Departmental Retreat: The Big Four and Integration

Fall is here, excitement is in the air, and we in the Department of Surgery have begun the journey towards clinical integration with our partners at Abington and Aria. On Saturday, September 24, 2016, nearly 100 attendees joined us in the Hamilton Building for our second Department of Surgery retreat in the last 18 months. This retreat differed from our first as we focused on two topics: The Big Four and Jefferson Health System Integration. The morning commenced with a reminder of our vision and mission statements, a review of the fiscal exigencies which prompted a need for change, and the charge to the participants. Dean David Nash then spoke on “Population Health: Is it the Secret Sauce?” and Dr. Anne Docimo, CMO, followed on the topic of “The Search for Value in the Healthcare Marketplace.” Next, Jasmine Arfaa, PhD, MHSA, and Terry Lynch (Press Ganey Associates) spoke on “The Patient Experience at Jefferson.” Finally, Mr. Neil Lubarsky, SVP for Finance, expertly discussed “Healthcare Cost Consciousness.” Following these four thought provoking talks, breakout sessions were held to encourage brainstorming and the prioritizing of our action plans. Following lunch, Hugh Lavery, SVP for Government Affairs, spoke on “Federal and State Landscapes.” President Steven Klasko, MD, MBA, speaking on his 3rd Anniversary at Jefferson (applause!) reviewed the numerous governance alterations that have taken place creating a more nimble and expansive Jefferson Health System. The half day retreat ended with a summary and action plan by each of the group facilitators. It was wonderful to sit in the same room with our colleagues from Jefferson, Methodist, Abington, Aria, and the Main Line. The interactions were robust, introductions were made, shared threats and opportunities were discussed, and…now the work begins! Soon, Jefferson’s Integration Management Office (JIMO) will nucleate surgical integration teams to help develop and implement changes to support our Jefferson Integration 2.0 goal. We will need timelines, milestones, and deliverables. Various project managers will be assigned. There is excitement in the air and hard work to do. We in the Department of Surgery have the opportunity to help lead this integration process. Recordings of the morning presentations are available at: jdc.Jefferson.edu/surgeryretrea

The Many Roles of an Academic Surgeon

One of our most important responsibilities is training the next generation of fellows, residents, medical students, and undergraduate students aspiring to a career in medicine. Last summer Sidney Kimmel Medical College launched our new educational curriculum, termed JeffMD (Jefferson.edu/JeffMD). There is great excitement as we have welcomed 270 new medical students, who will be engaged in an entirely new and improved curriculum focused on problem-based learning, small group sessions, lifetime learning, longitudinal threads and experiences. The Department has helped develop the new curriculum, and also hopes to bring to fruition a surgically-focused curriculum, for those medical students who differentiate early into a surgical field. Stay tuned for more, as this materializes under the direction of Drs. Gerald Isenberg and Harrison Pitcher. We also educate our learners by publishing books and journals focused on surgery. Congratulations to the many members of our Department who have led the way and brought to fruition the following major endeavors: • Cataldo Doria, MD, PhD, MBA, FACS, published Contemporary Liver Transplantation (book) • Alec Beekley, MD, FACS, published the 2nd edition of Front Line Surgery (book) • Gerald Isenberg, MD, FACS, released the first issue of the ACS online publication: Case Reviews in Surgery (journal) • Nicholas Cavarocchi, MD, FACS, FCCP, published Critical Care Clinics, Extracorporeal Membrane Oxygenation (e-book) • Francesco Palazzo, MD, FACS, and Michael Pucci, MD, FACS, are working on a new book The Fundamentals of General Surgery with many chapters already submitted. • Just two years ago Adam Berger, MD, FACS, edited a monograph on Melanoma, and David Tichansky, MD, MBA, FACS, edited The SAGES Manual of Quality, Outcomes, and Patient Safety • My personal project, the 8th Edition of Shackelford’s Surgery of the Alimentary Tract just celebrated the submission of the last of the 184 chapters that will make up this 2 volume set. Lastly, having just concluded my summer faculty chats with all 61 of our Jefferson-based faculty members, it is impressive to reflect on their accomplishments and achievements to date. It is certainly clear to me that our Department makes critical contributions to Thomas Jefferson University Hospital being named to the U.S.News & World Report Honor Roll, as the 16th best hospital in America. Please enjoy the various articles which compose this issue and keep up with our news on Facebook.com/JeffersonSurgery and Twitter@JEFFsurgery in between issues

The Spring of 2017…Change and Hope

There is excitement in the air at Jefferson this spring. We had a superb “Match” on March 17, and will be welcoming 6 terrific categorical general surgery residents come July. The Philadelphia Phillies just completed spring training well above .500, and there are high hopes for an improved year. In late April, the American Surgical Association − co-founded by our very own Dr. Samuel D. Gross (Chair of Surgery, 1856-1882) − hosted their 137th Annual Meeting here in Philadelphia. As part of the social program, attendees toured Lubert Plaza in the heart of our Center City campus, which includes the magnificent Samuel Gross Monument by Alexander Calder. Jefferson Health continues to sustain momentum towards further expansion, with the planned addition of Kennedy Health in New Jersey and Philadelphia University to our Jefferson family soon. Some work is already underway with Philadelphia University (see the Enterprise Integration column), taking advantage of their expertise in creative design, innovation, and space planning. Add to this the work being done at our Center City, Abington and Aria campuses by our 7 surgical 2.0 Integration teams focusing on patient-centered, highest quality care… much is happening. April 1 marked the launch of our Wave 2 EPIC implementation (inpatient EPIC) at our Jefferson Hospitals in Center City and on our Methodist campus. The power of this electronic health record (EHR) is quite amazing. Patients are being encouraged to sign up online for the “MyChart” patient portal, we are linked to other organizations via the Care Everywhere platform, and we now have one unified EHR for our outpatient and inpatient environments. As you might imagine, the surgical residents have embraced this new technology with great enthusiasm, while at least some of us (attending surgeons) are finding we have to work a bit harder to become facile. We look forward to further optimization of these systems, so that we can truly see the power of this far reaching, multi-layered EHR. Please enjoy the various articles which compose this issue and keep up with our news on Facebook.com/JeffersonSurgery and Twitter@JEFFsurgery in between issues

James Mann, M.D. (1759-1832): Military Surgeon for the Second War of Independence .

The War of 1812 is remembered for the Burning of Washington, and Francis Scott Key’s “The Star Spangled Banner,” but little else. It was a poorly funded war of relatively short duration and nebulous resolution. Under such circumstances, it is understandable that the “Second War of Independence” failed to produce many notable military or medical advancements. However, one surgeon took it upon himself to recount his experiences in the field. For his dedication to the art and science of medicine, James Mann deserves recognition

ECG Wave-Maven: An Internet-based Electrocardiography Self-Assessment Program for Students and Clinicians

Purpose: To create a multimedia internet-based ECG teaching tool, with the ability to rapidly incorporate new clinical cases. Method: We created ECG Wave-Maven (http://ecg.bidmc.harvard.edu), a novel teaching tool with a direct link to an institution-wide clinical repository. We analyzed usage data from the web between December, 2000 and May 2002. Results: In 17 months, there have been 4105 distinct uses of the program. A majority of users are physicians or medical students (2605, 63%), and almost half report use as an educational tool. Conclusions: The internet offers an opportunity to provide easily-expandable, open access resources for ECG pedagogy which may be used to complement traditional methods of instructio

Baron Guillaume Dupuytren: when brilliance combats professionalism.

Baron Guilluame Dupuytren was a French anatomist and surgeon who practiced during the 1800s and is considered by some to be the most brilliant and gifted surgeons of his time. His contributions to the field of surgery are quite extensive, yet his eccentric personality and attitude toward his colleagues, students, and patients raises a very interesting question: could Dr. Dupuytren (Fig. 1) and his many contributions to the field of surgery have thrived in today’s era of professionalism? The concept of professionalism is emphasized to medical students starting from day one of their medical training. How would Dr. Dupuytren, an esteemed anatomist, react to the idea that students are introduced to the idea of professionalism before entering the cadaver laboratory

John Blair Deaver, M.D., and his marvelous retractor.

John Blair Deaver was born near Buck, Pennsylvania, in Lancaster County on July 25, 1855, to Dr. Joshua Montgomery Deaver and Elizabeth Clair Moore. The elder Deaver was a reputable country physician, educated at the University of Maryland, who fathered three physicians and a college president. John Blair Deaver (Fig. 1) went to boarding school at West Nottingham Academy in Maryland. After boarding school he taught in Lancaster County country schools to raise funds to attend the nation’s first medical school, the University of Pennsylvania. On receiving his M.D. degree in 1878, Dr. Deaver completed 1-year internships at both Germantown Hospital and Philadelphia Children’s Hospital, after which he embarked into clinical practice. Alongside his brother, Dr. Harry Clay Deaver, he made home visits to patients to perform surgeries as well as managed a busy 16th Street and Vine Street Philadelphia office

Alton Ochsner, MD (1896-1981): surgical pioneer and legacy linking smoking and disease.

Edward William Alton Ochsner kept a plain, metal card file in which he recorded close to 50 years worth of medical experiences, research, and insights. The most populated topics were filed as Cancer, Lung and Cancer, Bronchogenic. These reflected his areas of greatest interest, for which he would go on to produce groundbreaking work. Of his many lifetime accomplishments, he is perhaps best known for being the first to report a link between cigarette smoking and lung cancer. This was just one of the many ways in which Ochsner worked to effect social change. The establishment of the Ochsner Health System in New Orleans was born from this similar passion. Ochsner went on to become one of the giants of his generation as a result of this tireless work as a leader, educator, and mentor

Emil Zuckerkandl, M.D. (1849-1910): Bridging Anatomic Study and the Operating Room Table.

In the mid-19th century, the Vienna School of Anatomy was at the epicenter of the rapidly growing field of anatomy. One of the school’s most distinguished professors, Hungarian-born anatomist Emil Zuckerkandl was instrumental in transforming anatomy from a descriptive science to one of practical and clinical value. A prolific researcher interested in nearly all areas of morphology and most famously, the chromaffin system, Zuckerkandl’s discoveries from more than a century ago still provide a foundation for surgeons to this day

Consecutive Case Series of Melanoma Sentinel Node Biopsy for Lymphoseek Compared to Sulfur Colloids

Introduction: Sentinel lymph node biopsy (SLNB) is an important adjunct in the staging of patients with melanoma. Preoperative lymphoscintigraphy (LS) with radiolabeled isotopes is essential to localize sentinel nodes for removal. Our study compared the effectiveness of Lymphoseek to standard sulfur colloids (SC) in patients with melanoma undergoing SLNB. Methods: We queried our IRB-approved melanoma database to identify 370 consecutive patients who underwent SLNB from 2012-2016 with at least one year of follow up. There were 185 patients in each group. Data points included characteristics of the primary melanoma lymphoscintigraphy, and SLNB. Student’s t-test and Chi-Square were used to analyze the data with a p-value of \u3c0.05 being considered significant. Results: Patients were equally matched in regard to age, sex, and primary characteristics of their melanoma. In comparison to SC, Lymphoseek required lower radiation dosages (p\u3c0.001), shorter mapping times (p=0.008), and decreased number of sentinel nodes removed (p=0.03). There was no difference in the number of patients with positive nodes (p=0.5). Additionally, there were no statistical differences between the two radioactive tracers in regard to the number of patients with false negative SLNB. Conclusion: Lymphoseek has the potential to decrease radioactivity and mapping time in patients who need SLNB. With a decrease in the number of nodes removed without loss of sensitivity, there is a potential to avoid unnecessary node removal and thus complications such as lymphedema. Longer follow-up will help to determine if there is any increase in false negative rates despite fewer nodes removed