American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

U.S. Scholar Alejandra M. Casar Berazaluce Experiences an Eventful RACS Annual Scientific Congress

The nice thing about working 21 days in a row and then boarding a transpacific flight post call is that you can barely remember those 16 hours even happened. The part I recall is waking up after some restful sleep to a spectacular sunrise and a good breakfast just prior to landing in Sydney, Australia.

This year, I had the honor of representing the Resident and Associate Society of the American College of Surgeons (RAS-ACS, @RASACS) at the 87th Annual Scientific Congress of the Royal Australasian College of Surgeons (RACS, @RACSurgeons, #RACS18) as the recipient of their 2017 International Exchange Scholarship. ‘Reflecting on what really matters’, the theme for this summit, brought together surgeons and trainees from around the world for a week of lively multidisciplinary discussions on a wide range of topics set in the heart of Darling Harbour. As a current surgery resident who has experienced medical training in three different countries, I was excited to see what adventures the down under would bring.

Monday started the Global Health Program and with it came a mind-blowing series of presentations from general, plastic, orthopedic, and cardiothoracic surgeons finding creative ways to deliver care to various LMIC in the region. Their dedication to their respective organizations and outside-the-box approach to health inequities were an invigorating start to what would soon become an in-depth discussion on the ethics of humanitarian aid and patient selection in surgical missions. The collective resilience, hope, perseverance, and wit in that room were tangible. It was refreshing to hear from many individuals with different nationalities, cultures, and credences sharing an undying passion towards the common goal of access to safe surgery for all.

Amid discussions on poverty and disease, the USA made a surprising appearance with its decreasing life expectancy and increase in deaths by despair, encompassed within Sir Michael Marmot’s (@MichaelMarmot) groundbreaking research on the social determinants of health. (If you are ever on the lookout for strong arguments supporting the role of physicians as advocates, I strongly recommend you study some of his work.)

In an ambiance that can only be described as Hogwarts-esque, a group of hooded figures of international renown welcomed new Fellows to the College surrounded by family and friends at the Convocation Ceremony later that evening. This was accompanied by Dr. Raquel Bono (@DHADirector) delivering the prestigious Syme Oration on integrating military and civilian medicine, which coincidentally featured San Antonio’s response to a recent mass casualty event as an example of this practice –a response I was personally involved with last fall at my home institution.

The rest of the week was just as captivating. I joined the Pediatric Surgery Program and had the opportunity of listening to the current trainees discussing their struggles as registrars. Unlike in the US, Pediatric Surgery does not require completion of a General Surgery program; however, advancement and certification has proven to be cumbersome and left many of them stuck halfway there. This immediately made me think of the undertaking that surviving preliminary positions represents for residents in the US. The most encouraging part of this conversation, however, was observing how the trainees took matters into their own hands and presented their own research on defining academic tracks and competencies for advancement while the attendings focused on ways to learn how to better evaluate them and help them succeed.

While my fondest memory of these sessions was hearing the excitement in my seatmate’s voice as she counted the number of females in the room, only to later learn it was Dr. Genevieve Cummins, the first female pediatric-trained surgeon in Australia; the program was packed with keynotes from the likes of Dr. George Holcomb, Dr. Colin Martin (@colinalexmartin), and Dr. Andrea Hayes-Jordan. It was heartwarming to see that, although experts in their respective fields, they all seemed as excited as I was to hear what the rest of the world was doing to treat these same conditions.

One of the most impressive talks I attended was delivered by a non-surgeon. Dr. David Lord, a Pediatric Interventional Radiologist, captivated his audience with descriptions of procedures most of us were not even aware existed for the treatment of multiple vascular malformations, reinforcing the importance of interdepartmental collaborations in patient care.

The Trauma Surgery Program included a panel discussion on mass casualty preparedness by physicians involved in the recent Paris, Las Vegas, and Manchester events. Although heart-breaking, the recounts of their stories helped us understand how the systems currently in place functioned to deliver care in these unfortunate circumstances and how they can be improved to better serve the needs of our communities.

There were series of talks on special general surgery populations, women in surgery, video and simulation in surgical education, plastic surgery, and ENT, among others of which breadth is too extensive to cover in this piece.

Plenary sessions touched on topics like leadership, communication, wellness, burnout, and resilience. They included speakers like Dr. Taylor Riall (@TaylorRiall), whose words helped humanize the figure of the modern physician while simultaneously making me a little jealous of the residents under her tutelage in Arizona given her sustained action plan for resident wellbeing. I also got to listen to Dr. Eric Levi (@DrEricLevi), who has since covered our Twitter feeds with pictures of elephants and socks (#crazysocks4docs), talk about the grim status of physicians’ mental health nowadays and invite us to reach out to those around us.

Morning and afternoon tea breaks provided us with not only delicious pastries and warm drinks, but also the opportunity to network with the most impressively diverse surgical workforce I have encountered in a single building. While navigating between conversations in languages I’d never heard before and English accents I still cannot fully decipher, I had the privilege of exchanging a few words with Dr. Barbara Bass (@ACSprez) and the President of the College of Surgeons of Bangladesh, who encouraged me to keep working hard to pursue the next series of goals in my career. I also crossed paths with another famous Twitterati, Dr. Adil Haider (@AdilHaiderMD), who was there to lead multiple sessions on trauma, outcomes, and international collaborations.

I had the pleasure of attending the Trainee and Young Fellow Association Dinner at the Taronga Zoo, where I ended up spending some quality time with a group of registrars from Perth. The most shocking realization during this event was the fact that none of these PGY4-equivalent residents had ever encountered a gunshot wound, nor had their attendings joining us on their way to the photo booth. After a flurry of conversations about responsibilities, autonomy, duty hours, and personal experiences, we got to share a delicious meal with a breath-taking view of the Sydney Harbour at night surrounded by animal noises from the nearby enclosures.

The time I spent outside the conference was as rewarding as the conference itself. I got to pet kangaroos, have breakfast with koalas, meet the world’s most poisonous snake, and help teach Vanderbilt faculty how to take selfies for their kids. I hiked 72,000 steps along the Australian coast, taking in the amazing views of cliffs and rowdy waves with an approaching storm. I toured markets for souvenirs, taste-toured Asian bakeries, and fell in love with Aussie chocolate mousse.

Like everything else in life, my trip to Sydney provided me with the opportunity to conquer new fears and uphill battles. As part of my personal tradition of doing something that scares me in every new place I visit, I ended my week with an evening climb of the Sydney Harbour Bridge (#bridgeclimb). It was there, overlooking the Opera House and the bright city lights 450ft above sea level that I got to truly ‘reflect on what really matters’.

The most important lesson I learned from this experience is that, even thousands of miles apart, we are all just human beings trying our best every day to make this world a better place for those that surround us.

I am extremely grateful for this opportunity and encourage all residents interested in broadening their horizons to take advantage of these resources that RAS-ACS so kindly makes available to us.

Alejandra M. Casar Berazaluce, MD, is a PGY2 general surgery resident at the University of Texas Health Science Center in San Antonio, TX, and a pediatric surgery research fellow at Cincinnati Children’s Hospital Medical Center in Cincinnati, OH.

Dr. Berazaluce pictured above Sydney Harbor
Photo of the Sydney convention center
Photo of the clouds from the airplane
Opening session of the RACS Annual Scientific Congress