Episode 002: UofT new faculty round table mini series (Part 4/4)
Guests: Dr. Parul Tandon, Dr. Fernanda Onofrio, Dr. Alexa Sasson, and Dr. Ali Kohansal
SHOW NOTES
Huaqi Li
Thanks so much for tuning in again to Scope Notes, your gastroenterology focused medical education podcast created by learners for learners!
For any new listeners, I’m your co-host Huaqi Li, current first year Internal Medicine resident at the University of Toronto in Canada working with my co-host Mo Bucheeri, current 5th year Gastroenterology fellow and Chief Resident also at the University of Toronto.
Mohamed Bucheeri
Hello!
Huaqi Li
Our amazing faculty advisor is Dr. Parul Tandon, a Staff Gastroenterologist and Clinician Scientist in inflammatory bowel diseases at the University Health Network/Sinai Health in Toronto.
With Scope Notes, you can look forward to monthly episodes covering all things GI including practice guidelines, research reviews, and special career topics! We’ll be specifically featuring prominent Gastroenterology staff from the University of Toronto and across Canada for their expert opinions. So come join us from your favorite podcast streaming app!
We would like also to extend a big thank you to the Division of Gastroenterology and Hepatology at the University of Toronto for their generous support of this podcast.
With all that being said, let’s move on to our episode! Today will be our last part of our 4-part mini-series featuring new faculty in the Division of Gastroenterology and Hepatology at the University of Toronto! Today, we’re joined by the wonderful Dr. Ali Kohansal who specializes in advanced therapeutics. Dr. Kohansal is based at the Toronto General Hospital and currently serves as the Director of the Advanced Therapeutic Endoscopy Fellowship.
Hi, Dr. Kohansal, thank you so much for being here today. To get us started, could you share with our listeners a bit about yourself and your training background?
Dr. Ali Kohansal
Yes, hi, thank you very much for having me. My name is Ali Kohansal, I'm a gastroenterologist here at UHN. My training background and area of GI subspecialty is advanced endoscopy. This includes a range of predominantly therapeutic, but also some diagnostic endoscopic procedures, including ERCP, which stands for endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, larger complex gastrointestinal polyp resections, endoscopic drainage of intra-abdominal collections and a variety of other gastrointestinal stent placements. As you know, advanced endoscopy is a very much a growing area within the GI subspecialty, and we're always looking to find less invasive alternatives to surgical management of GI problems or complications. As far as my background, I've just recently started working at UHN. Prior to that, I worked in several Canadian centers, including University of Alberta, and Dalhousie University. I am a native Torontonian, however.
Huaqi Li
Amazing. Thank you. I think you've also trained in Australia as well. I was reading some of your information online.
Dr. Ali Kohansal
Yeah. I went to medical school in Australia, and I did do some post medical school or postgraduate training there. The system there is based on the British system. So where, after you finish your medical school, you do a year of rotating internship, and then you go into a stream of medical or surgical specialty. So, I spent some time after graduating medical school there, but then shortly thereafter, I just came back to Canada.
Huaqi Li
Gotcha. So, you've trained internationally. You've trained across Canada as well, in Alberta. Dalhousie, how have these experiences shaped your career and practice thus far? You've also mentioned you practice in Toronto as well.
Dr. Ali Kohansal
Thank you. That's a really interesting question and I think in many ways, my training reflects my life journey as a whole. And I'll tell you what I mean by that. So like many other Canadians, my family and I were immigrants to Canada, and at any time when you leave familiar surroundings that you may be comfortable with, for a new place, a new culture and new language, there's always a transition period that you have to deal with, and some of that transition process is very exciting and rewarding, but some of the other aspects can be very difficult and stressful, and there can be setbacks, and sometimes even, you know, what we call, quote, unquote, failures. But I think as long as the change in the transition is made in pursuit of a goal, the stressful parts can not only be worthwhile, but in fact, they can help you build resilience and can foster a sense of strength and accomplishment. So, I think that sort of life journey and early life experience made me more prepared for not avoiding career transition periods and processes, and in fact, when I've had those opportunities, I've been able to embrace them.
So, it really has given me that perspective of looking at every opportunity and challenge on its own merit, instead of letting me be affected by that natural discomfort that you get when you think about changing your usual surrounding. So that life experience has been helpful in my career as well, because it's allowed me to take those opportunities. I'd also say that the exposure I've had to different medical cultures in different environments has been really helpful, both from a clinical and academic perspective, because it allowed me to be exposed to different ways of doing things, all generally in pursuit of the same goal, right? So then different medical environments, everybody, regardless of which part of Canada or really which part of the world you are, the common goal is to serve our patients the best we can, to innovate, to move patient care and quality of care forward. But if you go to different centers, you will notice that they all pursue that goal within the confines of their available resources and their own cultural attitudes and practices. And there's one thing I've learned from having worked in different places, is that every approach has its own advantages, and some disadvantages and some limitations. And I think that the goal, at least personally, for me, has been to try to absorb as much as the positive aspects of each site or each place that I've worked at, and then be able to share them with my colleagues at any different site that I've worked at. So that's really allowed me to have a more I think broad-minded approach to how I practice my medicine realizing that the answer is not always universal. There's often more than one answer for a medical question.
Huaqi Li
Thank you so much. I think, like you said, it's very important and also interesting to have different perspectives in your training. You mentioned about some of your roots in Toronto. What drew you to working at the University of Toronto, and what have you enjoyed the most so far?
Dr. Ali Kohansal
Yeah exactly, so I did my Bachelor of Science in U of T many years ago. So, I did have exposure to it as a student. There's really two aspects, right? So, there's a concept of Toronto as a city and as a community, and University of Toronto as an educational institution, and you know, UHN as a place to work in. Toronto, as a city, is a world class city, and it's very much a safe haven for a lot of people like myself who are immigrants, who have come from different places, from all across the world, that they just sort of make it work in this wonderful mix of ethnic diversity and diversity of thought and just being part of that has just always been a real positive for me. When it comes to working at University of Toronto, that that sort of also applies. What drew me, I mean there's always that usual accolades and prestige of working at University of Toronto as a world class university, but really specifically for me, just in my short time here, there's been really two factors that really stood out to me, and I've really enjoyed.
So, one of them is just the appetite and support for innovation and good ideas that can move sort of medical, domains of medical care, or quality of care or medical education forward. So, I've really been impressed by how eager everybody is to support and collaborate on any ideas that can achieve those goals. And the second thing, again, goes back to the same word of diversity and that's not just diversity of personnel, but also diversity of thought. So, it's the idea of having all these different ideas and different perspectives, and people sort of exchanging their versions and their good ideas and being able to be exposed to that. And really, I guess I'll add a third one in there too, and that's just the opportunity for learning. There are so many people that I've met just in this short time that are genuinely just interested in learning and teaching and exchanging what they know and learning, picking up what you know. And I think that for somebody who I like to think of myself as a lifelong student, I think that's really been attractive and really been great to see.
Huaqi Li
Thank you so much. I mean, I'm a little bit biased, but I definitely agree with the diversity and the kind of sense of innovation here at U of T.
Mohamed Bucheeri
Dr. Kohansal, I know one of the reasons that you moved to the University of Toronto is to also help establish the therapeutic endoscopy program at UHN. Can you tell us a bit more about that?
Dr. Ali Kohansal
For sure. As you already know, education in the domain of endoscopy has been one of my career passions and areas that I have devoted a lot of time to, and one of the really selling points in the recruitment process of me making the move to University of Toronto was this niche area for expansion. As I said earlier, therapeutic endoscopy has just grown by leaps and bounds just over the last decade, in terms of what we're able to do and in terms of indications that are available to us. To that end, that creates more demand for therapeutic endoscopy skills and for therapeutic endoscopy services. And so traditionally, what was happening in Greater Toronto was, you know, we had some specific centers which were fantastic at providing those services, and they were able, they had the capacity to provide those services.
Now, as the demand is ever increasing, I think there's just an unmet need for even further expanding and being able to provide those services in more than a limited number of centers. And that's where the idea of being able to provide those services within UHN at a higher capacity, and then being able to train future gastroenterologists and therapeutic endoscopists so that they can go and provide those services in their communities, was really appealing to me. In answer to the question there was a need, because the UHN therapeutic endoscopy program was still in very early stages as far as its fellowship program. So, I had some experience in the previous centers that I worked in, in starting and growing a program that was well established by the time I left. And so that idea of being able to do the same in such a great center was really appealing to me.
Mohamed Bucheeri
Great, and what's your aim for your program in the next 5 to 10 years?
Dr. Ali Kohansal
So, I think it's really two broad categories. One, make sure that not only have consistently well-staffed annual programs. So, by that, I mean we'll have fellows coming in and rotating through with us and getting trained essentially every year. One of our goals, is to expand the program. So currently we train one fellow per year, but our goal is, in the near future, to go to two fellows a year, so to double our capacity. And I think we have the volume and the scope of procedures to be able to accomplish that, and the second goal is to actually along the same lines, to be able to expand the breadth and the scope of what we do. Right now, our program is mainly focused on pancreatobiliary procedures and that within itself is expanding and I’d like to expand that further in terms of the procedures that we do and what we train our fellows to do, but there are also non-biliary and non-pancreatic endoscopic procedures that we have trained and qualified faculty within UHN, that could take the lead on train fellows in those skills. Essentially, we'd like to expand the program in its size, from one fellow to more. But then second is the breadth of the program itself, in terms of the learning opportunities and the techniques and the skills that we teach our fellows.
Mohamed Bucheeri
Great. So, planning to add like a luminal, or a third space aspect to the fellowship, hopefully in the next 5 to 10 years.
Dr. Ali Kohansal
Exactly, so that would be sort of the goal of being able to expect beyond just the hepatobiliary or pancreatic focus to third space, luminal. Even currently, there is some exposure for our fellows, but I think we would like to just be able to really formalize it and being able to offer it on a more expansive basis. Now I'll sort of digress a little bit and say every individual can't do everything. If you are getting more and more sub specialized, I foresee that at some point we’ll probably have two offshoots under the same umbrella of advanced endoscopy. So, one offshoot will be pancreatobiliary training, and another will be third space and advanced polypectomy or tissue resection training. Probably one year won't be enough to become an expert in both of those domains or offshoots and they may actually need to eventually diverge and become their own separate therapeutic endoscopy programs.
Mohamed Bucheeri
Thank you. And just to wrap things off, do you have any advice for people interested in pursuing gastroenterology and specifically therapeutics?
Dr. Ali Kohansal
I'm obviously biased. My first advice is, yes, by all means. You know, gastroenterology is a great subspecialty to pursue, so definitely would encourage anybody to do that. With regards to gastroenterology or therapeutic endoscopy, is just to pursue your passion. Don't limit yourself to just what you're comfortable with or where you're most comfortable. That comfort is not a great substitute for the great opportunity that you might potentially miss out on, and the initial discomfort that you might get with the experience and the transition to something new will actually end up providing you with some amazing experiences in the long term and will foster your sense of self fulfillment and resiliency. So, I think it's really important to not limit yourself when you're pursuing a passion.
The second advice would be, be resilient and don't be discouraged by setbacks. Therapeutic endoscopy, especially within the field of gastroenterology, is a field where we constantly have to face challenging situations. The reality that we weren't able to accomplish what we wanted to do sometimes, or we had an outcome that was, you know, a side effect, or there was a complication. So, in order to be able to deal with those scenarios and be able to carry on, well you need a great degree of resiliency, and also a great degree of, in my opinion, humility. So just always be aware that you will be able to provide a lot of great care to a lot of people but remember that nobody will ever always get it right. And just be aware of that. Finally, I would say, just keep an open mind. Again, always be learning, and that's something that also really serves you well when it comes to therapeutic endoscopist. You can't get too comfortable with one way of doing things. You should always be trying to learn new ways of doing things. You should always talk to colleagues, always be up on the newest ideas. That doesn't mean you have to adopt all of them, but you should always be curious about how things are done differently somewhere else, and you should try to learn whatever you think is useful from them.
Mohamed Bucheeri
Thank you very much. That was very useful and holistic advice.
Huaqi Li
Amazing. Thank you so much for your time, Dr. Kohansal.
That’s it for our episode today! Thanks so much to our listeners for tuning in, join us again next week! Come check out our website @ www.scopenotesGI.com where we’ll be posting our show notes for each episode and other resources. Follow us on social media for the latest updates @scopenotesGI on X (formerly Twitter) and Instagram. And if you have any feedback or just want to say hi, you can reach the team at scopenotesGI@gmail.com.
