 28 No. 6Gorton, Michael Pg 38 No. 7Gorton, Michael Pg 41 No. 8Gray, Sam Pg 44 No. 8Grigg, Michael Pg 6 No. 1Grigg, Michael Pg 6 No. 2Grig g, Michael Pg 8 No. 3Grigg, Michael Pg 6 No. 4Grigg, Michael Pg 6 No. 5Grigg, Michael Pg 5 No. 6Grigg, Michael Pg 5 No. 7Grigg, Michael Pg 6 No. 8Grigg, Michael Pg 5 No. 9Grigg, Michael Pg 6 No. 10Grumpy, Professor Pg 14 No. 1Grumpy, Professor Pg 13 No. 2Grumpy, Professor Pg 31 No. 3Grumpy, Professor Pg 17 No. 4Grumpy, Professor Pg 23 No. 5Grumpy, Professor Pg 15 No. 6Grumpy, Professor Pg 41 No. 7Grumpy, Professor Pg 15 No. 8Grumpy, Professor Pg 14 No. 9Grumpy, Professor Pg 24 No. 10Hanney, Richard Pg 22 No. 1Hanney, Richard Pg 28 No. 8Harvey, Nicole Pg 42 No. 7Hassen, Sayed Pg 20 No. 1Hassen, Sayed Pg 12 No. 3Herriot, Alexander Pg 32No. 10Herron, John Pg 16 No. 6Hollands, Mike Pg 5 No. 1Hollands, Mike Pg 5 No.Hollands, Mike Pg 6 No. 3Holling, Ray (LtoEd) Pg 52 No. 5Honeybul, Stephen Pg 30No. 10Jones, Nigel Pg 36 No. 2Kidding, Prof U.R. Pg 19 No. 1Kidding, Prof U.R. Pg 14 No. 2Kidding, Prof U.R. Pg 34 No. 3Kirkby, Brian Pg 22 No. 4Kitchener, Scott Pg 32 No. 7Kollias, James Pg 32 No. 4Kong, Kelvin Pg 28 No. 4Kong, Kelvin Pg 34 No. 5Kong, Kelvin Pg 49 No. 5Kruys, Edwin Pg 14 No. 7Lannigan, Francis Pg 38 No. 4Lee, James Pg 38 No. 2Lee, James Pg 20 No. 9Le Page, Philip Pg 22 No. 6Loh, Brian Pg 44 No.5Maddern, Guy Pg 24 No. 1Maddern, Guy Pg 29 No. 2Maddern, Guy Pg 40 No. 2Maddern, Guy Pg 21 No. 3Maddern, Guy Pg 45 No. 5Maddern, Guy Pg 14 No. 6Maddern, Guy Pg 44 No. 7Maddern, Guy Pg 16 No. 8Maddern, Guy Pg 19 No. 9Maddern, Guy Pg 21 No. 10Martin, Richard Pg 24 No. 4Masterton, John Pg 44 No. 2Masterton, John Pg 24 No. 5McCulloch, Glenn Pg 34No. 8Morrison, Stewart Pg 27 No. 9Mundy, Julie Pg 29 No. 10Mundy, Julie Pg 38 No. 10Neilson, Wendell Pg 43 No. 5North, John Pg 30 No. 4North, John Pg 33 No. 8North, John Pg 28 No. 10Perry, Chris Pg 28 No. 4Petterwood, Joshua (LtoEd)Pg 9 No. 8Quinn, John Pg 34 No. 1Read, David Pg 34 No. 5Renaut, Andrew Pg 30 No. 9Richardson, Martin Pg 20 No. 1Richardson, Martin Pg 12No. 3Rickard, Matt Pg 32 No. 10Riley, Geoff Pg 50 No. 4Saunders, Christobel Pg 30No. 10Smith, Julian Pg 40 No. 1Smith, Julian Pg 16 No. 1Smith, Julian Pg 27 No. 4Smith, Julian Pg 42 No. 10Soin, Kanwaljit Pg 19 No. 5Thomas, Mahiban Pg 34 No. 5Tobin, Stephen Pg 40 No. 1Tobin, Stephen Pg 27 No. 4Tobin, Stephen Pg 36 No. 5Tobin, Stephen Pg 42 No. 10Tregonning, Russell Pg 30No. 6Truskett, Phil Pg 30 No. 1Vonau, Marianne Pg 26 No. 7Vonau, Marianne Pg 40 No. 9Vonau, Marianne Pg 44No. 10Vonau, Marianne Pg 52No. 10Vasey, Carolyn Pg 18 No. 10Wang, Laura Pg 21 No. 2Watters, David Pg 20 No. 3Watters, David Pg 8 No. 4Watters, David Pg 8 No. 5Watters, David Pg 6 No. 6Watters, David Pg 6 No. 7Watters, David Pg 10 No. 8Watters, David Pg 6 No. 9Watters, David Pg 8 No. 10Walters, David Pg 32 No. 4Waxman, Bruce P Pg 34 No. 4Waxman, Bruce P Pg 46 No. 7Waxman, Bruce P Pg 32 No. 9Weidlich, Stephanie Pg 34No. 5Williams, Simon Pg 27 No. 1Williams, Simon Pg 36 No. 4Willis, Nigel Pg 28 No. 7Willis, Nigel Pg 26 No. 10Wines, Robert D (LtoEd)Pg 52 No. 5Wong She, Richard Pg 22No. 1058 Surgical News november / december 2014Surgical News november / december 2014 59

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