Tour diary – Drs. Sukhdeep Dulai and Ruby Grewal

Building Leadership and Wellness Through Connection

The American-British-Canadian (ABC) Travelling Fellowship is the legacy of Dr. Robert I. Harris, a Canadian orthopaedic surgeon, who saw the need for international exchange to ensure that orthopaedic care did not suffer from the isolation of surgical teams in the wake of WWII. In 1948, during his term as President of the American Orthopaedic Association (AOA), the ABC Fellowship began, promoting international cooperation and advancement in orthopaedics by cultivating leadership through knowledge exchange and networking. Knowledge dissemination has improved in the digital age, yet the ABC fellowship continues to be an important institution in leadership development in Orthopaedics. It promotes collaborations, fosters mentorship and lays the foundation for building networks. It facilitates reflection and critical reassessment of personal and professional priorities through discussions with like-minded, highly motivated individuals.

In April and May 2019, seven North American Orthopaedic Surgeons (2 Canadians and 5 Americans) travelled through the United Kingdom, Australia and New Zealand on the latest iteration of the ABC tour. Truly representative of the collective diversity of the COA and AOA, amongst us there are eight spoken languages, seven cities of residence, five subspecialties, three women, two immigrants and one goal: advancing Orthopaedics in the context of a healthy surgical community.

2019 ABC Fellows at Worcester College in Oxford

2019 ABC Fellows at Worcester College in Oxford

The 2019 ABC travelling fellows are:

Antonia F. Chen MD, MBA is an arthroplasty surgeon, Director of Arthroplasty Research at Brigham and Women’s Hospital and Associate Professor at Harvard Medical School in Boston, Massachusetts.

Sukhdeep K. Dulai MD, MHSc, FRCSC is a pediatric surgeon, Orthopaedic Surgery Specialty Lead at the Stollery Children’s Hospital and Associate Professor at the University of Alberta in Edmonton, Alberta.

Ruby Grewal MSc, MD, FRCSC is an upper extremity surgeon at the Roth|McFarlane Hand and Upper Limb Centre and Associate Professor at Western University in London, Ontario.

Derek Kelly MD, FAOA is a pediatric surgeon at Campbell Clinic and Professor at the University of Tennessee in Memphis, Tennessee;

Michael Lee MD, FAOA is a spine surgeon, co-director of the Operative Performance Research Institute at the University of Chicago Medical Center and Professor at the University of Chicago in Chicago, Illinois;

Philipp Leucht MD, PhD is a trauma surgeon, NIH-funded scientist at New York University Langone Orthopedic Hospital and Associate Professor at NYU in New York, New York;

Hassan Mir MD, MBA, FACS, FAOA is a trauma surgeon, Director of Trauma Research at Florida Orthopedic Institute, Residency Program Director and Professor at the University of South Florida in Tampa, Florida.

Through this unique and inspiring experience, we grew from being strangers to steadfast friends and have built a collaborative network to help navigate the challenges of orthopaedic practice. We were honoured to represent the COA and AOA and our respective institutions during our travels. Over the course of five weeks, we met over 45 former ABC fellows and countless orthopaedic staff and trainees, visited 23 orthopaedic hospitals/academic institutions/meetings, gave 82 lectures, stayed in 13 different hotels and took 8 flights, 5 trains, 5 boats, 2 coaches, and innumerable taxis/shuttles. A detailed account of our daily activities and the people we had the privilege of meeting can be found on our fellowship blog which has had more than 5000 views by more than 1000 viewers from more than 2 dozen countries! (https://aoatravelingfellowships.wordpress.com/)

To inspire future ABC fellows, the following is a taste of our experience, including some of the highlights of the tour and insights we gained.

UNITED KINGDOM

After arriving in the UK, we were warmly greeted by ABC alumnus and Honorary Secretary of the BOA Deborah Eastwood who gave us an orientation to tour etiquette and acquainted us with London. Over the next three days, we were introduced to the unrelenting pace, unparalleled hospitality and unprecedented access that characterizes the ABC tour. We toured and participated in scientific meetings at both the Royal National Orthopaedic Hospital at Stanmore and the Royal London Hospital and were introduced to GIRFT (Getting It Right First Time- a quality improvement program from the NHS) and NICE (the National Institute for Health Care and Excellence). We discovered that the NHS not only demands fiscal responsibility but supports cost-effective health care by providing significant funding for clinical research programs.

We were invited to the offices of the Bone and Joint Journal to meet with Editor-in-Chief Fares Haddad and esteemed members of the BJJ editorial board. We engaged in a healthy discussion highlighting healthcare systems and their impact on research support, the history and inner workings of the BJJ, new methods of quantifying research impact and the long history of the ABC Club to which we were in the process of being inducted.

Aside from our academic events, our hosts in London (Deborah Eastwood, Fares Haddad, John Skinner, Will Aston, Rob Pollock, Sam Oussedik, Pramod Achan and Manoj Ramachandran) treated us to many unique experiences. These included a private, special-access tour of the Tower of London, a visit to the Old Operating Theatre Museum at St Thomas’ Hospital, high-tea at the Ritz and a street art tour of East London including private barista lessons. We were the guests of honour at our first black-tie dinner hosted by the BOA Council and a slightly less formal, but no less enjoyable, London ABC Fellows reunion dinner hosted at St. Bart’s Great Hall. We quickly realized that our waistlines would almost inevitably pay the price by the time the tour would conclude!

Our next two days were spent in historic Oxford where hosts Andrew Carr and Matt Costa had organized tours of Nuffield Orthopaedic Center and Botnar Research Center and an intimate discussion on conducting research in orthopaedics. The traditional practices at academic institutions of using metrics that reward volume rather than quality were challenged in favor of alternative value structures. We were inspired to ask important, impactful research questions and to embed research in the care of every patient we treat. We were given the privilege of sitting down with Keith Willett (Director for Acute Care to NHS England) to discuss how government and academia can work together to effectively implement transformative change in healthcare and how politics can and will impact the future of our profession. With our formal academic program in Oxford concluded, we submersed ourselves in the history and culture of this university town highlighted by the privilege of a black-tie dinner at Worcester College.

The next stop on the tour was Wrightington where we visited the Wrightington Hospital and the Center for Hip Surgery (including the Charnley Museum). Our hosts Martyn Porter, Anil Gambhir and Bodo Purbach filled our minds with the history of Sir John Charnley, the innovations he brought to orthopaedics and the ways in which that tradition continues. We observed a Charnley hip being performed and visited the unique Barn Theatres to see this novel model of delivering surgical care in action, challenging many of our prior assumptions. We discussed the importance and limitations of national registries and the implications of using this data to monitor surgeon performance. During our formal scientific program, Mr. Chris Faux, Chairman of the John Charnley Trust, bestowed us all with the privilege of becoming honorary members of The Charnley Low Friction Society.

Moving further north, we entered Yorkshire and arrived in Leeds. Our host, Hemant Pandit, organized a stimulating academic session at Chapel Allerton Hospital with a balance of basic science, translational science, clinical practice and administrative topics. We visited the Institute for Mechanical and Biomedical Engineering (iMBE) where we were introduced to their innovative studies in orthopaedics. Our visit concluded with a trip to Wharfdale for a short hike with panoramic views of the countryside.

After a scenic train ride to Edinburgh, we were greeted by Phil Walmsley and John Keating. We all gathered at the beautiful home of Hamish Simpson for a delicious home-cooked dinner and enthusiastic discussion with a group of former ABC fellows. In conversation with them, it became increasingly clear to all of us that the fellowship continues to have a positive impact on our predecessors. Our academic program was held at The University of Edinburgh and The Royal Infirmary of Edinburgh and was a healthy exchange of ideas, including discussions of study methodology, basic science research and clinical trials. We concluded with a formal black-tie dinner where we got a true taste of Scotland with kilts, bagpipes and a stunning view of Edinburgh Castle.

Following our explorations of Scotland, we moved on to Durham in Northeast England where we were housed at the historic Lumley Castle. Our hosts, Ajay Malviya, Michael Reed and Paul Baker accompanied us on a tour of the storied Durham Cathedral before we headed to our ABC fellows networking session where we discussed ABC history and compared our various healthcare systems and practice models. Our academic meetings included consultants and researchers from throughout the region including Newcastle, Middlesbrough and York. A variety of important issues were discussed including standardizing care, optimizing patient and staff experiences, development of UK registries and the structure, funding and implementation of clinical trials in orthopaedics. We had an informative discussion with Michael, Ajay and Sir Jim Mackey (Chief Executive of Northumbria Healthcare NHS Foundation Trust, former Chief Executive of NHS Improvement) regarding mechanisms to ensure consistent, safe, high quality and compassionate care within financially sustainable local health systems including the Quality Improvement for Surgical Teams (QIST) program. Our visit concluded with a tour of the new Northumbria Specialist Emergency Care Centre, a novel model of acute care delivery.

Our next stop was Nottingham, where hosts Angus Wallace and Rob Ashford gave us an incredibly well-rounded and action-packed experience during what ended up being the shortest stop of our tour. We were introduced to the history of Nottingham as we walked through town to our mentoring and networking sessions. We were asked to inspire consultants and registrars from both Nottingham and Leicester to become future ABC fellows. Prior to our departure just 24 short hours after we arrived, we participated in a spirited half-day educational academic conference hosted at Queen’s Medical Center, followed by two fascinating guided tours at the National Justice Museum and the underground sandstone caves and concluded by dinner at the edge of Sherwood Forest.

Our final stop in the UK had us returning to London where we were hosted by Lieutenant Colonel Arul Ramasamy. For our day’s academic session, we were guest participants at a sobering, yet inspirational, meeting of the Combined Services Orthopedic Society at the Imperial College of London Centre for Blast Injury Studies. Sukhdeep and Derek also met up with Deborah Eastwood for a personal tour of Great Ormond Street Hospital for Children and a discussion of the importance of politics and networking in pediatric orthopaedic care. To conclude our time in the UK, we donned our black-tie attire for a surreal and privileged experience at the Armoury House of the Honourable Artillery Company Headquarters with the Combined Services Orthopedic Society.

AUSTRALIA

Over the next day and a half, we traveled through nine time zones to arrive in Brisbane. We were welcomed by warm weather (finally!) and our host Michael McAuliffe, who graciously spent the next three and a half days with us in a well-balanced mix of networking, scientific exchange and cultural exploration. Michael went to great effort to maximize our exposure to various programs in the region. We gave lectures at Ipswich Hospital, the Royal Brisbane and Women’s Hospital at the University of Queensland Center for Clinical Research and the Queensland University of Technology (QUT). At St. Andrews Ipswich Private Hospital, we had an intense discussion of the benefits, drawbacks and intricacies of the mixed public-private Australian healthcare system with CEO Jude Emmer and Director of Clinical Services Chris Jung. We toured the new Gold Coast University Hospital, an impressive public facility where orthopaedics has secured substantial resources due to strong leadership and advocacy. We were guests at their journal club and a couple of our own papers had been selected for discussion. Our academic program was rounded out by a guided tour of the Institute of Health Biomedical Innovation at QUT where novel applications of robotics were being investigated.

 

ABC Fellows visit the robotics lab at QUT with Professors Michael McAuliffe and Ross Crawford

On the lighter side, we enjoyed a brunch with local consultants and former ABC fellows, a scenic Brisbane River cruise, a visit to the Lone Pine Koala Sanctuary to experience Australian wildlife up close and personal, a trip up Mount Coot-tha for panoramic views of Brisbane and a much-loved beach trip at the Gold Coast.

We bid adieu to Queensland and flew to Melbourne, Victoria where we were enthusiastically welcomed by our host Phong Tran. We participated in a well-attended regional academic session at the Royal Australasian College of Surgeons where we discussed the importance of surgical societies supporting strong travelling fellowship programs and were inspired by the innovative work being done in Victoria. Kerr Graham and Michael Gillespie spoke to us of the importance of humility and integrity in clinical research and medicine. We participated in several mentorship sessions including meeting with members of the AOA executive, former ABC fellows, local consultants, trainees and members of the Orthopaedic Women’s League (OWL). Sukhdeep and Derek visited the Royal Children’s Hospital of Melbourne to tour the new world class facility that was designed with deliberate intention to optimize the patient and family experience.

We participated in the team building activity of tree surfing and a mindfulness session at Peninsula Hot Springs. We were also treated to a prime experience at Melbourne Cricket Ground (MCG) where we watched our first Aussie rules football match.

NEW ZEALAND

After flying into scenic Queenstown, we were welcomed by the attendees of the New Zealand ABC Alumnus Networking and Leadership Forum: Mike Barnes, Peter Robertson, Khalid Mohammed, Haemish Crawford, Gordon Beadel, Brendan Coleman, Andrew Graydon and Mike Rosenfeldt. Over the next two and a half days we engaged in teambuilding and soul-nourishing activities including a jet boat ride, golfing, cycling, fishing, a gondola ride, mountain-side luging, wine-tasting and in true ABC tradition, non-stop networking. It was apparent to us that New Zealand has a friendly and tight-knit orthopaedic community, with many similarities to Canada. The culture of mentorship was inspiring. The ABC Fellowship has been an important part of their orthopaedic leadership development strategy. The necessity of maintaining a healthy work-life balance was also impressed upon us.

Our next stop was Christchurch where our local host Gordon Beadel had arranged for us to participate in the New Zealand Orthopaedic Association Continuing Orthopaedic Education (NZOA COE) meeting. Amongst scientific lectures focussing on trauma care were discussions on health systems, mass casualties and physician/surgeon wellness. Many opportunities for networking were provided including an opportunity to share our experiences with NZOA President Rod Maxwell and local orthopaedic surgeons and trainees. While in Christchurch, we witnessed the strength of spirit in a community that is united in its recovery from the recent tragedies it has suffered.

The final group journey of our fellowship took us to Auckland. The pediatric surgeons in our group made a visit to Starship Children’s Hospital where we had an opportunity to compare infrastructure and care delivery models to those at our home institutions. Our hosts, Andrew Graydon and Mike Rosenfeldt treated us all to a relaxed afternoon including a scenic ferry ride and lunch on Waiheke island. We were the guests of honour at our final black-tie dinner of the tour where we met with council members of the NZOA, many former ABC fellows and a few potential future ABC fellows. To close out the 2019 ABC Fellowship tour, our hosts in Auckland gifted us with a much-needed opportunity to reflect as a group on what we had experienced and learned over the course of the 5-week tour.

POST-TOUR

The conclusion of the fellowship was bittersweet. We were overjoyed to be reunited with our families and loved ones but leaving our new friends and the nurturing environment of the fellowship to return to the routine of our practices has been an interesting challenge. We are now armed and emboldened with new ideas, priorities and opportunities, renewed energy and enthusiasm and the support of our new friends and colleagues around the world. Reconciling this with the expectations and demands of a surgical practice and family obligations, especially in light of having taken a 5-week “hiatus”, has been an imposing task that we continue to work through daily. The privilege of being an ABC fellow is also a responsibility to ensure that we share our experiences with those around us and mentor junior colleagues and trainees to reach for more. We have been tasked with contributing to the meaningful growth of Orthopaedics and committing to surgeon well-being. Our first such initiative has been to analyze the results of our ABC fellows research project, a multinational Physician Well-Being survey that we look forward to publishing and presenting in the near future.

Applying for the ABC fellowship should be considered by every eligible orthopaedic surgeon who wants to make contributions to orthopaedics extending beyond their direct patient base. The fellowship gives an opportunity to build strategic collaborations with key international orthopaedic centers and individuals in the English-speaking world. The exposure to alternative healthcare delivery models and strategies is invaluable for future leaders. The access to international leaders in thought and initiative is above that of any other venue available to the junior or mid-career orthopaedic surgeon.

We are thankful for our mentors who “tapped us on the shoulder” and encouraged us to apply for this fellowship.  We are eternally grateful to the COA and AOA for giving us this priceless opportunity and are humbled by the gracious hospitality that was bestowed on us by the BOA, BJJ, AOA (Australian), NZOA and especially, all our hosts and former ABC fellows.  We look forward to paying it forwards. Finally, we would be remiss without acknowledging the unwavering and selfless support of our families, colleagues and staff at home, without whom participation in the fellowship would not have been possible.

 

COA ABC fellows atop the Cow and Calf rock formation in Yorkshire

COA ABC fellows atop the Cow and Calf rock formation in Yorkshire