A champion of evidence-based surgery
Not many doctors can say they have transformed the culture of their discipline. As far as we are concerned, Dr. Robin S. McLeod can, and that is why she is 2017 recipient of our Duncan Graham Award for Outstanding Contribution to Medical Education. Her particular combination of clinical work, research, mentorship and teaching has changed the culture of surgical practice to become evidence-based.
When your student becomes your teacher – the ultimate reward
“Dr. Robin McLeod, principled, unassuming, unpretentious and uncompromising, my student became my teacher — and the teacher of countless others,”said Dr. G. William N. Fitzgerald, FRCSC, who first met Dr. McLeod during his senior residency year when she was an intern at the Toronto General Hospital.
Thanks to Dr. McLeod, generations of surgery residents and practicing surgeons now have the tools to incorporate new knowledge from clinical research into practice. Two innovations really stand out over the course of her career due to the enormous impact they have made.
Novel journal club that bridges learning into practice
Motivated by a concern that surgeons in training acquire the critical appraisal skills essential to providing evidence-based care, Dr. McLeod initiated “Evidence-Based Reviews in Surgery” (EBRS). What began as a paper-based journal club has quickly evolved into something much more impactful. Today, EBRS is an online journal club accredited and sponsored by the Canadian Association of General Surgeons. During the academic year, residents and practicing surgeons in general and colorectal surgery are presented a clinical article and asked to critique its methodology and clinical relevance in an online discussion forum with experts. Currently 1,000 surgeons formally participate and countless others observe on the website. The efficacy of the program has also been upheld in two randomized trials.
Innovative best-practice program standardizes surgical care
Dr. McLeod’s other great innovation has been to standardize evidence-based care through her “Best Practice in General Surgery” initiative. She was motivated by a desire to ensure that surgical patient care in teaching hospitals is standardized and based on best evidence. She led the development of several management guidelines on surgical topics, such as prevention of surgical site infections, management of intra-abdominal infection and enhanced recovery after surgery. She engaged hospital leaders to champion the concept and implement the guidelines in their respective institutions. One of these guidelines — enhanced recovery after surgery (ERAS) — has undergone an interdisciplinary trial in 15 teaching hospitals in Ontario. They reported good compliance, high patient satisfaction and improved post-operative recovery with a reduction in length of stay.
“I have been very lucky to have had wonderful teachers and mentors throughout my career, such as Bernie Langer and the late David Sackett and his colleagues at McMaster, who instilled in me the belief that care should be based on best evidence,” said Dr. McLeod. “I also want to acknowledge the many residents and research fellows that I have worked with, and how much I have gained from all of them.”