May 16, 2024 • 21 mins
In this episode, Tom Varghese, MD, FACS is joined by Jeremy Cannon, MD, SM, FACS, from the University of Pennsylvania. They discuss Dr Cannon’s Excelsior Surgical Society Presidential Address, emphasizing the crucial contribution of expeditionary surgical leaders in World War II and how their legacy serves as an example for military and civilian surgeons seeking to lead in austere settings today.
Disclosure Information: Dr Varghese has nothing to disclose. Dr Cannon received royalties from UpToDate for authoring an article on an unrelated topic. Dr Cannon's institute was supported by funding from CSL Behring.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
You are listening to The Operative Word,
a podcast brought to you by the Journalof the American College of Surgeons.
I'm Dr Tom Varghese,and throughout the series, Dr Lillian
Erdahl and I will speak with recently
published authors about the motivationbehind their latest research
and the clinical implicationsit has for the practicing surgeon.
The opinions expressed in this podcastare those of the participants,
(00:26):
and not necessarilythat of the American College of Surgeons.
Disclosure information:
Dr Cannon received royalties from UpToDate
for authoring an articleon an unrelated topic.
Dr Cannon's institute was supportedby funding from
CSL Behring.
(00:49):
Hello, loyal listeners,
welcome to another episodeof The Operative Word,
a podcast by the Journalof the American College of Surgeons.
I am incredibly honored to be joined todayby the amazing Dr Jeremy Cannon.
Jeremy, why don't you go aheadand introduce yourself to our audience?
Hello.
My name is Jeremy Cannon.
I'm a trauma surgeonat the University of Pennsylvania
(01:09):
and a recently retired colonelfrom the Air Force Reserves.
I have no disclosuresspecific to this podcast.
I did get some funding from CSLBehring to attend a PI meeting,
a few months ago.
And then the only other thing to mentionis that,
(01:30):
you know, I have been, privilegedto be part of the American College
of Surgeons partnershipwith the military health system.
And, in that role, have,
been, serving as a presidentof the Excelsior Surgical Society.
And you'll hear a little moreabout that here in a few minutes, I think.
Thanks so much, Dr Cannon.
We appreciate you taking the time.
(01:50):
So, today we're going to be deep divinginto the recently published article,
the 2023 Excelsior Surgical SocietyPresidential Address:
Expeditionary Surgeons (02:01):
Essential to Surgical Leadership in World War II
and today.
Dr Cannon, let's startfirst with the Excelsior Surgical Society.
Can you briefly tell us about
what the, how that society startedand, where it is today?
It's a fascinating story.
And, one that I've really enjoyedlearning more
(02:24):
about over the past several years. So,
they claim to have modeled themselvesafter a society from World War I.
That society was called the Eclat Club.
It was a group of surgeonsthat felt such a strong bond between one
another after having been deployedtogether that they wanted to reconnect,
(02:44):
post-deployment on a regular basis.
So in that, in that same spirit,that same model,
after combat operationsstarted winding down or when,
when things started to settle downa little bit in the Mediterranean
theater of World War II,
Colonel Edward Churchill,who was the chair of surgery at Mass
(03:05):
General, assembled a group of surgeonsat the Excelsior Hotel in Rome.
Their stated purpose was really to debriefabout a conference
they had just attended with some Britishand other allied colleagues
sort of evaluatingtheir surgical experiences during
World War II and defining best practices.
(03:25):
This group of U.S. surgeons
reconvened the day after,
at the Excelsior Hoteljust to sort of decide amongst themselves,
you know, what they thought of all that,
and discussed just a range of differenttopics, from open
fractures to blood product resuscitationand what have you.
(03:46):
And then from that initial meeting
in 1945, that group of surgeons
decided, hey, you know,that Eclat Club from World War I?
That was a pretty interesting idea.
Why don't we do something similar?
And so they started meeting outon a regular basis.
The first US meetingwas in October of 1946.
(04:07):
That's when the first Edward DChurchill lecture was given,
and that was given by Alfred Blaylock.
And the meeting was held in Boston,
well attended, and actuallythey met together with the Eclat Club.
So veterans from World War I,
and so they
you know, actually focusedon both surgical science,
(04:29):
they had the Churchill lecture,by Dr Blaylock,
and then they also attended a footballgame between Harvard and Holy Cross.
So, you know, a little,you know, a little,
athletic activity there as well.
So, it was a great model in this,the society continued for many years
thereafter.
And the fascinating thing,I think, for our audience members, Dr
(04:51):
Churchill is alsothe one specifically responsible
for the creation of the rectangulargeneral surgery residency model.
As many may remember before Dr Churchill
took that, advanced leapin surgical education,
the model was essentially a pyramid.
That is, they took in way more candidatesthan actual people
(05:14):
who were scheduled to graduate.
And Dr Churchill is the onethat really advanced surgical education by
saying the pyramid was an outdated modeland creating the rectangular residency
which exists today,that is, the same number of people
who start are the same number graduatesat the end of the training program.
It's amazing history there.
Dr Cannon,let's deep dive into your article.
(05:36):
So the theme of this symposiumthis year, you wanted to focus
on the optimal surgical leaderfor future large-scale combat operations,
as reflected about, from the experiencesspecifically from World War II onwards.
I guess the first question isevery war ends up having certain nuances
(05:58):
that are a little bit different,but there's some commonalities
as you go from war to war.
Could you just talk about that brieflybefore we talk about your
presidential address?
That's a great insight.
You don't want to end upfighting the last war.
That's a recipe for disaster.
Because, as you mentioned,there are nuances to each new conflict.
(06:20):
If you look specificallyat the US experience over the past
20 years, we've been involved in, in, inwhat's called an asymmetric conflict,
where, you know, we had air supremacythroughout the theater.
We could go wherever we wanted.
Now, the fighting on the groundwas very intense.
But the the weapons were, were often,
(06:41):
improvised, as in an improvisedexplosive device or IED.
They were not typically, manufacturedor machined.
And as a result, they were sort of,unreliable and inconsistent.
And could be in effect devastating,you know, if they, if they struck home.
But but inconsistent.
If we get entangled into a peeror near peer conflict
(07:05):
as we're seeingover in Ukraine with Russia,
the, consistency of
the weaponry,the lethality of the weaponry,
the ability to have free
range of motion across the theater.
It's going to be totally differentfrom what we've had in the past 20 years.
(07:26):
And much more similar to World War II,
which is why I think it's sovitally important to look back to the last
large-scale combat operationyou've been involved in.
If we're going to be at allprepared for for what might happen.
And using that as a premise,you started then,
talking about the expeditionary surgeon
(07:48):
as, hopefully I pronounced that correctly,
as the correct model going forward.
And I love the way that you startedthe description of comparing
that surgeon to your Swiss Army Knife.
talk to usabout how you got that model, comparison.
And what exactlyis an expeditionary surgeon?
(08:09):
Well, that's a great question.
You know, it just seems to align, where
a Swiss Army Knifeis the ultimate utility tool.
The origins of the Swiss ArmyKnife are pretty interesting.
It it started, I think even
before World WarII, maybe even in World War
I as a utility toolfor soldiers, Swiss soldiers.
(08:33):
And my
knife was gifted to me for my father,and had all sorts
of fascinating little gadgets on it,from a magnifying glass
to a toothpick, and what have you.
And it just it's low profile, lightweight,but so functional.
It seems to always have exactlywhat you need. So.
And in a similar fashion,it it seems like surgical leaders in
(08:57):
and combat operation,but I think especially large-scale
combat operationswhere these challenges of
lack of freedom of movement,
large volumes of casualties,you need strong leaders that that,
have broad experience
have incredible technical facility,but also,
(09:21):
come to the, come to the,
conflict zonewith, with, great leadership skills and,
and it just seemed to fit with the,you know, the analogy or the metaphor.
The Swiss Army Knife.
So I think we need to look for,
those, surgical leaders
in, in the wings that have this,
(09:42):
this sort of multi, facility,multi-talented capability
and groom them for futurebig leadership roles.
And the amazing part is that not onlydid you talk about
that utility, you know, being versatile,
but you also in the articleintroduced our readers
to a relatively new term,which is very common in the military world
(10:06):
being that may not be as, common
in, civilian life, which is this conceptof a VUCA environment.
and it's, correct me if I'm wrong.
It's, first started by the U.S.,Military War College, VUCA.
VUCA stands for volatility, uncertainty,
complexity and ambiguity.
(10:28):
And it was meant to describe a post-Cold
World war, Cold War world.
talk to us about VUCA environment.
And I think especially with the focusnow, we're in this post-pandemic world,
which probably is the greatest exampleof VUCA,
as, as well talk talk to us about that.
Yeah. Yeah. Great question.
(10:48):
You know, I was, reminded of thiswhen Dr Turner
gave her her, prior lecture in 2022.
Excelsior Surgical Symposium, and,
she gave, a real clinicon surgical leadership
and mentioned the need for real surgeonleaders
(11:08):
to be familiar with and comfortablein a VUCA environment.
So I've spent a little bit of timelearning more about VUCA.
The term sound, you know,a little bit similar, but there are,
subtleties and nuances, behind each one,you know, volatility.
I think we can all understandwhat that means, that,
you know, it's sort of like a flashpointor you think of places like,
(11:33):
the strait between China and Taiwan or,
the Red Sea,you know, these geopolitical flashpoints
and it just feels likewe're you're really sort of in a volatile,
world of
uncertainty and just,we we can't predict the future.
So in some ways, I guess you could say
we're always in an uncertain world,but it seems especially unclear.
(11:56):
You know, thethe outcome is not a foregone conclusion.
Complex:
there are so many stakeholders and
and so many different variables, that,
it becomes a very complex situation
and then ambiguous, you know, the,
the facts on the ground are,
(12:17):
opaque and and it's difficult to know,
what's right, what's wrong up from down.
And that's where we really need
clear thinkers, leaderswith strong moral compasses.
And those that are just
well-grounded, versatile and, and can,feel comfortable operating
(12:39):
in such a such a difficult environment,a VUCA world.
A VUCA world. Amazing.
I guess that this leads meinto the workforce need,
I think that,in your presidential address.
I mean, you really call into focus of
the skillsets that the expeditionary surgeon needs.
The VUCA environment, the changing world.
(13:01):
How big a workforce,is really needed to deal with that?
I mean, it sounds like it can't just bemilitary surgical training programs.
I mean, you need a workforce much,
much bigger than just providedby the military surgical.
training environmentsto really meet the needs of the future.
Correct? Well, I think you're right.
(13:22):
there
is an article recently published in JACS,
titled Putting Medical Bootson the Ground: Lessons
from the War in Ukraine and Applicationsfor Future Conflict
with Near Peer Adversaries,by Epstein et al.
And this is about a,
a, an organization that's really work
to support the educationof Ukrainian service members.
(13:45):
And in a table in that,
in that, manuscript,they describe the makeup of their team,
it's 2200 members about half
are half are, nursesor allied health personnel,
and the other half are physiciansand and surgical specialists.
(14:07):
So, you know, if you think about
our response to a large-scalecombat operation, it would take,
I think, something on that orderto, to, support that.
Now, the military, through
both active duty and guard and reserve
sources, can help get things started that.
(14:31):
But I think there's going to be a callfor volunteers and a need for really
ideas to to,
help fill the ranks.
So again,that gets back to the VUCA world.
We don't know what's going to happen.
I, you know, like everyonehope that we don't get embroiled
in some sort of large conflictin any area.
But it is useful, I think, as a thoughtexperiment or an exercise to,
(14:55):
to consider, you know, what the,the scale of the force might be.
I think that article gives you certaina good framework for thinking about
the proportion of folks involvedand then the size.
But I guess it also leads us to another,natural continuation.
Is that,you know, the focus of the article was,
(15:15):
you know, on the expeditionary surgeonand the military needs,
but there's probably leadership skillsthat translate across all surgeons.
That is, as you said,the VUCA environments are all around us.
Can you tell us about what,What are some of the leadership skills
you think that every,every surgeon should have or be exposed to
(15:36):
or should continue to developthroughout their career?
I think one of the most important onesis humility.
And then second, a close second tothat is empathy.
And I mentioned that in the article,you know, empathy towards
not just those that you're leading,but toward your superiors.
Like, you have to be able to put yourselfin their shoes, to know what,
(15:57):
what informationthey need to make sound decisions.
And then you need empathy for your peers.
Churchill,getting back to him, he talks a lot about
these sort of things in his book
Surgeons to Soldiers,which is a collection of,
essentially diary entries or reflectionson his experiences during World War II.
(16:19):
And, and in most sections, he talks
about some of the toughest decisionshe had to make
or some of the most difficult situationshe found himself in.
And, and I think that,
his character traitthat most endeared his coworkers
to him, his leaders to himand those that worked for him
(16:41):
at MassGen was his empathy and his ability to
to relate difficult to,or to relay difficult messages,
in a,
non-hostile, nonjudgmental, non
caustic waythat was still able to get results.
So I'd say humility first and foremostand then empathy is really invaluable.
(17:03):
That's amazing.
Dr Cannon, in the few moments that we haveleft, you had a, spectacularly
successful presidential year,leading the Excelsior Surgical Society.
we have this amazing article.
what are your thoughts,
or what are your plans nowgoing forward in terms of things that we,
as a profession, as a workforce, thingsthat we need to keep at?
(17:27):
Is it just continuingto raise awareness of,
the principlesthat you outlined in the speech?
Is it more we have to continue evolvingin terms of skill set acquisition?
What are your thoughtsabout going forward into the future?
Well, towards the end of the,
presidential address, in the article,I talk about focus, practice, designation.
You know, I think if we looked atmetabolic and bariatric surgery
(17:50):
as an example, through this processwith the American Board of Surgery
that gave the specialty of MBS,
legitimacy, as I've heard it said in,
in some of their publications,I'm wondering if,
focus practice designation forexpeditionary surgeons might fill a need.
(18:11):
I recognize it's a relatively small need,certainly not as large as metabolic
and bariatric surgery, but,a real need to,
legitimately,
identify a group of surgeonsthat is ready to, to, function
in a resource-constrainedoperational environment.
And it wouldn't be limitedto military surgeons.
(18:33):
It could be those that, want to go off,
on expeditions,who or who want to be involved
in humanitarian efforts or havea special expertise in disaster response.
so that's that's one thingI really hope to pursue.
We had had some initial discussions as,
early on as 2016about what this might look like.
(18:54):
And so I hope to pick up on that work.
if you look at some past
issues of the Bulletin of the ACS,there's this concept of a,
medical readiness think tank.
What are the strategic and policy changesthat need to be made
to to really help us be ready?
We've seen time and again through historythat at the beginning
(19:17):
of each new conflict,our outcomes are really atrocious.
Quite honestly, it was quantified that,
over the past 80 years,
since World WarII, there have been about 100
and 100 to 110,000 estimated deaths
due to this, what we call peacetimeeffect, 70,000
(19:37):
in World War II,
about 14,000 in Korea,
18,000 Vietnam and 4000 in Iraqand Afghanistan.
So those are, those are,that's low-hanging fruit.
Those are opportunities for
readiness
and and, and poor outcome prevention.
(19:58):
If you look at military health care today,unfortunately,
we're critically understaffed.
We're inexperienced.
many of our experienced,combat, surgeons are now retired.
and we're demoralized.
If you look at papers by MaryEdwards, in JACS,
she talks about thissort of crisis of of conscience.
(20:19):
There's there's a senseof a little demoralization.
So those are all things I hope to address.
I think through focused effortand hopefully, sound leadership,
we can get beyond this and be ready for,what might be around the corner.
Well, Dr Cannon,
I, my deepest admiration to youand everybody who gives their lives
(20:44):
on behalf of our nation, you know,thank you for the bottom of my heart,
for all the work that you've done.
Thank you
for writing this incredible articlethat was just recently published in JACS.
I think it's a lot of, contentfor us to mull over.
I, too am, optimistic.
I hope that this is the startof ongoing conversations
and hopefully better results in the yearsahead.
(21:07):
Thank you so much for joining uson, today's episode of The Operative Word.
Thank you, Dr Varghese.
It was really a pleasure and a privilege.
And thank you for the invitation.
Thank you for listening to
the Journal of the American Collegeof Surgeons Operative Word Podcast.
If you enjoyed today's episode,spread the word on social media
(21:28):
by using the hashtag #JACSOperativeWord.
Subscribe to The Operative Wordwherever podcasts are available,
or listen on the American Collegeof Surgeons website at facs.org/podcast.
You are listening to The Operative Word,
a podcast brought to you by the Journalof the American College of Surgeons.
I'm Dr Tom Varghese,and throughout the series, Dr Lillian
Erdahl and I will speak with recently
published authors about the motivationbehind their latest research
and the clinical implicationsit has for the practicing surgeon.
The opinions expressed in this podcastare those of the participants,
(00:26):
and not necessarilythat of the American College of Surgeons.
Disclosure information:
Dr Cannon received royalties from UpToDate
for authoring an articleon an unrelated topic.
Dr Cannon's institute was supportedby funding from
CSL Behring.
(00:49):
Hello, loyal listeners,
welcome to another episodeof The Operative Word,
a podcast by the Journalof the American College of Surgeons.
I am incredibly honored to be joined todayby the amazing Dr Jeremy Cannon.
Jeremy, why don't you go aheadand introduce yourself to our audience?
Hello.
My name is Jeremy Cannon.
I'm a trauma surgeonat the University of Pennsylvania
(01:09):
and a recently retired colonelfrom the Air Force Reserves.
I have no disclosuresspecific to this podcast.
I did get some funding from CSLBehring to attend a PI meeting,
a few months ago.
And then the only other thing to mentionis that,
(01:30):
you know, I have been, privilegedto be part of the American College
of Surgeons partnershipwith the military health system.
And, in that role, have,
been, serving as a presidentof the Excelsior Surgical Society.
And you'll hear a little moreabout that here in a few minutes, I think.
Thanks so much, Dr Cannon.
We appreciate you taking the time.
(01:50):
So, today we're going to be deep divinginto the recently published article,
the 2023 Excelsior Surgical SocietyPresidential Address:
Expeditionary Surgeons (02:01):
Essential to Surgical Leadership in World War II
and today.
Dr Cannon, let's startfirst with the Excelsior Surgical Society.
Can you briefly tell us about
what the, how that society startedand, where it is today?
It's a fascinating story.
And, one that I've really enjoyedlearning more
(02:24):
about over the past several years. So,
they claim to have modeled themselvesafter a society from World War I.
That society was called the Eclat Club.
It was a group of surgeonsthat felt such a strong bond between one
another after having been deployedtogether that they wanted to reconnect,
(02:44):
post-deployment on a regular basis.
So in that, in that same spirit,that same model,
after combat operationsstarted winding down or when,
when things started to settle downa little bit in the Mediterranean
theater of World War II,
Colonel Edward Churchill,who was the chair of surgery at Mass
(03:05):
General, assembled a group of surgeonsat the Excelsior Hotel in Rome.
Their stated purpose was really to debriefabout a conference
they had just attended with some Britishand other allied colleagues
sort of evaluatingtheir surgical experiences during
World War II and defining best practices.
(03:25):
This group of U.S. surgeons
reconvened the day after,
at the Excelsior Hoteljust to sort of decide amongst themselves,
you know, what they thought of all that,
and discussed just a range of differenttopics, from open
fractures to blood product resuscitationand what have you.
(03:46):
And then from that initial meeting
in 1945, that group of surgeons
decided, hey, you know,that Eclat Club from World War I?
That was a pretty interesting idea.
Why don't we do something similar?
And so they started meeting outon a regular basis.
The first US meetingwas in October of 1946.
(04:07):
That's when the first Edward DChurchill lecture was given,
and that was given by Alfred Blaylock.
And the meeting was held in Boston,
well attended, and actuallythey met together with the Eclat Club.
So veterans from World War I,
and so they
you know, actually focusedon both surgical science,
(04:29):
they had the Churchill lecture,by Dr Blaylock,
and then they also attended a footballgame between Harvard and Holy Cross.
So, you know, a little,you know, a little,
athletic activity there as well.
So, it was a great model in this,the society continued for many years
thereafter.
And the fascinating thing,I think, for our audience members, Dr
(04:51):
Churchill is alsothe one specifically responsible
for the creation of the rectangulargeneral surgery residency model.
As many may remember before Dr Churchill
took that, advanced leapin surgical education,
the model was essentially a pyramid.
That is, they took in way more candidatesthan actual people
(05:14):
who were scheduled to graduate.
And Dr Churchill is the onethat really advanced surgical education by
saying the pyramid was an outdated modeland creating the rectangular residency
which exists today,that is, the same number of people
who start are the same number graduatesat the end of the training program.
It's amazing history there.
Dr Cannon,let's deep dive into your article.
(05:36):
So the theme of this symposiumthis year, you wanted to focus
on the optimal surgical leaderfor future large-scale combat operations,
as reflected about, from the experiencesspecifically from World War II onwards.
I guess the first question isevery war ends up having certain nuances
(05:58):
that are a little bit different,but there's some commonalities
as you go from war to war.
Could you just talk about that brieflybefore we talk about your
presidential address?
That's a great insight.
You don't want to end upfighting the last war.
That's a recipe for disaster.
Because, as you mentioned,there are nuances to each new conflict.
(06:20):
If you look specificallyat the US experience over the past
20 years, we've been involved in, in, inwhat's called an asymmetric conflict,
where, you know, we had air supremacythroughout the theater.
We could go wherever we wanted.
Now, the fighting on the groundwas very intense.
But the the weapons were, were often,
(06:41):
improvised, as in an improvisedexplosive device or IED.
They were not typically, manufacturedor machined.
And as a result, they were sort of,unreliable and inconsistent.
And could be in effect devastating,you know, if they, if they struck home.
But but inconsistent.
If we get entangled into a peeror near peer conflict
(07:05):
as we're seeingover in Ukraine with Russia,
the, consistency of
the weaponry,the lethality of the weaponry,
the ability to have free
range of motion across the theater.
It's going to be totally differentfrom what we've had in the past 20 years.
(07:26):
And much more similar to World War II,
which is why I think it's sovitally important to look back to the last
large-scale combat operationyou've been involved in.
If we're going to be at allprepared for for what might happen.
And using that as a premise,you started then,
talking about the expeditionary surgeon
(07:48):
as, hopefully I pronounced that correctly,
as the correct model going forward.
And I love the way that you startedthe description of comparing
that surgeon to your Swiss Army Knife.
talk to usabout how you got that model, comparison.
And what exactlyis an expeditionary surgeon?
(08:09):
Well, that's a great question.
You know, it just seems to align, where
a Swiss Army Knifeis the ultimate utility tool.
The origins of the Swiss ArmyKnife are pretty interesting.
It it started, I think even
before World WarII, maybe even in World War
I as a utility toolfor soldiers, Swiss soldiers.
(08:33):
And my
knife was gifted to me for my father,and had all sorts
of fascinating little gadgets on it,from a magnifying glass
to a toothpick, and what have you.
And it just it's low profile, lightweight,but so functional.
It seems to always have exactlywhat you need. So.
And in a similar fashion,it it seems like surgical leaders in
(08:57):
and combat operation,but I think especially large-scale
combat operationswhere these challenges of
lack of freedom of movement,
large volumes of casualties,you need strong leaders that that,
have broad experience
have incredible technical facility,but also,
(09:21):
come to the, come to the,
conflict zonewith, with, great leadership skills and,
and it just seemed to fit with the,you know, the analogy or the metaphor.
The Swiss Army Knife.
So I think we need to look for,
those, surgical leaders
in, in the wings that have this,
(09:42):
this sort of multi, facility,multi-talented capability
and groom them for futurebig leadership roles.
And the amazing part is that not onlydid you talk about
that utility, you know, being versatile,
but you also in the articleintroduced our readers
to a relatively new term,which is very common in the military world
(10:06):
being that may not be as, common
in, civilian life, which is this conceptof a VUCA environment.
and it's, correct me if I'm wrong.
It's, first started by the U.S.,Military War College, VUCA.
VUCA stands for volatility, uncertainty,
complexity and ambiguity.
(10:28):
And it was meant to describe a post-Cold
World war, Cold War world.
talk to us about VUCA environment.
And I think especially with the focusnow, we're in this post-pandemic world,
which probably is the greatest exampleof VUCA,
as, as well talk talk to us about that.
Yeah. Yeah. Great question.
(10:48):
You know, I was, reminded of thiswhen Dr Turner
gave her her, prior lecture in 2022.
Excelsior Surgical Symposium, and,
she gave, a real clinicon surgical leadership
and mentioned the need for real surgeonleaders
(11:08):
to be familiar with and comfortablein a VUCA environment.
So I've spent a little bit of timelearning more about VUCA.
The term sound, you know,a little bit similar, but there are,
subtleties and nuances, behind each one,you know, volatility.
I think we can all understandwhat that means, that,
you know, it's sort of like a flashpointor you think of places like,
(11:33):
the strait between China and Taiwan or,
the Red Sea,you know, these geopolitical flashpoints
and it just feels likewe're you're really sort of in a volatile,
world of
uncertainty and just,we we can't predict the future.
So in some ways, I guess you could say
we're always in an uncertain world,but it seems especially unclear.
(11:56):
You know, thethe outcome is not a foregone conclusion.
Complex:
there are so many stakeholders and
and so many different variables, that,
it becomes a very complex situation
and then ambiguous, you know, the,
the facts on the ground are,
(12:17):
opaque and and it's difficult to know,
what's right, what's wrong up from down.
And that's where we really need
clear thinkers, leaderswith strong moral compasses.
And those that are just
well-grounded, versatile and, and can,feel comfortable operating
(12:39):
in such a such a difficult environment,a VUCA world.
A VUCA world. Amazing.
I guess that this leads meinto the workforce need,
I think that,in your presidential address.
I mean, you really call into focus of
the skillsets that the expeditionary surgeon needs.
The VUCA environment, the changing world.
(13:01):
How big a workforce,is really needed to deal with that?
I mean, it sounds like it can't just bemilitary surgical training programs.
I mean, you need a workforce much,
much bigger than just providedby the military surgical.
training environmentsto really meet the needs of the future.
Correct? Well, I think you're right.
(13:22):
there
is an article recently published in JACS,
titled Putting Medical Bootson the Ground: Lessons
from the War in Ukraine and Applicationsfor Future Conflict
with Near Peer Adversaries,by Epstein et al.
And this is about a,
a, an organization that's really work
to support the educationof Ukrainian service members.
(13:45):
And in a table in that,
in that, manuscript,they describe the makeup of their team,
it's 2200 members about half
are half are, nursesor allied health personnel,
and the other half are physiciansand and surgical specialists.
(14:07):
So, you know, if you think about
our response to a large-scalecombat operation, it would take,
I think, something on that orderto, to, support that.
Now, the military, through
both active duty and guard and reserve
sources, can help get things started that.
(14:31):
But I think there's going to be a callfor volunteers and a need for really
ideas to to,
help fill the ranks.
So again,that gets back to the VUCA world.
We don't know what's going to happen.
I, you know, like everyonehope that we don't get embroiled
in some sort of large conflictin any area.
But it is useful, I think, as a thoughtexperiment or an exercise to,
(14:55):
to consider, you know, what the,the scale of the force might be.
I think that article gives you certaina good framework for thinking about
the proportion of folks involvedand then the size.
But I guess it also leads us to another,natural continuation.
Is that,you know, the focus of the article was,
(15:15):
you know, on the expeditionary surgeonand the military needs,
but there's probably leadership skillsthat translate across all surgeons.
That is, as you said,the VUCA environments are all around us.
Can you tell us about what,What are some of the leadership skills
you think that every,every surgeon should have or be exposed to
(15:36):
or should continue to developthroughout their career?
I think one of the most important onesis humility.
And then second, a close second tothat is empathy.
And I mentioned that in the article,you know, empathy towards
not just those that you're leading,but toward your superiors.
Like, you have to be able to put yourselfin their shoes, to know what,
(15:57):
what informationthey need to make sound decisions.
And then you need empathy for your peers.
Churchill,getting back to him, he talks a lot about
these sort of things in his book
Surgeons to Soldiers,which is a collection of,
essentially diary entries or reflectionson his experiences during World War II.
(16:19):
And, and in most sections, he talks
about some of the toughest decisionshe had to make
or some of the most difficult situationshe found himself in.
And, and I think that,
his character traitthat most endeared his coworkers
to him, his leaders to himand those that worked for him
(16:41):
at MassGen was his empathy and his ability to
to relate difficult to,or to relay difficult messages,
in a,
non-hostile, nonjudgmental, non
caustic waythat was still able to get results.
So I'd say humility first and foremostand then empathy is really invaluable.
(17:03):
That's amazing.
Dr Cannon, in the few moments that we haveleft, you had a, spectacularly
successful presidential year,leading the Excelsior Surgical Society.
we have this amazing article.
what are your thoughts,
or what are your plans nowgoing forward in terms of things that we,
as a profession, as a workforce, thingsthat we need to keep at?
(17:27):
Is it just continuingto raise awareness of,
the principlesthat you outlined in the speech?
Is it more we have to continue evolvingin terms of skill set acquisition?
What are your thoughtsabout going forward into the future?
Well, towards the end of the,
presidential address, in the article,I talk about focus, practice, designation.
You know, I think if we looked atmetabolic and bariatric surgery
(17:50):
as an example, through this processwith the American Board of Surgery
that gave the specialty of MBS,
legitimacy, as I've heard it said in,
in some of their publications,I'm wondering if,
focus practice designation forexpeditionary surgeons might fill a need.
(18:11):
I recognize it's a relatively small need,certainly not as large as metabolic
and bariatric surgery, but,a real need to,
legitimately,
identify a group of surgeonsthat is ready to, to, function
in a resource-constrainedoperational environment.
And it wouldn't be limitedto military surgeons.
(18:33):
It could be those that, want to go off,
on expeditions,who or who want to be involved
in humanitarian efforts or havea special expertise in disaster response.
so that's that's one thingI really hope to pursue.
We had had some initial discussions as,
early on as 2016about what this might look like.
(18:54):
And so I hope to pick up on that work.
if you look at some past
issues of the Bulletin of the ACS,there's this concept of a,
medical readiness think tank.
What are the strategic and policy changesthat need to be made
to to really help us be ready?
We've seen time and again through historythat at the beginning
(19:17):
of each new conflict,our outcomes are really atrocious.
Quite honestly, it was quantified that,
over the past 80 years,
since World WarII, there have been about 100
and 100 to 110,000 estimated deaths
due to this, what we call peacetimeeffect, 70,000
(19:37):
in World War II,
about 14,000 in Korea,
18,000 Vietnam and 4000 in Iraqand Afghanistan.
So those are, those are,that's low-hanging fruit.
Those are opportunities for
readiness
and and, and poor outcome prevention.
(19:58):
If you look at military health care today,unfortunately,
we're critically understaffed.
We're inexperienced.
many of our experienced,combat, surgeons are now retired.
and we're demoralized.
If you look at papers by MaryEdwards, in JACS,
she talks about thissort of crisis of of conscience.
(20:19):
There's there's a senseof a little demoralization.
So those are all things I hope to address.
I think through focused effortand hopefully, sound leadership,
we can get beyond this and be ready for,what might be around the corner.
Well, Dr Cannon,
I, my deepest admiration to youand everybody who gives their lives
(20:44):
on behalf of our nation, you know,thank you for the bottom of my heart,
for all the work that you've done.
Thank you
for writing this incredible articlethat was just recently published in JACS.
I think it's a lot of, contentfor us to mull over.
I, too am, optimistic.
I hope that this is the startof ongoing conversations
and hopefully better results in the yearsahead.
(21:07):
Thank you so much for joining uson, today's episode of The Operative Word.
Thank you, Dr Varghese.
It was really a pleasure and a privilege.
And thank you for the invitation.
Thank you for listening to
the Journal of the American Collegeof Surgeons Operative Word Podcast.
If you enjoyed today's episode,spread the word on social media
(21:28):
by using the hashtag #JACSOperativeWord.
Subscribe to The Operative Wordwherever podcasts are available,
or listen on the American Collegeof Surgeons website at facs.org/podcast.
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