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Maxillofacial Oncologic and Reconstructive Surgery Group (MORS): At Harvest Time
EDITORIAL J Oral Maxillofac Surg 68:2933-2934, 2010
Maxillofacial Oncologic and Reconstructive Surgery Group (MORS): At Harvest Time The Illinois corn makes a rustling sound and looks a brownish gold in the September sunset. Those who, in the hopeful Spring plowed the ground, are anticipating a harvest, a bumper one or a lean one, but a harvest nonetheless.
Tuesday, September 28, 2010, 7:30 AM began with a mix of dread and anticipation as the committed few milled about the hallway outside the conference hall. As we entered the cavernous hall, nervous laughs echoed. “I heard we may have only 25 attendees.” “No one is interested in this stuff but us.” “No one wants to take care of sick people anymore.” “Well at least my Fellows showed up.” By 8 AM, it felt like ESPN GameDay! Every seat in the hall was filled, and the walls were packed with hundreds of overflow surgeons excited to learn and to participate. It remained so until the close of the session. At the end of the day, the committed few were grinning, “We will need a bigger room next year.” “You could feel the excitement.” “Our specialty has arrived.” “We finally figured it out; we are the ones best positioned to provide high quality care to these patients.” No, the topic was not orthognathic surgery, anesthesia, cosmetic surgery, implants, or temporomandibular disorders, which have generated so much excitement in the recent past. The topic was one of the most time-honored aspects of our specialty, the treatment of pathology, referred to by the Section 3 ABOMS (examiners in pathology and reconstruction) informally as . . .“You know . . . real disease.” For the first time and hopefully in the first of many years, the AAOMS annual meeting began its scientific program with a pre-meeting day devoted to Maxillofacial Oncology and Reconstruction (MORS). For someone with either a long memory or a short one, this is an amazing eventuality. In the long view, we stopped joint meetings and live Clinicopathologic Conferences with the American Academy of Oral and Maxillofacial Pathology 20 years ago due to poor attendance. For many practicing OMS, the pre-examination cram constituted their greatest effort in learning tumor biology and treatment. Many of the pioneers in oncologic surgery in
our specialty from the 20th century left no successors to carry on their work leaving this essential part of oral surgery to others. As an examiner on ABOMS in reconstruction as well, I can assure the reader that the knowledge base of many an examinee was a near recitation of methods of reconstruction taught in a board review course. In the short view, conventional wisdom is that oral and maxillofacial surgeons, particularly young surgeons, want to devote themselves to “lifestyle” aspects of the specialty that remunerate very well, eg, implants, dento-alveolar surgery and other officebased procedures. Let’s give that notion a big “Negatoreh!” (that’s a big no) vis à vis the appeal of MORS. Tumor surgery and reconstruction constitutes a high risk, high stakes, low remuneration, exhausting, and intensely didactic calling. For every hour in those tasks are additional hours of worry about what you might not have known or might not have done. After that worry comes feelings of inadequacy and guilt. Your long-suffering family might help in (some would say enable) that devotion or, worse, might turn from it, which leaves the surgeon to sort out his or her tattered professional and personal lives. No one devotes themselves to tumor and reconstructive surgery because it is easy. It was so odd in a way that the attendance and the interest were so high that it is deserving of speculation to consider the reasons. Also, with nearly a decade spent observing my colleagues Drs Dierks, Bell, Potter, and the Legacy Emanuel Fellowship in Maxillofacial Oncologic Surgery and Reconstruction, I feel as though I understand their present and former fellows and my former residents who have pursued MORS and would like to offer some insight into what makes them tick. Here are some of the things that I believe have compelled them to plow this earth, and will compel others to follow.
A Yearning to Use One’s Training After his Oregon residency and his fellowship with Ghali Ghali at LSU Shreveport, Brian Woo pursues his desire for a broad hospital-based practice in the
2933
2934 Fresno OMS program. Every day he is challenged to use all of his knowledge and skill in the care of his patients.
A Genuine Interest to Make Our Patients’ Lives Better After his Legacy fellowship and years on the Texas and Oregon faculty, Kevin Arce has returned to the Mayo Clinic, but the legacy of his devotion to his patients remains. The confidence and caring he demonstrated has led, I am sure, to improved outcomes in his patients.
A Love of the Technical Aspects of Major Surgery Remy Blanchaert was a gifted technical surgeon as a resident at UConn, but he topped himself at Maryland with Bob Ord as the first combined oncologic and microvascular surgeon in OMS. His confidence is earned, and his desire to always do a technically excellent operation remains in private practice in Kansas.
A Desire to Carry out Evidence-based Care At UC San Francisco Brian Schmidt applied brains, training, and an understanding of the fundamental questions to seek out important clinical research questions and apply them to clinical trials. At New York University (NYU), he will now lead those research programs as a clinician scientist able to ask the best clinically relevant questions and design research to answer them.
A Desire to Give Back to Their Programs David Hirsch finished his Bellevue residency and immediately entered the Legacy fellowship for the purpose of developing MORS at his program. He returned to the NYU faculty and simply accomplished just that. His accomplishments are concordant with other NYU advancements that make it a dynamic residency.
EDITORIAL
ship, and after that joined the group that trained him, and after that directed residency education at Emanuel, and after that developed the first Portland MORS symposium, AND linked it a concurrent meeting the Timberline Group devoted to considering the future trends of oral and maxillofacial surgery. He understands that in 2010, MORS is inexorably linked to the future of our specialty.
As an Achievement for Patients, for Community, and for Family Readers, hopefully many of whom were in the room, might feel a bit gloomy over my words about family possibly “turning from” them due to their devotion to MORS. Deepak Kademani and his truly lovely family gave the lie to that concern. At Minnesota now after his Legacy fellowship, Deepak includes his wife and children in all that he does and has achieved happiness and balance. It is personally heartening to see their smiles and how clearly proud they are of their husband and father. Deepak’s example illustrates that we can all model behaviors that allow the needs of our patients and our families to be met. Fittingly, Eric Dierks spoke as the afternoon sun reached its peak. He pointed out how essential our dental training is to the optimal surgical treatment and reconstruction of the cancer patient. This is exactly the same point that has been made about maxillofacial trauma care, cosmetic surgery, orthognathic surgery, and so many other areas. He explained how our specialty was the right one to inherit this area if we were willing to make the commitment. The packed room and the assembled former fellows were his answer. It was moving to see those who had plowed this ground so unassumingly for decades at the end of the day, basking with smiles in the sunlight, looking at their crop. The faces of Ord, Dierks, Bell, and MacIntosh glowed as though reflecting the corn in the evening sun. You could nearly see Irving Meyer, Fred Henny, Leon Eisenbud, and Kurt Thoma standing at the edge of the field, admiring the beauty of their work. LEON A. ASSAEL, DMD
A Desire to Move Our Specialty Forward It is no accident that after his trauma fellowship at Legacy, Brian Bell completed a year of tumor fellow-
© 2010 American Association of Oral and Maxillofacial Surgeons doi:10.1016/j.joms.2010.10.015
Maxillofacial Oncologic and Reconstructive Surgery Group (MORS): At Harvest Time The Illinois corn makes a rustling sound and looks a brownish gold in the September sunset. Those who, in the hopeful Spring plowed the ground, are anticipating a harvest, a bumper one or a lean one, but a harvest nonetheless.
Tuesday, September 28, 2010, 7:30 AM began with a mix of dread and anticipation as the committed few milled about the hallway outside the conference hall. As we entered the cavernous hall, nervous laughs echoed. “I heard we may have only 25 attendees.” “No one is interested in this stuff but us.” “No one wants to take care of sick people anymore.” “Well at least my Fellows showed up.” By 8 AM, it felt like ESPN GameDay! Every seat in the hall was filled, and the walls were packed with hundreds of overflow surgeons excited to learn and to participate. It remained so until the close of the session. At the end of the day, the committed few were grinning, “We will need a bigger room next year.” “You could feel the excitement.” “Our specialty has arrived.” “We finally figured it out; we are the ones best positioned to provide high quality care to these patients.” No, the topic was not orthognathic surgery, anesthesia, cosmetic surgery, implants, or temporomandibular disorders, which have generated so much excitement in the recent past. The topic was one of the most time-honored aspects of our specialty, the treatment of pathology, referred to by the Section 3 ABOMS (examiners in pathology and reconstruction) informally as . . .“You know . . . real disease.” For the first time and hopefully in the first of many years, the AAOMS annual meeting began its scientific program with a pre-meeting day devoted to Maxillofacial Oncology and Reconstruction (MORS). For someone with either a long memory or a short one, this is an amazing eventuality. In the long view, we stopped joint meetings and live Clinicopathologic Conferences with the American Academy of Oral and Maxillofacial Pathology 20 years ago due to poor attendance. For many practicing OMS, the pre-examination cram constituted their greatest effort in learning tumor biology and treatment. Many of the pioneers in oncologic surgery in
our specialty from the 20th century left no successors to carry on their work leaving this essential part of oral surgery to others. As an examiner on ABOMS in reconstruction as well, I can assure the reader that the knowledge base of many an examinee was a near recitation of methods of reconstruction taught in a board review course. In the short view, conventional wisdom is that oral and maxillofacial surgeons, particularly young surgeons, want to devote themselves to “lifestyle” aspects of the specialty that remunerate very well, eg, implants, dento-alveolar surgery and other officebased procedures. Let’s give that notion a big “Negatoreh!” (that’s a big no) vis à vis the appeal of MORS. Tumor surgery and reconstruction constitutes a high risk, high stakes, low remuneration, exhausting, and intensely didactic calling. For every hour in those tasks are additional hours of worry about what you might not have known or might not have done. After that worry comes feelings of inadequacy and guilt. Your long-suffering family might help in (some would say enable) that devotion or, worse, might turn from it, which leaves the surgeon to sort out his or her tattered professional and personal lives. No one devotes themselves to tumor and reconstructive surgery because it is easy. It was so odd in a way that the attendance and the interest were so high that it is deserving of speculation to consider the reasons. Also, with nearly a decade spent observing my colleagues Drs Dierks, Bell, Potter, and the Legacy Emanuel Fellowship in Maxillofacial Oncologic Surgery and Reconstruction, I feel as though I understand their present and former fellows and my former residents who have pursued MORS and would like to offer some insight into what makes them tick. Here are some of the things that I believe have compelled them to plow this earth, and will compel others to follow.
A Yearning to Use One’s Training After his Oregon residency and his fellowship with Ghali Ghali at LSU Shreveport, Brian Woo pursues his desire for a broad hospital-based practice in the
2933
2934 Fresno OMS program. Every day he is challenged to use all of his knowledge and skill in the care of his patients.
A Genuine Interest to Make Our Patients’ Lives Better After his Legacy fellowship and years on the Texas and Oregon faculty, Kevin Arce has returned to the Mayo Clinic, but the legacy of his devotion to his patients remains. The confidence and caring he demonstrated has led, I am sure, to improved outcomes in his patients.
A Love of the Technical Aspects of Major Surgery Remy Blanchaert was a gifted technical surgeon as a resident at UConn, but he topped himself at Maryland with Bob Ord as the first combined oncologic and microvascular surgeon in OMS. His confidence is earned, and his desire to always do a technically excellent operation remains in private practice in Kansas.
A Desire to Carry out Evidence-based Care At UC San Francisco Brian Schmidt applied brains, training, and an understanding of the fundamental questions to seek out important clinical research questions and apply them to clinical trials. At New York University (NYU), he will now lead those research programs as a clinician scientist able to ask the best clinically relevant questions and design research to answer them.
A Desire to Give Back to Their Programs David Hirsch finished his Bellevue residency and immediately entered the Legacy fellowship for the purpose of developing MORS at his program. He returned to the NYU faculty and simply accomplished just that. His accomplishments are concordant with other NYU advancements that make it a dynamic residency.
EDITORIAL
ship, and after that joined the group that trained him, and after that directed residency education at Emanuel, and after that developed the first Portland MORS symposium, AND linked it a concurrent meeting the Timberline Group devoted to considering the future trends of oral and maxillofacial surgery. He understands that in 2010, MORS is inexorably linked to the future of our specialty.
As an Achievement for Patients, for Community, and for Family Readers, hopefully many of whom were in the room, might feel a bit gloomy over my words about family possibly “turning from” them due to their devotion to MORS. Deepak Kademani and his truly lovely family gave the lie to that concern. At Minnesota now after his Legacy fellowship, Deepak includes his wife and children in all that he does and has achieved happiness and balance. It is personally heartening to see their smiles and how clearly proud they are of their husband and father. Deepak’s example illustrates that we can all model behaviors that allow the needs of our patients and our families to be met. Fittingly, Eric Dierks spoke as the afternoon sun reached its peak. He pointed out how essential our dental training is to the optimal surgical treatment and reconstruction of the cancer patient. This is exactly the same point that has been made about maxillofacial trauma care, cosmetic surgery, orthognathic surgery, and so many other areas. He explained how our specialty was the right one to inherit this area if we were willing to make the commitment. The packed room and the assembled former fellows were his answer. It was moving to see those who had plowed this ground so unassumingly for decades at the end of the day, basking with smiles in the sunlight, looking at their crop. The faces of Ord, Dierks, Bell, and MacIntosh glowed as though reflecting the corn in the evening sun. You could nearly see Irving Meyer, Fred Henny, Leon Eisenbud, and Kurt Thoma standing at the edge of the field, admiring the beauty of their work. LEON A. ASSAEL, DMD
A Desire to Move Our Specialty Forward It is no accident that after his trauma fellowship at Legacy, Brian Bell completed a year of tumor fellow-
© 2010 American Association of Oral and Maxillofacial Surgeons doi:10.1016/j.joms.2010.10.015