Society of University Surgeons 2014 Society of University Surgeons Presidential Address O. Joe Hines, MD, Los Angeles, CA
From The David Geffen School of Medicine at UCLA, Los Angeles, CA
GOOD MORNING, AND WELCOME to the 9th annual Academic Surgical Congress, and the 75th meeting of the Society of University Surgeons (SUS). During the past year, I began considering the role of the Society of University Surgeons in our matrix as university surgeons and our joint meeting with the Association for Academic Surgery (AAS). How could the Academic Surgical Congress (ASC) have grown so rapidly during a short period of time? What value do the SUS, the AAS, and the ASC bring to each of you sitting in the audience today? As you sit here in this auditorium, on occasion checking in with the rest of your life on your smart phone, you may be asking the question ‘‘why am I here?’’ Why have I traveled hundreds of miles, put my schedule on pause, arranged for coverage of my patients, traveled away from my family and friends, and generally put my life on hold to attend this meeting? It is an important question. Clearly the students, residents, and faculty in attendance find value in this meeting. And, if we could identify the most important reasons for this enthusiasm for the ASC, we may be able to elevate our game to an even greater level---a tenant that everyone sitting in this room certainly would uphold. We must make this meeting, and our organizations, the most valuable opportunity and experience possible for our membership. To understand why we attend this meeting, we can start by examining postmeeting surveys. After last year’s meeting, participants were surveyed, and one specific question focused on the
Accepted for publication April 16, 2014. Reprint requests: O. Joe Hines, MD, The David Geen School of Medicine at UCLA, 72-180 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095-6904. E-mail: [email protected] Surgery 2014;156:205-13. 0039-6060/$ - see front matter Ó 2014 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2014.04.032
reasons people chose to attend the 8th Annual ASC. Two-thirds stated they attended to present a paper or lecture and nearly as many stated they attended to participate in the scientific sessions of the meeting. The next most common reason was to see friends and colleagues. Few came to learn about new operative techniques or to see new innovations with our supporting vendors. Participants chose several reasons for attending the ASC last year, but I want to highlight the top three reasons---especially the concepts that we attended the ASC to present to others, to participate with others, and to see others. The ASC is big now. This year we have, as of January 27, 1,255 registrants. This represents a nearly 20% increase in registration over last year. We come from all over the country to attend this meeting. More than 100 of us come from California. More than 50 attended from Illinois, Michigan, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin. Massachusetts and New York are both represented by almost 40 participants each. And we come from all over the world. I would like to extend a special welcome to the our friends from other countries, especially the one person who came from each of the countries of Brazil, Grenada, Hungary, Italy, Puerto Rico, South Africa, Switzerland, Taiwan, and Thailand. Those who attend this meeting have a variety of educational backgrounds. I would like to highlight the more than 200 participants with the additional advanced degrees of MPH, PhD, and MBA. And, this year we have 14 undergraduate students, 24 graduate students, 50 postdocs, and 162 medical students. For those that have completed their education and training, we have nearly every surgical specialty and several nonsurgical disciplines represented here in San Diego. So here we are---1,255 people from all over the world with different backgrounds, goals, and viewpoints in this building at this time in the great city of San Diego. So I ask the question, ‘‘Why do we come to this meeting?’’ SURGERY 205
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I propose the hypothesis that we come to this meeting and spend these days together in order to connect. Connection is the essential activity for our humanity as individuals and as an organization under the big house of surgery. This morning, I am going to spend some time discussing the science of connection, talk about how the SUS is connected to its past, and end with some discussion about how our connections might influence the future for our organization and its mission. If you think that connection is not where it is for us---let me give you some facts that demonstrate how we value connection. Currently it is estimated that 7.1 billion mobile devices are currently in use in the world---this is larger than the entire world population. By 2017 there may be as many as 10 billion devices---this will be 1.4 devices for every man, woman, and child. When the Vatican announced the name of the new pope last year, twitter experienced a spike in tweets to 130,000 per second. Not convinced that connection is important to us? Of all of the influences in our lives, one dominant force is the Internet, and the site that dominates the internet is Facebook. Some have equated Facebook to a religion, and the numbers speak for themselves. If Facebook was a religion, it would be the third largest in the world. Citizens in this country spend 84,000,000,000 minutes per month participating in religious activities and 56,000,000,000 minutes on Facebook. Some interesting facts about Facebook that stood out to me: it has 1.2 billion users; every 20 minutes, 1 million links are shared, 1.5 million event invites are sent, 2.7 million messages sent; and over the past New Years Eve, 750 million photos were posted. Is it an accident that the top site in the internet is dedicated entirely to our social lives and allows us to connect with anyone in the world with access to a computer? Technology has completely revolutionized how we are able to connect with one another. Take, for example, the professional networking site LinkedIn, which gives you the ability to map professional connections and influence in your professional sphere. These social maps created in LinkedIn are color coded to represent different affiliations and groups, like previous employers, college classmates, and in which industries you’ve worked. You can use the map created for you on LinkedIn to view and measure your professional impact or to create opportunities for others. The map feature in LinkedIn allows you to adjust and control your connections simply by rearranging your connection maps and in turn rearranging your professional world.
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So my hypothesis is that we are here at this meeting and in this room to connect with others. We would like to forge new relationships to advance our science and research, to have fellowship with like-minded surgeons, to measure the temperature on our own career, to receive feedback on our progress and dreams, and overall to simply commiserate. With this background, I would like you to take the next 90 seconds to initiate a new connection. Please stand up and introduce yourselves to someone next to you that you do not know and connect. During the next few minutes, I am going to present some science to you that suggests that we are born hard-wired to connect. It is generally believed that homo sapiens became the most influential species on earth due to our unique ability to engage in abstract thought. But, in fact, our ability to connect and interact socially may be the most important factor that has influenced our dominance. All great ideas and projects require teamwork. The human brain has a neural network solely devoted to allowing us to work together as a team, read minds and anticipate the needs of others, and maintain the relationships required for success. Humans are the product of millions upon millions of evolutionary changes manifested by mutations that provided survival advantage. These adaptations are selected for because they promote our survival and reproduction. Evolution has also impacted our modern brains to help intensify the bonds we feel toward others and helps us to coordinate and cooperate together. Through time, our brains have become highly selected to connect to each other. It is this ability to connect that distinguishes us and has led to our success as a species. You might assume that the most successful among us are those with the greatest analytical skills, but in fact the most successful may be those with the greatest social intelligence. Some of our evolutionary success may be explained by brain size. Among animals, humans have relatively large brains, weighing about 1,300 grams---this is similar to the size of a dolphin brain. An elephant brain weighs about 4,200 grams, and some whales have brains as large as 9,000 grams. Even though we might not have the largest brains, humans do have the greatest number of neurons and neuronal connections. And what might be a better measurement of brain function or superiority is the concept of encephalization or the amount by which a brain deviates from what would be expected based on body size. Humans are at the top of the heap when it comes to encephalization.
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Human encephalization is 50% more than that of the next closest animal. Although the human brain makes up just 2% of the total body mass, it consumes 20% of the body’s energy, and this is even greater in infants at 60%. So why would evolution select for such a large brain that consume so much energy? Many reasons exist that may explain our large brain size and encephalization. These include the necessity for us to be individual innovators and problem solvers. It also includes the need to participate in social learning by imitating others and receiving instruction. The most important reason for a large brain though is the ability to connect and cooperate. If we agree to cooperate, there is a much larger benefit and this correlates to brain size. We recently have made huge advances in our ability to study the functioning brain to understand ourselves. Researchers like Dr Van Wedeen at Harvard use new technology to create never before seen detailed representations of the brains more than 100,000 miles of nerve fibers. The US government believes so strongly in this research that it has dedicated an annual budget of $40 million to the Brain Research through Advancing Innovative Neurotechnologies Initiative. Billions of neurons are involved in making up the brain, and these neurons create an incalculable number of neural connections. The circuitry in one brain is enormous and enough to circle the earth four times. And we now know that when we form a memory, there is a detectable physical change in the brain through the creation and destruction of synapses. It is estimated that humans create 1.8 million synapses per second from the second month in utero to the second month of life. By the age of 3, each brain neuron has an average of 15,000 connections and develops into as many as 1,000 trillion synapses as adults. Consider this---60 neurons are capable of making 1081 connections with each other, and the total number of particles in the universe is about 1/10th this number. Researchers at Caltech and University of California, Los Angeles (UCLA), have identified individual nerve cells that are reproducibly activated by the sight of specific individuals or objects in our lives. In their studies, these researchers used different photographs of Jennifer Aniston, and found that every time the subjects viewed a picture of her the same neuron fired even if it was a different picture. And when subjects viewed pictures of Hallie Berry, a different but consistently same neuron fired even when she was in costume
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as cat woman. These studies suggest that these ‘‘Jennifer Aniston’’ neurons are specifically involved in our ability to recognize others and connect. We have neuronal networks that help us establish and retain memories, and we have networks in our brain that allow us to establish social networks. These connections work to promote our social well being and are linked to the initial stages of connection typical of an infant and toddler. Infants embody a profound need to stay connected, and this need remains throughout the arch of our lives. As we develop, we become capable of forming social groups that can anticipate the needs of those in our groups---a concept called mindreading. During the preteen and teenage years, we are overcome by the need to fit in and become highly socialized and ‘‘harmonize’’ with those around us. These developments provide a means to deeper individual and group connection. Scientists now know that these processes and the ability to connect have an anatomic correlate. The brain has developed not only areas that can execute cognitive, motor, and visual tasks, but also areas that are focused on connection. These areas seem to be active when we are at rest and doing nothing and are called the default network or the task induced deactivation network. When we are executing a specific task, the default network turns off. This default network is activated when other tasks are complete and our thoughts drift to ourselves, others, and the relationships between these two, and supports the brain processes known as social cognition. An infant’s default network demonstrates activity from the moment of birth. Studies have demonstrated activation of these areas as early as 2 days of age but not in babies who are premature. At birth, babies are already experts at social connection and develop a deep connection to their mothers. Babies become very skilled at recognizing their mothers and facial patterns---so skilled that by 6 months babies can pick out facial features of different monkeys even though adults will state that the monkeys all look the same. Babies organize their understanding of their world by observing others facial expressions and reflect this into their own minds. With time all mammalian brains grow, but in order to grow properly connection with others is required. We know that rat pups that are groomed by their mothers have more synaptic connections than rat pups that are placed in isolation, and rats that are separated from their mother loose synaptic connections in both the cerebral and cerebellar cortices.
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Like I described earlier, our brains have a structural and functional ability to empathize--the concept of mindreading. In 1992 researchers at the University of Parma noted that the brains of macaque monkeys would fire when the monkey saw a human researcher grab a peanut and bring it to her mouth, as if the monkey was performing this task. The monkey’s brain was simulating what the monkey observed. From this work came the concept of mirror neurons---the idea that we have in our heads neurons that automatically recreate the mental pattern of those around us. These neurons are able to perform the task of imitation. Mirror neurons allow us to experience what others experience as if it were happening to ourselves. In many ways, the process of connection defines us. The physical brain is contained within our skull, but it becomes a mind when we are connected. A mind is the result of interaction between brains. Samuel Taylor Coleridge, an English poet, literary critic, and philosopher, and leader of the British Romantic movement, is often noted for an excerpt from his text Opus Maximum describing how a child develops a sense of self. A passage from his book describing a conversation between a mother and a child reads.. The child states ‘‘Touch me; only touch me with your finger.’’ ‘‘Why’’ the mother asked. And the child responds ‘‘I’m not here.’’ the boy cried. ‘‘Touch me, Mother, so that I may be here.’’
Not all of us are able to connect effectively to others. We all know people who are especially talented with connection, and we ourselves are drawn to these types. Some of us are simply not effective at connection, period. We cannot always control this, and our environment during our childhood and adolescence heavily influences our innate ability to connect. Children born into a family of connected individuals who easily join into conversation with each other and with new acquaintances are advantage over children who are not. Children born into a family where relationships are unstable and sometimes even threatening can become fearful, disconnected, and sometimes aggressive. These children may not be able to do the work of mindreading and miss cues or social signals from others. Regardless of each individual’s upbringing and ability to connect, our brains are primed to be effective social thinkers. We are primed to need social connection throughout our entire lives. When this need goes unmet, separation leads to increased production of cortisol and long-term
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social and cogitative deficits. Studies have found that children who are separated from their parents for long periods exhibit increased cortisol decades later. The need for connection has a physiologic mechanism and a defined biology. Would you be surprised if a doctor prescribed an over-the-counter anti-inflammatory for a broken heart? The pain of disconnection and social exclusion has a physiology and can be mapped to an area of the brain called the anterior cingulate cortex. The cingulate cortex is a structure that stretches along the entire length of the brain hugging the corpus callosum. The role of the anterior cingulate cortex in connection has been studied by Drs Nathan DeWall and Naomi Eisenberger, who randomized two groups to 1,000 mg of acetaminophen or placebo. Each day, the subjects answered questions by e-mail regarding the amount of social pain they felt that day. By the ninth day, the Tylenol group was feeling less social pain, and the difference between the groups widened throughout the study period until day 21. The researchers followed this study with a functional magnetic resonance imaging (MRI) study in which the study group again took Tylenol for 3 weeks and the control group placebo. The subjects were then asked to participate in a validated test called Cyberball, which simulates a game that includes various scenarios in which the subject is excluded. Those who had been taking the placebo for 3 weeks showed greater activity in the anterior cingulate cortex when they were excluded from the game compared with when they were included in the game. In contrast, the subjects taking Tylenol for three weeks showed no anterior cingulate cortex activity to rejection. Taking Tylenol made the brain’s social network less sensitive to the pain of rejection. On the other side, we also know that there is a physiologic basis for positive social interaction reinforcing our need to connect. Feedback that we receive from others who like, care, and love us, confirm our sense of well being. In a study, Inagaki asked subjects to lie in a functional MRI scanner and read two groups of letters from their loved ones. One group of letters contained positive statements of connection and praise, and the other group contained only facts like ‘‘you have blue eyes.’’ While reading the letters, the subjects underwent a functional MRI scan. The researchers found that while reading the letters with kind and thoughtful words the MRI patterns of activity were the same as those that correlate with pleasure. This area is the ventral striatum, which is activated with positive social reinforcement.
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Therefore, the act of connection with others has physiological ramifications in our brains that are equally critical to our well being as physical activities like eating, grooming, and sleep. This neural activation strengthens our social networks and broadens our field of connection. Through this work and others, we know that mutual cooperation activates our reward system, and being verbally groomed like a mother rat physically grooms its pups is a powerful reinforcing sign that we are safe and cared for by others. Evolution has resulted in us securing connection to each other and positive social regard. When we get together like we are today at the ASC, everyone wins. Our world and the world of an academic surgeon are extraordinarily complex and potentially dangerous. Nature has pushed us to connect with others and to please one another, and this increases the potential benefit of connection. This morning each of you made at least one new connection. We all have our own circles of connection, and like you, I have certain connections that are vital for me personally. As I have outlined this morning, it seems these are apparently physiologically critical for my existence. The most important of these connections is with my wife Karen. Karen is the most passionate and connected person I have ever met. Karen is the reason I am standing here today, and that we are here today in this room with our children. I am so grateful that we are husband and wife. I know that I am OK because we are together. Karen and I are both irreversibly connected to two other people here today, our children, Grant and Avery. Grant and Avery are both kind and funny, and Karen and I are very proud of them. And we have one other member of our family who we all connected to, Boomer---our dog. Professionally, I have had a singular institutional connection, UCLA. UCLA has provided me with my surgical training, the opportunities to excel in research, to give back by educating future academic surgeons, and to contribute to vision for our department and the UCLA Health System. One of the most important people in my career has been Dr Ron Busuttil, our chairman. Dr Busuttil is a former officer of the SUS, having served as the Secretary. Dr Busuttil sets a standard of excellence for our faculty, residents, and staff that is unparalleled in the country. His energy and passion for UCLA surgery provides so much opportunity for all of us at UCLA, and I am personally grateful for my connection with him and opportunities he has provided for me and my family. Thank you, Dr Busuttil. I would not have ever started my career in academics if Dr Michael
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Zinner had not plucked me out of Oklahoma as a medical student and brought me to California to train at UCLA. Dr Zinner is past president of both the SUS and the AAS. Dr Zinner is a great role model for many and is one of those people that have an extraordinary ability to connect. I thank Dr Zinner for connecting with me. Dr Stan Ashley taught me how formulate a hypothesis and execute a research plan. He introduced me to the world of academic surgery and has stood as a starwort for university surgeons. Stan is a past president of the AAS and has been a friend and great example. I am so glad to be connected to Dr Stan Ashley. I want to thank Dr Eric Fonkalsrud, who has reached out to me as a senior mentor and source of advice. Dr Fonkalsrud is also a past president of both the AAS and SUS, and in fact has been the president of nine regional, national, and international surgical societies. He was a founding member of the AAS and is a living legend in US surgery. Thank you, Dr Fonkalsrud, for your support and friendship. I am also connected to Dr Jon Hiatt. We are connected first because we have the same initials, but mostly because we share a passion for academic surgery and UCLA. Jon is now our Vice Dean for Faculty, and I have learned so much from him over the past years. The person that has been the most influential for me, though, is Dr Howard Reber. Howard and I have been working together for the past 16 years, and he has taught me nearly everything I know about the pancreas. Howard is a friend and colleague, and I am so grateful for my connection to him. It is difficult to distill all of the important opportunities he has provided for me. I believe the most important, though, is that he taught me the difference between a surgeon who happens to work at a university hospital, and a university professor who is also a surgeon. Thank you, Howard, for your friendship and example. Our organization, the SUS, has its own set of connections too. To map these connections would require some sophisticated software, but like all organizations we are here because of those who have come before us. Our symbol was modified from that of the College of Come in Rouen, France. This medieval college is generally credited with the earliest recognition of the importance of academic training for surgeons and the separation of medically qualified surgeons from barber surgeons. The five elements in the logo symbolize: fluer-de-lis/nobility, halo/purity, salve container/ therapy, lamp/creativity, and book/scholarship.
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Many have come before us who have sacrificed their time and creative energy to move our organization to the next level. There is little doubt that the SUS is connected to its past, and this year marks the 75th annual meeting of the Society of University Surgeons. I would like us to take a moment to recognize this important event. Dr Samuel Stabins is credited with founding the SUS. Two factors lead to the formation of the organization. First, there was no organization for younger surgeons to present their scholarly work, and Dr Stabins envisioned an organization for younger university surgeons that had not yet become members of the American Surgical Association. Second, the American Board of Surgeons had just been formed, and there was concern among young university surgeons about the process of certification and the implications for their work. And so a small group of surgeons meet at the New York Hospital February 26, 1938. In addition to Dr Stabins from the University of Rochester, there were Dr George Finney of Johns Hopkins, Dr Lewis Foster of Yale, Dr Frank Glenn of Cornell, Dr Louis Rousselot of Columbia, Dr Jean Stevenson of the University of Cincinnati, and Dr Robert Zollinger of the Peter Bent Brigham Hospital of Harvard University. Dr Alexander Brunschwig of the University of Chicago, Dr Frank Walton of Washington University, and Dr Cobb Pilcher of Vanderbilt could not attend. This meeting codified the formation of the organization. Surgeons could apply for membership if their university had been approved as member institutions. The first annual meeting was held in 1939. Ten honorary members were inducted, which represented the chairs for the respective 10 founding institutional members. A list of 46 new members was approved, and 13 papers were presented, including three based on experimental studies. Most of the business meeting was discussion and acceptance incorporation and bylaws of the SUS. Dr Stabins was elected president. The purpose of the SUS was and is to advance the art and science of surgery by: (1) The encouragement of its members to pursue original investigations both in the clinic and in the laboratory; (2) the development of methods of graduate teaching of surgery with particular reference to the resident system; and (3) free and informal interchange of ideas pertaining to the aforementioned subjects as a limited membership and common aims make possible. The second annual meeting was held at the New York Hospital, and five additional charter organizations were added to the SUS; the University of
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California San Francisco, Duke University Hospital, Massachusetts General Hospital, Illinois Research and Education Hospital, and Stanford University Hospital. The organization has met every year since this except for 1945 during World War II. In 1941, the organization was officially incorporated for a cost of $11 dollars. A meeting highlight at this third meeting was that a presenter who spoke on spider bites apparently had a live demonstration, and a large number of black widow spiders apparently escaped into the meeting room. In June 1942, the first papers of the SUS meeting were published in the journal Surgery. A strong relationship formed between the journal and the SUS, and Surgery remains our journal today 72 years later. At the 1947 meeting in Boston, the use of vagotomy in the treatment of peptic ulcer disease was praised and the membership decided to raise the annual dues from $10 to $15 dollars. The following year the dues were raised to $25 dollars. In 1950 the first proposal for adrenergic blocking agents in the operative management of pheochromocytoma was made. I think we would all agree that this resulted in every training examination and board test including a question on this topic. In 1951, Canadian schools and surgeons were allowed into membership. The following year, the SUS had a joint meeting with the Society of Clinical Surgery and the Halstead Club on the occasion of the 100th anniversary of the Halsted’s birthday. At this meeting Dr Mark Ravitch presented to the Society a gavel from the Department of Surgery at the Johns Hopkins University. Its inscription states that ‘‘the case is made from the oak seats in the gallery of Dr Halsted’s Operating Room, the gavel head from the maple banister, and the handle from an oak spindle of the North Staircase.’’ This is the same gavel we still in use today for our business meetings. The organization became one of the most important surgical organizations in the country, and the reasons for this were many. In his article commemorating the 50th anniversary of the SUS, Dr Zollinger noted the importance equal to, if not greater than, the practical and scientific information exchanged were the lifetime friendships formed. Many firsts were presented at the annual meeting, and the membership represented surgical leaders across the country. At the 20th meeting in Indianapolis Dr Edwin Ellison presented the first 24 cases of Zollinger-Ellison syndrome. And, in 1957, the first symposium on surgical education
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was conducted. In 1958 a paper describing one of the first murine xenografts models for the study of human malignancies was given. And remembering the context of the times now, wives were first allowed to attend the annual dinner. In 1959 Dr Ravich presented a paper on bronchial closure by stapling, and UCLA was admitted as the last member department. Also this year the first SUS Residents conference was initiated. Unfortunately in 1960, the 1959 decision was reversed for reasons we can all speculate, and the membership voted to exclude wives from the annual banquet. But, responding to probably some significant backlash in 1961, the wives were again were admitted to the annual banquet. At this same meeting Dr Zollinger presented work supporting evidence for a hormone from the pancreas that stimulated gastric hypersecretion, later to be called gastrin. By 1963, the organization had been appointing members as governors to the ACS and American Board of Surgery, giving a voice for university surgeons on national issues and certification. Curiously the 1964 meeting of the SUS was held at UCLA, the year I was born. The 1965 meeting was with the Association of University Anesthetists. In 1966, the early results of transfusion of frozen blood were presented. Early on, the SUS formed affiliations and connections to other like-minded groups around the world, in 1967, the SUS had a joint meeting with the British Surgical Research Society. Members had a session on the role of antibodies in rejection after transplantation. In 1968, the first description of intravenous hyperalimentation in beagles was presented. Dr Sabiston presided over the 30th annual meeting in Miami. At the 31st meeting, Dr Donald Morton who recently passed away, presented a paper on the role of immunotherapy to treat melanoma. The following year an important paper on the use of silver lactate cream to treat burns was presented, and Dr Gerald Austin presented the use of an intraaortic balloon pump with a reported 3/7 survivors. In 1972, dues were raised to $35 dollars. The SUS focused on issues related to surgical education and helped to frame the issues relating the training early on. At the meeting in 1973, a symposium was held entitled ‘‘Education symposium---are we truly measuring surgeon’s competency?’’ In 1975, the first interim council meeting was held at the annual ACS meeting, and the committee on social and legislative issues was formed. Papers from the Australasia Surgical Research Society and South Africa Surgical Research Society were presented.
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The following year was a bit of a disaster. A tripartite meeting with the British Surgical Research Society and the European Society of Surgical Research in conjunction with the Japan Surgical Society and the Australasian Surgical Research Society and the Surgical Research Society of South Africa was planned in Philadelphia. Unfortunately, the meeting was booked at the famous Bellevue hotel, and a few weeks earlier this hotel was ground zero for an infectious outbreak---the original outbreak later given the name Legionnaires disease. In 1977, Dr Fonkalsrud focused his presidential address on surgical education and suggested that faculty should be specifically remunerated for their work and time focused on education. In 1978 residents were invited to present at the regular meeting. The SUS was the first place at which heparin-induced thrombocytopenia was reported by Dr Donald Silver’s group at the meeting in 1979. At the 1980 meeting, Dr Polk, our Lifetime Achievement Awardee this year, gave his presidential address entitled ‘‘the sky is not falling’’ and suggested that ‘‘academic citizenship is a proud estate.’’ Congratulations again Dr Polk today for his SUS Lifetime Achievement Award. The following year, the first pancreatic segmental transplantation was described. In 1982, Mayor Ed Koch welcomed the membership to New York, and dues were increased to $75 dollars. The role of the general surgeon was already being discussed in 1983, and the organization sponsored a session on ‘‘are we, can we, should we train a general surgeon.’’ Dr Laurence Cheung described the role of aspirin in gastritis at the meeting in 1984. The sixth tripartite meeting with our sister organizations was held in 1985 and at that meeting Dr Steven Rosenberg presented work on the use of LAK cells in combination with IL-2 against cancer. In 1986 the Ethicon SUS Resident Research Award was established, and Dr Scott Gruber was the first recipient. Scott latter presented his work on the role of donor-specific T lymphocytes on freshly implanted allografts. In 1987 Dr Rhodes delivered his address entitled ‘‘Presidential Address.’’ During the year of Dr Zinner’s presidency in 1988, the official SUS necktie was approved and Dr Alden Harkin’s group presented work suggesting that sleep deprivation did not to influence surgical decision making. The SUS has had a core mission to support the development of surgeon-scientists. Funda Meric Bernstam published a paper last year evaluating the work of the SUS and SUS foundation toward
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this end. Of the 26 awardees, 84% remained in academic surgery, and 48% had gone on to receive independent research funding with 30% receiving R01 or equivalent funding, a remarkable program and legacy for our organization. In 1989, on the 50th anniversary of the SUS, Dr Ronald Ferguson wrote ‘‘What is the future of the Society of University Surgeons? Only a fool would assuredly attempt to answer. However, what can be said with some certainty is that our society is based on sound traditions that if maintained into the future will serve it well. We must be cognizant of change and understand the forces however unpredictable that give momentum to change. We must keep our minds flexible and innovative in our future challenges and be guided by those principles that have made our society prosper. Our future charge as university surgeons carries with it the responsibility to maintain excellence and quality in the advancement of the art and science of surgery.’’ On this 75th anniversary of our society, these words still ring true. We find ourselves here in this room connected to people from all over the world, thousands strong, and from two important organizations, the AAS and the SUS. This joint venture has been extraordinarily successful and allowed surgeons with various expertise, background, and aspirations to connect. The ASC is now the largest meeting focused purely on surgeons who have dedicated their careers to improving the lives of patients through a deeper understanding of the conditions that afflict them, the discovery of new interventions to help them, and the education of those who follow us. We set the standard for academic surgery in our country and carry the voice for our members. This week we will hear more than 800 presentations, and our meeting has now extended to 5 days with the addition of the new initiatives like mid-career and the surgical investigators courses. If we pause to think about the enormity of work and expertise it took to assemble this meeting it is really quite extraordinary. How could this have occurred? I believe it comes back to the theme of connection--that we naturally gravitate toward a state of connection. With the background regarding the science of connection, our two organizations have behaved in a predictable manner. And the similarities between the AAS and SUS have helped facilitate this connection. The mission statements of both organizations are very similar. The leadership of both organizations is connected, and in fact the leadership is really the same group of people. Except for one instance, the current president, president-elect,
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secretary, recorder/recorder equivalent, and treasurer are all members of both the AAS and the SUS. And, generally speaking, we all like each other. The committee structures of both organizations are very similar. Both organizations have committees on education, ethics, global affairs, issues, membership, and publications. In fact, many of these committees currently work directly with each other to coordinate activities and make plans for the ASC meeting. Our foundations have very similar purposes. Drs Dai Chung and Max Schmidt lead each foundation, which seeks to fund residents and young faculty in order to facilitate a quality experience of investigation hopefully providing them with the tools to be successful as an independent academic surgeon. And by the way, both foundations are largely approaching the same constituents and organizations to secure donations for these efforts. Now it is true that there are some differences between the two organizations. Some would state the culture or spirit of the two organizations is different. The SUS membership is a bit older and the processes a bit more traditional or maybe even outdated. The SUS council would never claim to be as fun or maybe even as innovative as the AAS council. I think I can safely say that the SUS membership largely never tweets, but things are changing. A few weeks ago, I asked one of the residents in our laboratory, Kathleen Hertzer, to perform some immunocytochemistry in the lab probing for first the AAS epitope and then the SUS epitope, and when we merged the images..we can see there is a nearly identical pattern. So where do we go from here? Well like Dr Ferguson said 25 years ago, no one can predict. We do have great momentum and a very special meeting that all of us must continue to nurture and support. Our two organizations will continue to work together and in new directions in order to deepen our connection. I would ask the leadership though to consider the young faculty member, surgical resident, or medical student in the audience today. We should focus on their needs and facilitate any activity that provides the chance to expand the impact each of them might have as they navigate their career. For the membership and attendees at this meeting the designation of AAS, SUS, or ASC is less important. What is important is the opportunity to connect, period. It has been a singular honor to serve the SUS, and I am very thankful for this. Each of you have made at least one new connection this morning, and I encourage you to take full advantage of this
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and the other connections you encounter over the next few days. After all this is our default state and in the end will lead to the fullest and most productive career and life for each of us, and allow for the most benefit for our patients. I conclude that my initial hypothesis is true---we attend this meeting to connect. LITERATURE CITED Brooks D. The social animal: the hidden sources of love, character, and achievement. New York (NY): Random House; 2012.
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Dewall CN, Macdonald G, Webster GD, Masten CL, Baumeister RF, Powell C, Combs D, Schurtz DR, Stillman TF, Tice DM, Eisenberger NI. Acetaminophen reduces social pain: behavioral and neural evidence. Psychol Sci 2010;21:931-7. Inagaki TK, Eisenberger NI. Shared neural mechanisms underlying social warmth and physical warmth. Psychol Sci 2013;24:2272-80. Lieberman MD. Social: why our brains are wired to connect. New York (NY): Crown Publishers; 2013. 50th Anniversary Meeting Society of University Surgeons. Surgery 1989;105(Suppl 2).
From The David Geffen School of Medicine at UCLA, Los Angeles, CA
GOOD MORNING, AND WELCOME to the 9th annual Academic Surgical Congress, and the 75th meeting of the Society of University Surgeons (SUS). During the past year, I began considering the role of the Society of University Surgeons in our matrix as university surgeons and our joint meeting with the Association for Academic Surgery (AAS). How could the Academic Surgical Congress (ASC) have grown so rapidly during a short period of time? What value do the SUS, the AAS, and the ASC bring to each of you sitting in the audience today? As you sit here in this auditorium, on occasion checking in with the rest of your life on your smart phone, you may be asking the question ‘‘why am I here?’’ Why have I traveled hundreds of miles, put my schedule on pause, arranged for coverage of my patients, traveled away from my family and friends, and generally put my life on hold to attend this meeting? It is an important question. Clearly the students, residents, and faculty in attendance find value in this meeting. And, if we could identify the most important reasons for this enthusiasm for the ASC, we may be able to elevate our game to an even greater level---a tenant that everyone sitting in this room certainly would uphold. We must make this meeting, and our organizations, the most valuable opportunity and experience possible for our membership. To understand why we attend this meeting, we can start by examining postmeeting surveys. After last year’s meeting, participants were surveyed, and one specific question focused on the
Accepted for publication April 16, 2014. Reprint requests: O. Joe Hines, MD, The David Geen School of Medicine at UCLA, 72-180 CHS, 10833 Le Conte Ave, Los Angeles, CA 90095-6904. E-mail: [email protected] Surgery 2014;156:205-13. 0039-6060/$ - see front matter Ó 2014 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2014.04.032
reasons people chose to attend the 8th Annual ASC. Two-thirds stated they attended to present a paper or lecture and nearly as many stated they attended to participate in the scientific sessions of the meeting. The next most common reason was to see friends and colleagues. Few came to learn about new operative techniques or to see new innovations with our supporting vendors. Participants chose several reasons for attending the ASC last year, but I want to highlight the top three reasons---especially the concepts that we attended the ASC to present to others, to participate with others, and to see others. The ASC is big now. This year we have, as of January 27, 1,255 registrants. This represents a nearly 20% increase in registration over last year. We come from all over the country to attend this meeting. More than 100 of us come from California. More than 50 attended from Illinois, Michigan, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin. Massachusetts and New York are both represented by almost 40 participants each. And we come from all over the world. I would like to extend a special welcome to the our friends from other countries, especially the one person who came from each of the countries of Brazil, Grenada, Hungary, Italy, Puerto Rico, South Africa, Switzerland, Taiwan, and Thailand. Those who attend this meeting have a variety of educational backgrounds. I would like to highlight the more than 200 participants with the additional advanced degrees of MPH, PhD, and MBA. And, this year we have 14 undergraduate students, 24 graduate students, 50 postdocs, and 162 medical students. For those that have completed their education and training, we have nearly every surgical specialty and several nonsurgical disciplines represented here in San Diego. So here we are---1,255 people from all over the world with different backgrounds, goals, and viewpoints in this building at this time in the great city of San Diego. So I ask the question, ‘‘Why do we come to this meeting?’’ SURGERY 205
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I propose the hypothesis that we come to this meeting and spend these days together in order to connect. Connection is the essential activity for our humanity as individuals and as an organization under the big house of surgery. This morning, I am going to spend some time discussing the science of connection, talk about how the SUS is connected to its past, and end with some discussion about how our connections might influence the future for our organization and its mission. If you think that connection is not where it is for us---let me give you some facts that demonstrate how we value connection. Currently it is estimated that 7.1 billion mobile devices are currently in use in the world---this is larger than the entire world population. By 2017 there may be as many as 10 billion devices---this will be 1.4 devices for every man, woman, and child. When the Vatican announced the name of the new pope last year, twitter experienced a spike in tweets to 130,000 per second. Not convinced that connection is important to us? Of all of the influences in our lives, one dominant force is the Internet, and the site that dominates the internet is Facebook. Some have equated Facebook to a religion, and the numbers speak for themselves. If Facebook was a religion, it would be the third largest in the world. Citizens in this country spend 84,000,000,000 minutes per month participating in religious activities and 56,000,000,000 minutes on Facebook. Some interesting facts about Facebook that stood out to me: it has 1.2 billion users; every 20 minutes, 1 million links are shared, 1.5 million event invites are sent, 2.7 million messages sent; and over the past New Years Eve, 750 million photos were posted. Is it an accident that the top site in the internet is dedicated entirely to our social lives and allows us to connect with anyone in the world with access to a computer? Technology has completely revolutionized how we are able to connect with one another. Take, for example, the professional networking site LinkedIn, which gives you the ability to map professional connections and influence in your professional sphere. These social maps created in LinkedIn are color coded to represent different affiliations and groups, like previous employers, college classmates, and in which industries you’ve worked. You can use the map created for you on LinkedIn to view and measure your professional impact or to create opportunities for others. The map feature in LinkedIn allows you to adjust and control your connections simply by rearranging your connection maps and in turn rearranging your professional world.
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So my hypothesis is that we are here at this meeting and in this room to connect with others. We would like to forge new relationships to advance our science and research, to have fellowship with like-minded surgeons, to measure the temperature on our own career, to receive feedback on our progress and dreams, and overall to simply commiserate. With this background, I would like you to take the next 90 seconds to initiate a new connection. Please stand up and introduce yourselves to someone next to you that you do not know and connect. During the next few minutes, I am going to present some science to you that suggests that we are born hard-wired to connect. It is generally believed that homo sapiens became the most influential species on earth due to our unique ability to engage in abstract thought. But, in fact, our ability to connect and interact socially may be the most important factor that has influenced our dominance. All great ideas and projects require teamwork. The human brain has a neural network solely devoted to allowing us to work together as a team, read minds and anticipate the needs of others, and maintain the relationships required for success. Humans are the product of millions upon millions of evolutionary changes manifested by mutations that provided survival advantage. These adaptations are selected for because they promote our survival and reproduction. Evolution has also impacted our modern brains to help intensify the bonds we feel toward others and helps us to coordinate and cooperate together. Through time, our brains have become highly selected to connect to each other. It is this ability to connect that distinguishes us and has led to our success as a species. You might assume that the most successful among us are those with the greatest analytical skills, but in fact the most successful may be those with the greatest social intelligence. Some of our evolutionary success may be explained by brain size. Among animals, humans have relatively large brains, weighing about 1,300 grams---this is similar to the size of a dolphin brain. An elephant brain weighs about 4,200 grams, and some whales have brains as large as 9,000 grams. Even though we might not have the largest brains, humans do have the greatest number of neurons and neuronal connections. And what might be a better measurement of brain function or superiority is the concept of encephalization or the amount by which a brain deviates from what would be expected based on body size. Humans are at the top of the heap when it comes to encephalization.
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Human encephalization is 50% more than that of the next closest animal. Although the human brain makes up just 2% of the total body mass, it consumes 20% of the body’s energy, and this is even greater in infants at 60%. So why would evolution select for such a large brain that consume so much energy? Many reasons exist that may explain our large brain size and encephalization. These include the necessity for us to be individual innovators and problem solvers. It also includes the need to participate in social learning by imitating others and receiving instruction. The most important reason for a large brain though is the ability to connect and cooperate. If we agree to cooperate, there is a much larger benefit and this correlates to brain size. We recently have made huge advances in our ability to study the functioning brain to understand ourselves. Researchers like Dr Van Wedeen at Harvard use new technology to create never before seen detailed representations of the brains more than 100,000 miles of nerve fibers. The US government believes so strongly in this research that it has dedicated an annual budget of $40 million to the Brain Research through Advancing Innovative Neurotechnologies Initiative. Billions of neurons are involved in making up the brain, and these neurons create an incalculable number of neural connections. The circuitry in one brain is enormous and enough to circle the earth four times. And we now know that when we form a memory, there is a detectable physical change in the brain through the creation and destruction of synapses. It is estimated that humans create 1.8 million synapses per second from the second month in utero to the second month of life. By the age of 3, each brain neuron has an average of 15,000 connections and develops into as many as 1,000 trillion synapses as adults. Consider this---60 neurons are capable of making 1081 connections with each other, and the total number of particles in the universe is about 1/10th this number. Researchers at Caltech and University of California, Los Angeles (UCLA), have identified individual nerve cells that are reproducibly activated by the sight of specific individuals or objects in our lives. In their studies, these researchers used different photographs of Jennifer Aniston, and found that every time the subjects viewed a picture of her the same neuron fired even if it was a different picture. And when subjects viewed pictures of Hallie Berry, a different but consistently same neuron fired even when she was in costume
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as cat woman. These studies suggest that these ‘‘Jennifer Aniston’’ neurons are specifically involved in our ability to recognize others and connect. We have neuronal networks that help us establish and retain memories, and we have networks in our brain that allow us to establish social networks. These connections work to promote our social well being and are linked to the initial stages of connection typical of an infant and toddler. Infants embody a profound need to stay connected, and this need remains throughout the arch of our lives. As we develop, we become capable of forming social groups that can anticipate the needs of those in our groups---a concept called mindreading. During the preteen and teenage years, we are overcome by the need to fit in and become highly socialized and ‘‘harmonize’’ with those around us. These developments provide a means to deeper individual and group connection. Scientists now know that these processes and the ability to connect have an anatomic correlate. The brain has developed not only areas that can execute cognitive, motor, and visual tasks, but also areas that are focused on connection. These areas seem to be active when we are at rest and doing nothing and are called the default network or the task induced deactivation network. When we are executing a specific task, the default network turns off. This default network is activated when other tasks are complete and our thoughts drift to ourselves, others, and the relationships between these two, and supports the brain processes known as social cognition. An infant’s default network demonstrates activity from the moment of birth. Studies have demonstrated activation of these areas as early as 2 days of age but not in babies who are premature. At birth, babies are already experts at social connection and develop a deep connection to their mothers. Babies become very skilled at recognizing their mothers and facial patterns---so skilled that by 6 months babies can pick out facial features of different monkeys even though adults will state that the monkeys all look the same. Babies organize their understanding of their world by observing others facial expressions and reflect this into their own minds. With time all mammalian brains grow, but in order to grow properly connection with others is required. We know that rat pups that are groomed by their mothers have more synaptic connections than rat pups that are placed in isolation, and rats that are separated from their mother loose synaptic connections in both the cerebral and cerebellar cortices.
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Like I described earlier, our brains have a structural and functional ability to empathize--the concept of mindreading. In 1992 researchers at the University of Parma noted that the brains of macaque monkeys would fire when the monkey saw a human researcher grab a peanut and bring it to her mouth, as if the monkey was performing this task. The monkey’s brain was simulating what the monkey observed. From this work came the concept of mirror neurons---the idea that we have in our heads neurons that automatically recreate the mental pattern of those around us. These neurons are able to perform the task of imitation. Mirror neurons allow us to experience what others experience as if it were happening to ourselves. In many ways, the process of connection defines us. The physical brain is contained within our skull, but it becomes a mind when we are connected. A mind is the result of interaction between brains. Samuel Taylor Coleridge, an English poet, literary critic, and philosopher, and leader of the British Romantic movement, is often noted for an excerpt from his text Opus Maximum describing how a child develops a sense of self. A passage from his book describing a conversation between a mother and a child reads.. The child states ‘‘Touch me; only touch me with your finger.’’ ‘‘Why’’ the mother asked. And the child responds ‘‘I’m not here.’’ the boy cried. ‘‘Touch me, Mother, so that I may be here.’’
Not all of us are able to connect effectively to others. We all know people who are especially talented with connection, and we ourselves are drawn to these types. Some of us are simply not effective at connection, period. We cannot always control this, and our environment during our childhood and adolescence heavily influences our innate ability to connect. Children born into a family of connected individuals who easily join into conversation with each other and with new acquaintances are advantage over children who are not. Children born into a family where relationships are unstable and sometimes even threatening can become fearful, disconnected, and sometimes aggressive. These children may not be able to do the work of mindreading and miss cues or social signals from others. Regardless of each individual’s upbringing and ability to connect, our brains are primed to be effective social thinkers. We are primed to need social connection throughout our entire lives. When this need goes unmet, separation leads to increased production of cortisol and long-term
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social and cogitative deficits. Studies have found that children who are separated from their parents for long periods exhibit increased cortisol decades later. The need for connection has a physiologic mechanism and a defined biology. Would you be surprised if a doctor prescribed an over-the-counter anti-inflammatory for a broken heart? The pain of disconnection and social exclusion has a physiology and can be mapped to an area of the brain called the anterior cingulate cortex. The cingulate cortex is a structure that stretches along the entire length of the brain hugging the corpus callosum. The role of the anterior cingulate cortex in connection has been studied by Drs Nathan DeWall and Naomi Eisenberger, who randomized two groups to 1,000 mg of acetaminophen or placebo. Each day, the subjects answered questions by e-mail regarding the amount of social pain they felt that day. By the ninth day, the Tylenol group was feeling less social pain, and the difference between the groups widened throughout the study period until day 21. The researchers followed this study with a functional magnetic resonance imaging (MRI) study in which the study group again took Tylenol for 3 weeks and the control group placebo. The subjects were then asked to participate in a validated test called Cyberball, which simulates a game that includes various scenarios in which the subject is excluded. Those who had been taking the placebo for 3 weeks showed greater activity in the anterior cingulate cortex when they were excluded from the game compared with when they were included in the game. In contrast, the subjects taking Tylenol for three weeks showed no anterior cingulate cortex activity to rejection. Taking Tylenol made the brain’s social network less sensitive to the pain of rejection. On the other side, we also know that there is a physiologic basis for positive social interaction reinforcing our need to connect. Feedback that we receive from others who like, care, and love us, confirm our sense of well being. In a study, Inagaki asked subjects to lie in a functional MRI scanner and read two groups of letters from their loved ones. One group of letters contained positive statements of connection and praise, and the other group contained only facts like ‘‘you have blue eyes.’’ While reading the letters, the subjects underwent a functional MRI scan. The researchers found that while reading the letters with kind and thoughtful words the MRI patterns of activity were the same as those that correlate with pleasure. This area is the ventral striatum, which is activated with positive social reinforcement.
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Therefore, the act of connection with others has physiological ramifications in our brains that are equally critical to our well being as physical activities like eating, grooming, and sleep. This neural activation strengthens our social networks and broadens our field of connection. Through this work and others, we know that mutual cooperation activates our reward system, and being verbally groomed like a mother rat physically grooms its pups is a powerful reinforcing sign that we are safe and cared for by others. Evolution has resulted in us securing connection to each other and positive social regard. When we get together like we are today at the ASC, everyone wins. Our world and the world of an academic surgeon are extraordinarily complex and potentially dangerous. Nature has pushed us to connect with others and to please one another, and this increases the potential benefit of connection. This morning each of you made at least one new connection. We all have our own circles of connection, and like you, I have certain connections that are vital for me personally. As I have outlined this morning, it seems these are apparently physiologically critical for my existence. The most important of these connections is with my wife Karen. Karen is the most passionate and connected person I have ever met. Karen is the reason I am standing here today, and that we are here today in this room with our children. I am so grateful that we are husband and wife. I know that I am OK because we are together. Karen and I are both irreversibly connected to two other people here today, our children, Grant and Avery. Grant and Avery are both kind and funny, and Karen and I are very proud of them. And we have one other member of our family who we all connected to, Boomer---our dog. Professionally, I have had a singular institutional connection, UCLA. UCLA has provided me with my surgical training, the opportunities to excel in research, to give back by educating future academic surgeons, and to contribute to vision for our department and the UCLA Health System. One of the most important people in my career has been Dr Ron Busuttil, our chairman. Dr Busuttil is a former officer of the SUS, having served as the Secretary. Dr Busuttil sets a standard of excellence for our faculty, residents, and staff that is unparalleled in the country. His energy and passion for UCLA surgery provides so much opportunity for all of us at UCLA, and I am personally grateful for my connection with him and opportunities he has provided for me and my family. Thank you, Dr Busuttil. I would not have ever started my career in academics if Dr Michael
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Zinner had not plucked me out of Oklahoma as a medical student and brought me to California to train at UCLA. Dr Zinner is past president of both the SUS and the AAS. Dr Zinner is a great role model for many and is one of those people that have an extraordinary ability to connect. I thank Dr Zinner for connecting with me. Dr Stan Ashley taught me how formulate a hypothesis and execute a research plan. He introduced me to the world of academic surgery and has stood as a starwort for university surgeons. Stan is a past president of the AAS and has been a friend and great example. I am so glad to be connected to Dr Stan Ashley. I want to thank Dr Eric Fonkalsrud, who has reached out to me as a senior mentor and source of advice. Dr Fonkalsrud is also a past president of both the AAS and SUS, and in fact has been the president of nine regional, national, and international surgical societies. He was a founding member of the AAS and is a living legend in US surgery. Thank you, Dr Fonkalsrud, for your support and friendship. I am also connected to Dr Jon Hiatt. We are connected first because we have the same initials, but mostly because we share a passion for academic surgery and UCLA. Jon is now our Vice Dean for Faculty, and I have learned so much from him over the past years. The person that has been the most influential for me, though, is Dr Howard Reber. Howard and I have been working together for the past 16 years, and he has taught me nearly everything I know about the pancreas. Howard is a friend and colleague, and I am so grateful for my connection to him. It is difficult to distill all of the important opportunities he has provided for me. I believe the most important, though, is that he taught me the difference between a surgeon who happens to work at a university hospital, and a university professor who is also a surgeon. Thank you, Howard, for your friendship and example. Our organization, the SUS, has its own set of connections too. To map these connections would require some sophisticated software, but like all organizations we are here because of those who have come before us. Our symbol was modified from that of the College of Come in Rouen, France. This medieval college is generally credited with the earliest recognition of the importance of academic training for surgeons and the separation of medically qualified surgeons from barber surgeons. The five elements in the logo symbolize: fluer-de-lis/nobility, halo/purity, salve container/ therapy, lamp/creativity, and book/scholarship.
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Many have come before us who have sacrificed their time and creative energy to move our organization to the next level. There is little doubt that the SUS is connected to its past, and this year marks the 75th annual meeting of the Society of University Surgeons. I would like us to take a moment to recognize this important event. Dr Samuel Stabins is credited with founding the SUS. Two factors lead to the formation of the organization. First, there was no organization for younger surgeons to present their scholarly work, and Dr Stabins envisioned an organization for younger university surgeons that had not yet become members of the American Surgical Association. Second, the American Board of Surgeons had just been formed, and there was concern among young university surgeons about the process of certification and the implications for their work. And so a small group of surgeons meet at the New York Hospital February 26, 1938. In addition to Dr Stabins from the University of Rochester, there were Dr George Finney of Johns Hopkins, Dr Lewis Foster of Yale, Dr Frank Glenn of Cornell, Dr Louis Rousselot of Columbia, Dr Jean Stevenson of the University of Cincinnati, and Dr Robert Zollinger of the Peter Bent Brigham Hospital of Harvard University. Dr Alexander Brunschwig of the University of Chicago, Dr Frank Walton of Washington University, and Dr Cobb Pilcher of Vanderbilt could not attend. This meeting codified the formation of the organization. Surgeons could apply for membership if their university had been approved as member institutions. The first annual meeting was held in 1939. Ten honorary members were inducted, which represented the chairs for the respective 10 founding institutional members. A list of 46 new members was approved, and 13 papers were presented, including three based on experimental studies. Most of the business meeting was discussion and acceptance incorporation and bylaws of the SUS. Dr Stabins was elected president. The purpose of the SUS was and is to advance the art and science of surgery by: (1) The encouragement of its members to pursue original investigations both in the clinic and in the laboratory; (2) the development of methods of graduate teaching of surgery with particular reference to the resident system; and (3) free and informal interchange of ideas pertaining to the aforementioned subjects as a limited membership and common aims make possible. The second annual meeting was held at the New York Hospital, and five additional charter organizations were added to the SUS; the University of
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California San Francisco, Duke University Hospital, Massachusetts General Hospital, Illinois Research and Education Hospital, and Stanford University Hospital. The organization has met every year since this except for 1945 during World War II. In 1941, the organization was officially incorporated for a cost of $11 dollars. A meeting highlight at this third meeting was that a presenter who spoke on spider bites apparently had a live demonstration, and a large number of black widow spiders apparently escaped into the meeting room. In June 1942, the first papers of the SUS meeting were published in the journal Surgery. A strong relationship formed between the journal and the SUS, and Surgery remains our journal today 72 years later. At the 1947 meeting in Boston, the use of vagotomy in the treatment of peptic ulcer disease was praised and the membership decided to raise the annual dues from $10 to $15 dollars. The following year the dues were raised to $25 dollars. In 1950 the first proposal for adrenergic blocking agents in the operative management of pheochromocytoma was made. I think we would all agree that this resulted in every training examination and board test including a question on this topic. In 1951, Canadian schools and surgeons were allowed into membership. The following year, the SUS had a joint meeting with the Society of Clinical Surgery and the Halstead Club on the occasion of the 100th anniversary of the Halsted’s birthday. At this meeting Dr Mark Ravitch presented to the Society a gavel from the Department of Surgery at the Johns Hopkins University. Its inscription states that ‘‘the case is made from the oak seats in the gallery of Dr Halsted’s Operating Room, the gavel head from the maple banister, and the handle from an oak spindle of the North Staircase.’’ This is the same gavel we still in use today for our business meetings. The organization became one of the most important surgical organizations in the country, and the reasons for this were many. In his article commemorating the 50th anniversary of the SUS, Dr Zollinger noted the importance equal to, if not greater than, the practical and scientific information exchanged were the lifetime friendships formed. Many firsts were presented at the annual meeting, and the membership represented surgical leaders across the country. At the 20th meeting in Indianapolis Dr Edwin Ellison presented the first 24 cases of Zollinger-Ellison syndrome. And, in 1957, the first symposium on surgical education
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was conducted. In 1958 a paper describing one of the first murine xenografts models for the study of human malignancies was given. And remembering the context of the times now, wives were first allowed to attend the annual dinner. In 1959 Dr Ravich presented a paper on bronchial closure by stapling, and UCLA was admitted as the last member department. Also this year the first SUS Residents conference was initiated. Unfortunately in 1960, the 1959 decision was reversed for reasons we can all speculate, and the membership voted to exclude wives from the annual banquet. But, responding to probably some significant backlash in 1961, the wives were again were admitted to the annual banquet. At this same meeting Dr Zollinger presented work supporting evidence for a hormone from the pancreas that stimulated gastric hypersecretion, later to be called gastrin. By 1963, the organization had been appointing members as governors to the ACS and American Board of Surgery, giving a voice for university surgeons on national issues and certification. Curiously the 1964 meeting of the SUS was held at UCLA, the year I was born. The 1965 meeting was with the Association of University Anesthetists. In 1966, the early results of transfusion of frozen blood were presented. Early on, the SUS formed affiliations and connections to other like-minded groups around the world, in 1967, the SUS had a joint meeting with the British Surgical Research Society. Members had a session on the role of antibodies in rejection after transplantation. In 1968, the first description of intravenous hyperalimentation in beagles was presented. Dr Sabiston presided over the 30th annual meeting in Miami. At the 31st meeting, Dr Donald Morton who recently passed away, presented a paper on the role of immunotherapy to treat melanoma. The following year an important paper on the use of silver lactate cream to treat burns was presented, and Dr Gerald Austin presented the use of an intraaortic balloon pump with a reported 3/7 survivors. In 1972, dues were raised to $35 dollars. The SUS focused on issues related to surgical education and helped to frame the issues relating the training early on. At the meeting in 1973, a symposium was held entitled ‘‘Education symposium---are we truly measuring surgeon’s competency?’’ In 1975, the first interim council meeting was held at the annual ACS meeting, and the committee on social and legislative issues was formed. Papers from the Australasia Surgical Research Society and South Africa Surgical Research Society were presented.
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The following year was a bit of a disaster. A tripartite meeting with the British Surgical Research Society and the European Society of Surgical Research in conjunction with the Japan Surgical Society and the Australasian Surgical Research Society and the Surgical Research Society of South Africa was planned in Philadelphia. Unfortunately, the meeting was booked at the famous Bellevue hotel, and a few weeks earlier this hotel was ground zero for an infectious outbreak---the original outbreak later given the name Legionnaires disease. In 1977, Dr Fonkalsrud focused his presidential address on surgical education and suggested that faculty should be specifically remunerated for their work and time focused on education. In 1978 residents were invited to present at the regular meeting. The SUS was the first place at which heparin-induced thrombocytopenia was reported by Dr Donald Silver’s group at the meeting in 1979. At the 1980 meeting, Dr Polk, our Lifetime Achievement Awardee this year, gave his presidential address entitled ‘‘the sky is not falling’’ and suggested that ‘‘academic citizenship is a proud estate.’’ Congratulations again Dr Polk today for his SUS Lifetime Achievement Award. The following year, the first pancreatic segmental transplantation was described. In 1982, Mayor Ed Koch welcomed the membership to New York, and dues were increased to $75 dollars. The role of the general surgeon was already being discussed in 1983, and the organization sponsored a session on ‘‘are we, can we, should we train a general surgeon.’’ Dr Laurence Cheung described the role of aspirin in gastritis at the meeting in 1984. The sixth tripartite meeting with our sister organizations was held in 1985 and at that meeting Dr Steven Rosenberg presented work on the use of LAK cells in combination with IL-2 against cancer. In 1986 the Ethicon SUS Resident Research Award was established, and Dr Scott Gruber was the first recipient. Scott latter presented his work on the role of donor-specific T lymphocytes on freshly implanted allografts. In 1987 Dr Rhodes delivered his address entitled ‘‘Presidential Address.’’ During the year of Dr Zinner’s presidency in 1988, the official SUS necktie was approved and Dr Alden Harkin’s group presented work suggesting that sleep deprivation did not to influence surgical decision making. The SUS has had a core mission to support the development of surgeon-scientists. Funda Meric Bernstam published a paper last year evaluating the work of the SUS and SUS foundation toward
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this end. Of the 26 awardees, 84% remained in academic surgery, and 48% had gone on to receive independent research funding with 30% receiving R01 or equivalent funding, a remarkable program and legacy for our organization. In 1989, on the 50th anniversary of the SUS, Dr Ronald Ferguson wrote ‘‘What is the future of the Society of University Surgeons? Only a fool would assuredly attempt to answer. However, what can be said with some certainty is that our society is based on sound traditions that if maintained into the future will serve it well. We must be cognizant of change and understand the forces however unpredictable that give momentum to change. We must keep our minds flexible and innovative in our future challenges and be guided by those principles that have made our society prosper. Our future charge as university surgeons carries with it the responsibility to maintain excellence and quality in the advancement of the art and science of surgery.’’ On this 75th anniversary of our society, these words still ring true. We find ourselves here in this room connected to people from all over the world, thousands strong, and from two important organizations, the AAS and the SUS. This joint venture has been extraordinarily successful and allowed surgeons with various expertise, background, and aspirations to connect. The ASC is now the largest meeting focused purely on surgeons who have dedicated their careers to improving the lives of patients through a deeper understanding of the conditions that afflict them, the discovery of new interventions to help them, and the education of those who follow us. We set the standard for academic surgery in our country and carry the voice for our members. This week we will hear more than 800 presentations, and our meeting has now extended to 5 days with the addition of the new initiatives like mid-career and the surgical investigators courses. If we pause to think about the enormity of work and expertise it took to assemble this meeting it is really quite extraordinary. How could this have occurred? I believe it comes back to the theme of connection--that we naturally gravitate toward a state of connection. With the background regarding the science of connection, our two organizations have behaved in a predictable manner. And the similarities between the AAS and SUS have helped facilitate this connection. The mission statements of both organizations are very similar. The leadership of both organizations is connected, and in fact the leadership is really the same group of people. Except for one instance, the current president, president-elect,
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secretary, recorder/recorder equivalent, and treasurer are all members of both the AAS and the SUS. And, generally speaking, we all like each other. The committee structures of both organizations are very similar. Both organizations have committees on education, ethics, global affairs, issues, membership, and publications. In fact, many of these committees currently work directly with each other to coordinate activities and make plans for the ASC meeting. Our foundations have very similar purposes. Drs Dai Chung and Max Schmidt lead each foundation, which seeks to fund residents and young faculty in order to facilitate a quality experience of investigation hopefully providing them with the tools to be successful as an independent academic surgeon. And by the way, both foundations are largely approaching the same constituents and organizations to secure donations for these efforts. Now it is true that there are some differences between the two organizations. Some would state the culture or spirit of the two organizations is different. The SUS membership is a bit older and the processes a bit more traditional or maybe even outdated. The SUS council would never claim to be as fun or maybe even as innovative as the AAS council. I think I can safely say that the SUS membership largely never tweets, but things are changing. A few weeks ago, I asked one of the residents in our laboratory, Kathleen Hertzer, to perform some immunocytochemistry in the lab probing for first the AAS epitope and then the SUS epitope, and when we merged the images..we can see there is a nearly identical pattern. So where do we go from here? Well like Dr Ferguson said 25 years ago, no one can predict. We do have great momentum and a very special meeting that all of us must continue to nurture and support. Our two organizations will continue to work together and in new directions in order to deepen our connection. I would ask the leadership though to consider the young faculty member, surgical resident, or medical student in the audience today. We should focus on their needs and facilitate any activity that provides the chance to expand the impact each of them might have as they navigate their career. For the membership and attendees at this meeting the designation of AAS, SUS, or ASC is less important. What is important is the opportunity to connect, period. It has been a singular honor to serve the SUS, and I am very thankful for this. Each of you have made at least one new connection this morning, and I encourage you to take full advantage of this
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and the other connections you encounter over the next few days. After all this is our default state and in the end will lead to the fullest and most productive career and life for each of us, and allow for the most benefit for our patients. I conclude that my initial hypothesis is true---we attend this meeting to connect. LITERATURE CITED Brooks D. The social animal: the hidden sources of love, character, and achievement. New York (NY): Random House; 2012.
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Dewall CN, Macdonald G, Webster GD, Masten CL, Baumeister RF, Powell C, Combs D, Schurtz DR, Stillman TF, Tice DM, Eisenberger NI. Acetaminophen reduces social pain: behavioral and neural evidence. Psychol Sci 2010;21:931-7. Inagaki TK, Eisenberger NI. Shared neural mechanisms underlying social warmth and physical warmth. Psychol Sci 2013;24:2272-80. Lieberman MD. Social: why our brains are wired to connect. New York (NY): Crown Publishers; 2013. 50th Anniversary Meeting Society of University Surgeons. Surgery 1989;105(Suppl 2).
