Peter J. Allen, MD.

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<h1>Peter J. Allen, MD.</h1>
<h3>2009 James IVth traveling fellow summary</h3>


<h2>Introduction:</h2>

<p>I was a James IVth traveler in 2009.  I am an associate professor of surgery at Memorial Sloan-
Kettering Cancer Center and my primary clinical and research efforts are on neoplastic 
diseases of the pancreas.  My goals of the travel were to visit the major UGI and pancreas 
centers in Europe, Australia, and Asia.</p>

<p>This narrative is primarily for future travelers.  I would encourage travelers to gain as much 
insight from previous fellows as possible as ìweî are typically not accustomed to this type of 
experience.  American surgeons in their mid-career do travel, but it is generally for 24 hours ñ 
or less - certainly not for a period of six weeks!  It is not our custom to routinely visit foreign 
institutions simply for the purposes of sharing knowledge, developing collaborations and 
friendships, and spending time in other cultures.  The James IVth was the single most valuable 
travel I have done in my career.  It is a terrific experience.  I will start with generalities about the 
trip, and then the specifics of my experience.</p>

<h2>In general (for the future traveler):</h2>

<p>Plan ahead.  This trip should not be planned at the last minute.  I decided to divide the time 
into two separate three week blocks of travel.  The first leg was to Europe and the second to 
Australia and Asia.  For each leg I began the process of planning approximately six months 
before departure.  This allowed me to best align both the people I wanted to meet and the 
institutions I wanted to visit.  I would recommend consultation with a former traveler as to which 
institutions match your interests and careful consultation with spouse/family as to which cities 
they would be interested in visiting (donít underestimate the value of the latter).  I was very 
fortunate in that Murray Brennan served as my sponsor.  We had multiple discussions about 
the best institutions to visit and the most interesting people to meet.  He sent introductory 
letters/email which facilitated my subsequent correspondence.  I have thanked him before, and 
I thank him again.</p>

<p>Limit the number of places you visit.  This recommendation is my opinion based on my 
experience.  The travel during this trip covers significant distance and more than a few time 
zones.  Being able to visit the people, institutions, and city can be difficult in three days.  My 
visit to Europe included five stops, and my visit to Australasia covered four.  I feel that three to 
four stops is optimal.  During my European leg I felt rushed, and felt that I did not spend as 
much time visiting the institutions, meeting the relevant members, and visiting the cities as I 
would have liked.</p>

<p>Bring family if you can.  You spend enough time away from your family while here.  I would 
recommend trying to bring family for this trip.  The distances are far, the cost can be high, and 
coordinating spousal and/or childrenís schedule can be difficult, but it is worth these efforts.  
My wife Sarah and our three boys (8, 8, and 10) made part of the leg to Europe (Edinburgh) 
and it was absolutely worth it.</p>

<p>Check out the latest tech before you leave. Before I left for Europe skype was a terrific find.  
This made communication with family and the office very easy.  This however was nearly 
obsolete six months the later during the trip to Australia and Asia.  At that time a very 
reasonably priced international roaming plan for the I-phone was terrific.  I would imagine the 
combination of skype and phone will be optimal in the future.  Check before you leave as this 
evolves monthly.</p>

<h2>My travel: </h2> 

<h3>Europe, spring, 2009</h3>

<p>The primary goal for my spring trip of James IVth was to visit the major pancreatic centers in 
Europe.  I decided to visit Claudio Bassi in Verona, Pierre Clavien in Zurich, Markus Buechler 
in Heidelberg, and James Garden in Edinburgh.  Secondary objectives included attending and 
presenting at the European Surgical Association, and having my family (wife and three 
children) meet me in Edinburgh at the conclusion of the trip.</p>

<h3>Verona</h3>

<p>University of Verona, Department of Surgery is organized into separate hepatobiliary and 
pancreatic units.  The pancreatic unit is lead by Drs Pederzoli and Bassi, and is currently 
staffed by three other very active pancreatic surgeons (Falconi, Salvia, and Crippa).  Dr. Bassi 
was a very gracious host and made sure that I enjoyed both the hospital and the city.  The 
Verona group is renowned for their academic achievements which include significant 
leadership in the ESPAC trials.  This group was extremely kind and welcoming and the 
opportunities to see the daily routine were excellent.  Morning and afternoon rounds, operating 
room, and the clinical research structure were all made available.  This is a very well-run unit 
and I would highly recommend any future travelers with a pancreatic focus to visit this 
institution.</p>

<p>Verona is a beautiful city and has amazing Roman architecture in the city center.  The town is 
easily accessible and easy to manage.  I stayed in the Hotel Sirhos which is next to the hospital 
and very convenient. </p> 

<h3>Vienna</h3>

<p>One of the suggestions Murray Brennan made before my trip was to try to attend one of the 
major European or Australian meetings.  I submitted an abstract to The European Surgical 
Association and presented these data there.  The meeting was very interesting, many 
excellent abstracts presented, and I gained an appreciation for the high level of surgical 
research being performed in European centers.  This also allowed me to gain an appreciation 
for the community of European surgery.  </p>

<h3>Zurich</h3>
      
<p>Dr Clavien has built an extremely successful HPB unit in Zurich.  It has a mix of both American 
and European structure, and seems to choose the best from both.  Stephan Breitenstein was 
my primary host and was very welcoming.  Stephan had also presented at the European 
Surgical and he was kind enough to introduce himself there and we made plans for the Zurich 
visit.  The clinical practice in this group is HPB with a wide mix between liver and pancreas and 
liver transplant.  The general surgical residents were very eager to share clinical and research 
experience and we had multiple occasions to discuss research efforts.  There were also 
multiple teaching conferences to attend.  I spent time with Stephan Breitenstein in the 
outpatient clinic and on rounds, and have ample opportunity to discuss similarities differences 
between our groups.  </p> 

<p>The city of Zurich is easy to manage and very accessible.  I stayed in the Hotel Florhof which is 
walking distance to both the University and the city center.  I arrived in Zurich on a Sunday 
morning and later in the afternoon took a train 20 minutes to the countryside to the town of 
Zug to meet friends who moved there from NYC.  The town of Zug sits on a lake at the base of 
mountains.  Amazing scenery.</p>

<h3>Heidelberg</h3>

<p>You cannot be a pancreatic surgeon and not visit Heidelberg.  Dr Buechler has built an 
extremely busy unit where multiple pancreatic and liver resections are performed almost daily.  
The group of surgeons in Heidelberg is very busy and very focused on pancreatic and liver 
resection.  Juergen Weitz performed his clinical fellowship with me at MSKCC and served as 
my host.  It was great to meet up with an old friend and see him in his own environment.  </p>

<p>I stayed in the Marriott hotel which is just across the Neckar River from the University ñ easy 
walking distance.  The old city is easily accessible and very interesting.  Juergen insisted on 
dinner in a ìtraditional Germanî restaurant where we had saumagan ñ stuffed pig stomach ñ 
which technically didnít violate the ìyou canít eat what you operated on that dayî rule but may 
have violated the ìyou should never put anotherís stomach in your own stomachî ruleÖ</p>

<h3>Edinburgh</h3>

<p>Edinburgh is a must see. </p> 

<p>Prof Garden is a terrific host, his group with Rowan Parks and Stephen Wigmore are very 
welcoming and engaged, the multi-disciplinary group is delivering state-of-the-art care in a 
national system that is establishing effective ways of communicating between institutions, and 
the city itself is steeped in history.  The ìnewî Royal Infirmary is located outside of town and is 
an integrated clinical and research facility.  The Department is very well organized and rounds 
with Professor Garden and the team are a highlight.</p>

<p>The city was very interesting and my wife and children joined me there.  We rented an 
apartment (found on VRBO) which was centrally located and very easy.  The castles and lore 
of Edinburgh and the surrounding areas are just perfect for three boys around the age of 10.  
Professor Garden arranged very pleasant evenings with Stephen Wigmore, some of the other 
attendings, and residents.</p>

<p>On my final day in Edinburgh I was scheduled to see Ross Carter and Colin McKay at the 
Royal Infirmary in Glasgow.  This hospital is an enormous old structure that has the feel of 
some of the older large public hospitals in America.  Ross and Colin are extremely busy and 
have the difficult task of managing acute pancreatitis.  They have been extremely innovative, 
with limited resources, and do a remarkable job with an extremely sick patient population.  I 
think after a month or two with Ross or Colin a surgical trainee would be well equipped to deal 
with the challenges of this process.  I would highly recommend a trip to see Glasgow as Ross 
and Colin are extremely engaging and their challenges at the Royal Infirmary are 
significant.  </p>     
           
<h2>Australia, fall, 2009</h2>

<h3>Sydney</h3>

<p>I left New York on a Friday night after office hours in the middle of November, rain and 50∞F.  I 
arrived in Sydney on a Sunday, sun and 104∞F.  Fortunately my primary host in Sydney was 
Phil Crowe.  He picked me up at the hotel (Sir Stamford at Circular Quay), told me to get some 
shorts on, and we went to the beach with his wife and daughter.  After swimming in the surf we 
went to a local restaurant for fish and chips and a beer.  Phil was a terrific host and put me in 
contact with David Storey at the Prince Alfred Hospital as well as Phil Truskett at the Prince of 
Wales.  I spent an additional day with Andrew Biankin at the Garvin Institute where he provided 
me a detailed tour and description of their work in tissue markers and clinical trials in 
pancreatic cancer.  One evening was spent at the Prince of Wales with the surgical residents 
and general surgical attendings where we discussed management of IPMN.  The residents 
were very engaged and the discussion was excellent.</p>

<p>Sydney is a wonderful city and it was great to stay downtown on the water.  This is not easy 
access to the hospitals but taxi service is readily available.  Phil Truskett organized an 
enjoyable dinner at a local restaurant with great Australian and New Zealand wine. </p>    

<h3>Melbourne</h3>

<p>The travel between Sydney, Melbourne, and Brisbane was quite easy.  There are commuter 
flights on the hour and the flights are short and comfortable.  My time in Melbourne was made 
even more enjoyable as my wifeís family (aunt/uncle/cousins) lives there and it was great to 
meet up with them. My primary hosts in Melbourne were Ben Thomson at the Peter MacCallum 
Cancer Center and Professor Chris Christophi at Austin Health.  At the Austin I spent a 
thorough day with residents and surgeons discussing research, visiting the operating suites, 
and presenting on cystic lesions of the pancreas.  We then re-grouped in the evening for a 
Greek dinner in the city which was a Prof Christophi favorite and a great deal of fun.
</p>
<h3>Brisbane</h3>

<p>My visit in Brisbane was made very enjoyable by Andrew Barbour.  Andrew also performed a 
fellowship at MSKCC, is a friend, and went to great lengths to make my trip worthwhile.  I 
arrived on a Sunday afternoon and in the evening we had dinner at Professor David Gotleyís 
house which sits on a hillside overlooking the city.  Professor Gotleyís wife and family were 
very gracious and we discussed many of the similarities and differences in medicine and 
culture between the U.S. and Australia. </p>  

<p>The next several days were spent between the institutions in Brisbane that perform most of the 
HPB surgery, the Wesley, the Princess Alexandra and the Royal.  Like the other cities in 
Australia the centers that treat patients are throughout the city however the group of surgeons 
interested in the diseases seem to work together rather closely.  I spent a day in the operating 
room with Ian Martin who has a very busy HPB practice and later we met for dinner with other 
UGI surgeons such as Nick OíRourke, Bernard Smithers, and Leslie Nathanson.  This dinner 
included a spirited discussion regarding the management of malignant and pre-malignant 
lesions of the pancreas.</p>

<h3>Hong Kong</h3>

<p>Hong Kong was the final leg of the trip.  I arrived late at night, and had reservations at the 
Cyberport hotel near Queen Maryís Hospital.  Professor Wong and Ronnie Poon were very 
gracious hosts.  I spent time both in the hospital, operating suites, and discussing research 
interests with the surgical laboratory.  Queen Maryís is a very large facility with cutting edge 
research and treatment in hepatitis and hepatoma. </p> 

<p>Hong Kong is an amazing city, and similar in scale to Manhattan.  I was able to enjoy the city 
with recommendations from Ronnie Poon.  Professor Wong was extremely gracious and took 
time to discuss the current efforts at Queen Maryís and graciously escorted me to lunch at the 
Hong Kong Club.  Ronnie also had arranged a dinner on Victoria Peak overlooking the city 
with spectacular night views of the city and harbor.</p>

<p>In conclusion, the James IVth experience was well worth the effort.  The effort is not only on the 
part of the traveler but also the host.  I can say that during my travel every single host made 
substantial efforts to make their institution and department available to me, to establish 
opportunities for discussion, and to expose me to their city and culture.  I would like to thank 
everyone who made this trip a valuable experience.  I would strongly recommend this 
experience to surgeons who would like to meet and exchange with their counterparts in Europe 
and Asia.</p>

<p>Peter J. Allen, MD<br />
Associate Professor of Surgery<br />
Memorial Sloan-Kettering Cancer Center<br />
New York, NY.</p>  
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