Message from the President

Transcription

1 B E R I TA CSM VOLUME 14 AU G U ST Message from the President Dr Lum Siew Kheong A new team has taken over the reigns in the College Council. It is my pleasure to welcome our new Council members Prof Dato' Dr Lokman bin Saim, Dr Rohan Malek and Prof Yip Cheng Har. There are many challenges ahead for the new Council but teamwork, goodwill and dedication will solve most of the problems ahead. As we welcome the new, we must not forget the old. I would like to take this opportunity to thank the 3 Council members who have left us, namely, Prof Jasmi, Dr Lim Kean Ghee and Assoc Prof Yusha, for their services to the College. Of particular mention is our past President, Assoc Prof Yusha Abdul Wahab, who has left us after serving in the College Council for 18 years!! Special thanks also go to Dr Lim Kean Ghee and his organizing committee for their wonderful work in organizing the Annual Scientific meeting in Cameron Highlands this year. The National Specialist Register (NSR) will have a life of its own once the amendments to the Medical Act are passed, presumably before the end of the year. Until that time, registration with the NSR is voluntary but newspaper advertisements for specialists positions in private hospitals are already beginning to stipulate registration with the NSR as a prerequisite for applicants. The Academy of Medicine is charged with the responsibility to provide the educational content for Continuing Professional Development (CPD) for specialists. This will enable specialists registered with the NSR to obtain sufficient points for re-certification. We are told that the tentative plans are for recertification every 5 years. The American Board of Surgery with a much longer history and far greater resources than us require recertification once in 10 years. My personal opinion is that recertification every 5 years will prove very time consuming and is beyond our resources to cope. It will be a tragedy if 90 percent of the practicing surgeons cannot fulfill the requirements of recertification at the end of 5 years. Members are encouraged to write to the College to express your views on this issue. The College of Surgeons, as a major component of the Academy of Medicine, will be moving forward to develop the educational content for surgeons and exploring the best mechanisms to deliver the CPD continued on page 2

2 continued from page 1 content to reach as many practicing surgeons as possible with minimal cost. This is a massive responsibility and the task requires a lot of human resource and IT skills. Every member is invited to help play a role. In particular, I welcome members with IT talents and those who have attended courses on critical appraisal of literature to volunteer their services to help the College in the tasks ahead. It is my hope that all specialist societies will also join us and work with us as a team. This is a wonderful opportunity for us to work together, forgetting sectional interest and looking at the big picture. The Academy of Medicine has now waived the requirement of having a publication as a precondition for membership. With this inclusive attitude, it is hoped that all surgeons will now find it in their interest to join the College of Surgeons and participate in the meetings and CPD programs of the College. Surgical training is changing very rapidly in the UK, Australia and the USA. We are not insulated from these changes and there are many issues that we will need to talk over with Specialist societies to face the challenges ahead. To this end, more frequent meetings with the Presidents of surgical societies in the major divisions of surgery will be initiated this year. We have to spend time together to think through many issues, share our knowledge, avoid short term agendas and allegiances to focus on the big picture for the good of the country. Finally, I would like to invite all our members to the Ministry of Health-Academy of Medicine (MOHAMM) Scientific meeting in Bayview Beach Resort, Penang from 6 8 September As Co-Chairman of the Organising Committee of the MOHAMM meeting, I have managed to get a distinguished faculty from the Surgical Department of the Johns Hopkins Medical Institutions as invited speakers to shared their knowledge and experience on a wide range of subjects including surgical training in the USA. Doctors with children in Medicine who are considering training in the USA may also find this meeting very enlightening. The detail program and application forms for the meeting can be obtained from Academy website at It is now my pleasure and privilege to introduce to you your new Council for the year 2007/2008. C O L L E G E O F S U R G E O N S C O U N C I L / P R E S I D E N T SENIOR VICE PRESIDENT VICE PRESIDENT HON SECRETA RY HON TREASURER CPD CHAIRMAN COUNCIL MEMBERS Dr Lum Siew Kheong Dr Noor Hisham Abdullah Prof Dato' Lian Chin Boon Dr Lim Lay Hooi Prof David Choon Siew Kit Dr Chew Loon Guan Dr Ashim Kumar Nandy Dr Andrew Gunn Kean Beng Dr Isa Omar Prof Dato' Dr Lokman bin Saim Dr Pall Singh Dr Rohan Malek Prof Yip Cheng Har e B E R I T A C S M page 2

3 The 76 t h Annual Scientific Congress of the Royal Austra l a s i a n College of Surgeons By Dr Lum Siew Kheong I represented the College at this meeting held in Christchurch, New Zealand from 6 11 May, THE COUNTRY AND THE RACS New Zealand has a population of 4,177,000 of which 363,700 live in Christchurch, which is the largest city in South Island of New Zealand. It has a temperate climate and the temperature was about 10ºC when I was there. European settlers came to NZ from A major historic building in Christchurch is the Christchurch Cathedral which was built in the city centre in the 1850 s. This beautiful cathedral with Gothic architecture is reputed to be the most visited church in the country. Christchurch International Airport serves as the major base for many Antarctic programs for the USA, Italian and the New Zealand Antarctic programs. Unemployed citizens in NZ are given NZD 180 per week and all retired persons over the age of 65 are given a pension of NZD 250 per week. Public hospitals provide A&E services to all without c h a r g e. All minor complaints like cough and colds are seen by the general practitioners and not in the public hospitals. Waiting time for elective surgery in the public hospitals may run into months and those who do not wish to wait usually take private insurance for private medical care. The RACS has 16 elected representatives and 9 Specialty Board representative s. The President is elected from among the Principal Office bearers in late Feb of each year and takes over as President after the AGM in May. Opening Ceremony with the Powhiri w e l c o m e The Town Hall where the RACS meeting was held The Ecumenical service at the C h r i s t c h u rch Cathedral The Christchurch Cathedral THE CONGRESS The theme of the congress was Competence, Communication and Te c h n o l o g y. The ceremony started with the Ecumenical Service at the Christchurch Cathedral. After this, the ceremonial functions adjourned to the Christchurch Town Hall. A traditional Po w h i r i (Maori welcome) was the highlight of the opening ceremony. The President of the RACS then introduced the guest Presidents from various Overseas Colleges. The Syme oration was delivered by one of the most distinguished scientist in New Zealand Prof Paul Callaghan FRS on Horizon science and the human implications. This was followed by conferral of honorary Fe l l ows h i p s, presentation of the various medals to their Fe l l ows for va r i o u s outstanding services and conferral of Fe l l owships to 76 new Fe l l ows. Plenary sessions were held daily and centred on information technology, skills acquisition with technology, surgical training and surgical decision-making. Wo r k s h o p s were held on PDA s, the paperless office, adding zip to Powerpoint, face lifting, body contouring after massive weight loss, the surgeon as a communicator, the surgeon as manager/leader, surgical audit, surgical training, College s web-enabled logbook for trainees and history of medicine is fun. Master classes were held at 0700 hr every morning and the topics included cardiothoracic surgery, tips for laparoscopic colorectal surgery, management of parastomal hernia, management of the difficult incisional hernia, assessment of the thyroid nodule, surgical oncology, neurotrauma, neurosurgical trainees meet the master, vascular trauma, endoluminal grafting and m a s s i ve facial injuries. Pa rallel sessions were held on breast surgery, cardiothoracic surgery, colorectal surgery, endocrine s u r g e r y, general surgery, head and neck surgery, hepatobiliary and upper GI surgery, medico-legal, military surgery, n e u r o s u r g e r y, paediatric surgery, pain medicine, plastic and reconstructive surgery, rural surgery, surgical education, surgical history, surgical oncology, transplantation surgery, trauma surgery and vascular surgery. In short, every specialty was represented at the RACS Scientific meeting and there was always something to suit the interest of the participants. I attended sessions on general surgery, breast surgery, plastic and reconstructive surgery and surgical education. All the sessions I attended were of high quality. continued on page 4 B E R I T A C S M page 3

4 continued from page 3 I N T E R N ATIONAL NETWORKING The International Presidential s breakfast meeting chaired by the President of the R ACS, Dr Russell Sitz, was held on the second day at 0700 hr in the morning! The Presidents of the American College of Surgeons, the RCS Ed, the RCS (Ireland), Japanese College of Surgeons, HK College of Surgeons, Thailand RCS and the College of Surgeons of Singapore were among those who were present. The new training curriculum of the RACS called SET (surgical education and training) was presented at this meeting. The meeting also discussed the importance of sharing of ideas, k n ow l e d g e, solutions and resources among our Colleges. This will reduce the economic cost of trying to re-invent the wheel when something had already been d e veloped by a sister College. The discussion was a good learning experience for me. The same group met again at the President s dinner and the Congress Banquet. These 3 opportunities enabled me to know the foreign Presidents well enough and enabled me to draw on their know l e d g e, experience and advice on many issues facing our College presently. Dr Lum Siew Kheong with Dr Edward Copeland, P resident, American College of Surg e o n s W H AT I LEARNT FROM THE CONGRESS 1. Major changes are occurring in training programs in UK, USA and Australia and this will have a major impact among Asian countries in a few years time. 2. Cross border training among Asian countries is something that needs to be explored for the future in view of the d e velopments in UK and Australia. This can only happen when equivalence in the training program between countries are identified and reliable mechanisms are made to ensure the quality of the trainees we intend to send abroad on exchange programs. College sponsored trainees may be a solution. 3. International collaboration to share problems, solutions, knowledge and development of training materials is important. International collaboration reduces the lag time required when we try to re-invent the wheel, reduce the cost of producing materials and is useful to validate usefulness of training materials across countries. 4. Regular meeting of Presidents of Surgical Associations to share knowledge of problems is very important to share our e x p e r i e n c e s, knowledge and maintain our netwo r k i n g. 5. The Philosophy of surgical training is important. a) End point training In this approach, one calls himself a colorectal surgeon if he has done subspecialty training in the discipline (1 3 ye a r s, depending on the country). b) Training as a life long process In this approach, one who has spent subspecialty training in colorectal surgery becomes a bona fide colorectal surgeon only when his practice has evo l ved over time to consist of 85% or more of colorectal surgery. Until such time, he is a general surgeon. c) A surgeon must be able to invent and re-invent himself many times in his career to suit the times and situation. 6. What constitute a competent surgeon? a ) Skill based model b ) Relationship model 7. Specialist Register and training: a) No subspecialty is recorded among general surgeons in the USA, UK, Hong Kong, Singapore, Thailand and Australia. All are listed as general surgeons. b) In Australia The Colorectal Society requires the colorectal surgeons to have 85% of their work in colorectal s u r g e r y. Even then they are not listed as colorectal surgeons but as general surgeons in the Medical Board register. It is their peers who recognize them as colorectal surgeons and refer cases to them because of their experience and c o m p e t e n c e. c) In Australia Endocrine surgery subspecialty training is not structured. Trainees spend 1 2 years in a well know n Endocrine unit and then apply to be a member of the International Endocrine Society. They continue their practice as general surgeons with an interest in endocrine surgery. Over time, after they establish a reputation by their excellent outcomes, they begin to obtain sufficient referrals to get a practice with more than 85% endocrine c a s e s. They, then, evo l ve to become endocrine surgeons and their unit becomes an endocrine unit. 8. Privileging and accreditation of procedures: a) There is no Federal or State legislation in the USA to govern this. b ) This is a local hospital decision, if any, in the USA. c ) Australia Not implemented in most hospitals. No one is prevented from doing any procedure except when there is peer objection at the Medical Advisory Board in the local hospital, as happened in the case of a surgeon in Sir Charles Gardner Hospital in Pe r t h. d) Self regulation is practiced in Singapore and Hong Kong. There are no government regulations. If one is uncomfortable with a procedure, he does it with another colleague. e B E R I T A C S M page 4

5 The ANNUAL S CIE NTIF IC M E E TING THE COL L E GE OF S UR GE ONS of 8 10 June, 2007 Cameron Highlands, Malaysia The Annual Scientific Meeting of the College of Surgeons was held at the Equatorial Hotel in Cameron Highlands from 8 10 June, 2007 under the able leadership of Dr Lim Kean Ghee with the theme Detecting Cancer Earlier. It was a very successful meeting and we had the privilege of having 3 Presidents from sister Colleges with us at the meeting. They were Dr Andrew Sutherland (President, RACS), Dr Chan Heng Thye (President, College of Surgeons, Singapore) and Prof Mobin Khan (President, College of Physicians and Surgeons of Bangladesh). The Council members had a breakfast meeting with visiting Presidents, past Presidents and University representatives to exchange ideas and views on various aspects of surgical training. Most who attended it felt it was very informative and valuable. From Left to Right: Dr Lum Siew Kheong (President), Assoc Prof Yusha (Past President) The meeting culminated with the Congress banquet which was very well attended. The newly elected President was introduced by the outgoing President, who in turn introduced the new Council to the members. Council Members 2007 / 2008 From Left to Right: Hisham, Lian Chin Boon, Lim Lay Hooi, David Choon, Lum Siew Kheong, Chew Loon Guan, Isa Omar, Pall Singh, Yip Cheng Har Absent from picture: Ashim Kumar Nandy, Andrew Gunn Kean Beng, Lokman bin Saim, Rohan Malek Council Members 2006 / 2007 From Left to Right (front row): Pall Singh, Lim Lay Hooi, Lum Siew Kheong (Senior Vice President), Uma Prasad (Ismail Orator), Yusha Abdul Wahab (President), Mobin Khan (President, Bangladesh CPS), Andrew Gunn Kean Beng, Dr Chan Heng Thye (President, Coll Surg Singapore) From Left to Right (back row): Isa Omar, Chew Loon Guan, Lian Chin Boon, Lim Kean Ghee, Andrew Sutherland (President, RACS) Hisham (Secretary), David Choon (Treasurer), Jasmi Absent from picture: Ashim Kumar Nandy Solo entertainer at Annual Dinner Guest Presidents From Left to Right: Dr Andrew Sutherland (RACS), Dr Chan Heng Thye (CS, Singapore) and Prof Mobin Khan (CPS Bangladesh) B E R I T A The delegates at the Annual Dinner C S M page 5

6 The College of Surgeons have been asked to send re p resentatives for various local and foreign exams every year. Fro m this year onwards the College will improve on our past systems by forming a Court of Examiners with Prof Yip Cheng Har as the chairperson of the Court of Examiners. The specialties where examiners are re q u i red will be in: Cardiothoracic Surg e ry ENT General Surg e ry Neuro s u rg e ry Ophthalmology Orthopaedic Surg e ry Paediatric Surg e ry Plastic Surg e ry Urology Members and Fellows of the College must be at least 5 years post Fellowship or post Masters before their application can be considered. They must be pre p a red to attend a short course for examiners to be organized by Prof Yip later in the year. They must also be pre p a red to travel either locally or to nearby Asian countries at short notice when requested to do so. It is imperative that they understand their responsibility to the College as their conduct will re f l e c t on the College, the profession and the nation. All members interested to be examiners for the College are requested to apply to the College giving their curr i c u l u m vitae and the speciality they wish to be an examiner. All applications must be addressed to Prof Yip Cheng Har, C h a i rman of the Court of Examiners, College of Surgeons, Academy of Medicine of Malaysia and reach the College b e f o re 15 September B E R I T A C S M page 6

7 6 8 September 2007 Bayview Beach Resort, Penang The Ministry of Health Academy of Medicine (MOH-AMM) meeting is just around the corner. All members are invited to attend and support this meeting. We have a distinguished faculty from the Department of Surgery of the Johns Hopkins Medical Institutions at the meeting who will share their experience and knowledge with us. There will also be a Pre-congress workshop which will be of interest to Surgeons and surgeons in training. The format of the workshop is given below: T I M E SESSION / TA L K S P E A K E R The latest Australian & UK models of training Dr Lum Siew Kheong P re s i d e n t College of Surgeons, Academy of Medicine of Malaysia The American model of training Prof Julie Freischlag William Stewart Halsted Professor & Surg e o n - i n - C h i e f, Johns Hopkins Medical Institutions (JHMI) Challenges in Surgical Training in Malaysia Dr Lum Siew Kheong Group Break up into 3 groups for discussion. Group Leaders TEA BREAK & REPORT WRITE UP Local Group Leaders Each group to present their 20 minute report Prof Julie Freischlag for discussion Dr Lum Siew Kheong GROUP FA C I L I TAT O R S Prof Julie Freischlag Prof Pamela Lipsett Prof Richard Schulick Dr Harjit Singh Dr Lim Lay Hooi Prof David Choon William Stewart Halsted Professor and Surgeon-in-Chief, JHMI S u rg e ry Program Dire c t o r, Professor of Surg e ry & Critical Care, JHMI Chief, Cameron Division of Surgical Oncology, JHMI Head of Gen Surg e ry Services, Ministry of Health Head of Plastic Surg e ry Services, Ministry of Health P rofessor of Orthopaedics, University of Malaya G R O U P 1 P rof Richard Schulick/ P rof David Choon Shortage of experienced trainers Creating enabling mechanisms for government and private specialists to be involved in training. Selection of trainees Can we improve on the present system? G R O U P 2 P rof Pamela Lipsett / Dr Lim Lay Hooi Long training period Optimising training in the years of compulsory service eg courses Earlier start to training for some Training vs Service positions Integrated surgical programs Using better assessment tools during training Recognition of importance of Non Surgical Skills G R O U P 3 P rof Julie Fre i s c h l a g / Dr Harjit Singh Is a National Board of Surgery the solution? Governance and standards Specialty/ Subspecialty emphasis Further details and registration forms are available from: or contacting S e c re t a r i a t 7 th MOH-AMM Scientific Meeting Jalan Folly Barat, Kuala Lumpur, Malaysia Tel: (603) , Fax: (603) acadmed@po.jaring.my B E R I T A C S M page 7

8 Do you want to be an Trauma and accidents is a grave problem in Malaysia. According to the statistics of the M i n i s t ry of Health, 9% of all hospital admissions was a result of trauma and this is exceeded only by normal delivery and complications of pre g n a n c y. 6% of all deaths in MOH hospitals was caused by trauma. These figures have not shown any improvement from The College of Surgeons feel that the ATLS course is a necessity for all surgical trainees, doctors in district hospitals, doctors in emergency departments and doctors in the armed forc e s. When more places are available, all doctors should be ATLS trained, as is done in Singapore. In Febru a ry 1976, a major tragedy occurred in the USA. An Orthopaedic surgeon, piloting his plane, crashed in ru r a l Nebraska. His wife died instantly, the surgeon and his 3 children sustained serious injuries and 1 child had minor injuries. The care the surgeon and his family received made him to say, The care for the patient in the field with limited re s o u rc e s must be better than what my children and I received at the primary care facility. There is something wrong with the system and the system has to be changed. After he re c o v e red from his injuries, he worked with a group of private surgeons and with financial help from a charitable foundation, they commenced the first trauma course for doctors in Nebraska. This p roved so successful that the American College of Surgeons (ACS) adopted it for implementation throughout the USA and this course became known as the Advanced Trauma Life Support course or AT L S for short. Every doctor in the USA is re q u i red to do the ATLS course within the first few months of his 1 s t year Residency. The ATLS course has now been e x p o rted to 50 countries in the world. In our part of the world, the ATLS is a re q u i rement for all surgical trainees in Australia, Hong Kong, Singapore, Thailand, Indonesia and even Pakistan. The ATLS course has been validated in many part s of the world in many circumstances. In one study done, it was found that a doctor who had done the ATLS course had the confidence and ability to manage an injured person in the rural setting as well as a patient managed at a large city hospital. The ACS is very concerned that the course be taught and conducted properly so that the quality of the course is never c o m p romised. For this reason alone, the ACS allows only the National Surgical Society to run the course and does not deal with any government body, any hospital, any university or any NGO. The College of Surgeons of Malaysia will try to i n t roduce the course to Malaysia, if the College is able to obtain grants or pledges in excess of RM 5 0 0, This amount of money is re q u i red in the first year to send an initial batch of local trainers for a student course followed by an i n s t ructor course in the USA. This is followed by the inaugural course in Malaysia which will be conducted by a trauma team from the ACS with the trained local instructors. There a f t e r, the local instructors carry on running the student course and, at a later stage, instructor courses to begin a chain of other centers within the country. Instructors are re q u i red to update their knowledge every 4 years in instructor courses in more established centers in USA, Australia, Singapore or Thailand. I am glad to say that all the international networking necessary to bring ATLS to this country has been done in the last 2 months. The Presidents of the ACS, RACS, CS Singapore and RCS Thailand have all agreed to help us. Applications are invited from all surgeons who must be at least 2 years post MS or FRCS to be trained as ATLS instru c t o r s. Please supply a 500 word curriculum vitae with photocopies of ATLS certificates (if any). The candidate must be pre p a re d to go to the USA / A u s t r a l i a / S i n g a p o re / Thailand (depending on approval from the ACS) for a period of up to 2 weeks. The College will pay for the airf a re, accommodation, course fees and a nominal meal allowance. All ATLS instructors are re q u i red to serve without monetary gain. After training, all instructors are re q u i red to play a leading role in helping the College to run the AT L S Course in Malaysia. Please send your application to: Dr Andrew Gunn C h a i rman of ATLS Task Forc e College of Surgeons, Academy of Medicine of Malaysia 19 Jalan Folly Barat, Kuala Lumpur AT LS Instructor? 16 th Asian Congress of Surgery & 3 rd Chinese Surgical Week October 2007, Grand Epoch City, Beijing, China Abstract Submission Deadline: 31 July 2007 Submit your abstract at All accepted abstracts will be published in the Asian Journal of Surgery, which is an indexed journal. Further information: B E R I T A C S M page 8