Error and complication: A Surgeon’s Nightmare

by Dr. Sarkis Meterissian

At Grand Rounds on February 26th, Dr. Sarkis Meterissian reviewed the current understanding of how surgeons react to complications, made the link between burnout and medical errors and proposed ways of coping with this important part of surgeons’ lives. This was an excellent overview of an important yet  neglected topic and one which we all encounter in our practice. We all have this experience and we would like to know yours, please share your thoughts….


Complications are a side effect of surgery. When a serious complication leads to significant morbidity or mortality as a direct result of a medical error, this side-effect can become a nightmare both for the patient and the surgeon. The root-cause of a complication is complex and may involve a lapse in planning, judgment, technical miscues, lack of coordinated teamwork or a systems-based problem. Whatever the cause, a surgical complication, in the end, effects patient safety and outcome. As the Royal College fine tunes CanMEDS 2015 before its release in the Fall of 2015, patient safety is one of the aspects that will be emphasized and it will be expected that surgical programs will have to address this important topic more formally in their curricula. But medical error effects more than the patient and it is well-known that it produces a second victim, the surgeon. Recently , papers have been published looking at this little discussed implication of surgical errors (1-4).  Continue reading

Virtual On-Line Patients and their Potential in Medical Education

by Drs. Nancy Posel and David Fleiszer

This month Nancy Posel and David Fleiszer team up and explore the use of Virtual Patients in medical education. The gaming industry has a long history of providing user’s with interactive platforms for entertainment. From simple Atari tennis  (yes, I am that old!) to the highly realistic and accurate Assassins Creed, gamers have been immersed in this virtual world. Why not join them and provide accessible and timely medical education?

What is a Virtual Patient Case?

A Virtual Patient (VP) is: “an interactive computer simulation of real-life clinical scenarios for the purpose of medical training, education, or assessment.” It is an online scenario that permits learners to engage interactively in a non-threatening and risk-free environment allowing for optimum patient safety. In this respect, VP’s may also be considered as screen-based medical simulation.

Essentially, a VP is an opportunity for a learner to work through a case that has a presenting complaint, symptom, or problem. The learner takes a history, may perform an examination, makes a diagnosis and institutes treatment.  Along the encounter, the learner must make decisions and deal with the result of these decisions, as in real life. Feedback built into the case provides the learner with the important educational feedback.  To see how a VP works, check out this video from UBC:

Continue reading

The Use of a Handover Communication Tool to Reduce Medical Error

by Kevin Lachapelle MD, FRCSC

Welcome to 2015! I wish you all a happy, prosperous, and safe new year. For those of you who follow our e-newsletter, please keep it up. Why not  share your thoughts with our surgical community by posting your comments on this blog.


Sign over  between on-call residents and between residents and staff has been part of the  care of the surgical patient since the age of modern surgery. Sign over is the transfer of responsibility and should be designed to ensure continuity and optimal care of the patient. In the past, residents and staff  were  ” always around” and on-call for their own service. We knew most patients well enough (  or at least we thought so ) and sign out was quick and most of the time implicit.

Over the last few years, work hour regulations ( the ” 16 hour ” rule ) and the increased complexity of our surgical patients have forced us to reconsider the manner in which we transfer care.  Residents and Staff no longer have implicit knowledge of events and given the present model of care, this is not surprising.  Sign over now occurs with increasing frequency  and since we know that communication errors are at the heart of nearly 70% of  medical errors, this transition period has important patient safety implications.  A recent paper (Starmer et al, NEJM 2014) suggests that a standardized hand over tool may reduce medical errors which occur during sign over.

So, what are we doing in Surgery to improve handover?  What type of communication tools are residents (and staff) using and how effective or useful are these tools? Should we have a standard approach to sign over? Let us know what you think?

Continue reading

“Patient at Heart. Science at Hand.” The New Medical Curriculum Comes to Surgery

by Sebastian Demyttenaere, MD

TCP Surgery Director


In September 2013, the Faculty of Medicine initiated the New MDCM Curriculum. Affectionately coined as  having the “Patient at Heart and Science in Hand”, the curriculum recognizes the importance of family medicine in addressing current societal needs, while simultaneously providing a program that is firmly rooted in science. There is an emphasis on interdisciplinary learning, early patient and clinical exposure and a longitudinal experience of cross cutting themes over the duration of the curriculum.   This first cohort will start the Surgery component in January 2015.  The Transition to Clinical Practice (TCP) Surgery course replaces the old ICM, or Introduction to Clinical Medicine.  As you may recall, in the old curriculum 2nd year medical students rotating through Surgery would be assigned to a specific surgeon who would serve as their “tutor” for a three-week period. Physicians from all four teaching sites (MGH, RVH, JGH, SMH) would likewise be asked to present a total of 30 lectures per cohort, with individual lectures being presented up to 6 times per year in most cases. Furthermore, the students would also each spend a week assigned to a surgical clinic, often alongside a 3rd and/or 4th year student, vying for physical space and learning opportunities.

Continue reading

Resident Duty Hours….Forcing a Paradigm Shift in Surgical Education?

by Kevin Lachapelle MD, FRCSC

I had a discussion over lunch recently with a few staff surgeons from General Surgery and after the usual pleasantries , the conversation shifted to resident “call”. Well, with the 16 hour rule , there is no longer Call, but a shift to “shift work” to comply with the 16 hour regulation. A regulation supported by the Canadian Charter of  Rights and Freedoms. This change in paradigm has created  significant challenges for Residents and Staff and patients especially at a time when surgical specialities are being forced to cut the number of Carms positions. I do want to know your opinion on how this change in coverage and clinical exposure  has effected residents, Staff, and patients. During our conversation at lunch, we highlighted a number of problems which we have noticed:

1) Services frequently over staffed during the day but cross-covered at night by a “float”,

2) A reduction in resident clinical exposure,

3) Lost Operative teaching and learning opportunities at night as Staff and residents work with each other for the first time,

4) A potential reduction in patient safety due to loss of continuity of care and frequent  hand-overs. We also had an enthusiastic exchange on the disconnect between the present duty hour pendulum and the literature on learning in the work place and expertise. We would like to know your opinion on how the 16 hour rule has effected your Surgical Education ( Resident, Staff, patient), what  are the problems and more importantly what are your creative solutions!

Continue reading

Summer Reading and (online) Learning

by Kevin Lachapelle MD, FRCSC

from Basin Harbour , Lake Champlain

“Basin Harbor, Lake Champlain”

I hope all of you are enjoying the summer and have set time for relaxation, family, and yourself. Reading is certainly a quintessential summer activity and being able to finish a good book is truly gratifying. The time also gives one the opportunity to think. Although we tend to read for pleasure, there is no reason we cannot combine that pleasure with learning. So, what have you decided to read and learn this summer and what time tricks do you use to help complete your objective? We would love to here what you are up to during the summer.

This summer I promised myself that I would schedule time to complete two learning projects.

Continue reading

Sometimes, You (may) Need a Coach

by Kevin Lachapelle MD, FRCSC

We take for granted the importance of Coaching in many fields such as sport and music both of which require a high level of performance. In sport, it is just one of those things that is impregnated in our psyche and we accept that one cannot attain elite status without excellent coaching. We often hear an athlete comment on the important positive role a particular coach may have had on the success of their career. This seems to be normal. But what is coaching, why is it effective, what is the difference between coaching and teaching, and how can coaching be integrated into Surgical Education. I am not an expert in the field but perhaps I can pique your interest to comment and discuss on line!

Continue reading

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