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National Careers Week 2019

National Careers Week is a celebration of careers guidance and free resources in education across the UK. After the success of our 2018 National Careers Week campaign, we've decided to take part again, with more great content. Join us between 4 – 9 March as we showcase a career in surgery, providing you with hints, tips and guidance as well as profiling surgeons as part of our Humans of Surgery campaign. 

Students and early years trainees regularly tell us that they are inspired by glimpses into the 'everyday' reality of surgery. This year, we are working with our members to showcase the real people working within surgery, and promoting the full breadth of rewarding careers available. If you are a surgeon, surgeon in training, or part of the surgical care team, you can get involved with our Twitter campaign, Humans of Surgery.

 

Ambika Chadha: Specialty Trainee in Oral & Maxillofacial Surgery

I remember the exact moment I decided to pursue a career as a cleft surgeon: I was 21, studying medicine at Oxford University and assisting in the theatre of an eminent cleft surgeon. As I observed him meticulously restore the facial anatomy of a baby born with a cleft lip, I contended with the complex aesthetic, functional and psychological consequences of re-establishing facial integrity and knew that this was the varied impact I wished to achieve in my career. Not long afterwards, I undertook my elective placement in South America with a charity mission specialising in cleft lip and palate. I felt a tangible energy and unified sense of purpose from the nationally-diverse, multidisciplinary team that would see me participating in such missions on an annual basis throughout my training. With each mission, my experiences remained permanently imprinted by the humbling resilience of patients and by the bonds that transform strangers into lifelong colleagues.

As a surgical trainee, I had to decide which specialty to pursue in order to train in cleft surgery. After an inspiring post in oral and maxillofacial surgery (OMFS), I determined that OMFS was the route for me given its breadth of training focussed on the face. I then became enrolled in the first cohort of the Dental Programme for Medical Graduates at King’s College London, during which I gained a comprehensive understanding of the relationship between intraoral and extraoral pathology. I subsequently gained a place on the Pan Thames higher specialist OMFS training scheme and was actively encouraged to cultivate my academic aspirations. After being mentored by another cleft surgeon who taught me to question seemingly established cleft surgical practices, I started a clinical PhD under his supervision midway through higher surgical training. This research was generously supported by both the RCS Surgical Research Fellowship and the RCS Dental Research fellowship – and logistically – by my Training Programme Director when I proceeded to have three daughters in the space of four years! 

The significant challenges I have faced in combining motherhood, surgery and academia have developed my resilience and resourcefulness over the years Through shared experiences, I have benefitted immensely from the supportive networks of Women in Surgery (WinS) and the Society for Women in Maxillofacial Surgery (SWiMS). Only now as I write up my PhD thesis as a senior trainee am I able to appreciate fully that optimal work–life balance is a work in progress. Moreover, I have learned that surgical training need not be a direct journey, but one that you can adapt to your personal and professional goals – whilst still maintaining your destination.

Vejay Vakharia: Specialty Trainee in Neurosurgery

I was interested in neurosurgery as a medical student. One day, I pitched up to the theatre at Addenbrooke’s Hospital in Cambridge and told them I would like to know more about the specialty. Before I knew it, I was observing treatment of an aneurysm, which is an out-pouching of a blood vessel in the brain. The surgeon was planning to place a metal clip across the neck of it to prevent it from bleeding again. The excitement, the high-risk nature and the immediacy of the task ahead had me hooked.

That was the beginning of my career, when I decided neurosurgery was my specialty of choice. As a medical student, I tried to align my CV and experience with neurosurgery so that I could improve my chances at national selection. If I were to start my career all over again, I would try and get as much exposure to as many different specialties as possible. That way, you can find the one that best suits your skills and personality and begin to align yourself to achieving the factors that you need.

As I progressed through my training, I learnt more about how technology is integral to modern surgery and I realised how interested I was in these advances. I wanted to marry that interest with my passion for robotics, to discover whether they could make a significant impact to a patient’s treatment. My work has now included translation of software for computer–assisted planning, helping us to calculate the safest trajectory when targeting different locations in the brain. This software enables us to treat patients with conditions like epilepsy more safely and much more quickly. It’s a very good feeling to know that these technological developments are ultimately improving patient care.

I’ve come to realise through my work that advancements in surgery don’t just come from medics, and it’s not all about blood and gore. I hear people say, ‘how could you operate on someone’s brain, aren’t you scared of damaging them?’ And I say, ‘surgery isn’t like what it was 50 years ago, it is much more refined’. We can now do complicated things in a minimally invasive fashion. Students can bring different degrees and skills into medicine to help diversify the specialty and improve our understanding. Surgeons couldn’t make these advances without collaborating with specialists like engineers and other scientists. We have to work together with a broad range of professionals in order to improve care. It used to concern me when I was a student that surgery could make people worse. Now I know, surgery can have complications and things can go wrong, but the aim is to do your best to alleviate pain and suffering.
 

Nicholas Alexander: Consultant Paediatric Surgeon

As a consultant paediatric surgeon, I am part of a big children’s service (we refer to ourselves as a family) at Imperial College NHS Trust looking after infants, children and teenagers. My work is sometimes very straightforward, such as a curative pyloromyotomy operation in a baby with pyloric stenosis (when the muscle that opens and closes to allow food to pass through the stomach becomes enlarged and begins to block food). 

More often, it is complicated and complex, caring for chronic incurable conditions. For these patients there is often no right or wrong plan, and you just find what works best for that individual. But you do this as part of a team, forming tight relationships with the family you are caring for. There isn’t just one patient – the parents and siblings are every bit as important.

Every day as a team we make decisions, which are never black and white. You never hear about that at medical school or in textbooks, and the uncertainty is sometimes difficult to reconcile – as a profession aren’t we supposed to know what is best? But that honesty and investment creates a therapeutic relationship with families, which is at the heart of good care.

Some days I think I am good at my job and other days that I am not good enough. That is part of being a surgeon. I don’t really have strong memories of successful operations, but I always remember the name of every baby and child who I have looked after who died. They stay with me forever.

I love my job for all its imperfections, for the friends and colleagues I work with, but most of all for the little people whom I get to look after on a daily basis. It is a privilege to be a consultant surgeon, and it is our responsibility to drive our practice to a patient-centred NHS.

Meera Joshi: Specialty Trainee and Clinical Research Fellow

My father had a renal transplant when I was 12 and I was able to witness what a transformation surgery could make to the lives of our whole family. This is when the first seeds of pursuing a career in surgery were planted. I gained as much exposure to medicine and surgery as possible while at school through work experience, volunteering in hospitals and researching relevant literature. Throughout medical school and during my junior doctor placements it was clear that surgery was the specialty for me. I was excited and scared by it all at the same time. Fortunately, I had the right mentorship and support along the way which has led me to where I am today, an ST5 surgical registrar, pursuing a PhD at Imperial College under the guidance of Professor Ara Darzi. 

It is fairly common that surgical trainees pursue a further degree such as an MD or PhD. Surgery is always adapting and evolving with much of this occurring through the latest research and technologies. Breaking huge research questions into bite sized pieces is often the way forward. A typical day for a research fellow can be varied, including teaching, recruiting patients into trials, laboratory based work, studying and balancing clinical commitments too. What is great about surgery is that every day is different. The days can be long, recruiting patients for studies in the day and on–call clinical commitments at night. However, knowing that we are contributing even a small amount can be incredibly rewarding. 

My advice for anyone wishing to pursue surgery is to spend as much time as possible shadowing, observing and following surgeons to understand what the specialty is really about. As a doctor it is important to take time with your patients – those extra few minutes can make all the difference to an individual and their family.

Surgery will require dedication. The hours are long and it can be both physically and emotionally draining. I have found keeping in touch with peers, trainers and mentors really useful as they can be a great sounding board when facing challenges as well as a source of inspiration.  

I feel privileged to be a surgeon. It was not until the late 19th century that women were allowed into medical school. Today, more than 50% of medical students are female.  I find surgery to be hugely rewarding, fulfilling and incredibly enjoyable. The key for any chosen specialty is that one must enjoy it. I love being part of a bigger team with the common goal of helping patients. What inspires me? My patients, peers, lifelong learning, pioneering research opportunities and meeting incredible mentors along the way.

Morgan McMonagle: Consultant in Trauma and Vascular Surgery

On 22 March 2017, a terrorist mounted the pavement of Westminster Bridge, hitting a number of pedestrians before making it on foot to the Houses of Parliament. More than 50 people were injured and six people killed that day, including the terrorist. Three miles away, Morgan McMonagle was the trauma consultant on call at St Mary’s Hospital, the receiving hospital for the incident.

It was a very quiet day. I was sitting on the trauma ward writing another chapter for my trauma book, Trauma: Code Red, when I noticed the BBC news alert on my phone. Within two minutes we had received the call confirming a major incident in central London. Downstairs in A&E, there was the same controlled confusion that often arises when a major incident may be declared. Minutes can often feel like hours. When we finally heard there had been a terrorist attack, we didn’t know much more. Within 40 minutes we had 8 casualties and numerous armed police in the hospital.

We are always prepared for any major trauma, as we have a well-tuned trauma response team in addition to mass casualty preparedness programmes – but you can never feel totally prepared for an event filled with unknowns. An attack like this is different to a typical major trauma and that feeling of the unknown creeps in. We didn’t know if another attack was planned, the potential numbers of those injured or if others were coordinating.

As with any major incident, there is a fight or flight response, but this is controlled when professionally trained. The adrenaline kicks in, and whether the casualty is the attacker or not, I am ethically obliged to treat. On this day, however, the attacker was brought in among the injured and I pronounced him dead almost immediately. There wasn’t much time to consider this further, as five bays were now taken by severely injured casualties and the teams caring for them. Those who needed surgery were taken upstairs to theatre so we could operate immediately and time began to move very quickly.

Returning home after a day in trauma is a bit like coming out of a major rock concert. You’re running on adrenaline for a number of hours and suddenly the curtain is drawn. Then there is this period of overwhelming fatigue. When you’re feeling that emotional slump, as I did with Grenfell, when there was so little I could do for so many, there is nothing more important than the support of your peers. Your family and friends do support you, but an important part of the healing process is the shared experience you have with your colleagues. You need to maintain your comradery when you are in battlefields like this. Even when there is only one victim. It also makes you more prepared to deal with a major incident. 

When you look back, do you have that sense of achievement that you did your best? If the answer to that is yes, you can allow yourself a comfort in that. We worked together to the best of our ability, to deliver the best care, and that is all that we can do.

My advice for any trainee surgeon is to get broad experience across all areas of surgery, including elective operating, as well as trauma and emergency surgery. Then, when you do experience tragedies like this, whether you are a foundation doctor or trainee, you have a wide range of experience to call upon. As you progress in your career, handling major incidents like this becomes easier. The difference between an amateur and a professional is that a professional will make judgements based on training and experience rather than emotion. They will be guided by their experience and skills. We still have empathy and a personal opinion, but it will be contained, and should not interfere with best practice. We do our duty as the surgeon. 

Networking is also important throughout your training, and building rapport with patients and colleagues alike. Through my networks I was able to call a surgeon friend in Utah ahead of one of the Westminster Attack victims returning home. I had trained with him in trauma in Philadelphia, and this connection meant that I could call him directly ahead of time to explain the situation. This created another special bond and solidified the holistic experience.

You also need to build a rapport with your patients. We became part of the shared experience of the victims from Westminster, and they a part of ours. There is an indescribable and undefinable connection between groups of people bonded by a shared experience, especially one so emotionally charged. An unspoken bond. We use these bonds to help us heal and to start the next day, whatever it may bring.
 

How to get involved

  • Use the hashtags #HumansOfSurgery and #NCW2019 and tag us @RCSnews
  • Include photos that show you in your work environment
  • Encourage your colleagues to join the campaign!

Guidance

  • Always ask permission from anyone who appears in any photos you take.
  • Do not share pictures of patients or operations without the patient's permission.
  • Think before you post. Be mindful that your tweets are public, and how you could be perceived by others. 

When using the hashtag #HumansOfSurgery please be aware that the RCS may retweet or re-distribute your story via our own networks.

Webinar: Making the most of your surgical placement

It is important to take advantage of the learning opportunities available to you throughout your medical career. It is important to make the most of your surgical placement, as this experience will provide you with exposure to surgery and the day-to-day responsibilities of the different roles within the surgical team.

If you are a medical student or foundation trainee considering your surgical placement, join our next webinar, Making the most of your surgical placement, on Thursday 7 March at 6.30pm. Sessions will include advice on:

  • gaining a full understanding of the learning opportunities available to you on your placement
  • the importance of showing your willingness to learn and become involved as part of the team
  • personal experiences from the panel, including guidance from vascular and general consultant, Stella Vig

The session will also include an invaluable Q&A and is FREE for RCS affiliate members. 

Affiliate Membership

Thinking of becoming a surgeon? There’s no better time to become an affiliate member of the Royal College of Surgeons. For only £15 a year, you can access advice, resources and opportunities to help you stand out from the crowd. Find out more about becoming an affiliate member.

How surgeons can get involved

If you are an established surgeon, help us to inspire the next generation by tweeting about your career and specialty during National Careers Week using the hashtags #NCW2019 and #CareersInSurgery. If you want to share your story as part of our Humans of Surgery campaign, you can get involved with #HumansOfSurgery

Follow us

Don't miss out on events, information and early bird offers! Follow us on Facebook and Twitter and remember to use the hashtags #NCW2019 #CareersInSurgery #HumansOfSurgery

National Careers Week 2018

Want to see what we got up to last year? Watch our Facebook Live interviews with seven surgeons from a number of different specialties.

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