Discovering the art of surgery


By Ciara Parsons, BA'15

For Tavis Apramian, an MD/PhD Candidate at Schulich Medicine & Dentistry, working in the field of medicine has been a lifelong dream. Curious, intelligent and passionate about health care—Apramian is thriving in his studies.

Despite his successes, the road to medical school wasn’t easy.

With his father being a family physician in Muskoka, Ontario, Apramian is no stranger to the medical world. Tied between his two interests of English and medicine, he pursued Biology and English during his undergraduate studies at Carleton University, which is where he also completed his MA in English.

On the advice of one of his professors from Carleton, Apramian decided to enrol in Columbia University’s MSc program in Narrative Medicine. While he says his studies in the arts shaped who he became, he felt more professionally connected to medicine and knew it was his calling.

But moving from the humanities to the clinical sciences can be challenging, and Apramian admits that sometimes it felt as though his dream was out of reach.

“After being rejected from medical school it was difficult to see the applicants who I had interviewed with putting on their white coats,” said Apramian. “The rejection I felt has turned into a sense of gratitude because Schulich Medicine & Dentistry’s MD/PhD program gave me a chance to combine the humanities and medicine in a creative way.”

Pegged as a future leader in health care by senior medical administrators, such as Dr. Chris Watling, Associate Dean, Postgraduate Medical Education, Apramian’s research in medical education has garnered wide-spread recognition.

His most recent work, which was published in the Annals of Surgery in May 2017, focused on the variations that exist in surgical technique and how surgical residents are taught by their supervisors.

“I went into my research very naive about the role of evidence in surgery. I assumed it was like a recipe or like building a car where the instructions are followed and the procedure is done the same way every time. But I discovered that isn’t the way surgery is done at all,” said Apramian.

The study, which followed the doctoral research he completed in 2015, identified that surgery is more like a craft, rather than a uniform practice, as each surgeon employed different techniques and methods in the operating room.

To test their hypothesis about the variations observed in the surgery, surgeons were asked to individually comment on intraoperative video of a learner-performed laparoscopic procedure. Apramian and his team noted how the surgeons critiqued and assessed the methods employed by the learner as a means of comparing opinion and understanding where differences could be observed.

“We asked surgeons about which types of variations they would prefer to see, what a non-negotiable difference is and what is merely a preference. We found that each surgeon preferred for things to be done a little differently than the other,” said Apramian.

As the first video-based educational study of its kind, his research suggests that surgical technique is inherited rather than designed. This unspoken complexity, in which residents have to navigate poses an issue to medical education because it raises the question of ‘how do we assess and deem medical learners as competent if so many variations exist within the practice of surgery?’

Speaking about his findings, he believes that they will impact competency based medical education and may help streamline assessment.

And now, as a medical learner himself who is in his first few months of clerkship, Apramian says his research has given him a lot to think about in regards to which area of medicine to specialize in.

“The role of the surgeon-scientist really intrigues me because it moves so strongly from the applied to the conceptual” he said. “For now, I’d like to stick to trying to better understand the lived experiences of many different specialties in Schulich Medicine & Dentistry’s clerkship year.”

Follow Tavis Apramian on Twitter @TavisApramian