Among the top New Year resolutions assembled by the Yale Gynecological Oncology Division in the past two years has been an annual spring excursion to Mainland China. The excursion that normally lasts a week or so is led by Dr. Thomas Rutherford MD, PhD, chief of Yale Gynecologic Oncology, as part of a voluntary medical team that also includes Dr. Pei Hui, associate professor of pathology, Dr. Gil Mor, professor of gynecology, Dr. Dan-Arin Silasi MD, assistant professor of gynecologic oncology and Dr. Michelle Silasi, fellow in high-risk obstetrics at Harvard Medical School, and Dr. Zhiyu Fang MD, senior research scientist at Merck, who plays a leading role in organizing each of the visits. This team brings a complete package of surgical, clinical management, and diagnostic pathology expertise along with translational investigations of gynecological cancers to regional medical centers in China. The team wrapped up its second visit in April of 2010.
For quite some time, Chinese physicians, often at senior levels, visited Yale with the intent of obtaining clinical training in the diagnosis and management of patients with gynecological cancers. They usually spend 6 to 12 months at Yale. While their experiences have been fruitful to some degree, many Chinese physicians have felt that the training is limited due to medical licensing restrictions. “It is not easy to learn the essence of modern gynecological cancer management if we are not fully engaged here at Yale”, said one visiting gynecologist from Beijing. Three years ago, Drs. Silasi and Rutherford asked the question: “if they cannot participate in real-time patient care at Yale, why don’t we go to their hospitals?”
In the spring of 2009 and 2010, the Yale Gynecologic Oncology team was formed to bring a complete package of modern clinical care to local hospitals in China. The team set off to China on May 6, 2009, and April 4, 2010, and visited one major teaching hospital at each of three Chinese universities: Xi’an Jiaotong University, Shaanxi University of Traditional Medicine, and Peking University. The visits were accepted with remarkable hospitality by the Chinese colleagues. For five or six days in Xi’an, the Yale team presented lectures to over 100 Chinese gynecologist with topics including neoadjuvant chemotherapy for the management of ovarian cancer (Dr. Rutherford); robotic surgery for benign and malignant gynecologic conditions (Dr. Silasi) and type 2 endometrial carcinoma and trophoblastic diseases (Dr. Hui).
Inside the operating rooms, Drs. Rutherford and Silasi, closely working with Chinese colleagues, performed staging surgeries on patients with various gynecological cancers. As an integral part of the patient care team, Dr. Hui provided intraoperative frozen section diagnosis during each operation and a complete pathological evaluation of the surgical specimens postoperatively. The operations were televised to a number of regional hospitals in Xi’an. Following the Xi’an experience, the team visited the Third Hospital of Peking University. Joined also by Dr. Gil Mor (associate professor of Yale Gynecology Department) during the trip of 2009, the interactions included lecturing and tumor board discussion of patients with gynecological cancers. Dr. Mor held an enlightening lecture on ovarian cancer stem cells.
“It was a very successful and a wonderful trip.” said Dr. Rutherford after each of the last two trips. “They were well-prepared and all surgeries went well, we were treated like royals and overall, it was a great adventure.” One of the benefits of seeing and touching the work that people are doing “in the field” is to have a personal connection and to find out first hand what needs they may have. “I think we have accomplished that” Dr. Rutherford continues.
As an alumnus of Xi’an Jiaotong University School of Medicine, “it has been such a fulfilling experience that I can help to bring something back to the school after some 20 more years since my graduation” Dr. Hui says. “It is truly remarkable that in just one week, our Chinese colleagues have been left with the impression that both their professional and personal aspirations are no different from ours.” He continues, “I think we’re different, but in reality, we’re really much alike in our professional and personal goals.”
“Our Chinese colleagues were so welcoming, and they were like sponges, so eager to learn,” says Dr. Silasi. “They were so appreciative of our help and I think we accomplished some great work.”
“What we are doing in China is so important because modern gynecologic oncology can be realistically introduced to Chinese physicians. Our efforts should pave the road to bring other significant medical developments to China, such as the Merck’s HPV vaccine again cervical cancer”, says Dr. Fang.
In addition to the clinical experiences in the hospital and the incredible collaboration between the Chinese and American teams, the Yale team enjoyed the opportunity to experience China’s rich culture. They visited the Terracotta Army, Qing Tomb, Dayan Pagoda in Xi’an and set their feet in the Forbidden City and on the Great Wall in Beijing.
Does it Make a Difference?
To answer the question: Yes, it does! The Yale and Chinese academic teams have not only established strong relationships rooted in the common interest of providing better care for our patients but a deep friendship based on mutual respect.
For two consecutive years, the Yale gynecologic oncology team has received strong support from all participating institutions, including the Yale Office of Institutional Planning and Communications, Yale Departments of Gynecology and Pathology, provincial governing bodies in China and ranking officials of all three Chinese Institutions.
The Discovery to Cure Clinical and Translational Research Fellowship was established to bring interested foreign physicians to Yale for clinical training and translational research. Selected physicians will take part in conducting clinical trials at the Yale Cancer Center and may be a part of the Gynecologic Oncology Division or the Reproductive Immunology Unit. This 12-month program will expose them to the design and conduct of clinical and translational research.
Dr. Liu Ming from Jiaotong University in Xi’an is now the first fellow in clinical trials of this program, and will complete his training in June, 2011. Dr. Jing Wu, Chair of the Gynecology Department of the Second Affiliated Hospital of the Xi’an Jiaotong University will be visiting Yale next March. The fellowship program also has a 3-month track for clinical observation, and Dr. Xue Xiang from Jiaotong University has recently completed the first clinical fellowship. Dr. Pei Hui has been appointed the Guanhua Lecture Professor at the Xi’an Jiaotong University and will work to further strengthen the academic ties between Yale and counterpart Chinese Medical Centers.