Ryan Falk is a current student in the Master in Global Surgical Care (MGSC) program at BISC. We had the pleasure to interview Ryan about his experiences in global surgical care and as a student in the Masters program as a family physician with enhanced surgical skills (FPESS), practicing in Inuvik, Northwest Territories.
Tell us a bit about yourself and your interest in global surgical care. Why did you decide to pursue medicine, and do a Master in Global Surgical Care at UBC?
I currently live in Inuvik in the Northwest Territories with my wife, Roohina Virk, who is a general practitioner (GP) anesthetist, and our twin daughters. Since completing an enhanced surgical skills (ESS) training program at the University of Saskatchewan in Prince Albert, I have been practicing rural general medicine, serving the community as a family physician and contributing to the surgical care of the region.
My journey to medicine was not a straight trajectory. Growing up, I moved around a lot and lived primarily in rural communities; my father was in the RCMP and I saw how he contributed in those communities beyond just being a police officer. As a child, I had pneumonia around the age 13. Despite not feeling that sick, the visits to my family doctor and at the hospital, including getting a chest x-ray, fascinated me and incited many questions. I have always been very curious and at the time I wondered “What is he doing?” “What does he know?” Early on, this was an experience that got me thinking about medicine as a potential career path. Another source of inspiration which encouraged my path into family medicine was my great uncle, who by then was a retired family doctor and had also been a pioneer in research in family medicine.
Global health has always been an interest of mine. During medical school, I went to Vietnam for a rotation and after I finished my family medicine training, I went to Haiti twice to practice general medicine. In my early practice as a rural family medicine doctor, I was exposed to places like Inuvik and had the opportunity to work with GP surgeons in rural regions. Those GP surgeon role models pointed me in the direction of the University of Saskatchewan’s program in Prince Albert. One of my surgical mentors in the program, Dr. Randy Friesen, one of the founders of the ESS program in Saskatchewan, thought I would be interested in taking one of the courses offered by Dr. Robert Taylor at the Branch for International Surgery at UBC at the time. This was before the Masters program even existed.
That course was SURG 510 – Surgical Care in International Health and I really enjoyed the course. It provided me a public health perspective on surgery, which is something I’d never thought of before. I began seeing the parallels between the course content and my life in Inuvik, providing surgery in a remote, rural community in Canada. In Inuvik, I often experience power outages, supply issues, or transport problems—challenges that developing countries also face. Having enjoyed SURG 510, I then enrolled in the Graduate Certificate (GCGSC) program when it was first created and had the opportunity to take other courses in the program, including SURG 512 – Global Disability: A Surgical Care Mandate and SURG 514 – Surgical Care in Humanitarian Disaster Response. I later laddered into the Master’s program. Taking the courses with my wife provided two perspectives, the surgical and the anaesthetic, and supported our practices in rural Canada.
I understand you are doing your field practicum project on Surgery in the Western Canadian Arctic: Using a Logic Model to Understand and Strengthen a Rural Surgical System. Can you tell us more about your project and how it’s been progressing? Are there plans to continue the research after you graduate? Have you been able to apply what you have learned in the program to a rural, remote setting in Canada?
The first part of the SURG 560 – Global Surgical Care Field Practicum course was developing the project. The second portion is doing the field practicum, the project itself, but for me that has been delayed for several reasons. Doing research in the NWT, I had to not only go through the UBC Research Ethics Board, but also another one in the territory, as well as obtain a territorial research licence and research agreements from the health authority here.
In regards to my project, there are two sides to it. One side is to describe a model or an example of how surgical services can be delivered to a rural and remote population, based on the system we have here. There is remarkably little in the literature on this topic, at least in academic journals. I think there are a lot of lessons that could be learned from this model for other parts of Canada, and perhaps other parts of the world, including how ESS physicians are networked into a surgical system with specialist support at our secondary and tertiary care centres. By describing it using a logic model, the other side to the project is to use that framework to come up with recommendations to improve the program, based on what I learn from my stakeholders. The logic model could then be used for ongoing program planning and evaluation.
One of the courses that was really helpful for the conception of this project was SURG 516 – Program Planning and Evaluation in Surgical Care Low Resource Settings. In addition to my academic advisor, Dr. Dawnelle Topstad, Dr. Laura Lee, the SURG 516 co-instructor, has been a helpful resource. I had no experience with qualitative research before this project and she has been instrumental for me. It has been an interesting process conducting and transcribing interviews, then coding and doing thematic analyses. I also connected with Dr. Nadine Caron, co-instructor of SURG 518 – Surgical Care in Canada’s Rural and Remote Indigenous Communities with Global Comparisons. The majority of the population in the region I’m studying is Indigenous, which was the focus of that course, so a lot of the themes connect between that course and my reality. It also all connects back to SURG 510, because at the end of the day this project is about health system strengthening and looking at surgical care as a part of the health system. Those three courses were key for me in the development of this project.
How do you think the courses leading up SURG 542 and SURG 560 has prepared you to apply your knowledge of global surgical care in leading projects in the community? You also published an article as a result of the Directed Studies course, SURG 542, Surgical Task-Sharing to Non-specialist Physicians in Low- Resource Settings Globally: A Systematic Review of the Literature. Can you tell us about how that process was for you?
Starting with SURG 510, I saw surgery through a different lens. That course mentions concepts like the importance of health system strengthening and the need for surgical access in underserved populations. I think recognizing that although it’s a different scale of a problem, it applies to Northern Canada, as well as developing countries. There’s a different sense of equity of access even within my region here. For example, if you live in Inuvik where the hospital is, people have a perception of better care than if they live in more remote areas which are farther from a regional centre.
While the first 3 courses build a contextual background, SURG 516 was unique because it starts to provide you with new skills. I think that combination has helped me to see the bigger picture of surgical programs – ours here in the NWT, or other parts of rural Canada, or in other projects in low and middle income countries (LMICs) – and to then apply program planning and evaluation tools to those programs.
SURG 542 was interesting in that it allowed me to explore an area of interest to me. I focused on which countries have non-specialist physicians (GPs, family doctors, medical officers) performing surgery, and of those countries which have a formal training program. Although I have been a contributing co-author before, I had never independently conducted a project and published research before. It’s one thing to read a literature review, since you often read them in order to keep up-to-date in practice, but it’s another thing to actually do one yourself. I have developed a new appreciation of literature reviews now, knowing how much work actually goes into them.
Following graduation of the Master’s program, do you have any plans to be continued to get involved with global surgical care?
Yes, I do. There are a few things that I may be involved in. I’m hoping that my current project leads to other projects, thinking about that program planning, evaluation, and monitoring cycle. A few research groups have shown interest in what I’m doing in this project. It can be hard to do research in the North, so it would be great if what I’m working on now could lead to further health system strengthening for a vulnerable population (rural and indigenous) right here at home. If that does happen, I’d like to be involved with that.
I know I have a lot more to learn as a researcher. I think one of the benefits to me from this Master’s program is opening the doors for me as a researcher as an on-the-ground, frontline physician. It has provided me the opportunity to also develop research skills to try to improve the system.
In addition, I have been involved in a surgical project in Ghana. I used that project for background for a couple of my assignments in some of the courses such as SURG 516 and SURG 517 – Clinical Research Methods for Surgical Procedures with Global Surgical Comparisons. That is another project that I’d like to continue to be involved in. At this point, I am keeping an open mind. But I would like to continue doing research and be involved in global surgery in Canada and elsewhere in the world.
If you were speaking of other trainees are those interested in pursuing global surgical care? What advice would you give them?
For anybody starting out in the field, I suggest taking a course such as SURG 510, or even the whole GCGSC program. If someone has an interest in global surgery, they could get a lot out of these courses. How I see myself in global health in general has evolved from when I first wanted to become a doctor until now. I think we have to be careful with how we engage in that kind of work, and I see my role now more in terms of capacity building. The program has helped shape my views with that not only from a surgical perspective, but in general terms as well.
For anyone wanting to do the Master’s program, I’d recommend it. I’ve learned more from it than I was expecting, especially with SURG 542 and SURG 560. Depending on your projects, it can be a significant time commitment, so you just need to be realistic about it. It helps that the program is designed with the working healthcare provider in mind. Personally, I would not have been able to take on the Master’s program without a supportive family and work colleagues. Also, you don’t have to be a surgeon to become involved in global surgery or take this program – anyone connected to surgical care, whether an anesthetist, a biomedical engineer, a nurse, or a radiation oncology technician, from Canada or an LMIC.
I also would say to think about SURG 542 and 560 early. You need the first set of courses to be able to conceive of a project but at least if you start exploring areas of interest early on, it would help with those courses, especially 560. The Branch staff, Dr. Taylor and Dr. Westerberg, and the instructors have all been very understanding and flexible, and they are great resources. Perhaps it is the nature of people who do global work and those involved in education, but I found all the instructors have been very approachable even after the fact if I needed to get in touch with them about something, beyond my involvement in each course.
What would you say is the highlight of the MGSC for you?
There have been a lot of highlights in many different areas. It was exciting to get published. But I think the highlight for me really has been the learning process, and the knowledge and the skills that I’m gaining, and whatever future opportunities this may lead to. One of the reasons I think medicine was a good fit for me is my curiosity, as I said at the beginning. I’m curious about so many things. So I think this Master’s program just has given me the opportunity to explore a different area, an area that’s relevant to my professional interest in rural surgery in Canada, and to connect that to global surgery.
Is there anything else that you’d like to share at all?
I appreciate all the support that I’ve gotten in the program. Everyone has always been very receptive. Things haven’t always gone to plan for different reasons. As I said, I took that first course before there was even a certificate, and at least a few of the courses the first time they were offered. The program has been evolving since I started, and me with it.