Newsletter  - Fall 2005    

Welcome to the Department of Surgery Newsletter. We hope you find this information helpful.

From Where l Sit..
Richard L. Gamelli, MD, FACS
 

Research in a clinical department of surgery is something that is often questioned as to its real value. Further, some are of the opinion that all research should be done by dedicated full time research scientists. My laboratory mentor as a surgical resident and junior faculty member at the University of Vermont was often heard to say “is surgical research done by surgeons or research that is done in a department of surgery”? Given the challenges of patient care and revenue generation that a clinical department faces today and the ever increasing competitiveness for extramural funding it would be easy to abandon this mission. Research permits our trainees to understand and experience a problem that is of interest to them, to learn first hand the problem solving approach to medicine, to develop critical thinking skills, to build systematic organizational skills, and the opportunity to bridge knowledge and application. To conduct research in a busy clinical department requires new approaches and new partnerships if we as surgeons are to continue to contribute to the development of new concepts, foster de novo ideas, and support the further enhancement of ongoing research initiatives. The current NIH roadmap seeks to develop innovative approaches to accelerate fundamental discovery and translation of that knowledge into effective prevention strategies and new treatments.

This NIH imitative is what many have called in the past bench to bedside research but today is more commonly referred to as translational research. Inherent in this approach is new pathways to discovery, research teams that are multi-disciplinary and a re-engineering of the clinical research enterprise.  Our Department of Surgery has had this as a major theme of our research effort over the past decade. This has evolved with the continued growth and development of the Burn and Shock Trauma Institute as envisioned by Dr. Freeark. With we continued growth of our research program members of the Division of Surgical Oncology are participating in an innovative program with the Oncology Institute in the Cardinal Bernadine Cancer Center.  Drs. Gerard Aranha, Margo Shoup, and Katharine Yao are working with other clinicians conducting a melanoma vaccine trial for patients with advanced disease.  Dr. Brian Nickoloff, Director of the Oncology Institute leads this team that has have developed a tumor specific dendritic cell based therapy. Dendritic cells harvested from the patient that have undergone immunomodulation and transformed into mature dendritic cells are injected directly into the patients lymph nodes where the can transform T-cells to attack specific tumor cell markers.  This approach allows the patients immune system to undergo amplification and be used to provide treatment to patients who have failed other forms of therapy.  While this is exciting information for melanoma patients, it’s more exciting if one understands that these concepts are fundamental to designing innovative approaches for other tumor such as pancreatic cancer. While there are many obstacles and challenges ahead with these approaches, it is only through such collaborative research partnerships of clinicians and scientists that we will develop new strategies to improve patient care. 

These research partnerships also demonstrate to our medical students, residents and fellows that as clinicians they can be involved and make an important contribution to advancing clinical medicine.  The tradition of knowledge in the service of humanity is a basic tenet of our being physicians. However, it is only by developing new knowledge that we can improve our care of patients.

Feature Article

In total, the Institute is conducting six ongoing clinical trials that involve seven trauma/burn surgeons, representing $750,000 in funded research. Studies include participation in a national trial of PolyHemeÒ, an oxygen-carrying blood substitute designed to increase the survival of critically injured trauma patients at the scene of the injury. Loyola is one of 20 Level I trauma centers participating in the trial, and the only one in Illinois.

The Illinois Burn Prevention Golf Invitational
Continues their Support of the Burn Unit

The Illinois Burn Prevention Golf Invitational, connected with the Northern Illinois Chapter of the National Fire Sprinkler Association (NFSA), has again chosen to support Loyola University Health System’s Burn Unit through their 10^th annual outing.  The organization’s total giving to the Burn Unit has totaled $45,000 over the past three years.  The 2005 contribution of $25,000 will enable the Burn Unit to purchase new doplers and bronoscopes, which help burn victims by allowing us to asses for lung damage and changes in circulation.

Fred Kroll and Amos Miner, who have co-chaired the golf invitational since its inception, met Dr. Richard Gamelli, Chairman of the Department of Surgery, at an event for Camp I-Am-Me.  The camp helps pediatric burn victims and is also supported through the annual golf event.  After this initial meeting a partnership developed between the Golf Invitational committee and Loyola, a partnership for which we are extremely grateful.

Mr. Kroll and Mr. Miner, along with other committee members, work diligently throughout the year, obtaining sponsorships and celebrity guest speakers for the golf events, allowing more funds to pass through to Camp I-Am-Me and Loyola University Health System.  More than 100 golfers participated in the 2005 outing, which is augmented by a silent auction, raffle, event sponsorships and program advertising.

The Illinois Burn Prevention Golf Invitational is held each year on the first Monday in June.  We are thankful for the NFSA’s tireless efforts in hosting this event and their ongoing commitment to our program.  Thank you for the difference you have made in our ability to care for our patients, making a positive difference in their quality of life.

Clinical Spotlight

New Faculty

On October 1, 2005, Wanda Cruz-Gonzalez, D.M.D. was appointed Assistant Professor of Surgery, Division of Oral and Maxillofacial Surgery and Dental Medicine.  She joins our Oral Health Center here at Loyola and will concentrate her practice in the area of General Dentistry.

Dr. Cruz-Gonzalez received her D.M.D. from the University of Puerto Rico School of Dentistry in 2002.  She completed her Dental Residency at the University of Illinois at Chicago and University of Chicago Hospitals.  Since 2003, she has been an associate in a general dental practice in LaGrange until she joined our staff in October.

Dr. Cruz-Gonzalez is a member of the following societies:  American Dental Association, Chicago Dental Society, Illinois Dental Society and Hispanic Dental Society.   She has given multiple scientific presentations during her training and private practice years and she has also actively been involved in research regarding Organ Transplant in Dentistry, Immediate Loading of Implants, Dental Caries in HIV Patients, and Intra and Post-Anesthetic Complications in Sedation Cases.

She can be reached by contacting the Oral Health Center at (708) 216-3678.

Cosmetic Surgery Becoming More Popular for Men

An article that featured Dr. Juan Angelats in the March 2005  issue of Loyola Living can be viewed at the following link:  http://www.luhs.org/news/pubs/ll/05_mar/index3.htm

Resident Corner

Reflections on a Decade of Education in the Department of Surgery…..

When I was asked to run the last educational meeting for the Department, instead of distilling some of the most important educational events over the last ten years, I chose to have a working meeting to make sure all of the loose ends were wrapped up before I left.  It was not until I departed and had some time for reflection on “the role that education has played and will continue to play in Loyola’s Department of Surgery”.  To that end I share a few historical thoughts about my observations and experiences over the last 10 years.

The decade I am referring to is not when I started, but the era when Richard Gamelli MD began his tenure as the Department’s Chairman on July 1^st 1995.  Shortly thereafter, I joined the faculty and my first epiphany was the degree of commitment that the faculty had to education starting with first and second year medical students who were involved in research projects with faculty members, to the third year clerks and forth year students on elective through to the general surgery residents and fellows.  Third year medical students rotating on the surgical clerkship were not innocent bystanders to the educational process but were expected to see their patient’s prior to resident rounds, present them on rounds and deliver a plan of care. They followed their patients carefully, attending operative procedures, rounds and clinics, tracking their patients through the system.  The educationally focused Morbidity/Mortality and service specific conferences such as the weekly Vascular Case Presentation Conference placed the emphasis on the resident as the surgeon decision maker and the expectation was that the residents outline the action plan.  After learning the history of Loyola, I am convinced that this focus on education came from the culture that was established by a group of senior surgeons instrumental in the early years of the residency some 30 years ago.  Those surgeons were: Drs. Robert Freeark, Gerard Aranha, William Baker, Fred Littooy, and Jack Pickleman.

The strong foundation for education that was built 30 years ago has become a mansion with many pillars of excellence.  One of those pillars is the burn service formally organized with the recruitment of Dr. Gamelli in the 1980s.  Third year residents are acting “chiefs” on this efficiently run service where daily rounds in the ICU take place on a predictable schedule.  The approach is multi-disciplinary including the nurses, physical and occupational therapists, pharmacists and dieticians who all contribute to the daily plan of care that is presented by the students and residents following the patients. Because of the emphasis on teaching during rounds, hands on technical procedures and opportunity for independent critical decision-making, the residents rate this service the highest of all rotations. In an attempt to measure the educational outcome of the burn service, Loyola students in a retrospective fashion were queried as to the degree the burn rotation met goals and objectives as outlined by the 6 competencies. (1)    Interestingly enough, the burn service was meeting those competencies even in the era before their description. Because of the strong feedback from students and residents, many principles of the burn service have been incorporated on other rotations.

With rotations such as the burn service, it was easy for me to step into an educational role in the Department.  My first “job” was the Director of Undergraduate Education. Running the clerkship taught me to hone important organizational skills and we pride ourselves in continuing to offer 3 months of surgery to students during the third year of medical school.  It is the critical manner of thinking, the technical skills (with suture lab experience and the operating room) and the fact that students really have ownership of the patients that has made the clerkship so valuable.  Students have rated the surgical clerkship at Loyola consistently above average on the national AAMC survey. Under Dr. David Holt’s, the current Director for Undergraduate Education, leadership, elective options have been expanded so now students can choose anesthesia, ophthalmology and pediatric surgery during the third year to help them start career planning. A new forth year elective was introduced this past year that basically offers preparatory skills for students seeking a surgical residency. Dr. Fred Luchette advocated strongly for students to fulfill their forth year ICU experience in one of the Surgical Intensive care units and with that change came the opportunity for students to spend time on a surgical service for the forth year acting internship floor experience as well. 

The most rewarding opportunity that I had with students was kick starting the Surgical Honors Society program.  Students historically found some way to identify and work with faculty members on research projects. I decided to formalize this process through an Honors Society.  Once a year students receive a listing of projects that are active in the Department and through a match system are assigned a faculty research mentor.  Students completing their work present at Surgical Grand Rounds twice yearly when time is set aside for those presentations.  Since the Society’s inception in 1999, 48 students have presented in this peer review format.  In fact, many students have presented at local, regional and national surgical society meetings as well.  This research “mentorship” experience has been a powerful tool for students as they decide on their future career plans.

My next major educational role was the position of Vice Chairman of Education and General Surgery Residency Program Director, which I was lucky enough to assume just six months prior to an RRC site review in March 2002.  Having an upcoming site review and compiling the PIF (Program Information Form) is the only way to really get to know a program from the inside and out.  The exercise paid off and we were granted another five years of approval. This was quite welcoming to me since we could then turn our efforts into developing novel programs for the residency instead of just trying to meet basic minimal requirements.

The success of those novel programs; however, rest with the faculty.  Dr. Fred Luchette and his trauma faculty offer the ATOM course now twice a year and in this course our residents learn advanced trauma surgical operative techniques.  Loyola is the only surgical residency in Chicago offering this experience.  The skills station has been formalized under Dr. Sharfi Sarker with first year residents having a defined curriculum that they need to master throughout the year.  The summer residency curriculum for four years has focused on the “six competencies” and this year the residents had sessions on leadership skills, teaching techniques, developing presentations for M&M, and improving professionalism through drafting a CV, and interviewing for fellowships and jobs.  Kim Echert, our Assistant Director for Surgical Education Programs presented the latter topic and quite the number of residents were not only extremely attentive during the session but also asked great questions.

In terms of the educational curriculum, Surgical Morbidity and Mortality conference was remodeled after Leo Gordon MD’s Matrix M&M model that was presented at one of the Association of Program Director’s in Surgery meetings.  Dr. Gordon, the program director of Cedar Sinai Hospital in Los Angeles, likened M&M to a roach motel—the good ideas are tossed about but never get out.  So using this analogy we improved our M&M by developing a system for note-taking during those sessions—residents are expected to incorporate evidenced based material during their presentations and these citations are documented in the notes along with the major “teaching points”.  These notes are then emailed out to all of the residents within a day or two of the conference.  This way all residents, including those who could not attend due to patient care issues, can benefit from the discussions.

An on-line curriculum was developed for the Resident’s conference last year that was highly effective in disseminating the material to the residents and provided them with an opportunity to test their knowledge by taking a quiz on-line prior to the conference.  Faculty members with expertise on the subject attend the conference and assist the resident in facilitating and discussing the material.  Most sessions included dedicated time to review the quiz material as a mechanism to help the residents prepare for their annual in-service training examination.  Dr. Michele Slogoff continues to oversee the resident conference and has put a lot of effort into improving the quality of the discussions and encouraging the residents to attend.

A new initiative by Dr. Raymond Joehl, the newly named Vice Chairman of Education and General Surgery Residency program director, is to organize the goals and objectives of each rotation by the six competencies.  Objectives (and competencies) will be PGY level specific. As compared to the current objectives, these will be “living” documents that the residents will be exposed to on the first day of the service and a mechanism will be introduced where the residents will demonstrate evidence of completion of the various objectives by the end of each rotation.

One example of the spiritual mission of Loyola and how that is incorporated in the Department is the invitation to participate on a medical mission trip to Peru organized by Dr. Juan Angelats, Chief of the Division of Plastic Surgery.  These medical missions take place every other year and residents are supported through the Department to participate in this experience, which provides surgical care to underserved individuals. Faculty members are active participants as well as Loyola nurses and Department of Surgery support staff.  Residents who have participated in this experience always comment that it offers an incredible “stepping stone” into practice and more importantly it gives them a perspective of what surgery is really about.

We reward teaching through the “Pickleman Teaching Award” which was created to recognize the best resident teacher at our annual Welcome and Farewell celebration every June.  The importance of medical students and the educational process led us to decide to empower the students to select this individual. Their end of rotation scores of residents are used to identify the top “resident” teachers and the Education Committee in the Department selects the final winner.  Last year Dr. Gerard Abood, a second year resident, was the named recipient for his behind the scenes attention to students and always willing to help them out attitude.  This is one way we acknowledge our past and continue the culture of education that Dr. Pickleman created at Loyola since he was the Course Director for the student clerkship for many years.   In fact any resident receiving a score of 4.5 or higher from the students (on a 1-5 Likert scale, 5=highest) has a letter placed in his/her file citing their teaching efforts and making them a member of the “Honor” roll of resident teachers. The Freeark Award, a newly established award in 2005, recognizes excellence in Trauma/Critical Care by a highly performing resident.   Residents can also apply for the traveling Keeley fellowship for support to visit national or international surgical programs with clinical or research excellence.

To the Department of Surgery, fellow faculty, residents, students, nurses and support staff—let’s take a lesson from history and continue that rich educational mission that has been and will continue to be a core competency of Loyola’s Department of Surgery.  It has been a sincere honor to have contributed a very small piece to that mission and I will always remember and cherish those times…..

Sheryl G.A. Gabram MD MBA FACS

Reference:

1.      Gabram SGA, Minks K, Hoenig J, and Gamelli RL:  Medical Student Electives in General Surgical Subspecialties:  Do they meet the six core competencies?  The American Journal of Surgery 188(3):  246-249, 2004. 
 

Robert J. Freeark Trauma Resident Award

The Department of Surgery and the Division of Trauma, Critical Care and Burns are pleased to announce the establishment of the Robert J. Freeark Trauma Resident Award.  It is only fitting that this award be established in Dr. Freeark’s honor.  He has dedicated his entire career to caring for the injured patient and is credited with establishment of the first trauma unit in the country during his tenure as Chairman of Surgery at Cook County Hospital.  The current Illinois state trauma system, the oldest in the United States, is the fruit of his resolve and his legislative efforts. His many publications have advanced the care of patients and the recognition of trauma surgery as a legitimate academic surgical specialty.   

Dr. Freeark earned his medical degree from Northwestern Medical School in 1952 with honors.  He completed a rotating internship in 1953 and a general surgical residency program in 1958 at Cook County hospital.  While in his residency he was the recipient of a research fellowship sponsored by the Jerome J. Solomon Foundation.  In 1960, he joined the Department of Surgery at Northwestern moving through the ranks from Assistant Professor to Professor and was the Director of Surgery (1958-1968) and the Hospital Director at Cook County Hospital from 1968 to 1970.   

During his tenure at Cook County Hospital, he established America’s first trauma unit in 1965 along with the Sumner L. Koch Burn Center and the Robin Dean Heliport.  In 1970, Dr. Freeark joined the Department of Surgery at Loyola as the Chairman, a position he held until his retirement in 1995.  Since then, Dr. Freeark has been Professor Emeritus and Special Assistant to the President for Health Affairs at Loyola. 

Dr. Freeark has received numerous accolades for his dedication to the health profession and specifically care of the injured patient.  He has been the President of the American Association for the Surgery of Trauma; a Director of the American Board of Surgery; Director of the Joint Committee for Critical Care Medicine; Vice President of the American Surgical Association; President of the Central Surgical Association; President, Midwest Surgical Society; President, Illinois Surgical Society; and the President of the Chicago Surgical Society.  He also served on the editorial boards of the Archives of Surgery and the Journal of Trauma.  Dr. Freeark, in 1973, was awarded the Outstanding Clinical Professor award by the Senior Class of the Stritch School of Medicine.  In 1980 he received the Alumni Medal from Northwestern University Medical School and was the recipient of the Stritch Medal from the Stritch School of Medicine in 1981.  He has received further recognition by receiving the Distinguished Surgeon’s Award for his contributions to safety from the National Safety Council in 1987 and the Christian Fenger Surgical Excellence Award from Cook County Hospital in 1992.  Dr. Freeark has been a visiting professor and an invited lecturer at several national and international venues and continues today. 

The selection committee for this award consists of the faculty members in the Division of Trauma, Critical Care and Burns, the trauma nurse coordinator, nurse practitioners, and the SICU Pharm D. with input from nursing and other support staff dealing with the trauma service and trauma patients.  Additional data include the faculty’s composite evaluation of resident performance on pre and post-tests utilized by the trauma critical care service.  Residents eligible for this award include the PGY-1, PGY-2 and PGY-4 rotating on the trauma/critical care program for the preceding academic year.  The purpose of this award is to recognize a resident who demonstrates the highest standards in the six competency areas of surgical education and practice as well as embodies those attributes demonstrated by Dr. Freeark during his surgical career. 

Sean Barnett is the first recipient of the Robert J. Freeark Trauma Resident Award for his “can do it” attitude while the trauma chief during the academic year ending 2004.  Mary Margaret Wolfe (the unsinkable Meg) was the recipient for 2005.

Research Resident

Luke Brewster is entering his third year in Dr. Howard Greisler’s vascular biology laboratory, which is investigating novel approaches to promote rapid and complete endothelialization after vascular intervention without stimulating concomitant vascular smooth muscle cell hyperplasia.  His work has been supported in part by the National Institute of Health through their National Student Research Service Award post-doctoral grant.   

He was recently awarded the National Resident Research Award from the American Vascular Association, and their work on the “Construction and Characterization of a FGF-1 Mutant-Collagen Binding Domain Chimera That Binds Collagen and Stimulates Endothelial Cell Proliferation and Chemotaxis” was featured at the Society of Vascular Surgery’s annual meeting in June.  

In September, they are presenting their work (in collaboration with Allen Samarel of Loyola’s Cardiovascular Institute) on limiting vascular smooth muscle cell hyperplasia in 3-D culture through disruption of the integrin-mediated focal adhesion kinase (FAK) cascade in Lausanne, Switzerland, at an international meeting on the interaction of cell surfaces with biomaterials.

Presentations at scientific meetings

Dr. Kovacs gave a seminar entitled “Estrogen replacement improves cell-mediated immunity in aged mice after burn injury” NIA Workshop: Endocrine-Immune Systems Interactions in Aging, Potomac, MD, April 2005.}

At the Annual meeting of the American Burn Association Dr. Kovacs gave a podium presentation entitled “Ethanol prior to burn injury increases susceptibility to pseudomonas infection and upregulates pulmonary chemokine production.” American Burn Association, Chicago, IL, May 2005.

Dr. Kovacs gave a mini-presentation on the “Pulmonary consequences of combined insult of acute ethanol exposure and burn injury.”  Annual Meeting of the Research Society on Alcoholism, Santa Barbara, CA, June 2005. 

In December of 2005, Dr Kovacs will give a Plenary talk entitled “Aging, traumatic injury and estrogen replacement” in a Plenary Session on Aging of the Immune Response, Plenary Speaker, Austrian Society of Allergology and Immunology Graz, Austria.

Book Chapters

Publications

Multi-system blunt trauma: Head, Chest & Extremity. Luchette, FA, Esposito TJ, Davis KA, Poulakidas SJ, Santaniello JM.    Editor, Rao R. Ivatury, Patient Management Problems In Trauma and Critical Care for the American College of Surgeons Committee on Trauma, Publisher, Decker Electronic Publishing. 

Grants and Clinical Trials