Joshua Vorstenbosch

Introduction: Surgical training, historically characterized by long hours, hierarchical culture, and critical feedback, has been associated with burnout and mental health challenges. Reforms, including duty-hour limits, competency-based education, and initiatives promoting wellness, equity, and psychological safety, have begun reshaping training in Canada. This review provides a national overview of these cultural shifts, mapping recommendations for best practices and research. Design: A systematic review identified studies on Canadian surgical residency culture. Two reviewers independently screened and extracted data, with risk of bias (ROB) assessed. Results: Twenty-one studies were included. Key themes were wellness and mental health (19 studies), feedback and learning environments (20), evolving surgical culture (17), equity, diversity, and inclusion (12), duty-hour reforms (14), and international transferability (8). ROB was low in 44.00%, medium in 36.00%, and high in 20.00% of studies. Discussion: This review of 25 studies highlights evolving themes in Canadian surgical training culture. Traditional endurance-based models are shifting toward inclusivity, wellness, and equity, with increasing attention to mental health, mentorship, and structured feedback. Duty-hour reforms, parental leave policies, and competency-based initiatives indicate generational and structural changes, though implementation varies across programs. Studies emphasize culturally responsive mentorship, psychological safety, and systemic supports to improve learning environments. While Canadian experiences provide valuable insights, differences in legal, institutional, and cultural contexts limit direct transferability internationally. Recommendations include implementing fatigue management plans, mentorship, simulation-based learning, and national coordination to foster a sustainable, learner-centered surgical culture. Conclusion: Canadian surgical training is evolving through duty-hour reforms, wellness initiatives, and equity-focused policies. While progress has been made, challenges remain in mentorship and cross-provincial consistency.

Common polymeric surgical biomaterials are susceptible to dysregulated fibrous encapsulation, which contributes to failure in 10% of implantable medical devices. While biomaterial factors influencing the underlying foreign body response have been extensively studied, the role of the implantation site—specifically the tissue microenvironment—remains poorly understood. Here, we explore the tissue‐specificity of the foreign body response by evaluating fibrous encapsulation around clinically‐relevant synthetic non‐biodegradable polymers across distinct tissue microenvironments. We first characterize the physicochemical properties of PDMS, PP, PTFE, HDPE and nylon, and develop a mouse model that enables direct within‐animal comparisons of fibrous capsule formation next to skin, bone, fat, fascia and muscle. Using this model and these biomaterials, we histologically assess the extent and quality of fibrous encapsulation at 7 and 28 days for all biomaterial‐tissue combinations. At 7 days, capsules adjacent to muscle are the thickest, but—at 28 days—capsules in contact with bone and fascia reach comparable thicknesses, which are significantly greater than those of capsules adjacent to skin. Although PTFE and nylon elicit less fibrous encapsulation at 28 days than some of the other biomaterials, adjacent tissue type has a substantially greater influence on fibrous encapsulation than stiffness, roughness or wettability. Interestingly, more vascularized tissues (i.e., skin and muscle) do not show significant differences in capsule thickness over time, suggesting that they may promote a more rapid initiation and stabilization of the foreign body response. Together, these findings identify adjacent tissue type as a dominant predictor of fibrous encapsulation for common polymeric surgical biomaterials.

Psoriasis is a chronic immune-mediated inflammatory skin disease characterized by excessive keratinocyte proliferation, immune cell infiltration and dysregulated inflammatory signaling. Despite the availability of biologic therapies targeting inflammatory cytokines, many patients experience incomplete responses or relapse, highlighting the need to better understand molecular regulators of cutaneous inflammation. CD109 is a glycosylphosphatidylinositol (GPI)-anchored protein previously identified by our lab as a co-receptor and negative regulator of Transforming Growth Factor-β (TGF-β) signaling that inhibits fibrotic responses. Emerging evidence suggests that CD109 also modulates immune and inflammatory pathways. In this study, we investigated whether epidermal CD109 overexpression influences cutaneous inflammatory responses. Transgenic (TG) mice overexpressing CD109 under the keratin-14 (K14) promoter were used to restrict transgene expression to the epidermis. TG and wild-type (WT) littermates were subjected to lipopolysaccharide (LPS)-induced skin inflammation. CD109 TG mice exhibited significantly reduced immune cell recruitment, including macrophages and neutrophils, along with decreased expression of the pro-inflammatory mediators IL-1α and MCP-1/CCL2 compared with WT mice. Transcriptomic analysis of primary keratinocytes revealed downregulation of multiple inflammatory signaling pathways in CD109-overexpressing cells, including TNF-α/NF-κB, IL-2/STAT5, IFN-γ, IFN-α, and IL-6/JAK/STAT3 pathways. Together, these findings demonstrate that epidermal CD109 overexpression attenuates cutaneous inflammatory responses by suppressing key inflammatory signaling networks and limiting immune cell recruitment, suggesting that CD109 may represent an important regulator of inflammatory signaling in the skin and a potential target for inflammatory skin diseases such as psoriasis.

Silicone – namely polydimethylsiloxane (PDMS) – is a widely recognized elastomeric biomaterial commonly used in implantable medical devices such as breast implants, cardiac pacemakers and drug delivery devices. Despite its widespread use, PDMS can elicit a strong foreign body response with fibrous encapsulation that leads to discomfort, pain and implantable device failure in approximately 10% of cases. Poly (styrene- block -isobutylene- block -styrene) (SIBS) is a thermoplastic elastomer used clinically as a drug-eluting coating for coronary stents and experimentally in ocular drainage devices. Although SIBS has demonstrated excellent biocompatibility in these applications, the foreign body response it elicits has not yet been extensively studied in more inflammation-prone anatomic sites such as skin rich in macrophages and fibroblasts. Here, we characterize the physicochemical properties of SIBS, examine its effect on macrophage-fibroblast interactions and evaluate its biocompatibility by implanting it subcutaneously in mice to ultimately assess its viability as a potential alternative to PDMS. We establish that both materials have comparable physicochemical properties, demonstrate that fibroblasts adopt a less contractile pro-inflammatory phenotype when exposed to SIBS-macrophage conditioned media and show reduced fibrotic encapsulation around SIBS implants in mice. These results suggest that SIBS could potentially be a favorable biomaterial alternative to silicone in clinical applications.