Fellowship Council - Display Listing

Program Director(s):
Ephraim S Tang
Douglas Quan

Description:

Western University offers a two-year clinical and research fellowship in hepato-pancreatico-biliary (HPB) surgery. The program provides clinical experience and exposure in a broad range of HPB cases. The goal of the program is to train fellows, who by the time of completion of the fellowship, will be competent and confident in the surgical management of all benign and oncologic HPB disorders.

Our program has a significant emphasis in minimally invasive approaches to HPB surgery including laparoscopic major hepatectomy and pancreatectomy, including pancreatico-duodenectomy, and we are committed to training our fellows in these procedures. The candidate will work closely with fellowship-trained preceptors in HPB surgery and transplantation. Fellows will be concurrently involved with the transplant service and will participate in the care of liver transplant patients in and out of the operating room. We believe that skills gained from training in liver transplantation including vascular reconstructions and hemostasis in patients with portal hypertension, are indispensable to the formation of the complete HPB surgeon.

Additionally, ERCP is a routine part of the practice for two of the contributing faculty, and fellows will have the opportunity to gain exposure to ERCP if desired.

Research is an expected part of this two-year program with opportunities to participate in basic science and clinical investigation. The research component can be tailored to the individual fellow's goals, including up to 6 clinical or translational research months. Our current basic science research focus includes pancreatic cancer organoid development; microRNA, circular RNA and RNA interference in cancer and ischemia-reperfusion injury; and optimization of normothermic regional perfusion for donor organ procurement.

There is an opportunity to enroll in Western University’s MSc in Surgery program which can be completely concurrently. We believe our fellowship program will provide excellent preparation for a fruitful academic career.

Basic Program Information:

Location: London, Ontario, Canada
Primary Program Site: London Health Sciences Centre (University Hospital Site)
Primary Hospital: Total bed size, # OR's, # Surgical ICU beds: University Hospital (Beds: 423, ORs: 16, ICU Beds: 38 )
Secondary Program Site: London Health Sciences Centre (Victoria Hospital Site)
Secondary Hospital: Total bed size, # OR's, # Surgical ICU beds: Victoria Hospital (Beds: 553, ORs: 15, ICU Beds: 30)
Clinic locations and schedule: Clinics are located on the 8th floor of the University Hospital (339 Windermere Rd, London, ON N6A 5A5) in the surgical clinic areas. HPB clinics are held Every Wednesday PM, and all day Thursday.

Multidisciplinary Pancreatic Cancer clinics are held every Monday afternoon at the Verspeeten Family Cancer Centre, located at Victoria Hospital (800 Commissioners Rd E, London, ON N6A 5W9).
University Affiliation: Western University
School of Medicine Affiliation: Schulich School of Medicine and Dentistry
Year Program and/or Designation Established: 1988
Number of Faculty: 6
% of Program Clinical: 80
% of Program Research: 20

Additional Program Information:

Interaction with Residents: Some cases shared
Is there a General Surgery Residency at the Primary Institution? Yes
Is there a General Surgery Residency at the Secondary Institution? Yes
Is there a curriculum in place for fellowship? Yes
Is there a skills lab at the institution with fellow access? Yes
Are there teaching conferences available for the fellow? Yes
Is there an evaluation tool for fellow by faculty in place? Yes
Is there an evaluation tool for faculty by fellow in place? Yes
Papers Accepted For Publication where PD was an author: 22
Publications that Involved Input from the Fellow: 22
Are funds available for the Fellow to attend conferences? Yes

Malpractice Insurance Information:

The fellow(s) only works as a fellow, i.e. does not/will not have attending privileges and the program provides the following:
This is a Canadian program. Exceptions are made for Canadian-based programs because of their governmental regulations and Sovereign immunity.

Contact Information For Questions:

Christine Bruckschwaiger
Phone: 5196633269
Fax: 5196633068
Email: Christine.Bruckschwaiger@lhsc.on.ca
Web: https://www.lhsc.on.ca/multi-organ-transplant-program/abdominal-organ-transplant-hepatopancreaticobiliary-surgery

Facilities

Dry Lab
Wet lab
Library
Administrative Support
Basic Science Research
Clinical Research
Simulation Lab

Citizenship and Visa Requirements:

Non Canadian Citizens eligible for/with planned Canadian Work Permit during their fellowship

Medical School Requirements:

We accept graduates of U.S. or Canadian Medical Schools and Foreign Medical Schools

Examinations and Certifications:

Applicants who hold a General Surgery specialty certificate from a Board or College outside of U.S. or Canada at the beginning of the fellowship

Licensure Requirements and Information:

Applicants must be eligible for a training license under the College of Physicians and Surgeons of Ontario. Requirements are outlined on the CPSO website.

https://www.cpso.on.ca/Physicians/Registration/Requirements

Accreditation Status	Accreditation Period	Length of Accreditation
Pending for HPB	-	0

Fellowship Opportunity # 1

Number of Positions Available: 1
Type of Fellowship: HPB-Transplant
Duration: 2 year
Start Day: August 1
End Day: July 31
Is this a salaried position? Yes
It is a requirement that the salary must be commensurate to a PGY 6 or greater in the same city. Does your program meet this requirement? Yes
Is the salary guaranteed for the year? Yes
Is there funding available beyond salary for meeting attendance, research, etc? Yes
Is the salary dependent on call? No
Is the Fellow on call? Yes
What are the on call requirements? Fellow will rotate on the abdominal organ transplant service and be responsible for donor activity for 1/3 of the time that they are on service. In addition, while there are no other set call duties, fellows will be expected to engage in after hours activity when there are emergent HPB cases, such as bile duct injuries, exploration, or take backs for HPB cases. The fellows will adhere to 80 hour work week restrictions.
What are the estimated fellow weekly work hours? 80 ho
It is a requirement that Health Insurance be provided. Do you provide health insurance to your fellows? Yes
Teaching Responsibilities: Yes
Courses/Academic Presentations: Yes
Does reimbursement for the above make up part of the salary? No
Does the fellowship contract include a non-compete clause? No

Clinical Outpatient Experience

Weekly clinics are held on Wednesday and Thursday in the general surgery Outpatient clinic. On average, 100 patients are seen per week in these clinics including HPB and general surgery patients.

Monday afternoon multidisciplinary pancreatic cancer clinic is held weekly for new pancreatic cancer patients, on average 3-4 patients are seen in this clinic per week.

Research/Scholarship Resources

Fellows will have support through our Transplant/HPB research coordinator, and statistical support through the division of general surgery. They will be expected to engage in research meetings that occur every two weeks.

Program Director(s) Detailed Information

Dr. Ephraim S Tang MD, MSc, FRCSC

At Institution Since: 2018
Program Director Since : 2024
Board Certification: Equivalent Fellow of Royal College of Surgeons of Canada

Society Memberships

AHPBA

Areas of Expertise

Hepato-Pancreato-Biliary Surgery, Transplant Surgery, Minimally Invasive Surgery, ERCP

Teaching Qualifications

The program director Ephraim Tang has spent the last 4 years working as a transplant and hepato-pancreato-biliary surgeon and spent 9 years training to provide specialized care to patients with benign and malignant diseases of the liver, bile ducts and pancreas. He is an award-winning teacher and has helped position Western University and the London Health Sciences Center as a National Leader in minimally invasive surgery for HPB diseases.

His educational qualifications include both Bachelor’s and Master’s degrees in Immunology awarded through the University of Toronto, as well as current work on a Masters Degree in Clinical Epidemiology through the London School of Hygiene and Tropical Medicine. He completed Medical School and Residency at Queen’s University in Kingston Ontario where he won awards for academic excellence in General Surgery and multiple resident teaching awards. He then went on to complete a combined research and clinical fellowship HPB surgery at Providence Cancer Center in Portland Oregon, with a clinical focus on minimally invasive HPB surgery, and a research fellowship in tumor immunology. Subsequently, he completed an ASTS transplant fellowship in abdominal organ transplant and HPB surgery at Western University in London Ontario where he was subsequently recruited and is now an Assistant professor of Surgery, with cross-appointment in the division of Oncology.

As an attending, he has pioneered the development of the largest minimally invasive HPB program in Canada, where over half of all HPB cases are performed laparoscopically, including major hepatectomy, live donor hepatectomy, pancreaticoduodenectomy with venous resection, and complex biliary pathology. In addition, he has won resident and medical student teaching awards and multiple research grants. His research interests include curriculum development for laparoscopic HPB surgery, outcomes research in HPB and transplant surgery, and the development of abdominal regional perfusion in DCD organ donation. He currently serves on multiple committees including the AHPBA education committee, and the CHPBA conference committee.

With the establishment of the Baker Center for Pancreatic Cancer, and generous donations to the Verspeeten Cancer Center, the development of an HPB fellowship is part of the goal of developing a world-class program of surgery for HPB diseases including the further development of MIS approaches including laparoscopy and robotics, as well as surgery for advanced HPB malignancies including vascular resection and reconstruction, and developing applications for transplant oncology.

Summary of Qualifications

PROFESSIONAL EXPERIENCE

Jul 2021-Present

Regular Attending Physician: Hepato-Pancreatico-Biliary, Transplant and General Surgery. London Health Sciences Centre, University Hospital Campus.

Jul 2021-Present

Assistant Professor: University of Western Ontario, Schulich School of Medicine and Dentistry, Department of Surgery.

EDUCATION

Aug 2018 – June 2020

Fellow: Multiorgan Abdominal Transplant and Hepato-Pancreato-Biliary Surgery. London Health Sciences Center, University Hospital. London, Ontario, Canada.

Aug 2016 – July 2018

Fellow: Hepato-Pancreato-Biliary surgery, Providence Portland Medical Center. Portland, Oregon, USA.

Aug 2016 – Present

M.Sc.: Clinical Epidemiology, London School of Hygiene and Tropical Medicine, Distance Learning Program. London, England, United Kingdom.

July 2011 – Jun 2016

FRCSC: Residency: General Surgery, Department of General Surgery, Queen’s University. Kingston, Ontario, Canada.

Sep 2007 – May 2011

M.D.: Queens University, Kingston, Ontario, Canada.

Sep 2004 – Mar 2007

M.Sc.: Immunology, University of Toronto. Toronto, Ontario, Canada.

Thesis: The role of AID in immunoglobulin gene-conversion.

Sep 2000 – Jun 2004

H.B.Sc.: Specialist in Immunology, University of Toronto. Toronto, Ontario, Canada.

Fellow Publications

Waugh, E., et al., Survival benefit of neoadjuvant FOLFIRINOX for patients with borderline resectable pancreatic cancer. Ann Hepatobiliary Pancreat Surg, 2024. 28(2): p. 229-237.
Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries. Br J Surg, 2024. 111(1).
Sachar, Y., et al., Reducing length of stay in patients following liver transplantation using the model for continuous improvement. BMJ Open Qual, 2023. 12(1).
Mallette, K., et al., The utility of self-expanding metal stents in benign biliary strictures- a retrospective case series. BMC Gastroenterol, 2023. 23(1): p. 361.
Lund, M.C., et al., Minimally invasive versus open synchronous colorectal and hepatic resection for metastatic colorectal cancer: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) analysis. BJS Open, 2023. 7(6).
Lin, K.X., et al., PD-1 and PD-L1 inhibitors in cold colorectal cancer: challenges and strategies. Cancer Immunol Immunother, 2023. 72(12): p. 3875-3893.
Glinka, J., E. Waugh, and A. Skaro, Reply: The urgent need for consensus around organ donation after assisted dying. Liver Transpl, 2023. 29(12): p. E45.
Glinka, J., et al., Liver transplantation with donation after medical assistance in dying: Case series and systematic review of the literature. Liver Transpl, 2023. 29(6): p. 618-625.
Brière, R., et al., 2023 Canadian Surgery Forum: Sept. 20-23, 2023. Can J Surg, 2023. 66(6 Suppl 1): p. S54-s136.
Luke, P.P., et al., Kidney transplant outcomes after medical assistance in dying. Can Urol Assoc J, 2022. 16(2): p. E108-e110.
Liu, R.Q., et al., Cost analysis of indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery. Surg Endosc, 2022. 36(12): p. 9281-9287.
Mikhail, D., et al., Clinical Significance of Isolated V1 Arteritis in Renal Transplantation. Transplant Proc, 2021. 53(5): p. 1570-1575.
Juriasingani, S., et al., Subnormothermic Perfusion with H(2)S Donor AP39 Improves DCD Porcine Renal Graft Outcomes in an Ex Vivo Model of Kidney Preservation and Reperfusion. Biomolecules, 2021. 11(3).
Alsager, M., et al., Liver transplantation in adult polycystic liver disease: the Ontario experience. BMC Gastroenterol, 2021. 21(1): p. 115.
Hindi, Z., et al., Liver Transplant Tourism. Liver Transpl, 2020. 26(2): p. 276-282.
Tun-Abraham, M.E., et al., Can we reduce ischemic cholangiopathy rates in donation after cardiac death liver transplantation after 10 years of practice? Canadian single-centre experience. Can J Surg, 2019. 62(1): p. 44-51.
Sharma, H., M.E. Tun-Abraham, and V. McAlister, Bidirectional graft-host hematological traffic in liver transplantation. Hepatobiliary Surg Nutr, 2019. 8(3): p. 253-257.
Sharma, H. and V. McAlister, Fatal graft versus host hemolytic reaction from Rhesus compatible mismatched liver transplantation. Hepatobiliary Surg Nutr, 2019. 8(2): p. 186-188.
Patel, S.V.B., et al., Machine preservation of donor kidneys in transplantation. Transl Androl Urol, 2019. 8(2): p. 118-125.
Chen, J., et al., Donor age is the most important predictor of long term graft function in donation after cardiac death simultaneous pancreas-kidney transplantation: A retrospective study. Am J Surg, 2019. 218(5): p. 978-987.
Bhattacharjee, R.N., et al., Subnormothermic Oxygenated Perfusion Optimally Preserves Donor Kidneys Ex Vivo. Kidney Int Rep, 2019. 4(9): p. 1323-1333.
Aquil, S., et al., The impact of a muscle pump activator on incisional wound healing compared to standard stockings and compression devices in kidney and kidney-pancreas transplant recipients: A randomized controlled trial. Can Urol Assoc J, 2019. 13(11): p. E341-e349.
Wanis, K.N., et al., Intermediate-term survival and quality of life outcomes in patients with advanced colorectal liver metastases undergoing associating liver partition and portal vein ligation for staged hepatectomy. Surgery, 2018. 163(4): p. 691-697.
Muller, X., et al., Defining Benchmarks in Liver Transplantation: A Multicenter Outcome Analysis Determining Best Achievable Results. Ann Surg, 2018. 267(3): p. 419-425.
Luke, P.P., et al., First Canadian experience with robotic laparoendoscopic single-site vs. standard laparoscopic living-donor nephrectomy: A prospective comparative study. Can Urol Assoc J, 2018. 12(11): p. E440-e446.
Wanis, K.N., et al., Patient Survival After Simultaneous ALPPS and Colorectal Resection. World J Surg, 2017. 41(4): p. 1119-1125.
Al Hasan, I., et al., Optimizing associated liver partition and portal vein ligation for staged hepatectomy outcomes: Surgical experience or appropriate patient selection? Can J Surg, 2017. 60(6): p. 408-415.
Hernandez-Alejandro, R. and H. Sharma, Small-for-size syndrome in liver transplantation: New horizons to cover with a good launchpad. Liver Transpl, 2016. 22(S1): p. 33-36.

Dr. Douglas Quan MD, MSc, FRCSC, FACS

At Institution Since: 1999
Program Director Since : 2001
Board Certification: Board Certified

Society Memberships

AHPBA

Other

ASTS, ILTS, TTS

Areas of Expertise

HPB, Transplantation Surgery

Teaching Qualifications

Assistant Program Director Douglas Quan has been a practicing transplant and HPB surgeon for the past 20 years and has been the fellowship program director of the ASTS transplant program at Western for that time as well.

Summary of Qualifications

He obtained his MD from the University of Saskatchewan in 1989, followed by an MSc in Pathology at the University of Western Ontario in 1995. This was followed by General Surgery Residency at UWO in 1995 and fellowship training in Endoscopic Management of Biliary Tract Disorders, in 1996 along with a Fellowship in Multivisceral Transplantation. In 1997 he attended the University of Toronto where he completed a Fellowship in Hepato-pancreato-biliary Surgery, and 1998 completed a Fellowship in Xenotransplant Research at the University of Cambridge in the United Kingdom.

Division of Time

Percentage of Time Spent in Clinical Activity: 80%
Percentage of Time Spent in Research Activity:20%

Case Load (as estimated by Program)

Case Type		# of Open Cases	# of MIS Cases (Lap & Robotic)	# of Endoscopy Cases	# of Anastomotic Cases (Bariatric programs only)
Colorectal	Bowel resections: Colectomy	3	5	0	0
Flexible Endoscopy	ERCP, Advanced/therapeutic	0	0	0	0
HPB	Bile duct- exploration	2	9	0	0
HPB	Bile duct- resection	5	0	0	0
HPB	Liver- <2 segments	6	16	0	0
HPB	Liver- ablation	5	10	0	0
HPB	Liver- lobe	14	14	0	0
HPB	Liver- other	25	4	0	0
HPB	Liver- wedge	3	20	0	0
HPB	Pancreas- distal	12	12	0	0
HPB	Pancreas- drainage	2	2	0	0
HPB	Pancreas- other	4	2	0	0
HPB	Pancreas- whipple	31	31	0	0

List of Contributing Faculty

Anton I Skaro MD, PHD, FACS, FRCSC	20%
Area of Expertise Transplant and Hepato-Pancreato-Biliary Surgery
Role in Training Contributing Faculty

Ephraim S Tang MD, MSc, FRCSC	20%
Area of Expertise Transplant and Hepato-Pancreato-Biliary Surgery
Role in Training Program Director

Juan G Glinka MD	20%
Area of Expertise Transplant and Hepato-Pancreato-Biliary Surgery
Role in Training Contributing Faculty

Douglas Quan MD, MSc, FRCSC, FACS	20%
Area of Expertise Transplant and Hepato-Pancreato-Biliary Surgery
Role in Training Assistant Program director

Kenneth Leslie MD, FRCSC	10%
Area of Expertise Pancreatic and General Surgery
Role in Training Contributing Faculty

Edward Davies MD, FRCSC	10%
Area of Expertise Hepato-Pancreato-Biliary Surgery and Surgical Oncology
Role in Training Contributing Faculty