Specialty Spotlight

A Surgeon in…Melbourne

MS HELEN MOHAN FRCSI, RECIPIENT OF THE SECOND PROGRESS WOMEN IN SURGERY FELLOWSHIP, SUPPORTED BY JOHNSON & JOHNSON, HAS TAKEN UP A FELLOWSHIP IN COLORECTAL SURGERY AT PETER MACCALLUM CANCER CENTRE IN MELBOURNE, AUSTRALIA

he PROGRESS Women in Surgery Fellowship, supported by Johnson & Johnson, is a prestigious bursary awarded by RCSI to promote female participation in surgical training at fellowship level. Ms Helen Mohan travelled with her family to Melbourne earlier this year. “ is Fellowship is hugely signi cant for me, allowing me to advance my career in colorectal surgery and to focus on providing high quality patient care, promoting research and surgical education.”

Helen grew up in Raheny on the northside of Dublin, with her parents and younger sister, Sara. “ ere were no medics in the family,” says Helen. “I was the rst, and then I married someone from my class, Rory Whelan, and Sara is now an SpR in Obstetrics and Gynaecology so my poor parents are surrounded by medics!”

Helen graduated from the School of Medicine at University College Dublin in 2007 with rst class honours. “We were one of the last years in Earlsfort Terrace,” she says. “I was in St Vincent’s University Hospital (SVUH) for nal med and did my intern year there, followed by Basic Surgical Training between SVUH and St Michael’s.”

Her interest in surgery was rst sparked on an elective in Tanzania. “I worked with a very inspirational surgeon from New Zealand, Dr Tom Gibson, who ignited my interest in surgery, and then during my intern year I had some excellent mentors, including Professors John Hyland and Oscar Traynor.”

A er the BST, Helen undertook a PhD in Pathophysiology of In ammation and Cancer, working in RCSI Fellow, Professor Des Winter’s and Professor Alan Baird’s laboratory at SVUH and UCD.

“It was a mixture of science and clinical research, looking at orphan nuclear receptors in colon cancer and in ammatory bowel disease, and also analysing the colorectal cancer database,” explains Helen. “As part of the PhD I had the opportunity to spend eight weeks in Denver at the University of Colorado Mucosal In ammation Programme with Dr Sean Colgan carrying out research on intestinal in ammation and IBD, as well as a month at Arizona State University where I got to work with Dr Raymond Dubois, who had published on the orphan nuclear receptor NR4A2.”

Helen’s strong research background is evidenced by more than 60 publications over the course of her career to date.

A er the PhD, Helen spent a year as a non-training Registrar in Wexford

General Hospital before being accepted onto the Higher Surgical Training Programme in 2013. “I did my rst year in Wexford, which was great because I already knew people there and had good relationships,” she says. “ e following year I went to Cork University Hospital and did six months of colorectal surgery and six months of vascular surgery, and from there I went to the Mater for six months. I took maternity leave when I had my rst child, Domhnall, in 2017, and then went to SVUH. It was nice, I had spent so much time there, it felt like coming home.” From SVUH, Helen moved to University Hospital Limerick – “I was pregnant with twins and su ered from severe hyperemesis which was challenging but I was very well supported,” she says. A er Oisín and Sophie were born, in June 2019, Helen took maternity leave during which she sat her exams. She was awarded her FRCSI in 2019 and CCST in 2020. Next came a stint at St James’s University Hospital with Professor John Reynolds RSCI Fellow (1998) focused on Upper GI, which is where she was based when COVID-19 hit in March 2020. She spent the last six months before she le for Australia back at SVUH on colorectal with Mr Sean Martin, Professor Des Winter, RSCI Fellow (1998), Ms Ann Hanly, Ms Helen Mohan, FRCSI RSCI Fellow (2010) and Mr Rory Kennelly, RSCI Fellow (2014). “ ere is a lot of moving around,” she says, “but I think we gain from working in di erent places. You get a real breadth of experience, and working in di erent units shows you there is more than one way of doing things. You pick up little tricks and tips from everyone you work with. Logistically it can be challenging, particularly when you have little ones. I’ve been lucky in that I have a very supportive partner. When I moved to Limerick with baby Domhnall I was lucky that my husband had nished his training scheme and was able to get a consultant job there at the same time. But when we had the twins, he was still in Limerick commuting while I was back in Dublin. at was tricky.” e family was supposed to leave for Melbourne in January of this year, but shortly before they were due to depart Helen and her three children all got COVID-19. “We had the whole house packed up in crates when we got sick,” she says. “I’d been planning the Fellowship since 2015 and put a lot of energy into it. When Domhnall was ve months old I had gone to a conference in Seattle to meet the consultants from the Peter MacCallum Cancer Centre for my interview, and

“The funding was really the di erence between being able to come and not.”

I knew it was a Fellowship I really wanted to do. I did worry when we got sick and had to cancel our ights that we weren’t going to get to go at all. e price of the ights became astronomical and it was so hard even to get into Australia because of the caps on visas. We eventually le a month later than we were supposed to. Five days a er we arrived, they stopped international arrivals to Melbourne, and the whole travel situation was very unstable.”

A er the stress prior to the family’s departure for Melbourne, the two weeks in hotel quarantine with three small children were not as bad as Helen had feared. “When we had COVID-19 I was very concerned that someone was going to get really sick or give it to someone else who would get sick, so the whole lead-up was quite emotional. We never got to say goodbye to my parents. But once we were in quarantine, I breathed a sigh of relief, because we were nally here on our big adventure. We were mentally prepared, we had a nice airy room, and at least once we were in the hotel the kids – now aged four and 18 months – weren’t disturbing anyone else.”

“ ere are three main areas of the work here,” explains Helen. “Firstly, the Centre is pushing boundaries in terms of locally advanced tumours in the pelvis and pelvic exenteration, with pioneering techniques for dealing with locally advanced tumours in patients who require surgery beyond standard resection.

“ e second group of patients are those with peritoneal malignancy, who we treat with cytoreductive surgery and HIPEC. And then the third aspect, and a key part of my Fellowship, is the huge volume of robotic colorectal surgeries, and standard resections, and we are applying robotic techniques to locally advanced tumours.”

Helen explains that the Centre’s approach is to harness all the new and innovative technology available to improve quality of life and quality outcomes for patients. “Also it’s a great opportunity for me to be involved in research and bring together some of the things I have been interested in over the years to improve patient care.”

Helen has found her colleagues at the Centre, including Mr Peader Waters, Colorectal Consultant, very welcoming. “ ey are a super team and the whole ethos and environment is exciting to be in,” she says. “It’s a very energetic unit. ere are excellent mentors and I am getting very good technical training. e head of unit, Professor Alexander Heriot, places a strong emphasis in preparing fellows for the management and leadership aspects of consultant practice and is an incredible role model. In Ireland on the higher surgical training programme, we are very well trained and that puts you in a good position when you are leaving Ireland to go on Fellowship to be able to take advantage of the opportunities that are presented. “ e patients come to the Centre

from all over the State of Victoria, from Tasmania, and from as far away as Western Australia. In one of my rst clinics, when I was making appointments for people to return, someone said, ‘We need to get you a map!’. Patients might live six hours away, the scale of distances takes a bit of getting used to.” Melbourne has been in lockdown for much of the time that Helen has been there, and she and her family have not got to explore very much yet. “It’s been quite intense and I’ve been working hard doing a lot of twilight and Saturday lists with RCSI alumnus Dr Satish Warrier, who is an excellent technical trainer and has pioneered a lot of robotic techniques. It would be very hard to get volume like this at home. Because it is a dedicated advanced cancer centre, you see cases every single week. Initially, my husband was working in Geelong, over an hour outside the city, and commuting but he recently got a job closer to home which will make things easier.” Helen says that without the RCSI PROGRESS Women in Surgery Fellowship funding she probably would not have been able to get to Melbourne at all. “It helped to cover the cost of the ights, which were considerable. e funding was really the di erence between being able to come and not. It’s also helped to defray the costs of childcare so that I could participate in lots of extra dual console robotic training lists in the evenings, which adds quite substantially to volume and experience. I had a lot of support from my family at home and hadn’t appreciated how much more challenging things are when you have no one other than yourself, and your husband is working an hour away.” As a past-president of the Association of Surgeons in Training, Helen is passionate about promoting diversity in surgical training, and encouraging other women to take up fellowships abroad. “Fellowships are so important in terms of surgeons being as trained as possible and being able to bring back a skillset that is adaptable and can be used to improve patient care.” Now that she and her family are settled in Melbourne, Helen has decided to stay on for a second year. “I am staying on to do a further colorectal fellowship a liated with the Austin Hospital,” she says. “ e emphasis there will be on robotic techniques again and on a wider spectrum of colorectal disease including in ammatory bowel disease and specialist endometriosis work. I’m hugely grateful to my trainers and mentors at home, and to RCSI for the support of the PROGRESS Women in Surgery Fellowship and to my family for their ongoing support.” ■ e RCSI PROGRESS Women in Surgery Fellowship, funded by Johnson & Johnson Medical Devices Companies through an educational In theatre at the Peter grant, is a prestigious bursary awarded to promote female participation in surgical MacCallum Cancer Centre. training at fellowship level.

In quarantine: Oisín and Sophie Ms Helen Mohan and Mr Peader Waters, Colorectal Consultant

Broadening e Mind

RECENT RECIPIENTS OF RCSI COLLES TRAVELLING FELLOWSHIPS IN SURGERY, MR EAMON FRANCIS AND MS ELAINE REDMOND RECOUNT THEIR EXPERIENCES, AND RECORD THE IMPACT OF THEIR AWARDS

he RCSI Colles Travelling Fellowship in Surgery is an award to promote the acquisition of additional surgical skills and knowledge that will contribute to the advancement of surgical science and practice in Ireland. e Fellowship is open to Fellows and Members of the College (in good standing) who are in, or have completed within the previous two years, a higher surgical training programme in Ireland. e Fellowship, which must be full-time, is tenable for one year abroad and includes a College Medal, stipend and travel allowance up to €20,000. Additional grants up to a maximum of €30,000 may also be awarded.

Surgical Fellowships continue to provide additional focused training opportunities across the surgical specialties for RCSI Fellows and Members, according to Director of National Surgical Training Programmes, Professor Kevin Barry. “ e award of Fellowship is a signi cant personal achievement with obvious bene ts in terms of continuing professional development and career progression. On a societal level, it creates long-term bene ts in respect of enhanced patient care, education, training and research.” In recent years, RCSI has expanded the range of Fellowships available. “I wish to acknowledge the dedication of all surgical trainees and to congratulate those who have been awarded Fellowships,” says Professor Barry.

Mr Eamon Francis, FRCSI

MR EAMON FRANCIS MB BCH BAO, MA, MCh, MSc (Burns), MSc (Microsurgery), FRCSI

Eamon Francis graduated from Trinity College Dublin in 2010 with an honours degree and the Seton-Pringle and Arthur Ball prizes in Surgery. He completed his internship at St James’s Hospital, followed by basic surgical training in Dublin (St Vincent’s University Hospital, St James’s and Our Lady’s Childrens Hospital Crumlin).

Eamon completed a number of higher degrees in parallel with his surgical training and he is completing his masters degree in Reconstructive Microsurgery through Chang Gung University Fellowship in Plastic and Reconstructive Surgery in Chang Gung Memorial Hospital, Taiwan. “I commenced my Fellowship at Chang Gung Memorial Hospital, Taiwan in July 2020. As a 3,800-bed hospital with 90 operating rooms and a 24-bed dedicated Microsurgical ICU, this is perhaps the world’s highest-volume centre for free tissue transfer.

“ is Fellowship radically changed my attitude to microsurgery. e mantra here is replace “likewith-like” and its seeming ease of application through planning and immaculate execution converted me to this approach. e focused training across all the realms of microsurgery, encompassing all the latest technological and technical innovations, was inspiring. e hands-on training, in combination with mentorship by the most preeminent leaders in their elds of reconstruction, has been incredibly special. e technical tips and tricks I learned, along with strategies to deal with “di cult” scenarios are priceless. e introduction to new skills such as “supermicrosurgery” have made me more eager than ever to push my abilities further.

“ e outpatient environment, while restricted somewhat by my inability to speak or understand the language, was still a great source of education. I learned how to evaluate and manage patients. I saw the results of reconstructions I was involved in and the patients’ feedback relating to these results. It helped me understand the neccessity of limiting donor site morbidity here, as it really detracted from any percieved bene t of the reconstruction by patients.

“ is Fellowship is operatively heavy, but through twice-weekly microsurgical conferences and weekly specialist microsurgical webinars, I was provided with both the technical skills and clinical acumen in reconstructing complex defects in both elective and traumatic settings.

“I am now armed with the expertise to deal with the full range of demands of Reconstructive Microsurgery in both Elective and Trauma settings.”

“ e objectives of the Fellowship – for me to acquire clinical training in Reconstructive Microsurgery across all sub-specialties including Head & Neck, Breast & Lymphedema, Hand, Trauma and Extemity reconstruction, and Facial reanimation and Peripheral Nerve surgery – were ful lled. Concurrently, I was involved with a research project for a masters in Reconstructive Microsurgery, under the supervision of Professor Fu-Chan Wei, awarded through Chang Gung University.

“ e Fellowship enabled me to build on the clinical and technical skill I learned in my training in Ireland. I am now su cently armed with the expertise to deal with the full range of demands of Reconstructive Microsurgery in both Elective and Trauma settings. I have also added another higher degree to my academic portfolio and collaborated on a number of peer-reviewed research papers. I have connected with a diverse network of peers and mentors who will provide support as my career progresses. is has only been possible through the support of RCSI to whom I am most appreciative. I believe I have represented RCSI, my mentors and the Irish specialist training scheme to the best of my ability this year. I was the rst Fellow from Ireland at Chang Gung and, as I rotated through all the microsurgical subspecialties, I received positive feedback with regard to attitude, knowledge and ability. I believe that despite the cultural di erences, the Taiwanese and Irish have very similar values and I know the Fellowship will welcome any Irish trainee who wishes to pursue advanced Microsurgical training.

“My training has provided me with invaluable experience in reconstructing complex oncological and traumatic defects across all the microsurgical disciplines and this will have a positive impact on patients in Ireland.”

Ms Elaine Redmond, FRCSI

MS ELAINE REDMOND MB, BCh, BAO (Hons), BMedSci (Hons), FRCSI

Elaine Redmond quali ed from University College Cork in 2008. She became a Fellow of the Royal College of Surgeons (FRCS Urol) in 2017, and completed her Higher Surgical Training in Urology with RCSI in 2019.

Elaine was awarded a Doctorate in Medicine (MD) from the University of Limerick in 2018 for her research which examined the e ect of bladder- lling rate on the sensation of urgency. She also holds a masters in Human Factors and Patient Safety from RCSI (2014). She has received numerous awards and grants for her work including the Irish Society of Urology Research Medal (2013) and the Ainsworth Scholarship (2019-2021).

In 2019, Elaine completed a GURS accredited fellowship in Reconstructive Urology at the University of Alberta Hospital, Edmonton, Canada. During this time, she worked with Professor Keith Rourke, an international expert and one of the world’s highest-volume surgeons in urethral stricture disease and male incontinence. In 2020, Elaine was the bene ciary of a Colles Travelling Fellowship in support of her Paediatric Urology Fellowship at BC Children’s Hospital, Vancouver, Canada. She returned to Ireland in August 2021 and has taken up practice as a Consultant Urologist at Cork University Hospital.

“British Columbia Children’s Hospital (BCCH) in Vancouver is the only tertiary paediatric centre in the province of British Columbia, serving a population of 4.7 million. e division of Paediatric Urology performs more than 800 surgical procedures and cares for more than 5,500 children a year. As the sole Fellow, supported by one-two residents, the Fellowship programme o ers an extremely high surgical caseload.

“I operated three/four days per week throughout the Fellowship which provided me with the opportunity to become pro cient in all aspects of paediatric urological surgery including proximal hypospadias repair and complex urinary tract reconstruction. I

“I feel well positioned to provide continuity of care for patients.”

attended regular outpatient clinics and a weekly multidisciplinary spinal cord clinic which ensured a high level of exposure to a wide range of pathologies, including dysfunctional voiding, neurogenic bladder, disorders of sexual di erentiation and spina bi da care. ere was a strong academic component to the Fellowship and I made a signi cant contribution to the research output of the department during my time there. I had the opportunity to present some of this research at the American Urological Association annual meeting, the Society of Pediatric Urology annual meeting and the Lorne D Sullivan research symposium.

“ e Colles Fellowship grant enabled me to subsidise the signi cant travel and relocation costs incurred in moving my family to Vancouver. I am very grateful to the RCSI for their support of my Fellowship training. is Fellowship has enabled me to achieve operative independence in a wide range of complex paediatric genitourinary procedures. I feel con dent in managing the many di erent cohorts of patients who may require paediatric urological surgery, including the care of patients with complex hypospadias, upper tract dysfunction and spina bi da/spinal cord injuries. I hope to have le BC Children’s Hospital with a long-lasting and meaningful connection to Ireland and I look forward to establishing clinical and academic links between our urology departments in the future.” ■