Shiraz Elkheir

McMaster University

1) It’s your Chief year! Did you ever believe this year would come? How would you reflect on the journey overall thus-far?

Dr Shiraz Elkheir SurgeonOh this question brings lots of memories (good and bad). It has been a long journey for me, especially being an IMG. My journey with surgery actually started in 2001 when I was still in Sudan (my home country), when I sat for the entry General Surgery exam. I did not start the training right away afterwards. I chose to defer it to get a Masters’ degree in Human Anatomy to better enhance my knowledge in the fundamentals of surgery, and I believe this helped me very much.

In our system at that time, a general surgical residency was three years after you have cleared the first part or entry exam, and you only become eligible to take that exam after at least two years of general practice after graduation. Training consisted of one year general surgery, six months orthopedics, six months urology, and three months for each of plastics, pediatric surgery, cardiac surgery, and anesthesia. Then we wrote the final (exit) exam. I did that in June of 2007. Afterwards I practiced as a junior general surgeon for a year.

In late 2008 I decided to leave Sudan and go work in Saudi Arabia to try and save some money to hopefully go to Egypt and start a plastic surgery subspecialization. As I was working in Saudi Arabia as an assistant professor of Anatomy, it became more and more clear to me that my initial plan was not going to work for many reasons, so I aborted it and started pursuing Canada.

The Canadian journey started in 2009 when I was navigating the process of immigrating to Canada as a skilled worker. At the same time I was browsing the relevant websites to get an idea of what I needed to do to be able to practice Medicine in Canada. It was a very tedious and mind boggling task as the process was very complicated and unclear. All the information was very depressing and actually pointing towards having to apply for residency all over again, and the outlook for that was very dark with an estimated 2% chance of landing a residency position (in any specialty). I wrote the MCCEE before coming to Canada and started applying for residencies, and of course was unsuccessful. That was the 2009/10 match cycle. I first set foot in Canada as a landed immigrant in March 2010.

I tried exploring other avenues of making use of my time and applied for Masters and PhD’s but that also didn’t materialize. After three months of trials, I decided to head back to Saudi Arabia to my teaching job. I spent a year there and worked on improving my profile for the match, and as such came to Canada and wrote the MCCQE1 and applied for another round of CARMS. I also applied for an MSc in Anatomical Sciences at Queen’s University as a plan B, in case I didn’t match. I didn’t match that year as well, but got accepted in the MSc Program at Queen’s.

In July of 2011, I quit my university job, packed and moved to Canada to start the MSc in Anatomical Sciences at Queens’s in September of 2011. Just as I was heading to Canada, the Center for Evaluation of Health Professionals Educated Abroad (CEHPEA), which is the Ontario’s IMG assessment body, announced availability of limited assessment spots for advanced placement in General Surgery among other specialties. I had to write about five different exams to be deemed “Practice ReadY”. I was then invited for an interview for a PGY2 position at Mac. I started my PGY2 in July of 2012. Meanwhile, I was done the didactic part of my masters, and out of kindness and compassion from the folks at Queen’s, I was able to complete my remaining requirements as distance learning, and finally defended my thesis and was awarded my degree in February of 2013.

2) So what is next? Where are you off to in July? Have you already lined up a job or a fellowship or are you still keeping your options open?

I will most likely be going directly into practice, community general surgery and most likely in a small-medium sized community. Residency has been tough on me and my family and I feel guilty about not being able to really devote enough time to my three little kids. As such I wasn’t keen on pursuing a fellowship position.

In terms of jobs, I have done some community electives and currently negotiating a possible opportunity in Northern Ontario that might be available around my completion date in 2016. Hopefully all works out well.

3) What are you going to miss the most about residency?

I will really miss my colleagues. I have been blessed by having an awesome program with really great fellow residents, each with a unique and admirable personality.

4) Where did you go to medical school and how did you come about the decision to specialize in General Surgery? Was it something you gradually got into or is there an “aha” moment from your background or training?

Dr Shiraz Elkheir SurgeonI studied medicine in Sudan in the University of Khartoum (1993-1999). Its one of the oldest medical schools in the Middle East and Africa, established in 1925. Its graduates have, and still are serving in different countries around the globe. Actually the school takes pride in saying that “The sun never sets down on its graduates”! It’s a six year program right after high school. I was very fortunate to have been part of a very special cohort of talented, enthusiastic young men and women of 330, with many of whom I still maintain close ties. We were the last class to graduate in the last century and our graduation coincided with the school celebrating its Diamond Jubilee, and hence we came to be referred to as the “Diamond Class” to this day.

The passion for surgery came slowly but lasted indefinitely. My good base in Anatomy served me well during the study of surgery in med school. I was always answering questions during rounds, understood surgical approaches quite easily and quickly became appreciated by my peers and preceptors.

Dr Shiraz Elkheir SurgeonThe history of surgery is filled with marvellous achievements and ideas, two of them which really made me feel that a surgeon can really go a step further were the use of an isolated and opened up piece of small bowel to absorb and control intractable ascites, and the other was the use of a reversed segment of small bowel to slow down intractable functional diarrhea relying on reverse peristalsis. Even in our current DNA age, look at bariatric surgery and how it transforms lives and sends DM and hypertension into remission.

Reflecting and analyzing all those experiences made me choose surgery as a career.

5) Where did you grow up and what did you do in your life before medicine? Not just professionally, but did you have any hobbies or passions that you still pursue?

I was born, raised, and lived most of my life in Sudan. I actually lived there continuously until 2008. I was a very active kid and most of my time from grade 4 to 10 was spent with the boy scouts. At one time I belonged to the sea and land scouts groups. It was very fun and we went on all sorts of camping trips, international expeditions, long distance rowing competitions, crafts, exhibitions and much more. During med school, the student’s union regularly organized medical voyages to remote areas of the country. These typically lasted between 7-10 days and were lots of fun and experience. Unfortunately, the pressures of work after graduation prevented me from continuing with those hobbies and activities. However, I love teaching, especially Anatomy, and continue to do so whenever I get a chance. I don’t know if that would qualify as a hobby or not! I also like taking care of my backyard and using power tools to do general simple repairs and small projects around the house.

6) If you had to go back and do something else, anything other than medicine, and more specifically surgery, what would it be?

Hmm, that is a tough question, but if I were to change careers within medicine, I think I might probably choose pathology or radiology. If I were to have a different career altogether, it would very likely be in a field such as aviation or automotive engineering. I was and am still fond of engines and mechanics and was an avid enthusiast of cars, though less so now because of time constraints. When I was a medical student, this passion was so intense, to an extent that I knew the number plate, make, model, and year of every luxury/exotic/rare car on the streets of Khartoum!

7) What was the scariest moment during your residency?

Hands down, that was the first day of residency. It was July 1st, 2012 and I was put on call. I had not set foot in a Canadian hospital before and had no experience with the system, not even as a visitor before that day. Even worse, I was completely off clinical practice in the four years preceding that day. And to make things worse, it was a very busy day with tons of consults and ward issues. My ID badge wasn’t activated so I couldn’t get scrubs, go into ORs, get a call room, etc. I was carrying my back pack on me all day and night, and actually never got to sleep at all. I am very grateful to the clerk (Salva Sdagi) who was on that day for being my guide and savior. I wish her all the best in her career and life.

8) What is your favourite “go-to” food on call?

That would be Chewy energy bars from Costco. I keep my backpack well stocked with these!

9) If you could give some words of wisdom to new Residents starting General Surgery in the light of everything we’re facing these days across Canada (limited jobs, duty hour restrictions, more and more specialization), what would it be?

First I would congratulate them on matching to their program (of choice hopefully) and salute them for choosing such a busy career. Residency is very busy and could wear you down easily and quickly, and before you realize you could slip in depression or burnout. What I found useful is investing in getting to know your peers. It makes sense since you will be spending a lot of time with them. Also don’t be shy about venting out your concerns and frustrations. You will be amazed when you learn that almost all of them are feeling the same way, and that in itself can be quite a relief. Try to think ahead of time as much as possible, specifically about practice type and location. Think about choosing your electives to give you an opportunity to sample areas of interest. Consider all options, especially small and rural communities, it is potentially very rewarding both professionally and possibly financially. And last but not least, love what you do!

Dr Shiraz Elkheir Surgeon