E39 Janice Pasieka On Gender Equity And Surgical Training

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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  00:50

There are a few mentors that you have in training that really push you that force you to become better both technically and non-technically. Dr. Janice Pasieka, is an endocrine surgeon at the University of Calgary and has mentored many general surgery residents and fellows. In this episode, we have a wide ranging discussion with Dr. Pasieka on issues ranging from gender equity, to surgical education and training to Dr. Pasieka’s rules on conferences. Dr. Pasieka, thank you so much for joining us on Cold Steel today, we really value your time and your contributions to the podcast. And it really means a lot to both of us personally. Dr. Pasieka, we’d wanted to start off by finding a little bit more about where you grew up. And I was thinking back to this as now your former trainee, I realized that I’ve never actually gotten the chance to sit down with you and ask you about where you grew up, and how you ended up in medicine and in surgery in particular, so I was hoping you could share that with the listeners on the podcast.

Janice Pasieka  01:54

Well, thanks very much Ameer and Chad for for inviting me and, and keen that I would be a great addition to the wonderful people that you’ve had on your podcasts to date. Um, so I actually was born in Sudbury in Northern Ontario, and grew up in suburbia, Toronto. And, you know, my family there, my dad was a mining engineer, my mother was a homemaker. And there was nobody in any of my family that were in medicine. So you can imagine when I just announced at dinner one day that I decided I wanted to go into medicine in grade eight, that they didn’t quite know what to do with this, this girl. So I don’t really know what it was that I focused on medicine. I think it was my love of the science and, and just a need to take care for people and and then I set my sights on that and basically went to university. I went to the University of Western Ontario and decided that I was work hard to try to get into medical school, and I got in after my second year, so I never completed a degree before I started medicine. And yeah, it was, in some ways to me I see it must have been a calling because I never looked back. And I couldn’t today imagine doing anything else as a career or profession. It’s just such a just such an honor and a privilege to be able to care for patients.

Ameer Farooq  03:52

It’s interesting that you say that Dr. Pasieka because we recently had Dr. Grace Rozycki  on the podcast. And she had a very similar story that she just was in her biology class and just just suddenly knew that she wanted to be a physician and no, and like she said, she like you said, very similar words. Like she just felt this calling. And I’m fascinated by this, this moment in people’s lives where they just have this clarity of vision. Was there a moment or you sort of knew that this was going to happen, or was there an experience that that made you feel that this was your calling? Or did you just sort of gradually feel like, you know, this is what you want it to do?

Janice Pasieka  04:36

Yeah, I wish I wish I could say that there was this you know, aha moment and you know, when you interview, you know, the medical students and the PGY1s when they sort of are applying. They give you these, you know, incredible stories of courage and things that happened in their life that set them on a thing for medicine. And to be honest, I can’t think of an aha moment. I just remember sitting at the dinner table and announcing that that’s where I was what I was going to do. And yeah, it wasn’t, it wasn’t anything that I was being exposed to.

Ameer Farooq  05:25

Dr. Pasieka, you know, you have all gone on to become one of the preeminent leaders in endocrine surgery, certainly in Canada for sure, if not in North America. What attracted you to surgery in general, and then in particular, endocrine surgery? And, you know, I remember you what you said about colorectal surgery being an operation along the dotted lines. But so how is endocrine surgery different than that? And what, what, what made you want to do endocrine surgery?

Janice Pasieka  06:00

Yeah, well, you know, there was an aha moment for going into surgery. I mean, once I got into medicine, I loved everything about it. And in my, between my first and second year, there was an advertisement for a medical student to go up to Fort Francis, which is north of Lake Superior to work as a medical student in their clinics up there. And I, they, I’m sure that the whole plan was to try to entice medical students coming up to rural communities to go into fam to help entice them to go into family medicine. Fort Francis is also close to Quantico National Park, which is just one of the best places to go canoeing if you’re canoeist. And so I immediately applied and got the job. So I went up there. And the mornings I spent with a surgeon called Jazz Spencer and his wife was the GP anesthetist. And he did surgical lists in the morning. And then in the afternoon, I was to go to the family medicine clinic. And it became very clear soon as I was in the operating room, that this is where I wanted to be. And it was hard to get me to go to the afternoon family medicine clinic. So that was the moment I decided on surgery. Endocrine surgery came around from the point of view of my love for physiology, and my love for endocrine and endocrine and endocrinopathies just fascinated me. And while doing general surgery at the time, I found it interesting and odd that you know, we would do resections on Crohn’s disease and ulcerative colitis. And as surgeons, we would make the decision as to what to take out and what to do and how to anastomose and all of those things. The gastroenterologist helped us with the diagnosis, but they didn’t dictate the surgery. And yet endocrine surgery when I was training, it was the endocrinologist that were dictating. Just take out half the thyroid, we want you to take out this adrenal gland. And there wasn’t a lot of thought, as you know, the workup and and that and I really got into the workup and said, You know, this is what I want to do. And at that time in Canada, at least, and certainly in Calgary, there really wasn’t endocrine surgery surgeons. So that story was, you know, almost the same way announced to my parents, I just decided that’s what I wanted to do. And there was a senior surgeon here named Hugh Galley, and who was just just a delightful gentleman, and when I told them that that’s what I wanted to do, he recalled reading the presidential address of Ed Paloyan for the American Association of endocrine surgery, on training endocrine surgeons for the future and address just happened to be a couple of months before I talked to you. And he said, Oh, I think I’m going to give you something and he gave me that journal. I still have it, and basically gave me the advice of what you want to do, these are the people you got to go for. That’s what I did.

Chad Ball  09:46

It’s so amazing how so many of us I think that’s that epiphany moment soon as you walk into an operating room, I think, and we see it through every day, right? We get to see someone love it or somebody who just can’t wait to get out of there. They’re counting the seconds, there’s there’s no doubt. Dr. Pasieka, you know, I’ve had a lot of conversations over many years about the importance or the role and the variable role to be honest of surgical conferences. And sometimes we talk about meetings in the context of their content. Sometimes we talk about the administrative or committee point of view. But really, certainly the social aspect of things is something that that you taught me a lot about the importance of that I was wondering if you could share with our listeners some of the the framework or the rules that that you look at with regard to conferences, because I think they’re they’re particularly relevant. They’re easy to forget, if you’re trying to move up in these societies or give a whole bunch of talks. And the second question, really, I have for you is, this all seems to be changing in the here and now so very much. You and I’d also talked a little bit about the age of COVID, and the shift to videoconferencing. What do you think that means going forward? And how do you think that’ll change what has been a very traditional model for many decades?

Janice Pasieka  11:05

Yeah, that’s a good question. So I’ll answer that sort of the the first on my, for those that haven’t heard my spiel on on surgical conferences. And, you know, there’s different philosophies that mentors will tell junior attendings and attendings on what to do about a conference joining different societies. And mine was that I think you what you need to do is define your peer group, the group that you identify most with. So for me, it was the endocrine surgeons, and it was both at the North American, so the American Association, but also on an international level. So those were meetings that you wanted to present your work, you wanted to, you know, illustrate that you were advancing the science of this subspecialty your specialty. And you use those meetings also to find collaborators. And so it’s your peer group that you do, you would focus on. Other meetings, you may have to or you may go to our ones in which are politically very important for you to go to, to be supportive, such as the surgical forums such as the American College and, and platforms like that. I think meetings and societies, the biggest thing you get out of them, beyond demonstrating to your peer group is the networking and being able to meet like minded people, but also the true giants and the leaders and, and then evolving in and working up in the organization, if that’s what you like to do, to become part of and forming that organization. The third thing that you know, you get out of it is this, just this incredible group of friends that are all over the world that you start to develop relationships with. And then the meetings that I like to go to, and why I probably did a lot of international meetings was you’ve visited very interesting and different places, you’ll get to experience different cultures. And I think what Chad’s alluding to is my rule of every conference that I go to, I have to, I have to attend the conference. You know, I’m not going there just to sign up on the first day. So I attend the conference. But at some point, I have to run or walk this the the city. I have to visit a museum or an art gallery. I have to visit a bookstore, and take on some sort of social event. And I’ve been very dogmatic about that. And I even go a day early or stay a day later, to make sure that I do all of those things. And it’s allowed me to see parts of the world and see things that I never would have experienced. I find that it would be sad to just fly in, go to the meeting and then fly out and realize that there was a Van Gogh exhibit at the you know, the museum and you’ll never get an opportunity to see it again. So then you go COVID and then they want to do this all on video. Well, I’m not sure how that’s gonna work because all of those things that I enjoy about being a member of an organization and going to conferences, the networking, the friends relationship, the culture and visiting places is not going to happen the same way over the video. So yeah, I don’t know. It’s gonna be interesting.

Chad Ball  15:15

It really is. I mean, there’s so many different factors at play, I think, you know, it’s interesting to see the virtual meetings conferences that have already happened. There’s certainly a widespread and I’m sure you’ve heard it too description of real fatigue, trying to sit and watch your computer on Zoom or whatever platform the individual conferences using for more than a couple hours at a time. I also wonder a little bit how, how the the millennial outlook on the trainee side. My anecdotal observation for a few years has been, there’s somewhat of a less less commitment to this traditional model of flying everywhere and spending money and taking time off work. So I do wonder, you know, how all of these factors will converge? What it will look like at the other end?

Janice Pasieka  16:00

Yeah, I think you’re right, Chad. I think, you know, you can look at the upside that it is going to be less travel and any travel, you know, to a conferences is time away from family, friends, and also your office. So it’s, it is stressful. So it may increase the attendance in the CME piece of it. But, you know, the personal connection, and, you know, I remember so distinctly, you know, my mentor Norm Thompson bringing me up and introducing me to Orlo Clark and Dr. Harrington and and just sort of, you know, they shook my hand. And then the next time they saw me, they called me by my first name, it was real. It was a thrill.

Chad Ball  16:45

Yeah, exactly.

Janice Pasieka  16:47

You’re not going to get that on a Zoom, I don’t think but you know, it is our new reality. And we’re going to have to somewhat embrace it, but I just don’t know what the, the replacement for the other things that I mentioned are going to be. I don’t know what that is.

Ameer Farooq  17:07

Dr. Pasieka, one of the things that you’ve already alluded to is the fact that you like to actually go to international events, and you’ve been active in national and international organizations, and have gone all over the world, trying to help educate. In particular, you’ve done a number of workshops and educational sessions in China. What has that experience been like? And what are the, how does that enrich your practice? And what does that made you learn about endocrine surgery as a whole?

Janice Pasieka  17:41

You mean, China in particular, or just?

Ameer Farooq  17:44

Well, I feel like I particularly remember you, when I was on service, you going to China and teaching these huge, huge seminars to all these people, about how to do, you know, whatever the topic was in endocrine surgery, whether it was ultrasound, or the actual technical aspects of, of doing the surgery. And I remember listening to that, and just admiring kind of the, the challenges that posed of, of going to a completely different country, where the languages that are different. But yet, you were super excited about that. And clearly, you’re passionate about that. And so I chose China, but obviously, you you’ve done that in many, many venues. So just curious what your what that experience has been like for you?

Janice Pasieka  18:28

Yeah, it’s been, it’s been a real enriching experience for me on a personal as well as a professional level. It’s a, it, it really is I’m fascinated by the different cultures, and, and if you take the time to sort of observe, and, and try to learn a little bit about the diversity in this entire world, and how these different cultures all come together. We’re all doing the same thing, taking care of patients, in our area, whatever, I found that to be quite fascinating. I, I also then felt it you know, and recognize, it was important to get out of my comfort zone every so often to really sort of, you know, help me grow as an individual and to, to sort of experience life in a different way and see how other people who seem incredibly happy with very little, you know, as far as physical possessions and that and yet they seemed happier than most of the people that I knew back in North America. And and just trying to understand that and understand what you know, happiness is from your, you know, from your heart and your soul. I also found that when, I traveled international that, in these in there, a lot of these countries, they were actually doing cutting edge stuff that hadn’t quite made it to North America. And they were doing it. And I was bringing back knowledge that hadn’t made mainstream North America academic medicine. I mean, a good example is, you know, taking the thyroid out through the mouth with no incisions on the neck. I mean, this was, you know, developed in Malaysia. And, you know, within a couple of months, they had done 50 cases, and then were presenting it and now that’s considered one of the techniques, but it was really cool to sort of see it at the at the onset. Because of the different cultures, the different ways that they can practice medicine, they were able to do something like that without having to go through the rigors of what we do here in North America, you know, new technology and new things. So it was it’s been really quite fun and enriching.

Chad Ball  21:12

It’s amazing how these international experiences by yourself and ourselves, and just all of us in general, including some of our guests really impact how we practice when we come back. Certainly mentally and sometimes physically as well. It’s it’s quite neat. Dr. Pasieka, you know, you’re certainly not defined by this, of course, and you certainly don’t don’t brag about it. But I’m gonna brag a little bit for you for our listeners, and I’m curious what your what your thoughts coming out of out of my comments will will be in regard to gender equality in particular? And for those of us that know, you mean, you were, I believe, certainly the first Canadian, I think it was the second woman to be president of the American Association of the Endocrine Surgeons, about 10 years ago. You were also the section head of general surgery in Calgary, which, just based on structure, I would, I would venture you can correct me if I’m wrong is certainly going to be the largest general surgery cohesive group in the in the country. You did a lot of that not only as a woman, but also relatively early, so to speak, in the in the arc of of your career. I’m curious how not only those accomplishments, but maybe more importantly, how, you know, gender equality has really come to the forefront so strongly in the past one to three years? How you view you view that how you apply that to surgery? You know, one of my other comments, I guess would be that I noticed this year looking at our University of Calgary poster that we finally have an equal number of women trainees to men trainees, and I think that’s, that’s just super. But how do you view the way the world is working right now? And the discussion that surrounds that concept?

Janice Pasieka  23:00

Oh, wow, that’s, yeah, that’s a big topic. And interesting one, because it’s, we, you know, gender equality. Obviously, I was one of the visible minorities when I was starting out my career. But you can look around at the structure of all the residency programs and departments, there’s a lot of other visible minorities that aren’t necessarily being represented at the leadership level. So I think the gender equality is is is one aspect of a conversation that’s worth discussing. But when I look at it, I would say it’s, it’s all diversity. It’s all under-representative visible minorities, that we should be putting in the same kind of grouping in some ways. From a purely gender perspective, you know, I didn’t, I didn’t I wasn’t, I don’t know how to say this, but I wasn’t I never thought that being a woman was going to take away my ability to achieve my goals. I knew I was standing, you know, on the shoulders of the, of the pioneers that really did break that barrier of being women in surgery. You know, the Frances Conleys, Robin McLeod, the Pat Newmans and people that really, you know, started that movement. So then, when I applied as a resident to get into a residency, it wasn’t such a foreign concept, so I think they accepted me on my merit. But you know, the difference at that time was that I wasn’t not everybody in the division really thought I should be there. But they were, they could tell me to my face, they didn’t think guys should be there that they, they didn’t believe women should be in surgery, that I was taking up a spot. And I didn’t have any repercussions. And they didn’t, they didn’t see it as being so politically incorrect and being holed up into somebody’s office saying you can’t say those things. They could they could voice their opinions and in public. And so I at least knew where what the landscape was. And I knew I wasn’t equally accepted across all boards. Then I think, when I was sort of, you know, mid career, I recognize that it’s politically incorrect to truly state your bias, right. And so it went underground. And yet, it was still very much there. And that’s when it scared me more, because then you didn’t know who was on your slide who wasn’t? And, and I think that you could look at this, you know, the, what’s happening right now with black lives matter. And, you know, if you read about the 60s in the civil rights, you know, I grew up thinking, Okay, well, they’ve sorted that one out that, you know, all lives matter, and there isn’t any racial discrimination. And yeah, that, you know, we, you know, all of a sudden, it clearly is still there. There’s this unconscious bias that we all have, for various reasons. And because it’s not being talked about, and openly spoken about, it’s a little more frightening to me. So maybe having a little bit more of a dialogue, and people thinking about it, and bringing it back to the forefront will at least help things. But yeah, Chad, I don’t know, what would what your were what your question was, you got me on that.

Chad Ball  27:26

No, I think that, yeah, that is clearly very well said. You know, I think it’s about time. And and I think you’re right, I mean, all this discussion and all this interaction, whether it’s been professional or unprofessional, lumped together, I think it’s probably helpful because it does put the the issue of equality across the board on the forefront of everyone’s mind. And I think all of us should be appreciative of that.

Janice Pasieka  27:52

Yeah, and, you know, what I would like to see is just more of an embracing of diversity. I mean, we don’t we that’s just it, we don’t want a bunch of people to them all form into the the same model of, you know, what the Department of Surgery has always been. What we want is a whole bunch of diversity around the table that are doing it very differently because of their culture, their upbringing, their race, their gender, their whatever. And, and I think, is what, that’s what we need to be more accepting of that it’s okay to have to accept somebody is going to do something completely, or not completely, but do it a little bit differently because of, they bring diversity to the table, but be accepting of that.

Chad Ball  28:47

And yeah, absolutely. Exactly. You know, we you and I’ve talked about this before, and I’ve talked about it on both on the podcast, as well as with other guests privately. And you know, specifically, there’s no question that strength comes from diversity, and we can be social about it, or we can actually be mathematical about it. And Scott Pages work has shown that now in two separate books that there’s a, an actual finite descriptive formula, mathematical formula for productivity and efficiency out of diversity. That its improved. And it’s, it’s remarkable. It’s, you know, I haven’t seen him speak one time at our through the presidential speaker at HPBA I want to say four or five years ago, was the most remarkable talk I’ve ever seen in it really set off lights, I think across 1000 HPB surgeons at that meeting. There’s no question that that diversity should always win biologically and psychological.

Janice Pasieka  29:42

Yeah. Yeah.

Ameer Farooq  29:44

Dr. Pasieka, I wanted to you know, I wanted to just mention this story, because I think it’s one of the neat stories that you’ve told me about what it’s been like just just fundamentally what it’s sometimes like to be a female trainee that that perhaps we just don’t know understand if you’re if you’re not a female trainee. You tell the story about coming back and starting as a staff surgeon at the foothills and not having any scrubs that actually fit you. And it wasn’t until Dr. Quan, May Lynn Quan is one of the breast surgeons at at in Calgary until she came in and kind of insisted that they bring scrubs sizes that are small, you know, that were small, and that fit fit appropriately, that you actually got scrubs that that fit you that weren’t hanging off you. And, you know, I think this story is important because, you know, on the one hand, you’re saying that, you know, you never felt like that you were discriminated against, or that or at least if you were discriminated, it was kind of open into your face. But, you know, underneath all of this, you did have to overcome many of these kind of unseen, subtle barriers that male trainees just didn’t have to face. And I’m curious what you tell female trainees, I know you you’ve been active in, in having a group with the female surgical residents, the female general surgery residents in Calgary, and I’m curious what you tell them and what advice you have for them.

Janice Pasieka  31:11

Yeah, I think that, you know, it is important that they recognize that there’s going to be things that are going to be different. And one of the ones that I think all female surgeons will talk about is the relationship with the nurses when you know, your junior resident and you show up on the on the ward, and that that can you know, women don’t play well together until they know each other well enough. And so, it’s important. And I tell them to, you know, it’s not don’t, it’s, you’re not there to pick a fight, you’re there doing the same job, but what you have to do is to prove to them that you are capable of this. And don’t worry, how they treat your male counterparts, worry about your own integrity, and be true to yourself. Doesn’t mean you have to then start taking on male qualities to be able to get the job done, do it in your way. But if you show them that you can take care of patients that you will respond to their their needs and, and treat them as as a part of the team. It may just take a little bit while but then they’ll respect you. And then you they will be your allies. So, you know, I think a lot of there’s a lot of sort of angst initially, just trying to make sure that people recognize No, I’m not the nurse, I’m the doctor, or I’m not the housekeeping staff. And because it’s just what happens initially, you know, even patients but not to react to it, but to embrace it and prove that you’re just as capable as the next.

Ameer Farooq  33:06

I think you know, that that demonstrates, again, how much you care about resident education. I think any of your your trainees, current and former will talk about having, having trained under you and the things that they’ve learned. I know, I certainly certainly have learned a ton from coming on your service. I mean, I came on, I think at the beginning of my fifth year, end of my fourth year onto your service. And I thought I knew how to do things like, you know, tie a tie a tie a knot around an instrument. And, and spending, you know, a few weeks with you was enough to just realize that, like your dedication to the basics and really getting those things right. Not only just technically but also conceptually like I still remember the little chalk talks you would give on the on the drapes, while we were waiting for, you know, the pathologies to come back and tell us if we had the parathyroid. I’m curious about what you think and I think I understand what makes you a good great teacher. But what do you think, are the characteristics of great teachers? And in particular, I’m very curious as what your approach is to the trainee that you don’t think is interested. And how do you approach that situation?

Janice Pasieka  34:23

Oh, well, okay, well, first of all, Ameer, I don’t need a pathologist to tell me that I have the parathyroid adenoma. I just want to make sure that

Chad Ball  34:33

I was I was ready to say that.

Janice Pasieka  34:39

So so I’m sorry. So well, first of all, I you know, a great teacher I don’t I don’t know if I’m a great teacher. I do my best to teach and I and I do try. And I I’ve sort of, there was a time that I wasn’t such a great teacher and I was not, I was not connecting with the trainees. And it, it took me to sort of step back. And I took on a coach Lara Cooke, who is a an educator here, and, and she’s a neurologist, took my challenge on me as a challenge. And really, because I was baffled by why I wasn’t being perceived as teaching, always trying to do is to teach and it wasn’t coming off correctly. And I know I’m intense. And so she really as a coach and and having that educational background taught me or showed me what how I was teaching and what I was teaching. I was teaching at a different level than this new generation of medical students were used to. And that’s what sort of floored them. And I wasn’t asking for didactic regurgitation. from a textbook. I was asking questions, as you know, that are a little off tangent outside the box, but it gave me the ability to see where you were thinking. And once I started to understand a little bit about what my style was, I wasn’t about to change that. But I recognized that I had to then spend more time trying to understand when I asked a question, hear what the answer is coming back to me, and then trying to figure out how I can work them through my algorithm or the way that they need to start thinking about this disease, or whatever it is, by enticing different questions, because they would have the knowledge, they just haven’t put it together in a in a in a box or on an algorithm. And, and that’s been, you know, that’s been a great learning process. And it and it really has to get my brain thinking. So when I asked you a question that I get some sort of answer I have to figure out, or, well, that’s not even close. But where is that coming from? And sort of start working from there. And so I think I’ve, I’ve improved, I think I’m a better teacher from that perspective. And I think I challenge people. And so how do I reach the trainee that’s not interested in learning? I think I don’t, if, if they are too not interested, or can’t answer a question and say, Well, I just don’t know. And they they give up, then I can’t delve and use my my brain or knowledge to try to figure out how to get them back on track, and try to show them that they actually do know, they just haven’t put the two pieces, A and B and C together. And so they give up, I give up. And yeah, I’ll be honest, I know that that’s what I do.

Ameer Farooq  38:21

I just have to comment that it’s amazing that you took it so seriously about resident education that you’d actually get a coach to help you get better. And I think that just shows just the level of dedication that you had to the craft, but also the insight that you had that that you just felt like things weren’t connecting the way that you want it to. And that’s just amazing to me. You know, I think one of the challenges that you in particular face when when you have general surgery trainees is that, you know, increasingly, there are fewer and fewer general surgeons who are doing thyroid and parathyroid in particular. And, you know, some of us may never do that probably ever again in their career, which is, which is kind of sad for for me to think about. But But I’m curious how you how you navigate that dilemma of having someone that you want to get a lot out of the rotation and a lot of the out of the experience, but may never actually do that operation again, and probably doesn’t have much experience doing it. How do you walk that line? Especially, you know, with the third factor of the context in which we live in which is that, you know, trainees just aren’t getting the volume that they used to.

Janice Pasieka  39:42

Yeah. So with you’re absolutely right. So I think a lot of things in general surgery have becoming so subspecialized, that there are going to be operations that people will go into a specialty that they won’t do particularly if they subspecialize in in a remote, a different, completely different area. But that doesn’t mean that the the techniques and you know how to how to handle the tissues in the in the neck aren’t going to translate into being able to do that in another part of the abdomen or with breast surgery and all of those things. So I see it as there are trainees that I’m teaching the surgical techniques and to be able to apply to wherever they are. I think that it’s your other part of the question was the how do we optimize this time in this environment. This is this is a real challenge, because what’s happening is more and more fellowships, and more and more people coming and wanting to focus and be and do, let’s say endocrine surgery, and obviously, you want to get them to master that part of it. And that could be at the detriment of the resident for you try to involve them in different parts of the cases, and get eventually the fellows to also be part of the teaching. But to when they’re getting into the OR less and less. Yeah, and and and I guess as surgeons, and Chad can attest to this, we’re under this incredible pressure of being more and more efficient. It’s I see, it’s gonna get even harder and harder. And I don’t have a good answer.

Chad Ball  41:57

Yeah, I’m not sure there is a good answer yet. But I think you’re right. Maybe I’m getting close to closing Dr. Pasieka , I wanted to touch on a couple of fun things. The first is you and I’ve talked about the HBO series called Chernobyl that outlines those events a couple of times. And certainly the the impact or the the interaction with ionizing radiation medicine and surgery and diagnostic tests is strong. And I think it’s an interest to both yours and mine. And although I wouldn’t say when I think radiation, I think a you but certainly what I think of radiation, I I do think of the thyroid. And I was wondering if if you could just talk a little bit about, you know, almost from a didactic point of view about radiation and thyroid cancer and where that all sits.

Janice Pasieka  42:46

Yeah, I mean, so you know, radiation has been shown to be one of the risk factors for developing thyroid cancer. And it’s, it’s just a fascinating story on how it was sort of first discovered, and it was a group of epidemiologists at the University of Chicago, that sort of put the piece together when they started seeing in the cancer center, a high number of patients that were in their 20s and 30s, that had thyroid cancer, this sort of big blip. And they noticed that they were all upper middle class, white Americans and not the major population of Chicago, which was African American. And they then started to try to figure out what the difference was. And what the difference was was access to health care. And these young adults, when they were children, their parents had the ability to get them the best health care at that time. And so in the 50s, they were getting their thymuses radiated, they were getting radiation, low dose radiation for acne for mastoiditis. And we created this problem, but in a group that were thinking they were getting the best health care. And that then really sort of allowed us to then understand that, you know, ionized radiation was a risk factor to thyroid cancer. And then the next sort of many other pieces, including the atomic bomb, and but the other and the Marshall Islands and the nuclear testing, have sort of reiterated that but it was the Chernobyl incident that was a fascinating story as well. And that, you know, it happened in what 1986 and it the day we started reporting that they had of this high incidence of childhood cancer, only three years out and everybody in the western world were saying, well, that’s not from radiation, because it’s got a 20-year lag period, three years, it can’t be from the radiation. And these guys persisted and kept showing. And sure enough, that type of radiation because it was short-acting isotopes on young kids, it was creating thyroid cancer at a much rapid growth so it is fascinating. And I think the story on a number of CT scans and what we we do, maybe, you know, 20 years from now, we will rethink all of that as well, Chad.

Chad Ball  45:45

Yeah, it’s it’s so interesting how the technology piece also plays into it. Now, you know, whether there’s a significant biologic rationale, of course, as you do know that, that perhaps that model, the trauma model doesn’t really reflect what we do with CT scans, independent of their decreasing radiation dose was sort of one big blast versus, you know, multiple, lower dose exposures may not be equivalent from a DNA DNA repair point of view, and so on. So it’s, it’s certainly really quite fascinating. The second last thing we want to ask is, what’s your love for collegiate basketball? I think I think most of us that that know you know it’s a huge passion. So.

Janice Pasieka  46:28

March Madness.

Chad Ball  46:29

Yeah, we’re exactly. Exactly. We’re particularly curious as to as to, you know, how that came about why Big Blue? And I’m really interested to know what what you think about essentially the the legal world in the US now driving more pay for those collegiate athletes who, you know, as you know, again, from from a gender equality point of view is unfortunate. But really, it’s it’s these large collegiate football programs and men’s basketball programs that really drive the financials for the entire athletic program and most universities that are of the right size.

Janice Pasieka  47:08

Yeah. Yeah. So, I mean, this is gonna be two years in a row, and and I’m going through withdrawal, there will be no tournament this year as well. Yeah. That’s two March Madnesses that I, I’m, it’s going to be tough. And, yeah, you know, it’s, since I was 10 years old, I’ve been an NCAA basketball fan. And, you know, initially, Marquette because of Al McGuire was a great coach, and I love the way he coached it. And I played then I played basketball in high school and in university. And then and then I was a Blue Devils fan, because of Coach K. But that stopped on the first day, I was in the operating room with Norm Thompson. And we were all we were operating across the table and, you know, just starting to get to know each other. And he was my, you know, I had arrived at Michigan. And we said, he said Oh, yes, you’re a basketball player. And you like basketball. And I said, Oh, yeah, yeah. And I’m Blue Devils fan and the room just stopped. And he says, that either changes today, or don’t show up tomorrow with a twinkle in his eye because he was a just a true gentleman. But the next day Go Blue. Absolutely. And Go Blue ever since.

Chad Ball  48:41

Well you’re at as usual, you’re a much better person than I because having growing up growing up in Edmonton, now living in Calgary for the better part of close to 20 years now, I still cannot convert to a Flames fan. I am curious what your thoughts are about the the increased pay for NCAA athletes?

Janice Pasieka  48:59

An NCAA, you know, athlete, you’re there to go to university and to be a varsity athlete and to do both well. And, and, you know, that’s why, you know, if I’m looking at a resume of a resident fellow or whatever, if they were a varsity athlete, right away, they they’re, they’re off on on my list because I know they can multitask. I know they can juggle many things. They have discipline, they’ve obviously have followed two passions in their lives, if and hopefully more on that type of thing. So I see NCAA, if you want to, you know, make it your career, then try to play professionally. But if you’re at university, I want you to go to university and get an education.

Chad Ball  49:55

Yeah, it’s it’s, it’s true. You know, it’s it’s such an interesting and complex topic. My my dad was was a dual athlete at the University of Minnesota, he was a quarterback and he also played hockey. And then he went on to professional hockey career was with the Boston Bruins for a little bit, as you know. And it’s interesting to listen to him in the years that he was in that University. He didn’t write a single exam, he didn’t go to class, he didn’t need to his job was to play was to play athletics. And then, of course, when when the pro hockey career died relatively quickly, because of injury, he had no education, he really had no, yeah, no, no way to make a real income. And my mother at that time was pregnant with me, and all of a sudden, there was a bit of a crisis. And, you know, to his credit, he, he went back to university, he became an accountant, and he did really well. But when he talks about the guys that that he grew up with, in that era, doing those same sports, most of them did not have such a positive outcome at all. So, you know, he certainly felt strongly with with my brother and I, that you had to go to school, and that was the goal and, and there was no negotiation about it, whether you’re playing University hockey, or whether you weren’t. So I completely agree with you.

Janice Pasieka  51:14

Yeah, and I think from a, you know, in the women’s, you know, there isn’t a professional women’s hand a, you know, Field Hockey League that you’re aspiring to. So most of the women sports are not there as a means of getting a scout to pick them up professionally, in the same way. What, but obviously, I just say the football and the basketball, that’s big money there. And I don’t like when I see good players leave early, and get, you know, to go into professions because, I go, well, you didn’t get your degree.

Ameer Farooq  51:55

This has been such a delightful conversation. And we’re so glad that we can have you on the on the podcast, I’ve learned so many things about you. And, and it just makes me reappreciate your dedication to the field of surgery and dedication. So thank you from all of us. In closing in closing, I wanted to just ask you, if you could go back in time, and this is a question we’ve asked all of our guests, if you could go back in time and gave give yourself advice at the junior resident level, at the at the chief resident level and at the attending surgeon level, what would those pieces of advice be?

Janice Pasieka  52:35

So a junior resident level? Yeah, it would be you know, just keep your head down, work hard, and take care of your patients. And that will that will serve you well. As a chief resident, I probably would tell myself, lighten up with the medical students, not everybody is as passionate about surgery or cares the way you do. So you don’t have to ride them as hard as as you did. And, and, and spend time just making sure that your junior resident is doing okay. Because they’ll make you look good if they can do their job. For an attending, I guess, I would say, you know, when you’re starting out, you know, follow your passion, your your passion, in, in medicine, and in particularly surgery, but also follow your passions outside of medicine. And don’t give up hobbies that you’re passionate about and say, well, I’ll get back to those at another time. Always keep them as part of your ability to, you know, to step away from medicine, and be and be true to yourself. I would say, above all, take care of yourself, both and your family and make sure that that becomes a priority. And it can’t be a priority maybe every day, but you got to keep working on that. And I think the one thing that I didn’t do early in my career, but I’m certainly doing more and more as I as I quote mature. And that is I go out of my way to try to learn one thing every day from a patient. And it’s and I’m not talking always about some new diagnosis or something in medicine, but to spend the time and get to, you know, find out a little bit about them and learn something new every day and you’ll go a long way.

Ameer Farooq  55:07

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.