“Once you determine your goal and work hard towards that goal, you will achieve it.” – Kamal M.F. Itani, MD, FACS
In this inaugural My Life My Story article, we are honored to interview Dr. Kamal M.F. Itani, the Chief of Surgery at the VA Boston Healthcare System.
Biographic summary
Dr. Kamal M.F. Itani is a world renown surgeon and researcher. He is the Chief of Surgery at the VA Boston Healthcare System, a Professor of Surgery at the Boston University Chobanian & Avedisian School of Medicine, and a faculty member at Harvard Medical School.
Dr. Itani obtained his medical degree from the American University of Beirut prior to moving to the US where he completed his surgical residency training at the Baylor College of Medicine and his research fellowship in the Department of Surgery at Duke University.
Prior to his move to Boston, Dr. Itani served as the Chief of General Surgery at the Houston VA Medical Center and the Assistant Dean for Graduate Medical Education at the Baylor College of Medicine.
Dr. Itani is a leader in surgical infections and abdominal wall reconstruction with a research focus on improvement of health services and surgical outcomes. He has served in numerous national and international professional leadership roles, including President of the Association of VA Surgeons, President of the Surgical Infection Society, Chair of the Surgical Quality Data Use group of the VA Surgical Quality Improvement Program (VASQIP), and Chair of the Research Committee of the American College of Surgeons (ACS). He is currently a governor of the American Hernia Society, a council member of the Massachusetts chapter of the ACS, and a member of the editorial board of JAMA Surgery and Surgical Infection.
Throughout his career, he has distinguished himself as an exceptional surgeon, researcher, educator, mentor, leader, and innovator. His prolific clinical, education, and research work has been recognized in hundreds of scientific presentations, peer-reviewed publications, book chapters, as well as numerous national and international awards.
Interview
Q: Could we start with your background and early education?
A: I was born and grew up in Beirut, Lebanon. My formative years were in French schools, and I always thought that I would continue my studies within the French system. Many Lebanese people are trilingual, and I am one of them. When it was time for college, I had a long conversation with my father who was an architect graduate of the University of Michigan about the pros and cons of the American vs. French system. In Lebanon, we also had among many others, the American University of Beirut (AUB) which is well known around the world, and which has a lot of outstanding graduates in all fields all over the world. I was fortunate to be accepted at AUB. My undergraduate degree was in Biology Chemistry followed by Medical School at the same institution.
Q: What has been your career and life journey from Lebanon to the United States?
A: As an International Medical Graduate (IMG) from AUB, my journey from medical school in Lebanon to my current position has been a struggle similar to the struggles any IMG would have encountered. I have had the good fortune during this journey to meet individuals who believed in me, who supported me, and made my dream a reality. If you are interested, I refer you to my presidential address of the Association of VA Surgeons which goes into the details of those struggles.1
My first rotation in medical school was internal medicine. I had great teachers and role models during that rotation who inspired me to decide, initially, to go into internal medicine. My second rotation was pediatrics, and I did not enjoy it as much. My third rotation was cardiac surgery, and I loved cardiac surgery and decided at that point that I wanted to be a cardiac surgeon. I never changed my mind, until I did my elective rotations in general surgery at the Massachusetts General Hospital in Boston. During these electives, I discovered the full spectrum of general surgery, loved it, and decided that I was going to apply to general surgery residency.
During my Massachusetts General Hospital rotation as an elective student from AUB, I was assigned to Dr Andrew Warshaw. He was doing a lot of pancreaticoduodenectomies using the pylorus-preserving modification, and those patients took forever to recover, mostly because of delayed gastric emptying. I was fascinated that despite a more physiologic operation than the more traditional pancreaticoduodenectomy, which entails an antrectomy, patients were having gastric emptying problems. When I asked Dr. Warshaw about it, he gave me the draft of a paper he was working on describing the delayed gastric emptying after pylorus-preserving pancreaticoduodenectomies and hypothesizing in the discussion of his paper about the possibility of a motility or hormonal disturbance. That captured my interest. I started researching the literature and discovered Onye E. Akwari, MD, FACS, at Duke. Dr. Akwari was a well-known general surgeon and gastrointestinal physiologist with a specific research focus on gastrointestinal motility and gastrointestinal hormones. I had studied the topic well before contacting Dr. Akwari and that spiked his interest in me during our telephone conversation. He invited me to visit him at Duke. The rest is history. I ended up spending three of my best years in research working in Dr. Akwari’s lab studying gastrointestinal motility after a pylorus-preserving gastrointestinal construct. You can read about Dr Akwari’s mentorship to me and our relationship in an issue of the Mayo Clinic Alumni Magazine.2
Q: This brings us to the importance of mentorship. What has been the role of mentors in your career?
A: My mentors over the years were Dr. Akwari, whom I mentioned; Shukri Khuri, MD, and William Henderson, PhD, who is a biostatistician. Dr. Khuri and Dr. Henderson started the National Surgical Quality Improvement Program within the Department of Veteran Affairs and disseminated it later to the American College of Surgeons (ACS NSQIP). Unfortunately, both Drs. Akwari and Khuri passed away. They were giants in surgery and their passing was a major loss to surgery in particular and to medicine in general. I also became involved in clinical trials, and Dr. Henderson was my mentor in this field. Together, we became the Co-Chairs of the ACS Clinical Trials Course, which continues to run today in a modified form. Dr. Henderson also provided me and my co-editor, Domenic Reda, PhD (one of Dr.Henderson’s mentees), tremendous advice and wisdom when we were writing our book on clinical trials design in surgery. Even at this stage of my career, I do not have the answers to many research, clinical, or administrative challenges, and I do not hesitate to call on one of my colleagues or previous teachers for advice on any difficult issue.
Q: When looking back, what were your characteristics that contributed to your great success in clinical work, research, education as well as leadership?
A: In a few words: patience, perseverance, motivation and ambition. I, like most IMGs, had setbacks along the way. Reaching a goal whether it is a research position, a residency or fellowship position, first faculty position were all fraught with setbacks and disappointments. Diversity, Equity and inclusion were almost nonexistent during my time as a trainee and faculty. It just took a lot of patience, perseverance, and resilience with the ability to re-tool every time. I learnt very quickly that working 10 times harder than any non-IMG graduate and showing results is key to success. As I mentioned above, working with the right mentors who believed in me was also critical. I never lost focus of my goal to become an academic surgeon. My research at Duke was very successful and in 3 years, I was the only research fellow at Duke who presented 3 times in a row at the Surgical forum and once at the American Surgical Association (a tremendous feat for a research fellow). For more details about my research interest and success, I refer you to the Bulletin of the American College of surgeons where I was profiled in 2021.3
I also always had an interest in education and hosted medical students in our lab at Duke. As a resident at Baylor, I became Chair of the Chief Resident Council and gained a seat on the Graduate Medical Education Committee. As a young faculty, I received several teaching awards most notable among them were the Fullbright and Jaworsky awards in teaching and evaluation, and a second one in leadership in education. I subsequently became the Assistant Dean for Graduate Medical education at Baylor College of Medicine and was in charge of the midterm reviews of all ACGME accredited programs and non-ACGME board certified programs. I was placed in charge of implementing the core competencies and the new resident work hour rules across all programs and departments. I was very successful in all the projects and was elected Chair of the Academy of Distinguished Educators at Baylor. I unfortunately never assumed that role as I moved to Boston around the same time. At the VA in Boston, with the merger of several facilities, I had to integrate the residency programs of 2 affiliated institutions under one roof. This was not a simple task with strong feelings among the chairs and program directors of both institutions. We ultimately were very successful and this model was replicated by many other VA programs in the country.
I ascribe my clinical success to the outstanding training I received at Baylor College of Medicine. Dr. Michael DeBakey, who was Chair of Surgery at Baylor, ran a very rigorous surgery training and made sure that all trainees, including the ones going into the surgical subspecialties, are all outstanding general surgeons with the ability to perform vascular and general thoracic surgery. I did a fellowship in Advanced Gastrointestinal Surgery but during my first few years as a general surgeon, I performed as many vascular and thoracic surgery as any busy surgeon in those specialties. This is why I continue to feel very comfortable in any of those areas.
Q: As an IMG myself, I would like to congratulate you on your absolutely amazing career and tremendous achievements. You have lived through different healthcare and educational systems, as well as different societal cultures and expectations. Would love to know your perspective on how this influenced your life and career and if you have any advice for students and trainees that are aspiring to embark in a surgical career abroad?
A: You should never be ashamed of who you are and of your background. Be proud of who you are. We have an advantage over non-IMGs in that we are multicultural and most of the time bilingual or trilingual. Our diversity as IMGs brings a unique dimension to any training program. For example, it was not uncommon for me to be assigned at Baylor or during my rotations at MD Anderson to the Arabic speaking patients who were referred for very complex surgical problems at these institutions. In an era where we now value equity, diversity and inclusion, we have the opportunity to have a prime seat. We are not there yet but we can learn from other groups like women in surgery who led the way and are achieving tremendous success in surgery.
Q: Any perspective on giving back and staying connected to your country of origin and your community in terms of clinical, research, and teaching expertise?
A: I have never lost sight of Lebanon and the American University of Beirut. I have helped countless graduates from AUB and other universities around the world by having them in research positions with me or as a mentor to them. I have been recruited to many prominent positions in the Middle East but decided to stay in my current position which I love and enjoy. I have also contributed in my role as secretary and member of the executive committee of the Arab American Medical Association, President of its Houston chapter, President of the Surgical Alumni Association of AUB and President of the New England Chapter of the AUB Alumni Association of North America. In this last role, I was able to raise enough funds for an AUB scholarship for many years to come.
Q: Are there other important perspectives that you would like to share with our readers?
A: Many of us have been very successful wherever we have been. You do not have to train in the US or work in the US to become successful. Once you determine your goal and work hard towards that goal you will achieve it. I cannot but think of all the amazing international surgeons who have been recognized as honorary fellows of the American College of Surgeons and American Surgical Association. As you move along the way in your career, do not forget to mentor and help those who come and seek your assistance. They need guidance and will be successful if you help them and guide them.