Post graduate surgical students

Mr Michael Zhu
Working towards prevention of acute kidney injury in patients undergoing cardiac surgery

Acute kidney injury (AKI) after cardiac surgery is a common, yet difficult problem to tackle. New clinical research at Monash Medical Centre and Monash University may allow clinicians to detect the real-time risk of AKI intraoperatively, offering an opportunity to predict AKI up to 1-2 days earlier than current methods of diagnosis.

The latest research has been conducted by Bachelor of Medical Science (Honours) student Michael Zhu under the supervision of Professor Julian Smith, Associate Professor Roger Evans and Associate Professor Andrew Cochrane. Michael has also been supported by a Monash University Honours scholarship.

The prospective study used a feasible and relatively non-invasive technique, involving a fibre optic oximetry probe deployed in the urinary catheter, to evaluate the relationship between urinary oxygen tension (PO2) and the development of AKI after cardiac surgery requiring cardiopulmonary bypass (CPB).

The study is ongoing, with a current sample-size of 35 subjects. The data indicate that patients who later developed AKI experienced significantly longer and more severe periods of urinary hypoxia intraoperatively; with a median of 14 min per hour of surgery in the AKI group, compared to just 30 seconds per hour of surgery in the non-AKI group.

The promising study has shown that real-time monitoring of risk of AKI during cardiac surgery is feasible and may be prognostically useful. This may in-turn offer clinicians the opportunity to intervene in the operating theatre to minimise the risk of AKI.

The next step will be to investigate, in a large animal model, whether intraoperative interventions (e.g. during CPB) can result in changes in renal and urinary oxygenation. Subsequently, this may translate to strategies to reduce the risk of AKI in patients having open-heart surgery.

Michael wishes to thank his dedicated supervisors for their tremendous support throughout the Honours year. He will present his research at the upcoming Annual Scientific Meeting of the Australia and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) in Cairns.

Surgical careers after PhD

What happens after doing a PhD – does it impact on your career as a Surgeon?  Each edition we will feature a surgeon who has completed a PhD and how this has impacted on their subsequent career.

Mr James Lee

Combining a clinical and research career in Endocrine Surgery

James Lee is a consultant endocrine surgeon at The Alfred and Monash Health. In 2014, he successfully completed a PhD on microRNA biomarkers of thyroid cancer at The University of Sydney. He currently holds the position of Adjunct Senior Lecturer at the Central Clinical School Department of Surgery, through which he continues to advance his interest in surgical research and education.

Upon completion of clinical fellowships at Austin Health (Melbourne) and Royal North Shore Hospital (Sydney), James embarked on a laboratory-based PhD to study the potential role of miRNA in the management of thyroid cancer. In his studies, James investigated the miRNA expression profiles of papillary thyroid cancer in subgroups of patients. The thesis also examined the potential utility of circulating miRNA molecules as a biomarker of recurrence. His studies showed that both tissue and circulating miRNAs have the potential to be biomarkers of thyroid cancer recurrence. James’ doctoral work also suggested that thyroid cancer cells seem to use miRNA-containing exosomes as a form of inter-cellular signaling.

Through his doctoral studies, not only was James able to gain a deeper understanding of the thyroid cancer disease process, he was also able to enhance his appreciation of the rigours of the scientific methods. As a result, his skills and understanding in the pre-clinical research fields, combined with his clinical training, put him in an ideal position to lead translational research projects. With close collaboration between clinicians and scientists, a translational research team can implement bench research findings to improve patient care, as well as take clinical problems from the bedside, and solve them in the laboratory. James is currently in the process of setting up a thyroid cancer research group to conduct further translational studies in the fields of miRNA and exosomes.

Another one of James’ passions is surgical education. He has recently established and run a very successful Monash University short course “An Introduction to Surgical Research”. It is hoped that this course will become an annual event. James is currently the Younger Fellows Representative in the RACS Section of Academic Surgery Committee, and is the convener of the Annual Academic Workshops in November. At the Alfred, James enjoys mentoring surgical trainees and residents who have an interest in research, and helping them with their clinical research projects. This year, James has joined the organising committee of the Biannual Alfred General Surgery Meeting.

In recognition of his work, James has recently been awarded the prestigious Royal Australasian College of Surgeons Foundation for Surgery Senior Lecturer Fellowship. One such fellowship is awarded each year to a Fellow of the College who is deemed by their peers to have made, and is likely to continue to make, significant contributions to academic surgery. James is excited and humbled by the award, which will help him further his career in academic surgery.
More information on James’ research and publications at:
http://www.mrjameslee.com.au/research.html

Teaching Update

Undergraduate teaching

Surgery is one of the pillars of the Monash University medical degree. Monash students are fortunate to have access via their clinical schools to a world class surgical education, thanks in the most part to the commitment, experience and enthusiasm for teaching of hundreds of surgeons throughout Melbourne, regional Victoria and Malaysia. Elements of surgery are taught across all years of the program and at almost twenty clinical sites.

In 2016 Monash University appointed Mr Peter Evans and Mr Tristan Leech, both practising surgeons, to the position of Curriculum/Assessment Leads for Surgery.

We have embarked on a project to update and document the surgical curriculum into a format more useful to students and surgeon/teachers, review and develop assessment materials and develop new online learning modules accessible to all students to reduce the amount of doubling up on didactic teaching required at individual sites currently

 This project is a collaboration between surgeons at all Monash University Clinical Schools and campuses, from Box Hill to Bendigo, Johor Bahru and beyond.

We are proud to announce the formation of the Surgery Discipline Reference Group (S-DRG) who will act as site-based curriculum and assessment advisors. In turn, they are inviting input from surgeons of all specialties at their sites to provide recommendations and content in specific areas of the curriculum. We have the full support of the Monash University and the Departments of Surgery at the various sites.

If you are passionate about surgical teaching and want to know more or get involved in this exciting and overdue modernisation of the curriculum content and delivery, please get in touch with us, or your local S-DRG representative. We’d love to hear from you!

• Peter Evans  peter.evans@monash.edu
• Tristan Leech   tristan.leech@monash.edu
• Curriculum/Assessment Leads, Surgery

The Monash University Surgery Discipline Reference Group (S-DRG)

Central Clinical School

• The Alfred Hospital – Mr Simon Grodski
• Cabrini Hospital – Ms Kaye Bowers
• The Epworth – A/Prof Martin Richardson
• Frankston Hospital – Mr Tristan Leech

 Clinical School Johor Bahru

• Johor Bahru – Mr Suneet Sood

Eastern Clinical School

• The Angliss, Box Hill Hospital, Maroondah Hospital - Mr Nigel Sacks

Rural Clinical School

• Bendigo Base Hospital - A/Prof Beth Penington
• La Trobe Regional Hospital - Mr Neil Jayasuriya
• Mildura Base Hospital – Mr Rotimi Afolabi

School of Clinical Sciences at Monash Health

• Dandenong Hospital – Mr Stephen Rodgers-Wilson
• Monash Medical Centre – Mr Mark Cullinan

MUSIG 2016

The Monash University Surgical Interest Group (MUSIG) is a not-for-profit, student run organisation, dedicated to promoting the profession of surgery to medical students at Monash University. Since the last edition of the Cutting Edge, MUSIG has been busy with several key events.

Surgical Careers Symposium  

In April, MUSIG held a Pathways into Surgery Symposium, where each of the nine RACS Surgical Specialties were represented by a distinguished Consultant Surgeon or current surgical Trainee. The event was keenly attended by students across all year levels and was streamed live to regional Clinical Schools. Surgeons highlighted the fascinating world of their chosen specialties, discussed personal career pathways, and covered topics ranging from advice on becoming a competent and proficient surgeon, to involvement in research and academia, and the importance of mentorship.

MUSIG would like to thank the Victorian Regional Office of the Royal Australasian College of Surgeons and each of Monash University’s Departments of Surgery for their wonderful support of this event.

Surgical Skills Workshops

Across May to August, MUSIG held four surgical skills workshops (Alfred, MMC, Gippsland and Preclinical), reaching over 200 medical students. Stations ranged from basic suturing and hand-tying, to more advanced skills such as laparoscopic simulation, airway management, chest-tube insertion, bowel anastomosis, cyst removal, z-plasty and tendon repair. Guided by outstanding surgeons and trainees who generously volunteered their time and expertise, students wetted their appetite for surgery, brushed up on their surgical anatomy and gained a greater understanding of the intricacies and dexterity involved in surgery. At each of the workshops, surgeons gave very positive feedback and praised students for their enthusiastic attitude and learning abilities.

MUSIG and attending students would like to extend another heart-felt thanks to all Surgeons who assisted as tutors, and to the Departments of Surgery at the Central Clinical School, the School of Clinical Sciences (Monash Health), the Gippsland Clinical School and the Department of Anatomy & Developmental Biology for their ongoing support and backing.

How can you get involved?

Many doctors and surgeons tirelessly share their knowledge and passion for surgery at our events. If you, or staff in your Department are interested in teaching medical students with a keen interest in surgery, please feel free to contact our chairs Michael Zhu and Matthew Lam at musig@mumus.org.

An Introduction to Surgical Research

The inaugural Monash University, Central Clinical School short course “An Introduction to Surgical Research” was held between June and September this year. The course was designed to equip participants with the foundation knowledge and practical skills required to conduct clinical studies on surgery related topics. This year’s course was attended by 12 budding surgeons who have an interest in surgical research. The cohort comprised of surgical registrars, residents and medical students. The course was held over 3 weekends, 6 weeks apart. The intervals between instalments of the course allowed the participants time to assimilate the knowledge, apply their newly learned skills to their current projects, and complete pre-course reading and tasks.

The course was predominantly run by academic surgeons James Lee (Endocrine Surgeon at The Alfred) and Sebastian King (Paediatric Surgeon at Royal Children’s Hospital). Prof Danny Liew (Chair of Clinical Outcomes Research at DEPM and Consultant Physician at The Alfred) ran the statistics days, while Prof Wendy Brown (Chair of CCS Department of Surgery and Upper GI Surgeon at The Alfred), Prof Jonathan Serpell (Director of General Surgery at The Alfred) and Assistant Prof Brandyn Lau (Health Sciences Informatics at the Johns Hopkins University School of Medicine) brought additional dimensions to the course in guest speaker roles.

Throughout the course, the participants were presented with hands-on, practical, and interactive sessions on a wide spectrum of surgical research skills – from generating structured research questions, gathering and analysing data, to disseminating research findings via conference presentations and journal publications. With the knowledge and skills they gained from this course, many of the participants have gone on to start research projects, while others have found new techniques and confidence to propel their current studies.

The course feedback was overwhelmingly positive. In particular, one participant commented, “Really practical, real world examples. Great course, will recommend.” Another participant remarked “Excellent speakers, enthusiastic sessions, well-tailored to specific needs within the group.” Finally, from a participant who is about to start a research year, “Thoroughly enjoyed, found it extremely relevant and makes me look forward to commencing surgical research.”  Dr Marlie Stowe was the winner of the brief presentation competition (pictured above).

As the convenor of the course, James would like to thank all the faculty members and participants for their enthusiasm and efforts.
Further details of the course is available at www.tinyurl.com/teachmeresearch  The course will be conducted again in 2017.
Enquiries can also be directed to James at: James.Lee@monash.edu

Monash Institute of Medical Engineering (MIME)

The Monash Institute of Engineering (MIME) was established in late 2014 to foster collaboration between engineers and medical professionals across the entire Monash Medical Faculty and its teaching hospitals.  CSIRO and other Monash Faculties such as Science, Business, Art, Architecture and Design are also involved so that multidisciplinary teams can be set up to solve clinical problems with the development of new medical technology, devices, and IT solutions. 

We welcome the involvement of surgeons for any ideas they wish to develop for new surgical instruments, 3D modeling, mechanical and electrical devices, robotics, mechatronics, new materials and new imaging techniques.  Our engineers and scientists work on scales from nano- to micro- to the macro- scale.  A number of Monash affiliated surgeons are already involved and some have been successful in obtaining our seed grants for new technology development.

The current successful seed grant projects are on our MIME website.

We would be pleased to advise on how to set up a collaboration, the IP issues and how to develop connections with industry.  We will also advise the surgeon on how to plan and achieve a commercial outcome for their ideas.  Please contact me (j.rosenfeld@alfred.org.au) of Heather St John the MIME Chief Operating Officer  at Heather.Stjohn@monash.edu  if you wish to explore ideas.

Monash Partners

 Background: Monash Partners Academic Health Science Centre is a collaboration between clinical care providers (public and private), Monash University, and health research institutes and was recognised by the NHMRC in 2015 as one of four internationally leading Centres in Australia. Established in 2011, founding members are Alfred Health, Monash Health, Monash University, Cabrini Health, Epworth Healthcare, Baker IDI Heart and Diabetes Institute, Burnet Institute, and Hudson Institute of Medical Research. In September 2016, Peninsula Health and Eastern Health joined Monash Partners, extending its coverage to 3.5M Australians (15% of the population). We catalyse, facilitate and enable integration of research, education and health care, building partnerships to accelerate the pace, scale and impact of research and innovation to deliver tangible health benefit. Our vision is “to measurably enhance the health of the communities we serve.”

Monash Partners provides a non-competitive collaborative space, transcending traditional silos across public, community, primary care, ambulatory and acute services and across the translational research continuum from benchtop to public health and policy, creating a systems platform to improve health.

Progress on priorities emerging from our theme and discipline strategic plans includes:

• Expanding our partnerships: Importantly we are beginning engagement with Primary Health Networks and regional partners around collaborative opportunities.
• Revitalising and supporting Theme and Disciplines: optimising partner engagement in the executives, revising and revitalising leadership, providing administrative support, organising collaborative forums and contributing to a Monash Partners retreat to review groupings and structure and progress strategic priorities and planning.
• Streamlining Research Ethics and Governance: a Council nominated multi-organisational, multidisciplinary working group is co-developing and implementing a model to streamline and harmonise ethics and governance review across the Partner organisations to create efficiencies of scale through the sharing of best practice, resources and processes. Supported by a project officer, funded by the Partners, the group is chaired by Professor Paul Myles and is working in collaboration with the NHMRC and Victorian Government.
• Accredited Good Clinical Practice (GCP) Training: all Monash Partners staff have access to accredited ICH GCP training, at no individual charge, at the AMREP and MHTP campuses. Refresher GCP training is also available, and a suite of training is being developed for clinical staff to build capacity in clinical research and healthcare improvement. This training program is provided by Monash University and funded by the Partners.
• Building a culture of research: implementing a coordinated range of initiatives to build a strong research culture in our partner health services by increasing awareness and engagement with patients, the community and health professionals. We are adapting and implementing strategies proven effective internationally in this endeavor, which is funded by the Partners and coordinated by Ms Cheryl-Ann Hawkins.
• Data driven health care improvement and research: a multi-organisational, multidisciplinary Data forum has been held with all key stakeholders and an Executive is being finalised. They will focus on improving data quality, harmonisation and linkage to optimise and align population health and drive health care improvement. This initiative is being led by Assoc Professor Jim Buttery and Professor John McNeil with representation from all partners.
• Engaging and integrating with primary care and community health: the primary and community health discipline, led by Professor Grant Russell, is forming an executive, to be chaired by Professor Leon Piterman. The executive will bring together key stakeholders in primary care and provide an opportunity for enhanced primary care collaboration, integration, innovation, communication and leadership.
• A problem focused collaboration in falls prevention: a multi-organisational, multidisciplinary workshop has been held, an Executive, chaired by Professor Terry Haines, has been formed. Working groups have been established to maps falls prevention guidelines/practices/models of care across the Partners, examine disinvestment in the current falls risk assessment tool, and explore opportunities for patient/family and caregiver engagement in falls prevention activities.
• Health care innovation and systems improvement: Monash University has appointed a newly funded Professor of Health Care Improvement, Professor Rick Iedema and his team, with formal partnerships with Warwick University in the UK. This initiative will link to the relevant disciplines in Monash Partners to co-develop a range of capacity building education programs in this area for staff across the partnership.
• Catalysing and facilitating integration of early translational research into clinical and population health practice and research: a lead has been appointed to facilitate and enable inter digitation of early translational research into later phases of translational research, informed by successful models internationally. A committee will be formed shortly.
• Building a National Alliance of AHSCs: Monash Partners is taking a leadership role in collaborating nationally through an Alliance of Academic Health Science Centres to provide a platform to drive better health outcomes.
• Communication: A communications lead is soon to be appointed and will update the website and provide regular Monash Partner updates. We are also working with the NHMRC to highlight key collaborative success stories and would be keen to hear from anyone.

Proposed activities next on the agenda:

• Public, patient and community involvement: we are progressing a range of strategies around public and patient involvement (PPI) to enable greater engagement, to catalyse co-design, and build capacity for stakeholder engagement for researchers, clinicians and for patients and the community.
• Education program: This work is just starting and will progress over the next 12 months in collaboration with Monash University and the Partners.

Key contact details:

• Angela Jones, Senior Program Lead: angela.jones@monashpartners.org.au 
• Helena Teede, Executive Director: helena.teede@monash.edu