He is a passionate researcher, mentor and educator. In the following interview, he shares insights on leadership, gives advice for less experienced surgeons and tells what inspires him.
You have a very distinguished career as a surgeon and educator – looking back, are you where you expected to be and who inspired you?
I would not have predicted that I would end up where I am, but I’m very happy – it has exceeded my hopes and dreams in many regards. I was inspired by my experiences looking after patients with spinal cord injury. I could see the devastating impact these injuries had on individuals – these were young people I could relate to. I was also inspired by two mentors: Drs. Charles Tator and Alan Hudson. Both had a huge impact on my career and helped me to make two important discoveries about myself: that I was passionate about the creativity and knowledge brought by research, and that I had the opportunity to travel the world and engage in the discipline I enjoy so much at an international level.
Do you see any difference in generation Y or the millennials compared to when you were a young surgeon?
I’d say each generation is different. I really enjoy the mentorship and my goal remains the same: to train and coach these people to I really enjoy the mentorship and my goal remains the same: to train and coach these people to become better than me.become better than me. The people I’m training and interacting with now are so incredibly bright and talented. Yes, they learn information in different ways than I used to and have a different perspective on work life balance for example, but I still see the passion for the profession and the interest in moving forward. It’s easier now to maintain connectivity with people around the world. Interacting with the next generation keeps me enthusiastic and motivates me to stay on top of my game. They constantly challenge me with new knowledge and perspectives, asking very intelligent questions and trying new approaches. I feel very positive about the next generation.
Speaking of younger generations learning information in different ways. Many surgeons struggle to embrace social media. You are very active on it and have a large follower base worldwide. Is there any advice that you can share?
I use Twitter a lot for knowledge dissemination– making people aware of lectures we’re giving and research we’ve published – and I use Twitter a lot for knowledge dissemination– making people aware of lectures we’re giving and research we’ve published – and we’ve found that very helpful. Also, I encourage all my students and faculty to have a LinkedIn profile because it's helpful in building a web profile.we’ve found that very helpful. Also, I encourage all my students and faculty to have a LinkedIn profile because it's helpful in building a web profile. Patients check it a lot, which I find very positive from a professional side. We also have our web page and try to direct traffic there whenever possible. I also have a Wikipedia profile. One area of caution is to be very careful in separating personal life from professional life, for example on Facebook. I also recommend surgeons to be careful about the types of photos disseminated on social media. With that caveat aside I’d say that social media in general is very positive for me.
In your view, what is the biggest challenge young surgeons are facing today?
I always tell my medical students, there are two sides to being a spine surgeon. On the one side, you get to see some very interesting procedures, the outcomes are generally good, and there are many rewards. On the other side, it’s also very tough, from both the cognitive and technical aspect. There's a lot to learn medically and the technical aspects are challenging. It can be very difficult to deal with complications. There are also challenges on a personal level. It takes a lot of your time, it’s not a 9-5 job, and you need to have a very supportive family that understand that. These have always been challenges for surgeons, but probably more so now because we live in a world where information is flowing so quickly and treatment protocols move at such a fast rate. Societal expectations are changing, patients are engaged in their own care, they set very high expectations on the doctor in terms of communication and engagement, and quality is being rigorously measured so we’re really under the microscope.
What advice would you give a young surgeon with regards to new technologies and other developments in spine surgery?
To embrace new knowledge as it comes forward but also recognize Embrace new knowledge as it comes forward but also recognize that not everything new will stand test of time.that not everything new will stand the test of time – you always should critically evaluate new techniques and information as it comes forward. Be open but always employ critical thinking. That’s why I think research training is essential education for spine surgeons even if they do ‘t do research themselves.
How do you manage the challenges associated with cultural differences in your team?
If one is open to embracing the different cultural perspectives it is incredibly rewarding. I work with people from all over the world, but one of the first examples I had of true international collaboration was the AOSpine international cervical myelopathy For me, leadership involves leading from the front, creating a clear vision and getting people excited about it, but also listening to the input people are giving you and shifting gears if necessary.study, which was a multicentre international study with 16 clinics in 4 continents. It was challenging to bring it together – we had to translate protocols into different languages and there were time zone challenges for scheduling – but the rewards were enormous. We found a lot of commonality and the areas of difference were interesting to explore and see if we could synthesize into unified protocols. The trick is to be open to the ideas of others. For me, leadership involves leading from the front, creating a clear vision and getting people excited about it, but also listening to the input people are giving you and shifting gears if necessary.
Many people ask you for advice, but where do you go or what do you do when you need inspiration?
I go to my cottage in northern Ontario. I love the water and the woods. In the summer I go canoeing, swimming and cycling to help me unwind, and in winter I love to ski. I like to do things that allow me to relax and stop thinking.
Which piece of research are you most proud of in your career?
I recently read an article on the top 10 developments in spinal surgery and it was surreal to see that the article included two discoveries I have made. The first is in the area of secondary injury hypothesis, in which I discovered that after a traumatic injury to the spinal cord the initial trauma is amplified by secondary injury events including ongoing compression and ischaemia. We were able to translate this into clinical practice through a clinical trial I led, which shows that early surgical decompression and I guess I did something that might matter, that might actually help people. AOSpine should also take pride in that because they made it possible for me.reconstruction improves the outcomes in spinal cord injury. This has been translated into guidelines that will be published in August in the Global Spine Journal. We’re now taking this forward in the clinical trial of Riluzole. The other basic science discovery I made was that re-myelination can lead to improved recovery and this has been translated into clinical trial, with neural stem cells. You look at your life and say ‘I guess I did something that might matter, that might actually help people.’ AOSpine should also take pride in that because they made it possible for me.
Speaking of your own educational experience, you have recently been awarded the Germán Ochoa Travelling Fellowship. What does it mean to you and what are your plans?
First, it’s a great honor to receive this award. Germán was a great friend and a wonderful individual. When I heard about this award the terms of reference resonated with me because for some time I’ve wanted to take a sabbatical to reflect on what I’ve done and what I might want to do in future. Already for a while I’ve had an interest in deepening my collaborative relationships with European and Middle Eastern investigators.
I am taking a mini sabbatical at the Charité Clinic in Berlin. I have established connections to the Charité over the years, as I’d collaborated with investigators in basic science and clinical research studies. Also, my family is German and I speak German.
In Toronto, we have close connections with the Middle East – many surgeons from the Middle East have trained here over the years and I’ve been asked on various occasions to visit the region. It has struck me that spinal cord injury is a particularly important issue in the Middle East. Because AO recently sponsored the development of guidelines in spine trauma and spinal cord injury I thought that this would be an excellent opportunity to deepen relationships there. I expect to begin my fellowship early in 2018, and I’m very excited about planning the strategy and how I will emerge from the programme.
What does being a member of AOSpine mean to you?
AOSpine is in my view the most important international organization in professional spine surgery. It’s a fantastic organization; one that embodies the spirit of fellowship and AOSpine is in my view the most important international organization in professional spine surgery. It’s a fantastic organization; one that embodies the spirit of fellowship and camaraderiecamaraderie. It’s been wonderful for fostering many of the professional developments I’ve enjoyed, as well as the research and educational opportunities. I would really encourage people to join the AO. For me it’s been a transformative experience.
Michael Fehlings, MD, PhD, FRCSC, FACS , FRSC, FCAHS
- Professor of Neurosurgery, University of Toronto
Vice Chairman Research Department of Surgery, University of Toronto
Fellow Royal Society of Canada
Fellow Canadian Academy of Health Sciences
- Halbert Chair in Neural Repair and Regeneration
- Senior Scientist McEwen Centre for Regenerative Medicine
- Co-Director, University of Toronto Spinal Program
- Head, Spine and Spinal Cord Injury Program
- Toronto Western Hospital, University Health Network
Michael Fehlings is the Chairperson of the Steering Committee of the AOSpine Knowledge Forum SCI, and the winner of the AOSpine Germán Ochoa Traveling Fellowship. Under his lead, the guidelines for the Management of Degenerative Cervical Myelopathy and Acute Traumatic Spinal Cord Injury were developed. They will be published as a special focus issue of the Global Spine Journal in August 2017.
The Fehlings Lab, based in Toronto, Canada, is one of the world’s leading labs in the field of translational research in neural repair and regeneration. Michael Fehlings leads a research team of around 50 people. He trains between 7 and 10 Fellows from around the world with varying surgical backgrounds each year.
Michael Fehlings has received numerous prestigious awards including the Gold Medal in Surgery from the Royal College of Physicians and Surgeons (1996), nomination to the Who's Who list of the 1000 most influential scientists of the 21st century (2001), the Lister Award in Surgical Research (2006), the Leon Wiltse Award from the North American Spine Society for excellence in leadership and/or clinical research in spine care (2009), and the Olivecrona Award (2009) from the Karolinska Institute in Stockholm, Sweden (known as the "Nobel Prize of Neuroscience") for his important contributions in spinal cord injury. In 2012, he received the Reeve-Irvine research medal for spinal cord injury. In 2013, he was again honored by the North American Spine Society with the Henry Farfan Award for outstanding contributions in spine related basic science research. He was also honored, in 2013, to receive the H. Richard Winn Award from the Society of Neurological Surgeons, which is the highest honor for academic neurosurgeons in North America.
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Newsletter 12 August 2017