Interview with Tamzin Cuming WinS Chair

Can you briefly outline your surgical career so far?

'I chose surgery back in the 90s when I thought it was the hardest to get into. I liked both medicine and surgery, but I thought I would try surgery first. I followed my senior registrar from my houseman job down to Brighton for my CT training. I had a lot of fun, and really enjoyed general surgery, paediatric surgery and urology.

'I then did my FRCS and passed it during a year out. I also did a locum job in Urology for three months and found I preferred general surgery. I then did some travelling and returned to a further locum position. Following this, I got my training number at the end of my year “out”. I moved to Hastings to complete a breast/endocrine/vascular job, and during this, found out I was pregnant (which hadn’t been the original plan!). After having my baby, I returned after only four months, with my partner also changing his job location. It ended up being more complicated, with the hospital nursery shutting often before my shift had finished. My colleagues would sometimes have to mind my baby whilst I finished up at work, which was obviously stressful and not sustainable, and at the same time my baby started losing weight. This pushed me to decide I needed to go less than full time, which was unusual in 2001. I ended up in a previously unappointed post which wasn’t my preferred specialty. It was poorly organised and I ended up working more than my contracted hours, and my baby continued to lose weight. I then made the decision to leave medicine. I had not received much support or advice regarding my situation and felt it wasn’t sustainable.

'I kept my number during my time off and was persuaded to continue doing one day a week which I chose to do at St Mark’s in colorectal for six months. I also managed to find two job-sharing female surgeons who suggested I work for Jenny Ackroyd, which I found revelatory. I had a second child and took a year for maternity leave, this time returning as less than full time from the start. I subsequently moved to a different job which was again poorly organised and unsupported, so I left surgery once again returning to the one day a week job I had done previously. During this I had a further year of maternity leave with my third child. My concern at the time was that I was never going to make it through surgical training. At that time I felt like a half-trained surgeon who was not independent in anything. I therefore dedicated these years to training in endoscopy so I could do that as a staff grade if I had to come out of training.

'A little while after my maternity leave, I re-entered training under Helen Pardoe and Peter Lunniss full time. I managed to find a job share partner at a training day, and together we found a willing consultant to train us both. It was a network of women who helped us find a trainer. The job share was hard work but worked well, and I went on to have another job share partner during the remainder of my training. At that point, the onus was on the trainees to sort, with no help from the training programme.

'I eventually went back full time and completed a fellowship and a masters by 2012. Following a year of locum consultant work, I got my substantive post. My area of subspecialty interest now is in AIN, running the national service out of Homerton.'

What do you love about being a surgeon?

'I don’t want to put people off doing surgery by talking about my experiences! There are plenty of female surgeons from my generation who didn’t have as much trouble as me.

'I think I was determined not to be broken by the system and make it through. There is something completely addictive about surgery. The thing is, I never wanted to do anything else as much as surgery. I didn’t want to be bitter or resentful about doing another specialty as I don’t think that’s a good way to do your job. I had considered medicine, particularly gastro, but the medical training pathway is also hard work, and you miss out on operating. There is something just very satisfying about finding a surgical solution to something, and knowing you can perform it yourself.'

Have you faced difficulties during your career as a female surgeon, because of your gender?

'Yes! Although how much of that was linked to being a mother, I’m not sure. In the 90s prior to children, I was 1 of 4 female SHOs, and a consultant remarked that he would not want all women again as we were so much more hard work. It was the first time I viewed myself as different to just a surgical trainee. I had not noticed our gender, but he clearly had. I have also heard other comments about female trainees just ending up having babies. Children are hard work, and parenthood requires an element of juggling, but it needn’t mean the end of your surgical career. Working for Jenny Ackroyd was the first time I didn’t feel like I was having to fight in my job to get enough training and be taken seriously.'

What do you think is the biggest difficulty facing female surgeons or trainees today?

'I think the difficulty which seems to affect women more than men is establishing a work-life balance, particularly women with children. For example, you may have to spend longer training because of having children and going on maternity leave, and therefore you reach your consultant career later. You may be less likely to have a research degree for example, and less likely to become a professor or follow an academic path, because of the extra time it takes to get into these fields on top of your existing day-to-day work. But this doesn’t explain why there also seem to be these barriers for women without kids. Again, this has a knock-on effect of not enough female surgeons at the top of surgical organisations or research fields which is off-putting to more junior female trainees.

When did you first get involved with WinS, and what attracted you to the group?

'The second time I left surgery and returned, I went to work for Helen Pardoe at Homerton, and I was complaining about how hard it was to find less than full time job and how difficult it was to work with small children and that I feared I wouldn’t finish training. She had seen an advert for a flexible training rep with WinS, as she was part of it, and suggested I apply for it. I got the position in 2007 and stayed with the committee for five years until I was a consultant. I demitted from the forum on becoming a consultant and I had this idea that things had improved for women at that point. There seemed to be an absence of sexist remarks at work, and female trainees seemed to be getting good training. Because I was known to WinS, they approached me to take part in an “Inspire the Future” charity advert, which I agreed to. This was used in gender bias training and went viral at the time. I then presented it at the ACPGBI meeting and following this, I was asked to chair the task force in equality, diversity and inclusivity which I did for a year until a chair was elected. During my tenure in this role, we conducted focus groups across the ACPGBI, and I was appalled at what I heard, not just from women but across the board. There was discriminatory behaviour happening still. I realised that the reason I thought things were better for women, was that I had been the consultant in theatre. This is what spurred me to apply for chair of WinS.'

What are your plans for WinS in the future?

'I am very aware that I have some illustrious predecessors who have achieved incredible things with WinS. I want to try and tackle why some women do not want to interact with the WinS group, and I would like us to be as relevant as possible to people of all genders. Knowing that one of the reasons I am still working within surgery is the camaraderie I have felt from both female and male colleagues along the way, I think we can provide this for each other through WinS regardless of gender.

'There are still issues with how women appear in surgery, with younger trainees being put off by small behaviours they come across, for example, men thoughtlessly dropping comments about women in surgery, and not seeing enough women high up in consultant and leadership roles. Therefore, I think there is still work to be done to achieve equity. This is also important for our patients, who should have the opportunity to seek care from surgeons of all genders.

'In the short term, I am excited to host our open theatre at the Future Surgery show this November, which is free for RCS England members to attend. This will be in place of our own WinS conference, which will return next year. We will be running sessions there which will be relevant to everyone, regardless of gender and training stage.

'I also want to do more work relevant to all women, regardless of whether they have children, as I am aware that female surgeons without children can feel that we are less applicable to them. In addition to this, we will of course still have an important focus on parenthood.

'Across my tenure, longer term, I want to do some research into the reasons women leave surgery, and also the reasons for and against women choosing surgery in the first place. I feel we are not getting enough medical students and foundation doctors into theatre to inspire them in the first place.

'Essentially, I want us to be an access point for support to anyone struggling, so we can keep more women in surgery, but also be outward looking and inspiring to get women to feel that surgery should be no different for them than for men.'

Any words of advice for female trainees or students considering a career in surgery?

'I would like to encourage all female trainees and students considering surgery, to do surgery! There is nothing that is “instead of” surgery. Keep your options regarding specialty open, and do not feel pressured to go into a supposedly “female friendly” specialty because of the lifestyle. You have to love what you do to make it worthwhile. Don’t give up something you love, there is no reason why you can’t be anything you want to be."