E33 Chuck Vollmer On Peer Review And Productivity

Listen to this Podcast

Chad Ball  00:15

Welcome to Cold Steel, the Canadian Journal of Surgery podcast with your hosts Ameer Farooq and Chad Ball. The goal of the CJS podcast is threefold. The first is to highlight the best research currently being completed by Canadian surgeons. Second is to offer educational topics for both surgeons and trainees alike. And most importantly, the third goal is to inspire discussion, thoughts, creativity and career development in all Canadian surgeons, we hope you enjoy it.

Ameer Farooq  00:51

Dr. Chuck Vollmer is a hepatobiliary and pancreatic surgeon at the University of Pennsylvania. In this episode, we delve into Dr. Vollmer’s training pathway, his passion for the pancreas, and why he has done over 1000 peer reviews for surgical journals. Dr. Vollmer, thank you very much for joining us today on Cold Steel. We really appreciate your time, especially amidst all this craziness. And we thought we’d start by just asking you to tell us, especially for listeners who don’t know you as well, where you grew up, what attracted you to medicine and about your training pathway?

Chuck Vollmer  01:27

Okay, well, I’m really pleased to be with you today. It’s a great honor. I’ve been a good friend of Chad’s for a long time in our professional careers, and really pleased to bring what I can to this podcast. It’s something new for me. So I grew up in the great American city of Philadelphia. It’s really kind of ingrained in my heart and soul. Where I, you know, came from. It’s my roots. I was ultimately able to get back here, after long training, that I’ll get into at some point. But started out as a kid, actually, my father’s a banker, and we had to go away for four years in my early formative years to London, England, for a stent that he had there. And that was pretty influential on me, because it really made me very formal. I really adopted the British education, and the British ways of life at a very early age. I still can’t spell very well because of that. But I learned a lot at the outset, from the structure of the British society. And I came back to Philadelphia and went to prep school in the area, and kind of credit that to really being important in developing my critical thinking skills. And particularly in how to make an argument. I had a very challenging high school experience. Where you always put yourself out there to make your points and defend yourself. Ultimately went off to the University of North Carolina, just after Michael Jordan had left. My family had been there, my parents have had both been there. And ultimately, my son went there as well. So, we’re very, very fond of Chapel Hill. In terms of my medicine background, I basically have nurses all around me and my family. My grandmother, my mother, my sister, and my wife are all nurses. It kind of all started out with basically pulling off some of my mother’s nursing textbooks when I was about eight, nine, ten years old. Starting to read them and getting fascinated with anatomy. It just stuck with me really early. And I pretty much knew around the age of 10, 11, 12 that I wanted to be a doctor. And because of the anatomy of a very honest surgeon is what I wanted to be. So I’m one of those unique people who sort of had a path directed from the outset. I actually received Grey’s Anatomy at the age of 11 from my grandparents, because they saw my investment in at that point. And I still had that book and I have the highlighting to put into the book at that point. So I was on the path pretty early. I then got the opportunity to spend my summers in college at Fox Chase Cancer Center here in Philadelphia, as I was really interested in cancers in concept. But I was able to spend that time basically as a gopher for the chair of surgery – Chair of surgical oncology. So I got to see his whole gig. The research, things that he did, I was actually in his research lab for a number of years. As well as seeing patients that, you know, in my high school years, basically, in the office with him, and actually sitting in and hearing administrative responsibilities and those kinds of things along the way. So, I got a very good picture early on what academic surgery was about. And I was actually seeing Whipples and liver resections at the age of 19. And I think like when you see that, you’re like at the ultimate plateau of what surgery is all about from the outset. Everything else is a long way down. And I will say, I will credit that for how I got into the field that I am with pancreas surgery. I was able to go to medical school at a great surgical training grounds – Jefferson University here in Philadelphia, the home of Samuel Gross. Also, the place where the heart lung machine was made with Dr. Gibbon. And it has a very proud tradition, it makes surgeons. A very big proportion of the student body goes into a surgical field. So, it’s a really good place for that. Now, at that point, I want to get out of town. I come back to Philadelphia and kind of was sort of tired of the northeast. And I was hell bent on getting back to the south, or the West. It turns out, I ended dead center in the middle of the country at Wash U for residency. Washington, St. Louis. It was probably the best thing. I walked into the doors of Barnes Hospital. And I knew immediately just walking into the hospital that I felt comfortable there. And my interview day was perfect. And it was the place for me. And what I really was influenced there was by the Chairman – Sam Wells – who was the structure of the program, and the intensity of it. And it was just a great training ground. It’s one of the top five surgical training groups in all of America and continues to be that way. He was gracious enough to allow me to go to UCLA to do my research years and actually to sort of fly the coop from the Wash U research endeavor. And he allowed me to do that, because he knew that I’d be going to a very prominent MD PhD surgeon sciences lab with Jim Economou, ultimately, president of the American Surgical. And I went there to study gene therapy for hepatocellular cancer. It was a great experience. The basic science elements that I learned from Jim about how to make a hypothesis and think and attack study designs and all that kind of stuff. I still live with my clinical research endeavors today. And ultimately went back to St. Louis, finished the residency, and then it was off to fellowship in Toronto, Ontario. Probably the best part of my life was that fellowship experience.

Chad Ball  08:12

Chuck, I think, you know, certainly for those of us that do HPB, we know the weight and in particular the history of the Toronto fellowship program that you’re engaged in. As you also know, we recently had Paul Greig on the podcast. And, you know, I sort of told some stories in that podcast a little bit about how he, he was so formative for me, you know, even as a medical student around him on his rotation two or three times and how much he taught me and, and then, of course, you know, as I came through training and, and then started as a junior staff, he was still a real guiding light, in my professional and to be honest, personal career as well. I was curious what are some of the things that Paul taught you and that you carry with you?

Chuck Vollmer  08:57

So, you know, we just recently had the opportunity to celebrate Paul’s retirement at the HPBA meeting. It was great opportunity to bring all the former fellows together. Great evening to celebrate his brilliance, basically. But what I’ve always said, I said there, is that Paul is the heart and soul of the Toronto program. I mean, we know what Bernie Langer did to make it. We know the brilliant people involved in the faculty. When I was there, there were basically six faculty, all of which were professors at that point in time, you know. Paul and others, and it was just ideal place to be. But Paul is basically the humanity of the program. And it’s who he is, you know? He is a person. He is a real human being. I’ll tell you a couple, you know, influential things that I remember about Paul. It all started on the first day when I showed up. It was Elijah Dixon and myself and Ian McGilvery, we were the three fellows. And I came all spruced up, really tight and wound up as an American, you know, wearing my coat and tie and the likes. Paul’s there in jeans and a polo shirt. First day. It was a weekend. Elijah is there in scrubs and Ian as well, Kind of get the message immediately about how it’s going to be up there. A little bit more relaxed. But he welcomed me immediately on day one as a colleague. As a true colleague, not a pupil at that point. I remember we were looking at Zollinger Ellison’s patient. And it was very complex, multiple surgeries into it. And he turned to me and said, so Chuck, how do you do this in St. Louis? How do you do this in St. Louis? You know, so he was, he wanted to know. He was probing. He was out there. And he wanted to know that my opinion and thoughts will be valued immediately. And I thought that was just a great, you know, setup for the whole thing. I do remember a time when we were always talking scrubs. We really used that opportunity for the educational moments. Like we used to a lot in the old days. Less so now. But I remember a time we were about to go in on a case. And we were talking about the resident, the chief resident that we would be working with. That’s one thing about Paul is he brings everyone into the case, and he’s able to dole out grated responsibility, you know, the intern gets the gallbladder, the resident does, you know, certain elements and the fellow does the, you know, things that are more suited for them. So he’s able to choreograph that. But I remember being in sync. And basically saying something very, you know, punky. And I said, you know, this is a resident, he is worthless. And he kind of said back that, whoa, you know, take it easy boy. And he said, you know, these people need something from you, okay. You can’t write them off. And why don’t you sort of invest in getting them better in that case. And he actually, he challenged me to engage with, you know, people who I felt were sort of a lost cause or had no value. He also taught me how to have patience, in that process. And I will say that Paul invested time in me. I remember hours, side by side, in his office, over his, you know, sharing his computer screen, trying to write things. He saw that I was an energetic, enthusiastic person with some horsepower. I had ideas, I wanted to put them out there in the academic realm. He was not that way, by nature. He was not an academic, not well published. But he knew how to think. And he knew how to reason through things. And he sat there with me academically, and he put in the hours with me. And that was a great role model for what I would ultimately, you know, do as an investigator and a mentor to people. And I think the last thing I’d say about Paul is that he showed me that teaching has a methodology. He was so far out in front of the curve of this, I mean, this is years before we even formed the fellowship process at the HPBA that he championed. But there was a methodology to how to teach people. And I learned his tricks and tricks of the trade and his skill. And it’s also something I took to my first job at Harvard, where I actually got very enthused about medical education and the likes and did a fellowship in medical education there. Largely because I was stimulated by what he had shown me – the path he had shown me. He’s just a great guy, and it’s gonna be, you know, a hard thing for Toronto not to happen there. As well as the HPB world.

Ameer Farooq  14:28

We wanted to ask you about what clearly is a passion for you, which is the pancreas. You sort of alluded to it a little bit in that you saw pancreas and Whipple operations at a very early age. But what’s so appealing to you about the pancreas and why has that become such a huge passion for you?

Chuck Vollmer  14:48

Yeah. So I’ll get back to what I why I sort of told you my story as a youngster is I was just attracted to anatomy first and foremost, just totally fascinated by the human body and its function and form and all that kind of stuff. And as time went on, I sort of always had felt that abdominal anatomy is the best. I mean, it’s just from a functional standpoint, working in the abdomen, it’s very challenging, complex, and it takes a lot to understand it. You know, perhaps only the other thing that was maybe more attractive is the head and neck in terms of the complexity of things. Like the abdomen. But originally, you know, having my experience of Fox Chase, I wanted to go on a pack of surgical oncology. And back in the 80s, that was, you know, sort of the new kid on the block. Surgical oncologist was the general surgeon who did all the great cases who did the big stuff and did it, the complex stuff that was hardest. But, you know, essentially, in my lab years where this happened, the conversion, you know, in second or third year, when I went to the lab, I started to think about the next steps and the fellowship process. And basically, in the early 90s, the balkanization of general surgery had already, you know, moved ahead. And it was actually Steve Strasburg – another Torontonian – who had just come down from there to start the GI surgery division at Wash U, who showed me the way. And he basically said, you know, taught me that Oregon based training is really a great way to do it. I wasn’t so interested in learning all about cancer for the whole body, I was much more geared to the niche, that point as well as a lot of other people. So Oregon based training came in vogue. And that’s really when the rise of HPB surgery happened. When I trained, there were only two or three fellowship options. We didn’t have the potpourri that we have available now. So that sort of got me going there. Now, I liked cancer conceptually. And the diseases in the pancreas were very challenging, okay, particularly cancer, for it. So, I think that’s another thing is that I was up for a challenge. I’m always, you know, stimulated to compete, and to attack things. And this was sort of an ultimate challenge to get into that. I also wanted to, as I grew into the residency and such, I wanted to do excel at the highest level of technical proficiency. And you understand that when you get into the pancreas, the transplant, and liver surgery, you know, you’re pretty much up in the big leagues. And in fact, a little story from my experience in Germany, is that you know, of all the training pyramid, that you go forth in a fellowship process over in the German system – turns out the pancreas is at the very pinnacle of the pyramid, about seven or eight years into training, do you get the opportunity to do pancreas surgery, and that’s actually after liver transplantation in their paradigm. So finally, I’d say the other very influential thing for me is the role models in the field attracted me and their styles. I like their comportment, I like their bravery, their grace, I found them to very much embrace scholarship. And I was really, these were aligned with the characteristics that I admired. I’m actually stimulated, that I have not actually mastered this craft yet. And that keeps me going. And, you know, I think that’s the challenge of pancreas. I guess my last little nugget here is, you know, Mike Sarr is a very well-known person in general surgery, but he’s basically from the Hopkins stable. And he basically was invested in the pancreas. And I remember hearing him say, this is my organ. You know, there was a sense of possession there. A sense of wonder. A sense of, I’m going to go figure this thing out, because it’s got so much challenge. And, you know, I kind of aligned with that sort of frame of mind. Like, I want to go all in and see where this goes.

Chad Ball  19:36

You know, what’s interesting with me when you talk about that Chuck. You know, it makes me think a little bit going back to Paul Greig. You know, Paul Greig would have said the same thing about the liver. And it was always impressive to watch him debate, you know, chemotherapy trials with the medical oncologists and you know, pathology with a pathologist, it’s a remarkable privilege and an amazing thing to watch when someone like you or him is fully focused on the depth of a given organ or a relatively narrow field. Not surprisingly, I think then, you know, in your career so far, you published a number of really impressive landmark papers, publications. Not only in the pancreas, but in particular, the pancreatic fistula. And one of the things that we’ve been a beneficiary of in Calgary, both Elijah Dixon and myself and our other partners is inclusion into your really multinational, essentially global pancreatic fistula study group. And I was curious how, you know, how you got that started? What the challenges were. How, besides as you point out your personal engine and horsepower, how is that group and your research program remain so productive and so innovative and been able to moderate. I would argue, and I mean, this in a very collegial and nice way, moderate some pretty big egos globally, to produce that kind of that kind of result?

Chuck Vollmer  21:01

Yeah, well, I think it all starts with the problem. The question and what pancreas fistula is all about. I mean, it is, you know, the classic Achilles heel, but it’s the source of all of our concern. In the field. I mean, from a technical standpoint, it’s the biggest problem we have to deal with. And it impacts patients terribly. And it also impacts us as the surgeon, it’s terrible when you think that you’ve done your best job, and you are technically sound, and adept, and you put something together and it just craps out. And you’re head scratching, and what’s going on, how did this happen? How could it happen, etc. I actually started my interest in this back in medical school. I was on the GI surgical service in the early 90s. And I just remember my role in the morning was to go, you know, do the notes and do the rounds. And we started out in the ICU. And you know, back then, for GI surgery, the ICU was the killing fields. It was terrible. I mean, there were five to 10 people on the service in the ICU at all times. And I remember distinctly, you know, looking at these abdomens that were open, they had six drains coming out of them, every humor coming out of them, and thinking, you know, how does a person survive this? Why are we in this state? And how do we get through it? So, you know, at that point, I realized that this is a big problem. And I think you have to attack big problems, you know, to get on. I think your relevance in the field is going to be dictated by you know, what you’re actually studying. So, when I got to the point of being in an attending and going on my research path, I realized that there was a community of likeminded peers interested in asking questions and studying them. I credit the pancreas club for this and other societies where you can get in the same room, and ideas fly, and you see the interest and the wonder that other people have, and you can just, you know, bounce things off each other. So, what I was struck with by in my peer group is that we were actually less interested in our egos. And our own personal, you know, career trajectories, as we were in defining problems. Asking what they are and answering them. And coming to a collective to put them together. I think this sort of distinguishes my mid-career peer group from our predecessors in a way in that we, you know, we’re more comfortable working together as a group, I think. So what I also realized at that point is the literature anymore, or in the early mid-2000s, you know, it couldn’t be generated by standalone centers anymore. It just wasn’t good enough to have a single center experience of 200 cases. The statistics didn’t allow for it, the things that you would, your conclusions that you would make weren’t strong enough, and the variability wasn’t there. So you needed the N, and you needed variety. That’s, I mean, that’s really the strength of our literature now, is to be getting in there. So basically, you know, in terms of the group, I basically developed a business plan. In essence, I remember like any of the big projects I’ve conducted with groups, I put out a document. Here is the plan. Here are the thoughts, here’s the approach, here’s the methodology we would use. I invited people to come in and join in. And, you know, I think at the outset, it was easy to get my friends together to do it. But then we got more important people and bigger centers and you know, bigger names and the likes, you know, people who were advanced and older than I was, and had their careers already made. And they joined in because they saw that we had some momentum going. And I will say, I’ve always felt the pressure that this group is you know, we have to do it well, we have to do it right and fairly, and we want to come out with the best product that’s there. And fortunately, this particular experience has been very successful. We’ve had a number of papers at the highest level of surgical impact journals. And I think people see that quality, and it fuels the fire. So we originally developed the risk score for the fistula but we needed to extend its functionality, basically. And to do that, we needed variants in practice. So you know, it’s been productive, because actually, for this problem efficiently, we have so many questions to ask. I’m really grateful to my colleagues who have allowed me to take the lead. And I’m grateful to them for their tireless efforts in the detailed data accrual. And this is basically a partnership between attendings, you know, thought level attending level people driving young trainees who are interested in getting into the field. Who are doing a lot of the hump work for us. So, in essence, I’d say our data set that made this group is a hybrid between big data like NISQUIP, and IS, you know, the administrative stuff with its lack of granularity. And then the hybrid with the practice level kind of granularity. And that’s allowed us to look at the technical details of the surgery. You brought up the word egos. I don’t see the egos. I really don’t. We’re all enthused to find out the path forward in our field, and how to improve. And I think that’s, you know, set the egos aside. I’ve had nothing but good things to say about how we work together as a group, bringing the smart people together to answer these questions.

Chad Ball  27:38

I think, again, it’s such a huge tip of the hat to you Chuck. You know, it’s your motor and your vision and your ability to bring all these groups globally together. And again, some of the papers that you’ve produced are fantastic. As you may know, you know, we just had a recent podcast with a guy named Shahzeer Karmali. He’s a high volume, geriatric surgeon in Canada, and he talks specifically about your intersection of whiplash and geriatric paper and how that’s changed that field entirely. So, some of the creative tangential thinking that you’re showing us is really, really quite interesting. And I think, you know, people in all fields should pay attention to what you’re doing, because I agree with you. This way of accumulating data and collaboration and quite honestly, groups think, is certainly the way forward. It’s interesting you mentioned the pancreas club. That’s probably one of my very favorite meetings. And I always thought the name was a little bit unrepresentative of the science and the collaboration that goes on there, because it is a big meeting. And it is so exciting. Similarly, you know, you just finished your presidency of the Americas HPB Association, which is, I would argue, certainly, our Pinnacle group. How was that experience for you? I mean, I know one of the things you clearly did was develop a long-term strategic plan for the association. He had a bunch of other things, of course, too, but how did you deal with challenges? How did you enjoy that? What was that experience like?

Chuck Vollmer  29:06

Yeah, so you know, the HPBA is the most important professional experience I’ve been through. You know, it’s basically my adult fraternity. I was at a big fraternity in college. You know, the principles of fraternity are scholarship, fellowship, connection, philanthropy, the likes. These are the sort of the bedrocks of what fraternities are about, despite the public image of them. And I would say that, you know, this was basically my, I found a new home in that in my adult life through the HPBA. Now, I talked about the balkanization of general surgery, the move to specialization. You know, right now we are in the age of specialty societies. Regional societies are withering away in terms of relevance. National societies have their purposes. But realistically the enthusiasm of surgeons is in the domain that they live day by day. So that’s why the HPBA became so important to me. And I remember back to Paul again. You know, I introduced him to the HPBA, I was a fellow and I have a number of presentations, I asked him to come, you know, support me at the meeting in 2003 I think it was. And he really hadn’t been there yet. And he came down. And he came over to me midway through, and he said, I’m so glad you brought me here, Chuck. He said, these are my people. And he was just, he found, you know, the, the fraternity there. And that was the fuse for, you know, for him and what he did for the organization, which was pretty amazing. Thereafter, we’re indebted to what he did for the education fellowship elements. But that’s what it was all about. It’s like, the thing about HPBA is the camaraderie, I think. It’s the strongest part of it. And it’s just a great energetic time of year to get together with your friends. Now the presidency was basically the culmination of about 20 years of involvement from when I was a resident. Actually, when I gave my first presentation as the chief resident there. And then ultimately, about 10 years of investment as a leader in there and I was party to membership committee, kind of pulled on my former passes as a rush Chair of my fraternity, to you know, become a person getting people involved in the organization. And then the program committee. And then ultimately, the leadership points thereafter. And I have to tell you, for the young people out there, you know, who kind of look at the leaders of the field, and how’d you get there. I’m just going to tell you the answers of what Mark Calorie told me once about how he got to his high-level leadership places. It’s all about sweat equity. You got to put effort into it, you got to bring ideas, you got to bring energy, and you got to be creative. And when you do that, you’ll be seen. And I also credit this to about the organization, pancreas club, HPBA. You got to go and, you know, tell people who you are, let them see who you are. You can’t be a wilting Lily on the sideline. Get up to the microphone, be part of the discussion, you know. Put yourself out into the spotlight a little bit. Let people know what you know, and what you think. And good things will happen from that. And I was very aggressive early in the career at these places to, you know, not sit in the background, but get up and pose some questions and give some perspectives. And I think that helped me out a lot for that. Now, you know, essentially, as we got to the top here in the presidency, I felt that…so I’m at heart, a strategist, I’m always sort of looking, I love games, I love the strategy elements of games. And I’ve always thought about my career on the long term. I’ve always enjoyed strategy. So it’s kind of natural that when I got to the presidency, that was what we were going to do, and we hadn’t really invested in thinking for the future for about a decade or more. It seemed to me that we were straying into a number of boutique kind of niche endeavors, often driven by the upper leadership’s personal interests, each of which I will fully say advanced the society greatly. But it was getting to the point where we were sort of relying on what was the President’s gig? What were they into? And that’s what was going to happen for this. And I actually wanted to take a step back from that and secure the structure and function of what the organization and maybe sort of refocus on what the membership was wanting and their needs. And I thought that was a good time to do that and bring my strategy, you know, elements into it. I felt that we needed to chart some new horizons for the future. And our this was the 25th year of our anniversary, gave us a lot of… it was the ideal opportunity to sort of takeoff from the past and project forward to the future. And with that, ultimately, the nature of my presidential address was the title “Get Better”. And what it was, is to look back at, you know, how we got to that point of celebrating our 25th anniversary, but what were the things that we needed to go forward with, and I think, you know, a lot of this had to do with shoring up functionality of the organization, as well as the financial security that would allow us to give products and give value to the members. That’s what they want from this organization. And we needed to get the tools for that.

Chad Ball  35:55

I have to say Chuck, you know, my professional practice, sort of straddling the HPB world and straddling the trauma world, both in Canada, in the US and then globally, the HPBA is a unique, almost unique organization. For so many of the reasons that you that you’ve stated so eloquently. It’s a really neat place to be and to be fair, we have to give you credit, in terms of the Canadian HPB Association, because our sort of strategic planning that we went through as a process last September, was essentially an emulation of what you did on a smaller scale. So, thank you for that. It was good. It was actually a really productive process. You know, the association is just over 10 years old now. And it was time for us to do that as well. If we shift gears here a little bit, you do a ton of peer reviews, on publication submissions for a variety of journals. I think I do too. And I don’t really want to talk about, you know, my view of it. But I know you and I are sort of similar, probably about one a day. And I think people look at that and say, Oh, my God, that’s craziness. But I want to ask you and put it out there as to why you think that process is so important, and why you engage in it so vigorously.

Chuck Vollmer  37:16

Yeah, so maybe not one a day. But I did look back recently and tallied how many reviews I’ve done. I’ve done over 1000 reviews. So I think it comes back to the fact that literature, I feel literature is the bedrock of our practice. And I think that there’s a sanctity to the literature, and that it should be the truth. And it should be based on solid analysis to get to the truth. And you know, the facts that come out in literature should be airtight, and things that we can believe in, to project forward. We’ll get back to Toronto in a way for this, because my experience with this started with Bernie Langer. He introduced this to me, you know, I was a fellow and he had a paper to review. It was on hydatid cysts. It was from Turkey, and, you know, hotbed for that disease process. And as an HPB fellow I was sort of just, you know, diving into the pool on all these topics of HPB and I really didn’t know much about it. So it challenged me to have to study the problems I was reading about. But I remember, you know, working hard on it, and giving them back a thing that was pretty bland and kind of complimentary, and wasn’t really that scathing. And I remember him looking across the desk and saying, Charles, you are too kind. And he then went on to sort of inculcate me into the fact that peer review is a duty, and it’s a process that needs to be done with the utmost respect for those principles I had just told you. He basically told me, you know, it’s our duty to make sure what’s in the literature is actually credible and real, and that garbage gets thrown out. And that kind of stuff that isn’t worthy, for whatever reason, doesn’t see the light of day. Because once it’s out there in the literature, it’s quotable. People can just, you know, bend it to whatever purpose they need it. So, I thought that was a very important point. It told me that it aligned with my own discerning nature and you know, to be critical, critical thinking etc. So, I will tell you that I’m a hard reviewer. I’m tough on things because of these purposes.

Chad Ball  40:02

Duty is an interesting word though, right? You know? This is to come back to that, because I would wholeheartedly and passionately agree with the use of that term. And you know, as an editor of a journal now, I do find it interesting when folks will decline reviewer invitations yet, you know, a week later or a week before their submission comes through the journal.

Chuck Vollmer  40:24

Or better yet, they want to be on your board.

Chad Ball  40:27

Sure. Yeah, exactly. Yes. It’s interesting, I don’t know, whether it’s a microcosm lack of insight there or whether, I mean, clearly, I guess they don’t feel a duty to that greater scientific process and methodology.

Chuck Vollmer  40:42

Well another thing about Mike Sarr – he’s the head editor of surgery, has been for 22 years. So another thing he sort of brought out is this concept of citizenship in the community. And as an Eagle Scout, previously, for me, I get that entirely, you know? You’d get that merit badge. As part of the way to get to become an eagle, you have to do citizenship in the community. Well, the same thing holds in our field. That this is part of, you know…if you’re an academic, it’s really a component of the job. And you’re exactly right. If you want your work to be judged fairly well, and with value, you have to put in your own hours yourself to understand how that’s done and contribute. So I’ll tell you some other thoughts on this. I like the literature, you know, basically, because I’m an investigator. If you’re an investigator, and you want to put your work out there, you have to learn how to navigate the literature. And to use it to your advantage for dissemination. I like thinking, I like chasing questions. I like creative approaches. And, more than anything else, I actually like writing, which I didn’t think I did in my early life. But, you know, when they get into it, and you start doing it, you get into the process of it. And, and that’s why, you know, the literature is attractive to me. So, I think of writing as the ultimate form, still, of dissemination of knowledge. And you can argue that, like what we’re doing here with a podcast is the new world. And there are other ways of this getting out there. But, you know, people will basically look back and say, if it’s down on paper, it is meaningful, right? So, you know, the literature is our history in a lot of ways. And it’s our path forward after that. And so, the best advice I give to the young people who are getting out there, as investigators, you know, is you’ve got to have projects, and papers that have a purpose. You’re wasting your time, you’re wasting other people’s time, and you’re likely to get rejected if you’re just rehashing something with a new flavor on it. And you have to know what the literature already holds out there. There are 20 papers on pseudo papillary tumor histories. You know that there’s no room for more value from that at this point.

Chad Ball  41:56

I mean, that’s a great point. We just recently had the Dr. Feliciano on the podcast. And, you know, one of the things he and I talked about was a command of the history of the literature and reviewing quite honestly, is such a great way to do that. It’s really under appreciated.

Chuck Vollmer  43:47

Well, actually, I take off on that in a different way. I’d say the reviewing actually puts you in the vanguard of what is out there. So, I probably read, you know, this may be a fault at this point, but I probably spend more of my time reading a lot of stuff that’s not going to get published. That never makes it. Then I do the actual published journals. That’s just the nature of where I am with this process at this point. But what it does do is it opens your eyes to what are people thinking? How are they attacking things? And you know, what’s the nature of the investigative field at this point? So, it’s sort of like an intelligence. A form of intelligence in a way to know where is the leading edge right now. And you can take that back to help your own research processes. You get ideas, not that you’re copying and I’m not suggesting that. You’re not pilfering ideas, you know, projects and such. But you get methodologic ideas. You get to see what the field is going and how you can write your paper to get to that published point.

Ameer Farooq  45:03

Dr. Vollmer, you know, one of the recurring themes on the podcast that you brought up in this conversation and other guests have brought up is this idea of having a passion and really going after it. Like clearly what you have with the pancreas. But you know, there’s sort of this other strategy of approaching projects and research, which is to sort of have multiple pots in the fire or lots of side hustles. What advice do you have to young trainees? And do you have a preference on either approach? Or do you think it’s an individualized sort of thing?

Chuck Vollmer  45:41

Yeah, well, I think you’re a creature of your environment, for sure. And for some people, you’re going to be in very fortunate situations to have great mentors and icons that can show you the way. And other people aren’t, unfortunately. But you can overcome that with your own passion. And drive. I think you brought something up about pots in the fire there. I do think it’s very important for the young people coming out. You should maintain your floor of potentiality, as far as you can go with that. And, you know, I did that on an academic term, in terms of clinical interest, research interests, educational interests, and leadership interests. And at the outset, you know, when I had energy, the energies and time wasn’t that important to me, etc., I was just finding a way to keep my toes in each of those domains. Same thing to be said, in terms of your research process. It’s going to be very limited. I think any good research, whether it be basic science, or not, the people who’ve really, really done well, and had huge successful careers, have been flexible, and have had different lines of attack that they pursue. This goes to the basic sciences icons too. They don’t just get into one thing, one idea and one way to attack it, because ultimately, those things find they have a shelf life, and they burn out. So, you got to sort of be nimble. So, I would say, from a research standpoint, you need to keep that potentiality. Maybe you should be doing a little bit of outcomes research, you should have a little bit in a clinical trial realm. You know, you could do practice based stuff, you can do big database, kind of stuff. You can do methodology stuff. There’s value in all these things, find the ones that ultimately you’ll narrow it on with an expert piece. So, I’d say, basically, your research needs to have a big picture plan. It can’t just be, oh I like this idea. And let’s just go for it capriciously or haphazardly. You basically have to have a bigger, long term process to it. And the questions need to sort of build up to the higher relevance, ultimately. You can’t be thinking you’re going to swing and hit a homerun at the outset of your career. I would encourage you to build building blocks along the way. Now, we as surgeons are primarily clinicians. So, we need to apply our work for value, and improve the field. And I think that’s just been the underpinning of everything I’ve done. It’s been to come to something at the end of that paper, or the end of the project, or the presentation you give, you got to come to something that offers a path forward. And the one thing I always say to my scholars is, you know, have the next paper in mind when you’re writing your current paper. And if you’re really good, you’re going to foreshadow what that next paper is. What the moves will be in that next paper, in, you know, sort of your discussion and conclusion area. And sort of like a chess game. You’re always looking ahead. Be ahead of the rest of the field. And if you are, you will get published, because you’re going to be pushing the boundary. In terms of productivity, I think if you’re starting out, the best thing you can do is go find yourself an engine for your chassis. You got to get young people involved and I was really blessed to meet Dr. Pratt. And he started the whole gig for me back at Harvard Medical School. He was a student; he was on my service. He said I like the things you’re doing; I like this idea of a care pass that you developed. Would like to study that a little bit more, boom, boom, boom, can I take a year off and study under you? And I’m like, perfect. You know, I was one or two years out, starting, and I need a horse to ride. And one day with that, and then fortunately, in the years, since I’ve had about a decade’s worth of young scholars here at Penn, called Harrison scholars, and what they have, they have the energy, and they have the skill sets. My statistical knowledge was good in 2000. And now we’re 20 years later. I rely on the youngsters to keep me in the vanguard of what’s going on with skills necessary. And then, you know, we feel each other. I feel like I’m the conductor and they’re the engine. And I think that’s really important. Last thing I’ll say about this question – this thing about, you know, developing your research and that’s something Elliot Chakoff taught me. He was the chairman at Beth Israel Deaconess. As I was leaving that institution, he took over. But he’s very much out there with this idea of owning a question. And you got to find out what that question is. For me, it’s clearly pancreas fistula. You know, I want to know everything about it, and I want to possess it, I want to own it, and master it and get to the bottom of it. And Elliot makes the point that, you know, everyone’s got this in them. Everyone’s got that question. You just got to sort of find the way to answer it. And there’s so many options and so many ways to go about things particularly in the current academic environment. There should be a way to get there.

Ameer Farooq  52:01

You’ve been listening to Cold Steel, the official podcast of the Canadian Journal of Surgery. If you’ve liked what you’ve been listening to, please leave us a review on iTunes. We’d love to hear your comments and feedback.  So, feel free to email us at podcast.cjs@gmail.com, or connect with us on Twitter @CanJSurg. Thanks again.