Dr. Sophocles Voineskos joined the faculty of the Department of Surgery at McMaster University this past November. No stranger to the University — he completed his MD, his Masters, and his residency here — Dr. Voineskos has fit right in with his plastic surgery colleagues and has been a driving force behind our Department-wide mandate of keeping McMaster at the international forefront of surgical research. Here, we sit down with Dr. Voineskos to discuss his career as a surgical researcher, the people who have inspired him to pursue a life in research, and his upcoming research projects.
Interview by Blake Dillon, Communications Coordinator.
Discuss your path to plastic surgery. At what point did you decide to pursue a career like this? Talk about your journey to becoming faculty at McMaster.
As a medical student, I was lucky to find great mentors in Dr. Achilles Thoma and Dr. Nick Strumas, who were the Program Chair and Program Director at the time. Their mentorship continued when I entered the plastic surgery residency program here at McMaster. I was so fortunate that they supported and encouraged my interest in the Clinician Investigator Program (CIP) and that I got to be part of the first cohort of the McMaster Surgeon Scientist Program (SSP) lead by Dr. Sheila Singh. The decision to take two years in the middle of residency to do my Master’s degree in the Clinical Epidemiology Department at McMaster was a landmark moment in my career. With Dr. Mohit Bhandari as my thesis supervisor and Dr. Thoma and Dr. Maureen Meade on my thesis committee, I learned a great deal about health research methodology and acquired important clinical research experience that has been invaluable to my career today. Clinically, I was drawn to microsurgery while working with Dr. Bain, Dr. Levis, and Dr. Avram. After residency, I completed my reconstructive surgery fellowship at Memorial Sloan Kettering Cancer Center, which was eye-opening both from a clinical and research point of view. After my fellowship, I was recruited back to McMaster to help expand the breast reconstruction program at St. Joseph’s Hospital with Dr. Mark McRae, and to make contributions to research in our Division and the Department of Surgery.
What are your principal interests as a surgical researcher at McMaster?
The main goal of the specialty of plastic and reconstructive surgery is helping to improve health-related quality of life and patient satisfaction. Historically, these outcomes were viewed as imprecise concepts, and traditionally have not been studied as rigorously as morbidity outcomes or adverse events. I am passionate about Patient Reported Outcome Measures (PROMs), which are tools that offer the opportunity to quantify outcomes such as quality of life and satisfaction from the patient’s perspective that can help guide clinical care. I believe that PROMs should be routinely included in research and clinical care to better understand the effects of surgery from the patient’s perspective.
You mentioned Drs. Thoma and Strumus as mentors, but who else has helped nurture you, from a research perspective, and why were they so impactful?
Including the important individuals mentioned previously, I have had even more mentors that have shaped my career to what it is today. If I had to pick three, I would say Dr. Bhandari, Dr. Andrea Pusic, and the aforementioned Dr. Thoma. Each one of them has been an amazing mentor, and each has had, and continues to have, a major influence on my research career. People who know Dr. Bhandari know that he is always thinking big. He mentors with enthusiasm and consistently makes himself available for his students. He has been incredible at pushing me to the next level, and I feel invigorated and focused after leaving meetings with him. Dr. Andrea Pusic was the external advisor for my Master’s Thesis. She is one of the reasons why I chose to do my fellowship at Memorial Sloan Kettering Cancer Center. Dr. Pusic and her team have developed a set of highly specific PROMs that are used around the world, including the BREAST-Q, a PROM for all types of breast surgery. It is through her that I developed this passion for outcome measurement, and patient-reported outcomes. Dr. Thoma has been my biggest influence. He is an altruistic, reliable, and genuine mentor who will tell me exactly what he’s thinking. He has provided academic opportunities, linked me to excellent mentors (such as Dr. Bhandari and Dr. Pusic), provided resources to optimize my chances of success, and offered advice for both career and personal development. Most impactful by far, and this is not just for me, is that Dr. Thoma is a mentor who always has the best interests of his mentees at heart, and he has been an outstanding mentor for dozens of surgeons like myself.
Of your few-dozen or so PubMed citations, which ones make you most proud?
I would say it would be the two papers resulting from my thesis work, where we analyzed RCTs in plastic surgery that assess surgical interventions. I think an RCT comparing two (or more) surgical interventions faces unique challenges. It is a different animal from a non-surgical intervention. I am proud of them for a number of reasons, but I will give you two. First, it got a conversation started about the conduct of RCTs in our specialty. We highlighted a number of ways to improve methodological steps like randomization, blinding, choosing the right outcome measure, calculating sample size, industry funding, and conflict of interest. Second, I probably learned the most from that project. Not only about the content of the project, but how to manage a research team, a large research project, and how to deal with and learn from failures along the way.
How do you define success in the context of research?
The neatly packaged answer is a clinically meaningful project that improves our patients’ outcomes or lives. But the journey of the research project itself and the people involved are sometimes just as important in the success of the research. The connections and collaborations that start from research build into stronger teams that can accomplish more advanced projects. The junior people who are involved in a project get excited about research and use their skills to impact future patients and tackle more clinical problems — it then grows exponentially in this way. Something that struck me early on when I was doing basic science research was when my supervisor pointed out that useful findings can help not only your own patients, but patients across the province, the country, and even worldwide.
What do you have planned, research-wise, for the next little while?
We have multiple research collaborations now within the Division of Plastic Surgery. We are building our reconstructive surgery database where we are incorporating patient-reported outcomes. A large future project will involve the intersection of mental health, cancer treatment, and cancer defect reconstruction. As a specialty, we are good at the physical aspect of reconstructing an oncologic defect. But there is also a major psychological toll that a cancer diagnosis, cancer treatment, and cancer reconstruction takes, and we need to get better at addressing that. I think the first big step is being able to measure it properly, which will help us understand what interventions can work best for our patients.