Cold Steel: Canadian Journal of Surgery Podcast

In honor of National Nursing Week in Canada, which is May 11th to May 17th, we are re-releasing an early episode with Lauren Kiwan, nurse clinician for general surgery at the Foothills Medical Centre. Lauren shares what surgeons can do to improve the OR. Revisit this important episode with us.___Lauren Kirwan is the nurse clinician for general surgery at the Foothills Medical Centre. She is currently finishing up her nurse practitioner degree. We wanted to ask Lauren her thoughts about what it means to be an OR nurse and what she wishes surgeons would do to make the OR environment better. We also hear about the impact of COVID19 on our nursing colleagues. We’d love to hear from our nurse listeners – what are some things that make your day or make you mad in the operating room? Email us at podcast.cjs@gmail.com with your thoughts and comments. Links:1. Melinda Davis on the Anesthetist - Surgeon relationship: https://soundcloud.com/cjs-podcast/e40-melinda-davis-on-career-counseling-and-the-anesthetist-surgeon-relationship2. Atul Gawande paper on Safe Surgery Checklist implementation in South Carolina. Perception of Safety of Surgical Practice Among Operating Room Personnel From Survey Data Is Associated With All-cause 30-day Postoperative Death Rate in South Carolina. https://journals.lww.com/annalsofsurgery/Abstract/2017/10000/Perception_of_Safety_of_Surgical_Practice_Among.14.aspx

While we hope that none of us “botch a surgery”, medico-legal concerns are issues that affect most surgeons at some point in their careers. Previously on the podcast, Dr. Richard Mimeault and Liise Honey spoke to us about the landscape of medico-legal concerns in surgery, and the anatomy of a lawsuit. In this episode, we talk about the CMPA's innovative approach to try to prevent errors from happening in the first place. Richard Mimeault and Elisabeth Normand join us to talk about "Theatre Arts", a workshop developed by the CMPA to help OR teams improve the quality of the care, and most importantly, improve the culture and dynamics of the team. In this episode we talk about the Theatre Arts workshop and how improving culture may have profound impacts on patient safety and satisfaction. Links:Theatre Arts workshop: https://www.cmpa-acpm.ca/en/education-events/workshops/workshop-theatre-artsCMPA x Cold Steel on Medicolegal risks for surgeons: https://www.youtube.com/watch?v=7Mkw68prEP0CMPA x Cold Steel – the Anatomy of a Lawsuit: https://www.youtube.com/watch?v=LRUh95LauFw Contact the CMPA: https://www.cmpa-acpm.ca/en/connect/contact-us

For a newly graduated surgical resident, one of the most interesting and perplexing question that many folks have to deal with is a surprisingly simple one: what should a full-time surgical job look like? For many of us, we simply looked at what our predecessors job looked like, and modeled our own careers after them. This meant ensuring that our schedules were jam-packed with clinical activities every day, without much consideration for other aspects of our career (such as call and research, for example).At the beginning of March, the American College of Surgeons released a framework of standards of what they think reasonable expectations are for a surgeon’s job. We have the link to the paper in the shownotes. The ACS is the one of the largest surgical organizations in North America, and this standard framework they have put out is really a statement on what they think is necessary to ensure that surgeons have a sustainable career. They put out standards for call, access to the OR, access to clinic, resource access, inpatient census, clinical support, and even fatigue mitigation.Dr. Pat Murphy, trauma and acute care surgeon at the Medical College of Wisconsin, was a previous guest on the show to talk about his work trying to define what a full time acute care surgeon should look like. He actually brought this framework to our attention, and we invited him to join us once again on Cold Steel to discuss the implications of such a framework.We would love to hear your thoughts. Send us an email at podcast.cjs@gmail.com, or find us on X (@colsteelpod, @ameerfarooq & @pbatesmurphy)Resources from this episode:Wood, Douglas E MD, FACS, FRCSEd; Wolinsky, Philip R MD, FACS2; Dodgion, Christopher M MD, MSPH, MBA, FACS3; Farmer, Diana Lee MD4; Gantt, Nancy L MD, FACS5; Napolitano, Lena M MD, FACS, MAMSE6; Timmons, Shelly D MD, PhD, FACS. FAANS7; Welsh, David J MD, MBA, FACS8; Winfield, Robert D MD, FACS9; Bura, Connie BA10; Essig, Rachael MD11; Turner, Patricia L MD, MBA, FACS10. Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers. Journal of the American College of Surgeons ():10.1097/XCS.0000000000001880, March 03, 2026. | DOI: 10.1097/XCS.0000000000001880https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/acs-brief/march-3-2026-issue/acs-releases-workplace-standards-framework-to-support-sustainable-surgical-careers/Pat Murphy on Cold Steel: https://www.canjsurg.ca/content/e184-pat-murphy-workforce-planning-acute-care-surgeryhttps://calnewport.com/

It's that time of year again. Can you sense it? The anticipation, the anxiety, the dread, the wracking of heart and head? Yes, it's almost time for final year Canadian medical students across the country to submit their rank lists to CaRMS.On this episode we explore the history of CaRMS and the underlying matching algorithms.We then talk about some of our top tips when building your CaRMS rank list.What do you think? How did you make your rank list? Send us an email at podcast.cjs@gmail.com.Links:Young TA. Teaching medical students to lie. The disturbing contradiction: medical ideals and the resident-selection process. CMAJ. 1997 Jan 15;156(2):219-22. PMID: 9012725; PMCID: PMC1226912. https://pmc-ncbi-nlm-nih-gov.proxy.queensu.ca/articles/PMC1226912/ https://pmc-ncbi-nlm-nih-gov.proxy.queensu.ca/articles/PMC1226912/Roth AE. The origins, history, and design of the resident match. JAMA. 2003 Feb 19;289(7):909-12. doi: 10.1001/jama.289.7.909. PMID: 12588278.https://impact.stanford.edu/article/how-does-applied-economics-maximize-kidney-transplantsCal Newport’s books: https://calnewport.com/writing/

This Evidence Based Reviews in Surgery (EBRS) webinar was filmed July 2025. This webinar was moderated by Dr. Kelly Vogt and Dr. Chad Ball, and featured panelists Dr. Bourke Tillmann and Dr. Emilie Joos.In this EBRS webinar, we discussed Getting out of the bay faster: Assessing trauma team performance using trauma video review" (Maiga et al., 2024).Links:Maiga AW, Vella MA, Appelbaum RD, et al. Getting out of the bay faster: Assessing trauma team performance using trauma video review. J Trauma Acute Care Surg. 2024;96(1):76-84. doi:10.1097/TA.0000000000004168

This Evidence Based Reviews in Surgery (EBRS) webinar was filmed January 2022, in collaboration with UNITAR. This webinar was moderated by Dr. Chad Ball and Dr. Neel Detta, and featured panelists Dr. Keith Lillemoe, Dr. Majella Doyle and Dr. Jeff Barkun. In this EBRS webinar, we discussed Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy (Brunt et al., 2020).Links:Brunt LM, Deziel DJ, Telem DA, et al. Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy. Ann Surg. 2020;272(1):3-23. doi:10.1097/SLA.0000000000003791

The William Ersil Research day invited guest and moderator for 2025 was Dr. Krista Goulding. Dr. Goulding is an Orthopedic Surgeon at Mayo Clinic Arizona, where she specializes in caring for patients with sarcomas and other cancerous and non-cancerous tumors of the musculoskeletal system. Dr. Goulding’s expertise is in limb preservation surgery using innovative techniques (synthetic and bone transplants, 3D printed and patient-specific implants, joint replacement). Her goal is to cure cancer while preserving function and quality of life. She is involved in research on a national and international scale, and is currently researching ways to improving surgical, oncologic and health-related quality of life outcomes for patients with malignant bone and soft tissue cancers.In this “How I Built This” segment of the research day, we explored Dr. Goulding’s career.Links:What are the 2-year survivorship outcomes of custom hemipelvis reconstruction after hemipelvectomy and revision arthroplasty? The evolution of a custom ilium "monoflange". https://pubmed-ncbi-nlm-nih-gov.proxy.queensu.ca/36255157/Košir U, Denis-Larocque G, Tsimicalis A, Freeman C, Turcotte RE, Cury F, Alcindor T, Goulding K. Psychological functioning, coping styles and their relationship to appraisal of physical limitations following invasive surgical procedures for soft-tissue sarcoma: A qualitative study. J Surg Oncol. 2020 Jun;121(8):1266-1275. doi: 10.1002/jso.25915. Epub 2020 Mar 27. PMID: 32221986.

Dr. Teresa Purzner MD PhD FRCSC is a clinician scientist neurosurgeon with a special interest in neuroncology and general neurosurgery. She completed her residency training at the University of Toronto, and her PhD training at Stanford University. Her lab, run jointly with her husband Dr. James Purzner, is focused on interdisciplinary approaches to identifying novel drug targets for brain cancer as well as the translation of promising new drug targets into human-ready therapeutics. Her work has led to the identification of a critical new drug target in the brain tumor medulloblastoma – a discovery that she has since translated into a novel drug for both brain cancer and skin cancer, currently being tested in phase 1 and phase 2 clinical trials. This work has resulted in her being named a Stanford Interdisciplinary Graduate fellow, Biox fellow and SPARK fellow, and has earned her both national and international recognition including the Annual Award of the American Academy of Neurological Surgery, the K.G. McKenzie prize for Basic Science Research, AANS Louise Eisenhardt Award and the Neurosurgery Research and Education Fellowship.She is a mom, an entrepreneur, and design-thinker, having created her own baby food company as well as redesigned the Integrated Brain Tumor Program. Links:Integrated Brain Tumor Program: https://surgery.queensu.ca/administration/announcements/integrative-brain-tumor-program-achieving-best-class-patient-outcomeshttps://www.ibtp.ca/purzner-labhttps://www.theglobeandmail.com/business/economy/article-how-a-neurosurgeon-used-her-entrepreneurial-background-to-revamp-a/

Dr. Brian Cameron is a retired pediatric surgeon who has spent much of his life dedicated to global surgery. In this conversation, we discuss his new book Ripples from the Rupununi: Dr. Aidun’s Healing Journey. We talk about what it takes to write a book and also discuss the book itself. Let us know in the comments or via email: Have you ever thought about writing a book? Links:E78 Brian Cameron On Global Surgery: https://www.youtube.com/watch?v=bdetQSXBRMQRipples from the Rupununi. https://books.friesenpress.com/store/title/119734000491425890/Brian-H.-Cameron-Ripples-from-the-Rupununi Surgical training in Guyana: the next generation. Cameron BH, Martin C, Rambaran M. Can J Surg. 2015 Feb;58(1):7-9. doi: 10.1503/cjs.010414. PMID: 25621909 Free PMC article. Evaluating the long-term impact of the Trauma Team Training course in Guyana: an explanatory mixed-methods approach. Pemberton J, Rambaran M, Cameron BH. Am J Surg. 2013 Feb;205(2):119-24. doi: 10.1016/j.amjsurg.2012.08.004. Epub 2012 Dec 13. PMID: 23246285 International surgery: the development of postgraduate surgical training in Guyana. Cameron BH, Rambaran M, Sharma DP, Taylor RH. Can J Surg. 2010 Feb;53(1):11-6. PMID: 20100407 Free PMC article. Teaching in Fiji: practising medicine, coping with coups. Cameron BH. CMAJ. 1989 Apr 1;140(7):833-5. PMID: 2924235 Free PMC article. No abstract available.

Campbell Roxburgh is a consultant colorectal surgeon and Professor of Colorectal Surgical Oncology at University of Glasgow in Scotland. Mr. Roxburgh is a multi-faceted researcher, surgeon and academic. He has a large body of research in systemic inflammation and tumor response, as well as clinical trials. We were lucky enough to have him join us at Queen’s University for a week. In this talk he gave to the general surgery division, he talked about the development of robotic surgery in Scotland. What stood out for us from his talk was the deliberate, systematic approach to introducing a new technology adopted by the NHS, as opposed to the way that technology is often rolled out in North America. We also had a great time asking Campbell questions at the end of his talk, and we particularly liked his response to how to find work-life balance as a surgeon and an academic.What do you think? How should something like robotics be rolled out in Canada? Email us at podcast.cjs@gmail.com. Feel free to leave us a voicemail, and we might play your response on our next episode. Campbell Roxburgh on X: @C_RoxburghLinks:https://www.gla.ac.uk/schools/cancersciences/staff/campbellroxburgh/Ingham AR, McSorley ST, McMillan DC, Mansouri D, Chong D, MacKay GJ, Wrobel A, Kong CY, Alani A, Nicholson G, Roxburgh CSD. Does robotic assisted surgery mitigate obesity related systemic inflammatory response and clinical outcomes in left sided colorectal cancer resections? J Robot Surg. 2025 Mar 5;19(1):98. doi: 10.1007/s11701-025-02261-0. PMID: 40042780; PMCID: PMC11882609.Ingham AR, Kong CY, Wong TN, McSorley ST, McMillan DC, Nicholson GA, Alani A, Mansouri D, Chong D, MacKay GJ, Roxburgh CSD. Robotic-assisted surgery for left-sided colon and rectal resections is associated with reduction in the postoperative surgical stress response and improved short-term outcomes: a cohort study. Surg Endosc. 2024 May;38(5):2577-2592. doi: 10.1007/s00464-024-10749-3. Epub 2024 Mar 18. PMID: 38498212; PMCID: PMC11078791.

Dr. Mohammed Bellal is a consultant urologist based out of Birmingham, UK. He specializes in complex functional reconstructive surgery. He’s also the UK’s first paralyzed surgeon. Dr. Bellal has probably one of the most powerful talks we’ve ever heard called “The Gift of Adversity”. During our conversation with him, we explore the power of fate, and how letting go of the outcomes is such a difficult but powerful life lesson we all need to learn. We also delved deeply into how Dr. Bellal has adapted to his paralysis and has come back to practice as a surgeon, and his insights on how we might design the operating rooms of the future. Links:The Gift of Adversity: https://youtu.be/uTPVvPMod2Q?si=VTn616zCI8M7oF71https://www.bbc.com/news/uk-england-birmingham-63586045

It’s hard to describe exactly what Dr. Stephen Foster is. Dr. Foster is a general surgeon, urologist, infectious disease doctor, entrepreneur, and missionary who has spent his career working in Angola. We caught up with Dr. Foster to talk about his life working in Angola and really to explore his thoughts on empowering non-MD providers to provide life-saving care. Dr. Foster has a fascinating biography called “The Benefit of Steel: The Life and Times of Steve Foster.” For us, the conversation with Dr. Foster has reminded us of the huge inequities that exist in the world, but also the tremendous effort of folks like Dr. Foster to make the world a better, more humane place.If you want to get in contact with Dr. Foster to support his foundation, you can find his email in our show notes.Links:Stephen Foster Email: stephen@fosterangola.ca https://www.amazon.ca/Benefit-Steel-Times-Steve-Foster/dp/B07Y4K7CM4https://www.nytimes.com/2015/03/29/opinion/sunday/nicholas-kristof-a-little-respect-for-dr-foster.html

The only thing that can save us from our irascibly self-centered existence is to make sure that our existence is in the service of othersMark Shrime, ENT surgeon, global surgery researcher and now career coach is our guest on this episode. The quote I read was from his wonderful book, “Solving for Why: A Surgeon’s Journey to Discover the Transformative Power of Purpose”. It’s important to understand just how much of a fascinating person Mark Shrime is to get a context for this conversation. Dr. Shrime was the International Chief Medical Officer at Mercy Ships, an international NGO that operates hospital ships. Mark is also one of the major figures in the global surgery space, and was part of the 2015 Lancet Commission on Global Surgery. If that were not enough, he is also an American Ninja Warrior! We explored why Mark felt the need to write a book on purpose as well as his insights on global surgery, amongst many other topics. This was such an important conversation not just for surgeons but for anyone trying discover meaning and purpose in their life. Links:https://www.markshrime.com/ https://www.hachettebookgroup.com/titles/dr-mark-shrime/solving-for-why/9781538734162/?lens=twelvehttps://www.thelancet.com/commissions/global-surgeryShrime MG, Alkire BC, Grimes C, Chao TE, Poenaru D, Verguet S. Cost-Effectiveness in Global Surgery: Pearls, Pitfalls, and a Checklist. World J Surg. 2017 Jun;41(6):1401-1413. doi: 10.1007/s00268-017-3875-0. PMID: 28105528.Smith ER, Kapoor P, Concepcion T, Ramirez T, Mohamed M, Dahir S, Cotache-Condor C, Adan Ismail E, Rice HE, Shrime MG. Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study. BMJ Open. 2023 May 2;13(5):e069572. doi: 10.1136/bmjopen-2022-069572. PMID: 37130683; PMCID: PMC10163539