Resident Spotlight: Dr. Nicole Jedrzejko, PGY-5, General Surgery

Could you briefly introduce yourself and tell me a little bit about your background?

Hello! I grew up in Orangeville, Ontario, a town of ~30,000 people. My parents both immigrated to Canada in the early 1990s, my mother from Somalia and my father from Poland, and they greatly valued education and community. I grew up obsessed with school and the opportunities hard work within it gave this weird little mixed kid with a bad haircut. Most of my childhood was spent reading in the public library, singing in choirs, and annoying my two younger siblings while my father drove trucks and my mother ran a daycare. I credit my hard-working parents and their million sacrifices for my desire to serve the community through medicine, though funding postsecondary education was difficult. I ended up fashion modelling throughout high school to help with tuition and split my time between Toronto, Montreal, New York City, and Sydney during a year off after high school. However, Hamilton became the first city I felt at home after arriving at McMaster University, where I became the first in my family to receive a degree! A BHSc (Honours) and MD later, my sights were set on surgery.

What led you to pursue a career in General Surgery, and what do you find the most rewarding about the field?

Before medical school, the only doctor I knew personally was my own family doctor, thus I was never privy to the lifestyle and scopes of practice throughout medical subspecialties. My medical school experience was shaped by McMaster’s Niagara Regional Campus, a site with 28 students per year and very few residents. We were placed on rotations directly with staff throughout community hospitals in the region, and the surgeons were incredibly welcoming. First assisting, morning rounds, and reviewing consults as a fresh medical student bolstered my independence and interest in general surgery’s unique charm as a humanity equalizer. The combination of teamwork, broad anatomical/pathophysiological scope of knowledge, and mastery of performance pressure made the OR the most fascinating place.

General surgery has diverse opportunities for subspecializing (we cover acute care, bariatrics, breast, colorectal, endocrine, endoscopy, hepatopancreaticobiliary, minimally invasive, pediatric, trauma, transplant, oncology, vascular, upper GI/foregut, and thoracic surgical subspecialties), but I was always more attracted to its breadth over depth of practice. UBC’s residency program is one of Canada’s rare balances of tertiary-level subspecialty and community-based general surgery service coverage and education. I aspire to be the jane-of-all-trades community general surgeon who can support patients in less-resourced areas, both nationally and internationally.

What brings you to pursue a master’s outside of Canada?

Since my undergrad days, I’ve been interested in global health, especially understanding how health systems strive for equity in health outcomes with patients from vastly different socioeconomic, cultural, and regional demographics. Bridging the intense clinical training of a surgical residency with skills in research methodology, statistics, and critical appraisal was the logical next step to contribute sustainably to global surgical research. I had a childish dream to study in Oxford ever since visiting the campus on a high school trip, never thinking it would be possible. My program directors, Dr. Ahmer Karimuddin and Dr. Tracy Scott, along with my mentors Dr. Emilie Joos and Dr. Andrea MacNeill made it possible to pursue graduate study during residency. I was drawn to Oxford’s MSc in Global Health Science and Epidemiology, a small program that specializes in non-communicable diseases and big data statistics. Over half of my classmates are physicians from all around the world (others are engineers, geographers, public health specialists, and more); I am one of three surgical trainees and one of three Canadians. The program is over two-thirds done now and it’s been intense!

How has your experience as a Global Health Science & Epidemiology student influenced your approach to General Surgery?

Our first two terms of study were focused on principles of epidemiology, statistics, and global health topics (from communicable and non-communicable diseases to health economics). I am now applying that content knowledge to my dissertation that content knowledge to my dissertation examining patterns in breast cancer surgical approach in the UK Million Women Study. The opportunity to collaborate with world-class epidemiologists, statisticians, and clinicians in a nationally representative cohort study has immensely inspired what I think is possible back home in Canada and in low-resourced settings around the world.

So much of surgical research is singlecenter observational studies, but to better understand disparities in surgical care across regions and borders, we need to collaborate with health systems strategists beyond our field to build larger, comprehensive databases and better disseminate research findings with the public and leadership.I had a little practice as a junior resident building BC’s cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) patient outcome dataset for the BC Peritoneal Malignancy Program, but I’ve learned so much more about how to make patient databases more powerful and practical.

I’m inspired by my new colleagues to integrate research and leadership into my career aspirations in general surgery on behalf of patients and communities who deserve better representation in data.On a more personal note, taking time out of clinical training to learn something different has been a godsend for my mental health. Residency, especially in surgical specialties, can be grueling and all-encompassing. Becoming a student again has given me perspective and context for what I loved about Gen Surg in the beginning. I really needed that after two hard years of senior residency during COVID-19.

Congratulations on the birth of your baby! How do you juggle parenting and residency?

Thank you! Shoutout to all the resident parents out there! I thought I knew tired before becoming a mom, but I had no idea. As a junior resident, I watched many seniors start their families and “balance” them with residency, and I had so much respect for their confidence and courage. My program directors have been strong advocates for families throughout my residency; every rotation I did while pregnant followed all RDBC rules and found ways to support my learning and health throughout. My daughter was born at the start of my PGY5 year, and after a year of maternity leave and a year in my MSc, I’ll be starting resident-parent life soon.

I have no words of advice that haven’t already been said. Being a parent is the hardest and most rewarding responsibility of my life, but what was unexpected was how much becoming a mom helped with my anxieties about work, school, life, etc. If my little one is okay, everything else feels a little more manageable. Still, it’s important to remember to put on your own oxygen mask before placing one on the person next to you: self-care is necessary to care for others. Every resident needs that reminder. Finally, I owe everything to my superstar husband who has been an ultimate supporter of my career and the best dad you could imagine.

What advice would you give to other resident physicians who are planning to start a family or are currently pregnant?

Family planning can be a misnomer; everything from fertility challenges to scheduling conflicts can make starting families an unpredictable process. Be honest with your partner/support team throughout the journey and keep them close. Your program directors are supposed to be your allies, so make sure they are in the loop on your plans as much as you feel comfortable (I am very privileged to have found great support in UBC Gen Surg; not every resident has this relationship with their program). Keep up-to-date with RDBC Collective Agreement policies on maternity/parental/ adoption leave and workload in pregnancy, because you are your loudest advocate on rotations that intersect with family planning. Your health is paramount, especially now. Finally, a wise mentor of mine once described work as a liquid that will fill any container you give it. Don’t let it spill into the precious moments with your family that you deserve to enjoy. Invest in quality Tupperware.

Are there any notable advancements or breakthroughs in cancer care epidemiology that you find particularly exciting or promising?

Cancer epidemiology, like many health research fields are booming with technological advances, international collaboration, and public interest, but there are many relatively simple questions still unanswered. The use of large-scale prospective cohort studies with the capacity for biological specimen sampling will likely provide the strongest evidence for insight into the strength, shape, and trend of many cancers’ associations with multiple common exposures (e.g., environmental, dietary, sociodemographic, and genetic risk factors). For those interested, check out publications from the UK Million Women Study, European Prospective Investigation into Cancer and Nutrition (EPIC), and the China Kadoorie Biobank. Though we may never find a modifiable risk factor with such a strong association as tobacco smoking and lung cancer (fun fact: this link was found in the large cohort study called the British Doctors Study which began in 1951 in Oxford), these large studies are providing robust evidence for clinicians and public health systems on cancer prevention, screening, and treatment strategies. I’m particularly interested in how COVID-19’s interruptions to regular screening programs affect breast, cervical, and bowel malignancy presentations and health system resource use, the rising incidence of early-onset colorectal cancer, and improving access to breast cancer screening/treatment programs in low/middle-income countries. Cancer epidemiology is a meticulous field of study, where flashy findings are heavily critiqued, and effects may take decades and millions of participants to best measure and describe. Regardless, I’ve been so inspired by my colleagues’ dedication to the highest quality study design and analysis. Our population’s health depends on it.

Do you plan to stay in Oxford after residency? Any future projects you will be working on after residency?

Oxford has been absolutely lovely, but I’m looking forward to being home again. I cannot yet confirm my staff position, but I am hoping to decide on a community hospital with academic opportunities to mentor medical students and residents while still maintaining the breadth of general surgery I love. The first couple years of staff life will be focused on finding the elusive balance of clinic/endoscopy/OR time, call coverage, and being a good partner and mother. But I hope to apply my MSc in building a prospective regional surgical outcomes dataset to better target health policies to the Canadians we serve. My lifetime career dream would be to honour my family’s legacy and return to my mother’s homeland of Somalia to work with an organization like Médecins Sans Frontières with a knowledge base and ethical framework to contribute meaningfully to international surgical collaboratives. And somewhere, write a children’s book. Stay tuned!