How do you become the head of School of Surgery, and what skills do you need to succeed? With Gill Tierney

[00:00:00] Mat: Welcome to Doctors at Work. My name’s Mat Daniel and this podcast is about doctors’ careers. Today, I’m having a conversation with Gill Tierney. She’s the head of the School of Surgery in the East Midlands, an experienced medical educator, and president of the Association of Surgeons of Great Britain and Ireland.

In this episode, we discuss how doctors can get involved in medical education, and how one role leads to another. She highlights the key role that people skills play when it comes to succeeding in non-clinical roles, and I love her top tip to do what gives you pleasure. I hope it’s useful.

Welcome Gill. Tell me a little bit about yourself.

[00:00:49] Gill: Hi Matt. Thanks for this invitation. So, I’m Gill Tierney. I’m head of School of Surgery of the East Midlands. I’m a colorectal surgeon. I work in Derby. And I’m also president of the Association of Surgeons of Great Britain and Ireland. My practice includes elective and emergency.

I do a bit of inflammatory bowel disease and colorectal cancer.

[00:01:12] Mat: Thank you very much. And I invited you today because I was interested in your leadership roles and maybe particularly in relation to training. So, let’s start with head of school of surgery. What’s it like to be head of school of surgery?

[00:01:25] Gill: Thank you. A constant delight. Does that sound sarcastic? No, it’s a good thing. It’s a good thing. So, it’s, I think everybody as they go through a medical career would get a little bit bored just doing the one thing all the time. And there are various sort of professional options that people take.

And I’ve always been very interested in teaching and training. So, they felt like a natural fit. And it feels like halfway through a journey of educational roles. I’m hoping it’s not the end of my educational roles, but it’s definitely not the start. So, I don’t know. I would say to people who were keen on pursuing this sort of approach that perhaps even starting when one is a trainee oneself to teach medical students.

So just if you’re interested in that sort of thing, you can make that part of your normal working week. And certainly, me and a lot of contemporaries back in the 90s did that as part of our jobs, taught the medical students in Nottingham, as it happens on a weekly basis. And that’s really enjoyable. I think you learn as much as you teach really in that kind of role.

And there’s a sort of a natural evolution then to when you become a consultant to carry on that undergraduate teaching, but also you begin to be offered and postgraduate training and teaching roles. And within surgery one would always be a clinical supervisor or an assigned educational supervisor to your surgical trainees.

And also, to your non-surgical trainees who are passing through surgery. I think that’s really useful as well. So, I would always say, take the opportunity to clinically supervise a foundation doctor from a position of being a consultant surgeon, because you will learn lots about the foundation program and what’s expected of them.

And also meet people who are going on to other careers within medicine, which I think is really refreshing and adds to your knowledge as a surgeon, because you can get a bit blinkered. The older you get, the more only surgical you become. I’m also, was an assigned educational supervisor to a core trainee.

And that’s a regular role that sort of recurs with different people. fulfilling that post. And that’s been interesting because you can observe the development of the curriculum and the structure of training at a set grade. You see what was expected of core trainings you may have supervised 10 15 years ago compared to what’s expected of them now.

So, you see the evolution of training roles. Then obviously it’s nice to be supervisor to surgical registrars because that’s more about the nuts and bolts and craft of our specialty or it feels like that to me. So, I think those roles are open to everybody at an early stage of their consultant career.

And then there’s more formal roles within a trust. So, if one is interested in the generic nature of postgraduate education, things like being the Foundation Programme Director or the Deputy Foundation Programme Director are roles that are open within trusts and those are funded roles. I’m conscious I’m just talking here, Matt.

Funded roles with time given to a week to do that sort of thing. And that teaches you a bit about leadership, interaction within the various structures within a trust. And embedding yourself as part of the establishment of a trust. So those roles are useful from that point of view for one’s own professional development as well.

Equally, if you seem very surgical, the college tutor role is a fabulous role. So, these are tripartite appointments within a trust where you represent your trust, your deanery, and the Royal College of Surgeons. Either England or Edinburgh, they have slightly different titles. Most trusts would allocate a resource, a certain amount of pay towards that role.

And the demands on that role come from those three different areas, and that’s quite an interesting challenge. And everybody does those jobs in a slightly different way, with varying degrees of enthusiasm as well. But if you find something that lights your candle, you can really be a fabulous college tutor.

And the minute you start those roles, you then see a little bit more about the structure of the world of postgraduate training. Because I think… People who aren’t involved in that understandably don’t really know much about it, but you begin to see who interacts with who, how money flows to do with training, how you can improve the quality of the trainees’ experience and what you do with those really difficult situations that arise.

So, I would say there’s an actual progression from being a college tutor to considering being a program director and a program director is more specialty specific. You could do it for a core program. I would say core is one of the most difficult programs to be the director for because they’re a very heterogeneous group of trainees all with hugely different career ambitions.

There’s lots of them. They’re in many different hospitals and yeah, they can be quite a challenging group to try and accommodate and give the best training opportunity to. Separate to the core training program directors is the higher surgical training program directors in many ways. That’s a slightly easier role because they’re very specialty specific.

So, an ENT surgeon would be the ENT TPD. And that’s a great role because you get to see people go through that whole journey, that six to 10 year, it’s very flexible these days, program of higher surgical training. And you observe people start as an entry level as an ST3. and finish with their certificate of completion and apply for consultant jobs.

So that’s really rewarding to see people make that journey. And once you’ve done that, and most of these roles, the way the structure is, you’re often offered a second term within that role, if you’re performing and you’re enjoying it, just to keep stability and organisational memory. And once you’ve done those roles for a couple of times, the next logical step really is head of school.

And head of school is a little bit more Not political, but it’s more about people management rather than hands on trainee management. And it’s dealing with fellow consultants, your TPDs, the deanery staff, interacting with the dean quite a lot, and interacting nationally as a group of heads of school, which is hugely valuable.

I would say that’s one of the most productive and informative forums that I take part in. COPS, the Confederation of Postgraduate Schools of Surgery, where there are 11 Heads of School of Surgery, and we meet twice a year and everybody’s facing similar challenges but in different regions of the country and everybody has slightly different ways around and different solutions.

So, I find that a really intellectually stimulating and useful group to engage with. So that’s my short answer to what’s being Head of School.

[00:07:37] Mat: That’s brilliant. If I’m thinking, then… What I’m hearing is that you started with one thing and one thing led to another, you taught medical students and then you were clinical supervisor, educational supervisor, and then things, one thing led to another and here you are now as the head of School of Surgery.

What kind of skills do you have that helped you succeed in all of those roles?

[00:08:02] Gill: So, I think I’d take it back a little bit and say, firstly, what would motivate somebody to do anything? I think you should only do something because you want to do it. So, you should never do anything because it might be more money or power, whatever power is these days, or kudos.

Those are all really bad reasons. You should do what you’re drawn to. And what you like doing because you’ll do it well and then I think if you do something well it’s recognized often. Sometimes it isn’t, but sometimes it is. And then you’re offered more opportunities. So, skills that would draw me to it.

I really enjoy teaching and I think famous last words. I think I’m a good communicator. And. And it definitely gives me pleasure, a hundred percent. So, I think when you’re engaged and stimulated, you give more of yourself. And I have a natural ebullience and quite an informal style. And so then, yeah, I tend to not get offered, but you see what’s available.

I think if you have a passion for something and you want to do it, you’ll do it well, whatever it is.

[00:09:01] Mat: And how did you know that you were passionate about this field?

[00:09:04] Gill: I think there’s a little bit about self-knowledge, isn’t there? I will come away from a teaching session from any group, undergrads or postgrad, on a high.

It makes me happy. And when I look at things that I would have to cut in my job plan to accommodate something else, I’m conscious, note to self, never to cut that bit. Because that bit stimulates part of me that other bits don’t stimulate. So, there’s a bit of selfishness. I like. The feedback I like, groups of learners always say something different or new or you definitely learn from teaching 100%.

And I think it keeps you on your toes and it stops you stagnating because you have different younger inevitably people going through. in this role all the time. I think, what would I say about formal qualifications? I don’t have any. So, I, most surgical trainees of my vintage had to do a higher degree.

So, I have a thesis, but it’s got nothing to do with educational training. It’s a very science, cancer biology kind of thesis. And thereafter I looked at colleagues who did, Masters of Medical Education, those kinds of things. And I think if it’s required for a job that you want, definitely do that kind of thing.

If you’re just doing it to collect badges, I think be really careful about whether it’s for you and what it’s going to add to you. I think ad hoc courses that one might get exposed to along the way are definitely good. If somebody offers you the opportunity to do a module on leadership or a module on educational styles or something, as much for the people you’ll meet who are doing it at the same time as you, as for the content of the module.

So, I think anything where you can meet other enthusiastic human beings with a similar interest is of value, rather than necessarily what title badge or thing you get at the end of it.

[00:10:46] Mat: I hope you’re enjoying the show. If you are, please click subscribe so you will be notified when new episodes come out.

This podcast is part of my mission to help doctors create successful and meaningful careers. You can be part of that mission too by forwarding this show to any one person who you think might benefit from listening. Thank you. Now on with the show. One of the things that I’m interested in is sometimes I have a conversation with new consultants and they’re not sure what to do.

So, did I say I want to do something other than my clinical work? But I’m not sure what to do. I don’t know where to get started. I think for you, obviously, it was easy because you identified this passion. And you follow that. What would you say to people that say, I want to do something, but I’m not quite sure what to do.

[00:11:31] Gill: So, I think that’s fascinating. I think that’s the best thing about that is if somebody has the insight to be asking that question. That’s brilliant. That’s already the first hurdle is overcome. And there’s lots of people who don’t think to ask that question, or I don’t know, wouldn’t know that they should.

I would say from observing. It’s really important in that first bit of your consultant job to bed in and set up your practice and gain a little bit of a reputation and just do the really boring nuts and bolts for a little bit of time. How long that bit of time is will differ for different people.

I think increasingly there’s a little bit of a Not the glumness, that’s the wrong word. The pandemic and the post pandemic aftermath have definitely affected the medical profession at all levels and it’s really important to acknowledge that we still all need to deliver the service that we do. for the population that we do.

We work in a country where our education and our higher education is government funded to a large extent, and we work in a public service. So, no matter who we are, we still have to band haemorrhoids on a wet Wednesday afternoon. That’s because that’s what the public that we serve require doing.

So, everybody’s going to have a mundane aspect to their job. And that’s just necessary. And that’s what pays our salary. And the key is then Once one is established in practice, then thinking, yeah what do I like? And I think it’s one of those self-knowledge things, isn’t it? Writing down activities that make you happy, activities you find interesting, things you absolutely hate, and things that will be a disaster.

And then having the insight to look and my observation of a medical career is you can either be come very into NHS management locally and nationally. Feels a bit of a poison chalice at the moment, difficult, lots of things to impose without necessarily budget control. So that would frustrate me at a local level.

And again, self-knowledge. For any choice you make in life, self-knowledge is really important. So, I know I like to be liked and I like to feel happy. And I don’t mind conflict, as long as that conflict has resolution. And so, I couldn’t be a clinical manager because I would be disliked. My conflict wouldn’t always have resolution and that would make me cry and make me very unhappy.

So, I ruled out that sort of job fairly early on. So, NHS management would be a thing. You can get very into the technicality of your specialty. So certainly, in general surgery at the moment, I think the same in ENT, actually robotics, so if you want to get super into technology, become a preceptor in robotics in a super specialized procedure within your own clinical field and travel around and teach others and give talks and drive forward some very advanced clinical aspect of your job.

That’s the thing that you could do. Education and training, which we’ve touched on. What else do people do? Let me just think. I guess it’s medical politics, so maybe BMA or colleges, those kinds of things. And the specialty organizations, they’re quite rewarding. But I think you must, as I said at the beginning, only do something because you want to do it.

Don’t do it because you think it’s going to get you something else because I was doomed to failure. And don’t do too many other things. And don’t do it too early. Where I’ve seen people come into disaster a bit is being slightly attracted by shiny things, not realizing how much time these things would take, and then ending up in trouble because they’re not able to deliver the nuts and bolts of their job.

So, you always have to be really honest with yourself about what your capabilities are and what the cost to you will be if you’re going to do something extra. So, I would say at the moment, I am absolutely maxed out. I would, I always have to say no to any other opportunity that comes down, no matter how much I like it, because I know it will upset the value of what I contribute and the other things that I do.

And I won’t be able to do it as well as I’d want to do. So be clear with yourself. about giving something up before you start something new, I think as well, so that you don’t deliver patchily and become unreliable. That’s a really bad thing to be.

[00:15:32] Mat: There’s only so much energy and time that any of us have to what we devote to.

And what are the downsides or what are the bad aspects of being head of school of surgery?

[00:15:44] Gill: Oh, so I would say. I think everything is about human factors, any role you do is about how you interact with other humans. So that’s about self-knowledge and then being able to identify what motivates another person and then recognizing how your interaction is going, questioning yourself as to why you might feel a certain way, questioning as to why the other person seems to feel a certain way.

And then trying to reach your mutual common goal. So, there’s tons of psychology in any role that you take, I think. The bad bits of being a head of school are having to say no to people, usually around a budgetary thing. So, some people will have a brilliant idea. for a great thing that would definitely be good, but there won’t be the money to be able to facilitate that properly.

And that must be really frustrating for people to hear. Another bad bit is you really rely on altruism and goodness from the people, even in the roles. Cause we all know the informal roles take up so much more time than the pay and time equivalent that’s given to them. So, it relies on a degree of altruism.

And there comes a point, I think, where perhaps as head of school, you need to be quite strong and go back to the Dean and indeed NHSC and say these people aren’t going to deliver this anymore for this. This is not acceptable. You’re relying on their goodwill too much and that’s not appropriate.

Equally, you need to sometimes say to your TPDs, can you just do this because it’s the right thing to do. And I get that you’ve really delivered and I’m really grateful. And so, it just takes a bit of negotiation and human, human skills, really difficult bits of trainees in difficulty. It’s been quite eye opening to see at the various shades of life carnage that people go through because we’re all just fallible human beings, just because we’re surgeons and surgical trainees doesn’t make us any different to anybody else.

And some people’s lives. Can enter meltdown very easily and you can see how a human can come off the rails. So, it’s nice to be able to help stop that process and offer the support that’s available. But it’s really sad when you see somebody who either didn’t know they could ask or who sought that support and the people they’ve sought it from didn’t know what was available.

So that can be sad and happy all at the same time.

[00:17:57] Mat: Can we talk a little bit about trainees in difficulty?

[00:18:00] Gill: I think that one needs to acknowledge, so here we are as established consultants, so I feel pretty solid. I feel I’ve got a professional reputation. I think bad things can happen, but I feel like I have quite a robust base for dealing with things.

And I’m married, my child has left home, I’ve delivered. Trainees are often not necessarily in an established relationship, so they have the uncertainty and sometimes upset that phase of life can give you, or they have young families come with all sorts of challenges, and then at the same time they’re trying to do professional exams which are expensive and stressful and require and they’re having professional challenges, especially post pandemic about getting the numbers under their belt of things they’re required to do.

I think they feel unappreciated. I think so. If a patient related issue arises for somebody with that slightly less firm foundation professionally, the impact is tremendous. So, I think it’s acknowledging that. And I think also telling some people it’s okay not to continue. I think we’re all medics, we’re all competitive and driven and we all think we’re type A and we have to be this amazing surgeon and sometimes it’s really hard to realize that maybe that’s not for you and maybe it’s okay to say I made a terrible mistake because I was really enthusiastic in my foundation job and I really liked these people but actually I realize now.

It’s not about the job. I just like the people and it’s okay to give somebody permission not to be a surgeon. That’s quite a hard conversation to have.

[00:19:38] Mat: I think you’ve obviously had loads and loads of experience. of trainees. What would be your advice for somebody who’s going through surgical training at the moment or training anywhere in medicine?

[00:19:52] Gill: So, to try and enjoy it, that’s absolutely there was a guy who was a deputy dean when I was in med school and I went to Nottingham and they had alphabetised themes, so theme A, B, C, D and E and he was just saying don’t forget theme F, which is fun. So, I really think everybody thinks they’re on this journey to the goal.

And you have to remember that the journey is life, the experience, we’re not, it’s not all going to be suffer now because it will be all right in a bit. Remember now is now and you are living, and this is your life. So, to try and enjoy it as much as you can to bond with your colleagues. I think cohorts of trainees have been disserviced by the pandemic, that lack of face-to-face meetings where everybody would go to the pub afterwards together or catch up with somebody you hadn’t seen, who didn’t realize was there.

going to be there. I think cross specialty education. We used to have big sessions with anaesthetists and surgeons. That’s so good for just making friendships and building relationships. There’s loads of evidence, isn’t there, about human interaction and relationship forming. So, make, have fun and make friends.

Those would be my two big bits of surgical advice.

[00:20:55] Mat: Now, if I come back to leadership in medical education then. So, I know you talked a lot about your journey. And what advice you would give to people? You started talking about being very clear why you wanted to do it. So why?

Why would somebody want to be involved in medical education?

[00:21:13] Gill: Because it’s one of the most rewarding things you can do. So, I think take it back to when you were a med student. Remember the sessions that really lit your fire. Why would you not want to be giving laps and doing that? It’s not altruism. It’s completely, almost completely selfish because it makes you feel so nice to see people work out an answer for themselves, to see people go from basics to getting, you can watch their faces, that’s, there’s nothing like that, that really gives something to the teacher, I think.

The party answer is you’re making it safer for patients, which is obviously very important. But yeah, there’s nothing nicer to see somebody go from novice to expert. It’s just a great thing. And I think a lot of people just do that on their own, but if you can facilitate and make them feel safe to go on that journey that’s a great thing.

[00:22:02] Mat: I have to say I love the tip that actually just feels good to do it. That’s a, and that, that actually, that would be a really good career mantra for everything that we do, isn’t it? Do what makes you feel good. Absolute. And then maybe my final question then, if you’re thinking about, co consultants or somebody’s thinking about, should I embark on this journey?

Of postgraduate training leadership what would be your top tips for somebody who’s considering that?

[00:22:27] Gill: I think seek out people who do those roles already and speak to them and ask how they got to them, what they found was useful along the way. Look at what’s available in your immediate environment as almost baby steps towards that goal and have no ceiling to your ambition.

So, I think there’s a little bit when we’re younger and perhaps not so established in our careers, we think I could never be whatever anybody can be anything. There is no barrier. And yeah, just do a thing that you want to do for the right reasons. And maybe, along the way, keep a tidy list of stuff you’ve done that feels appropriate, almost reinforcing your professional image.

So, it’s never until one fills in an application form that you realize how much you’ve done. So maybe keeping a little journal note of all the stuff you do, which, we would do for appraisal as consultants, but keeping that kind of professional diary. It’s quite important because then it will also reinforce you if you’re considering I might not be good enough or whatever, you’ll see no, actually you are.

And when a role comes up, always look at the person spec and just check that you will fit the person spec, or you can look like the person spec. So yeah, keep maybe be, I was very unstructured and extremely lucky. And I think maybe nowadays a bit more structure would be helpful.

[00:23:43] Mat: That’s wonderful. Thank you very much, Gill.

[00:23:46] Gill: It’s a pleasure, Mat. Thank you very much.