Fiona Myint is Professor of Surgery at University College London (UCL) and a Consultant Vascular Surgeon at the Royal Free Hospital. In 2017 she established the Surgical Leadership Program with colleagues from Harvard with the specific aim of preparing Consultant Surgeons for leadership roles across the world. Having spent a life-time focusing on surgical training Surgery International met up with her in London to discuss surgery, leadership and life beyond Medicine.
Our appointment has been booked three weeks in advance. In the intervening weeks she has travelled to the West Indies as part of the ACCM to accredit Medical Schools before returning to a busy emergency Vascular on-call week which has seen her return home in the small hours of the morning on three consecutive nights out of seven. At the end of her emergency surgery week she Chairs a number of meetings at the Royal College of Surgeons in England where she is senior Vice-President before rounding up a 15 day period of exams at the Royal College of Surgeons of England as supervising examiner and which has seen over 600 trainee surgeons sit the MRCS examination. We have about an hour before she travels to Manchester to sit as part of a team on a GMC appeals panel. There is a lot to get through so we get started.
Fiona Myint trained at Guy’s Hospital Medical School in London before basic surgical training at St. Bartholomew’s Hospital. Most of her higher surgical training centred around London which has been home for as long as she can remember. During her training she spent some time in research working in the laboratory of Nobel Laureate Professor Sir John Vane. Her field of study (the mechanisms of ischaemia-reperfusion injury) appears to have cemented her aim to pursue vascular surgery as a career.
Was she particularly driven? She thinks not but was very much aware that she had opportunities that were denied her parents (both international medical graduates) and so was keen to avail herself of all those opportunities still denied to many who find themselves working in the UK having qualified abroad. That said it is noteworthy that both of her siblings hold the title Professor and have Chairs in their respective academic fields. If nothing else there appears to be an undeniable familial work ethic.
Was there anyone who stands out as being particularly influential in her training? There were many but the conversation returns to Professor John Wyllie on more than one occasion.
Did she have any particular problems during her training because she was female in a substantially male dominated field? Surprisingly not. But she is quick to acknowledge that she was in many ways an exception to the rule.
‘I was lucky enough to train during a time where team structures were still the norm and I had supportive bosses. We all signed up to an unwritten agreement. You worked hard. You looked after the patients on your ‘firm’ and in return you were trained’. Does she regret the restriction in working hours that resulted in the demise of these traditional structures?
‘Not really. They had to change. Training has had to move away from a process of osmosis which happened over long weekends on-call to a more structured process. The casualty of that change however was in some cases removing that very immediate link between trainer and trainee which was always so important. Responsibility for training became a collective responsibility and as a consequence, diluted’
What does she think of the recent revelations about female surgeons, sexual assaults in the work place and their under-representation in senior management roles? She gives me a slightly withering look.
‘Well they come as no surprise to any female surgeon … ever. The culture has to change’. There is a tacit acknowledgement here that whilst the current challenges facing female surgeons are trending on a variety of social media platforms the reality is that it has been this way for decades and no doubt responsible for many leaving the profession.
‘Women make up more than half the medical school intake yet few are encouraged into surgery. We need to change this at an early stage’. As Patron of the UCL Student Surgical Society she has done her best to engage all medical students at the earliest stages of their careers.
‘There is evidence that female surgeons have better surgical outcomes than their male counterparts. Rather than focusing on, and learning from, those aspects of surgical technique or practice which might benefit all surgeons in training the emphasis has always been to undermine such publications with the usual list of possible confounding variables’.
She talks encouragingly of her work as Chair of the ‘Parents in Surgery’ project at the Royal College of Surgeons of England (RCSEng). The ‘Parents in Surgery’ project was the flagship activity that emanated from Baroness Kennedy’s report on Equality Diversity and Inclusion commissioned by the RCSEng following widespread accusations of sexism and racism in surgery. During the course of writing her report it was noted that surgeons in particular have issues with parenthood.
‘Female surgeons have a higher incidence of fertility issues. Because of the nature of their training path they tend to start families late and commonly feel disadvantaged on the career ladder as they raise their families. Surgeons who are parents of any gender also find it difficult to balance childcare with the long inflexible hours of a surgeon’s working life’.
The ‘Parents in Surgery’ project first set out to establish what the problems were and in doing so also commissioned the Nuffield Trust to undertake some further survey work. There are issues with timetabling, rotations, childcare, finding time and support for fertility issues and a culture of regarding parenthood issues as not compatible with being a successful surgeon.
‘Having established the facts we are now working with stakeholders to effect changes that better support parenthood and a career in surgery’.
Professor Myint has held many key roles throughout her career, many of them traditionally held by her male counterparts. We talk about glass-ceilings and the lack of female surgeons in key leadership roles.
‘We have an increasingly diverse surgical workforce. Despite this the same traditional demographic appears to be returned to high office time and time again’.
It is noteworthy that in the 150 years that the Royal College of Surgeons has existed (and where she is currently senior Vice-President) it’s ruling Council has only ever elected one female surgeon as President and has never elected a person of colour.
What does she think of this?
‘It is disappointing considering the demographic of the surgical workforce. However, it takes time for change to happen. The constitution of Council is evolving and this will give us a more diverse pool from which the leadership can be elected. We have to stop thinking ‘what does the person in that role traditionally look like’ and start thinking ‘does this person have the potential to fulfil the role well’.
We talk about the Harvard Surgical Leadership Program (SLP) which she developed with Harvard. Where did the idea come from?
‘My involvement was seeded by an idea from one of my trainees. We developed the concept further because there were no courses available for more senior surgeons which dealt with Leadership issues’.
‘There were very many courses aimed at residents, or short term courses teaching specific components of leadership but what was needed was something more comprehensive and which linked a number of essential components’.
The course is very much international attracting participants from every continent. There are three workshops each lasting four days and which are held either in Boston or London. There is a continuous on-line lecture course, webinars, group course work and an individual capstone (a business plan related to their practice). Harvard SLP benefits from access to faculty from Harvard Medical School, Harvard Business School as well as other Harvard schools.
‘Many of the speakers cover important aspects of team leadership, emotional intelligence, negotiation, understanding finances, human factors and team dynamics in the way that only Harvard faculty can.’
‘The capstone is the final achievement for the participants because they work on this with a named member of faculty and so many of these exciting entrepreneurial, quality improvement or educational projects have come to real life fruition, some on regional, national or international scales. This can only be good for surgical services to our patients worldwide’.
The Harvard Surgical Leadership Program (SLP) has been running since 2018 and Professor Myint continues to co-direct the program with Program Director Sayed Malek, the Clinical Director for Transplant Surgery at the Brigham and Women’s Hospital in Boston.
I ask her about work-life balance (although she prefers to call it work-home balance given that she sees medicine and surgery as very much part of her life). How has she managed to balance professional and personal responsibilities?
‘It’s not been easy! Balancing the two has been a challenge. But I’m certainly not alone in having to juggle responsibilities. And it’s not just an issue for mothers either, its anyone with caring responsibilities and almost everyone who has a family to consider. One learns to plate spin’.
She acknowledges that having a husband (also a surgeon) who was adept at nappy changes and prepared to share child-care responsibilities was key to a success in balancing professional and family life.
‘We have spent nearly 18 years meticulously matching on-call schedules to avoid clashes and ensuring that at least one of us was available for school parents evening, summer holidays and the inevitable school Christmas performance!’ That said there have been more Christmases that she would care to remember where one or other of them was not at home for Christmas dinner because they were in the OR delivering emergency care.
Occasionally work and home responsibilities have merged. Rather than keep them strictly segregated she has been happy to allow a little blurring of the lines. During school holidays, rather than miss a teaching session to undergraduate medical students she has, on occasion, taken her daughter along to the sessions.
‘She was always royally spoilt there! After having been to a few she began to remember the key learning points of the teaching sessions to the extent that she insisted on taking part in the end of session quiz. She scored pretty well! I’m pretty sure some of the medical students realised this and I suspect there was a minor degree of collusion as a result! One year at an undergraduate surgical conference a medical student taught her how to hand tie surgical knots on the back row of the lecture theatre with a pair of shoelaces. She still ties knots that way to this day!’
Has her daughter followed her into Medicine? There comes a decisive ‘No!’ Having adjusted to parents who disappeared in the middle of the weekend only to return in the early hours of the morning following an emergency call it is perhaps no surprise then that she is currently studying Philosophy at University!
Does she have any free time? Perhaps a little more than before now her daughter is at University. How does she spend the time? When not at work she can be found on the North Norfolk coast bird watching or on occasion at a F1 Grand Prix venue at a variety of locations around the world. She has had some success in the field of wildlife photography and is a long-term supporter of the RSPB and the Zoological Society of London (ZSL). She is a long-term supporter of the NSPCC and has run up the stair cases of London sky-scrapers to raise money for the charity.
‘Time away from work is inevitably family time. Bird watching in and around the north Norfolk coast is a huge contrast to a busy on-call’.
There is also virtually no phone reception on the coast there which provides another undeniable advantage.
More information on Harvard’s Surgical Leadership Programme here
