Mark Bloomston,M.D.

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<h1>Mark Bloomston,M.D.</h1>
<p>Assistant Professor of Surgery<br />
Division of Surgical Oncology<br />
The Ohio State University</p>

<h3>2009 James IVth traveling fellow summary</h3>

<h2>Introduction</h2>

<p>I had the fortune of being selected as a James IV Traveling Fellow for 2009. While I 
was tremendously honored to even be nominated, being selected was truly 
humbling. I immediately sought advice from previous travelers (Tim Yeatman, John 
Sweeney, and Richard Shulick) as well as other James IV members and respected 
members of the surgical community (Murray Brennan, Yuman Fong, Jean-Nicolas 
Vauthey, and James Garden). With their invaluable assistance, particularly Dr. 
Brennan, I planned a two-part trip to Europe then Hong Kong and Australia to visit 
some of the world leaders in liver and pancreas surgery.</p>

<p>Reading the reports from previous travelers and discussions with people directly 
and indirectly familiar with the experience still did not prepare me for the magnitude 
of the experience. As someone early in his career that has not done much 
traveling abroad, to describe this experience as life-changing would be a gross 
understatement. I gained an entirely new perspective in the management of HPB 
malignancies, learned new techniques of surgery, formed research collaborations, 
and forged new friendships; all clearly embodying the spirit of the award. I was 
immediately amazed by how quickly and enthusiastically my travels were embraced 
by each prospective host. Given the complexity of coordinating multiple visits in 
succession to foreign countries, the assistance offered by each host and his team 
was invaluable and made for a smooth trip.</p>
      
<h2>Trip 1: Europe, June 2009 (4 weeks)</h2>

<p>The first trip was planned for four weeks to tour major centers of excellence in HPB 
surgery throughout Europe. This included visits to see James Garden in 
Edinburgh, Pierre Clavien in Zurich, Claudio Bassi in Verona, Markus Buechler in 
Heidelberg, and Jacques Belghiti in Paris. Through the generosity of my division 
chief, Dr. Bill Farrar, I was fortunate to be able to bring my wife and three 
daughters (we left the 2 year old with the grandparents) with me for the entire 
month. Not only was the trip professionally fulfilling, the impact it has had on my 
family is immeasurable. Not a day goes by where we donít reminisce about our 
experience.</p>

<h3>Edinburgh, Scotland</h3>

<p>My journey began in Edinburgh, Scotland where I was hosted by Professor James 
Garden at the University of Edinburgh. The hospitality from him and his team was 
outstanding. I was warmly greeted by Professor Garden at the ìNewî Royal 
Infirmary of Edinburgh where we had some time to discuss some of the history of 
the department and the hospital. </p>

<p>We met Rowan Parks and Stephen Wigmore 
(both previous James IV travelers) and the rest of the HPB team for morning 
rounds. The service consisted of the full gamut of HPB patients with benign and 
malignant diseases, along with various complex General Surgery patients from 
emergency in-take. Rounds were truly multidisciplinary and the highlight of the visit.</p>

<p>Basic and translational research is clearly a central component of the Department 
of Surgery. A tour of the newly opened Biomedical Research Facility demonstrated 
state-of-the-art labs with fully functional core facilities. The majority of the principal 
investigators had R01-level funding with Surgery residents playing an active role in 
many of the labs. Mr. Wigmore arranged a nice afternoon of scientific 
presentations which highlighted their high-quality research.</p>

<p>Dinner was with Rowan Parks, James Garden, and Neil Mortensen (colorectal 
surgeon from Oxford and James IV member). We had dinner at the New Club of 
Edinburgh which was very exclusive and offered a beautiful view of the castle. We 
discussed many issues, including the future of medical journals.</p>

<p>We had rented an apartment on the Royal Mile, which captured the essence of 
Edinburgh. The days ended early enough to spend great quality time with the 
family visiting the castles and walking the city.</p>

<h3>Zurich, Switzerland</h3>

<p>In Zurich, I was mostly hosted by Stefan Brightenstein. We met at morning report 
then straight to ICU rounds with the consultants and fellows. These were all HPB 
patients ranging from liver transplants to acute pancreatitis. The strong research 
atmosphere that Professor Clavien has created was immediately palpable. Ward 
rounds were also completed as a group, including residents, students, and fellows. </p>

<p>Everyone was naturally inquisitive and continually discussed ongoing projects and 
new ideas in the context of patient care, continuing into the multidisciplinary clinic.
The operating theatre was certainly in line with the academic theme. During the 
course of two hepatectomies (one for colon metastases and one for gallbladder 
cancer), studies were undertaken on ischemia-reperfusion and tissue collected on 
protocol.</p>

<p>We then toured the research facilities, which were quite extensive. The lab was 
quite active and state-of-the-art including capabilities for small and large animal 
surgery and imaging.</p>

<p>Zurich was beautiful and quite easy to manage on foot and by tram. While I had 
limited time to visit the city, my girls still refer to it as one of their favorite stops.</p>

<h3>Verona, Italy</h3>

<p>Professor Claudio Bassi was a most gracious host and embodied the Italian spirit. I 
was greeted with a hug at morning report and immediately treated like one of the 
team. Case discussions were open and honest with the expected underpinning of 
evidence-based medicine. As one of the busiest pancreas units in Italy and all of 
Europe, the University of Verona has been instrumental in shaping modern 
pancreas surgery.</p>

<p>In the operating theatre, there was never a rush but the cases always moved 
along. I was fascinated to watch a radiofrequency ablation for a locally advanced 
pancreatic cancer, marking their 92nd patient undergoing such treatment.</p>

<p>I had an opportunity to visit the new research facilities housed in the Department of 
Pathology run by Aldo Scarpa. Although Professor Scarpa was away, his team 
graciously gave me a tour and we had opportunity to discuss ongoing research 
between our two institutions.</p>

<p>Professor Bassi had arranged adjoining rooms at the nearby Hotel Siros which 
comfortably accommodated my family. The hospitality was outstanding and Verona 
did not disappoint as an enchanting city.</p>

<h3>Heidelberg, Germany</h3>

<p>In Heidelberg, we found a place we would happily call home. We rented an 
apartment within walking distance of the University of Heidelberg, the Neckar River, 
and the Heidelberg Castle. There were sites and playgrounds around every corner 
for the kids and the Germans were incredibly welcoming.</p>

<p>The magic, of course, was visiting Professor Buechler and what is arguably the 
heart of pancreas surgery. The Department is incredibly busy, full of HPB 
surgeons who find time to maintain great academic productivity. Each faculty 
member manages a database and is given resources to manage a research team. </p>

<p>They clearly demand high level productivity from themselves. The highlight of the 
trip, though, was the two to three hours spent with Professor Buechler in his office 
drinking coffee, discussing clinical trials in Germany, his thoughts on building and 
maintaining a productive department, and his views on modern academic surgery.</p>

<p>I was impressed by the devotion to data management, clinical protocol, and tissue 
collection in spite of the tremendous volume of surgery.</p>

<h3>Paris, France</h3>

<p>I met Professor Jacques Belghiti at morning conference on Friday at 9:30AM. He 
welcomed me and immediately invited me in and introduced me to the faculty and 
residents. Professor Belghiti has developed a truly modern Department of Surgery, 
surrounding himself with many young, energetic surgeons, nearly half of which are 
women. The discussion was lively and the Professor clearly respected everyoneís 
opinion. Friday conference was to discuss cases for the following week. Every 
case was discussed openly and at length. They referenced literature and 
described their own experience as well. The day ended early and I was 
encouraged to enjoy Paris with my family, which I did.</p>

<p>Mondayís cases were the expected bevy of complicated liver cases. Professor 
Belghiti did not disappoint as he demonstrated the hanging maneuver to better 
access a posterior lesion along the IVC in what he termed ìsegment IX.î
The common theme each day was collegiality, multidisciplinary discussion, and 
evidence-based medicine.</p>

<p>On the last night we had a nice dinner at Chez Fernand with Dr. and Mrs. Belghiti. 
The conversation was light and friendly. We discussed US economics, politics, and 
geography.</p>

<h2>Trip 2: Asia/Australia (2 weeks)</h2>

<h3>Hong Kong</h3>

<p>For the second leg of the trip, we left the kids behind with their grandparents for 
the long journey to Hong Kong. We were met by Professor John Wong on Sunday 
morning in a traditional Chinese teahouse where we ate dim sum. Most of the 
conversation revolved around life in Hong Kong, family, plans during our visit, etc. 
He did speak about his training in Australia and his views on the evolution of the 
Department of Surgery at Hong Kong University. He was amazingly kind and made 
my wife and I feel quite welcomed.</p>

<p>The remainder of my visit to Hong Kong was largely orchestrated by Professor 
Poon. There was no detail left unattended. Cars promptly met us everywhere and 
a gift basket from Professor Fan welcomed us to our hotel room. I was met on 
Monday by Dr. Poon, and ushered directly to the operating theatre for a live donor 
right hepatectomy. As expected, the dissection was meticulous. There was a crowd 
of visiting surgeons but, as the James IV traveler, Professors Poon and Lo made 
sure I was always part of the case. Following surgery (and a traditional Chinese 
lunch), I was granted a tour of the research facilities. Members of Professor Poonís 
lab presented their work where we had a lively discussion. The lab residents were 
familiar with my interests and tailored their presentations accordingly.</p>

<p>The Hong Kong Jockey Club was the setting for a Chinese dinner hosted by 
Ronnie Poon and his wife. They were most gracious hosts and amazed us with 
their devotion to academia and their account of life in Hong Kong with a large 
family and busy careers. They were glad to finish their day ìearlyî with us around 
10:30PM.</p>

<p>The next two days were filled with operative cases, multidisciplinary cases 
conferences, and resident presentations of clinical research. Dinners ranged from 
a Western motif in the ìCentralî with visiting surgeons from India, Saudi Arabia, 
and Great Britain to a traditional Chinese theme with house staff and junior faculty 
on our third night. Common were great hospitality and lively diverse conversation.
Thursday and Friday we were left to our own devices. We went to Macao to do a 
little gambling and walked up and down the streets of Hong Kong shopping. Of 
course, we took the opportunity to watch the nightly skyline light show along the 
river.</p>

<h3>Adelaide, Australia</h3>

<p>For our last stop, we arrived in Adelaide on a Saturday afternoon. We were able to 
unwind and walk the beach. Sunday we went to Barossa Valley for sightseeing and 
wine tasting. That night, Dr. Rob Padbury picked us up at the hotel to take us back 
to his house for dinner. Being a wine expert, he and his wife treated us to great 
wine and food. I was the 3rd James IV traveler to visit their home in the last 12 
months.</p>

<p>The next two days gave me the opportunity to visit both Flinders Hospital and the 
Royal Adelaide. Discussions of complex HPB cases focused on multidisciplinary 
approaches and protocol-driven therapies. These conferences were lively and 
honest and reflected their state-of-the-art management. Evident throughout all 
patient care was Dr. Padburyís commitment to quality control and minimization of 
errors.</p>

<p>In summary, to describe this experience as an opportunity of a lifetime just doesnít 
give it justice. Professionally, I learned both technical and philosophical 
approaches to diseases that I have been able to immediately incorporate into my 
practice. I formed collaborations which have already proven fruitful and developed 
friendships that will hopefully last a lifetime. Personally, it gave me an opportunity 
to spend time with my wife and children in a way that few get to experience. Not a 
day passes where we donít reminisce about our whirlwind tour through Europe.</p>

<p>I thank the members of the James IV Association of Surgeons for their generosity. I 
would also be remiss if I did not thank my Chairman, my Division Chief, and my 
partners for graciously supporting me and my practice through this process.</p>

<p>Respectfully,</p>

<p>Mark Bloomston, MD<br />
Assistant Professor of Surgery<br />
Division of Surgical Oncology<br />
The Ohio State University</p>

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