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Right. Oh, ok. Yeah. Um Bella, you can start speaking now. Um It's your part. Thank you. Sorry, I could, I couldn't hear you because I was on mute. Yeah, nice to meet you all. Sorry. Virtually. Um My name is Bella Hausen. I'm one of the intervention. Radiologists at Preston is part of the LS University teaching Trust, which was made up of five hospitals, but Preston is the vascular center where, where I work and where the majority of vascular cases come in. Um So endovascular work. Um It basically means anything to do with blood vessels, whether arterial or venous. We also deal with lymphatics. Um And I don't do anything that involves cutting people open everything is minimally invasive. Um I suppose some of the work like um tunneled lines does involve, you know, but nothing I would say that I don't really do anything beyond 3, 3.5 centimeters of cutting. I never go beyond that. It covers everything. So women, men, Children, it, it's basically everything really. And I've tried to kind of give you a rough category of different areas and there are subspecialties. So some people may not do carotids some may not do pediatrics because it's that vast. Um, you know, most people tend to subspecialise even within the endovascular world. Um, in terms of how you get there, I think there's various routes, but probably not as vast as it used to be. When I was in training. Now, you would either go through interventional radiology training or through vascular surgical training. Um, but certainly when I was doing it, you would do the typical thing to get into medical school, which I believe that's changed as well. Um, it seems to get worse and more difficult each time. And the more I hear, the more I think Jesus, if I was in your generation, I probably will be stacking shelves in Tesco. I can't even fulfill half of the application forms. Um Essentially I went through from medical school to foundation training and then core training. Um, and then into IR now, my path was slightly different because I was a plastic surgical trainee with subspecialty of microvascular. And my foundation training program was heavily vascular. I was quite lucky in that sense that it was very much tailored to me and my needs. And I think in the whole program, I probably did just four months, maybe two months GP and, and four months A&E and the rest was all just vascular surgery. And from there, it was another two years of just plastic surgery. Um And then it was a big change of decision to where do you go from there? And what I wanted to do versus what existed? Um And what existed is not really what I was good at or what I wanted to be doing. And I hadn't ever heard of Endovascular. I'd never heard of ir if I'm honest, I never even knew it existed. It was only towards the end of my core training that somebody suggested, um you have a look at Congress and looking at med tech and looking at the devices and the engineering and the material engineering, which is what I was really interested in and going through that path. What they didn't warn me is about the radiological exams that were involved. That was a major shock to the system. And God, you know, people like me weren't designed for those exams. But anyway, I made it in the end and again, I was lucky in my training that heavily. It was endovascular. I didn't really do much of the general radiology stuff. It was all very much endovascular through all. Um Now if you go to different countries, it would be other specialities that would do it. I don't know. Oh, yeah, I did some research sabbatical fellowships as well in between. But that's something you choose, depending on where you want to go and what you want to do. And also because I actually thought I would never come back, I would just stay in New Zealand. So, and that's another story. If we have time, we can discuss it. Um Next slide, please let me just see if I put down. Yeah. So there's different ways of getting into endovascular work like I mentioned. But if you go to Europe or other countries, you can also go through similar procedures being done by interventional cardiologists. There are people called angiologist, there's interventional nephrologists, interventional neuroradiologist. Sometimes they're not even called intervention, they're purely surgical, but they do similar work. So there's a lot of crosslinks and interlinked work done by different specialities. And I think for me personally, it's not important. The important thing is that you get the appropriate training to be able to do the procedure and depending on where you are, what location, what region of the country. So for example, I think if you were in my region in the Northwest, you probably would go through endovascular through ir for certain things, whereas I'm assuming that maybe other parts of the country may need to go through vascular surgery. Um I don't think yet, I'm uncertain that you would go through cardiology, for example, to do aortic work. I don't think that exists in the UK yet. But for example, in Italy, you would literally go through any training and you can come out doing any bits. So I have my uncle's a cardiologist and he does aortic stuff like similar to me, which sometimes scares me. But that's another story. Um So again, what I'm saying is the world is your oyster. You can get through various fruits. I think the bottom line is that you choose a good training program that could adequately provide you with a good number of experience and lots of different professionals to show you different techniques in different ways because there are many ways to doing the same thing. And it's important to tailor that for each patient and each procedure. So the more tools and skills you have, I believe the better you would be and more confident you would be at doing them the procedure for that particular patient. Uh Next slide. So as a woman working in this field, obviously, I'm much older than you guys. Hopefully, when you come into this field or into surgery in general, I'm hoping many of the dinosaurs that I've had to deal with have retired or already left. I know certainly one of them is retiring this week. Thank God. So I don't think, well, I'm hoping that you certainly won't see some of this stuff that I've seen. Uh I it's, it's not pleasant, but I wouldn't say that's the bulk of my experience. I'd say that the majority are supportive, helpful, encouraging, two of my mentors are male and my partner is male and the super, super supportive of women in this field. There is a lot of myths and bias towards it. For example, when I was going in, I didn't know much about radiation. Um And I was told, you know, gosh, your ovaries are going to fry because you haven't had kids. So you can forget that. Which is not true. There's a lot of radiation protection tools that you put on. In fact, I would say that you probably have more radiation exposure flying than you do in this practice. So, in fact, I don't even know why you ever mentioned it, but just in case somebody has scared you of it, that's completely false. If you dress appropriately and you follow the rules, it's completely irrelevant. Um Poor run through training. I think that used to be in the past. I don't think that will definitely not exist for you guys. It's run through for both vascular surgery and interventional radiology. Um Lack of role models. My question is, do you really need role models? I mean, there was none for me and I don't think I really care. There's loads of good people operating and that's good enough. You just need to learn techniques and you need to have good mentors that will help you support you. And I don't mean to help and support just from um an operative point of view, you may sometimes need it in decision making. You come to a crossroad, which job should I take? Should I move to this area? Should I not? Or you come across a difficult situation at work? And you may just want a second opinion or advice from somebody. So I think it's definitely a good idea if you come across somebody senior and then they don't have to be investigated. They could just be in the NHS setting or any senior role setting that they can advise you and help you throughout your career. I think that's worth its weight in gold. And I've been super, super, super lucky to have a guy called Steven de souza. Now he happens to be an interventional radiologist, but senior one and he's kind of always been there in the background for me to pick up the phone and say which mortgage should I be taking? It's got nothing to do with this. But it's nice to have somebody who's been there that can give you tips, lack of work life balance, that's everywhere. You know, it doesn't matter what specialty, not even a doctor. I mean, my sister in law is a lawyer and I would say that her life is much worse than mine will ever be. So it just depends what you want to make out of your life, what job plans you choose, which job you can take on how much you want to take on. You can make your world and life work, but you can also balance it out. That's entirely up to you. So we've already done radiation. But I mean, as long as you wear cover lead shield, appropriate gown, that's not an issue. And most sites that operate this have good fluoroscopy. None of the old ones because they're outdated now. So I think for you guys, it won't be an issue. Um, we'd already did these role models and like I said, again, you don't need females. I mean, if there's a great female role model to have, that's great. I don't think you should worry whether it's female male. It doesn't matter. As long as there's somebody supportive that you can talk to. That's all that should matter. And we've kind of mentioned a work life balance, but I think you can definitely achieve it here. It's no different than any other job you can find. Um I'm not sure why I added this. Probably it's just to show you that you can be, you know, nobody and just turn to hospital, do some jobs and go home and that's absolutely fine. Or you can take it all the way and go into international. That's again, entirely up to you. And these are just some of the talks over the years and again, supported by colleagues who probably don't care whether I was man or woman or monkey as long as I was delivering the work and I was doing good work. That's really the bottom line. Oh yeah, this is just to show you can have a life, you can use your annual leave wisely. You can have Children, twins, healthy, fine and you can manage and do it all and you can do a marathon as well. I'm not saying what time I did it in but you can definitely do it. Um The only thing I would say is that if you had the option of help and support in the form of, if you have family that you're close with, who you get along with, they are absolutely worth their weight in gold. And so if you can drag them with you or somewhere near them, I think it makes life so much easier if you can. Of course, that's not for everybody. And you know, it's not possible. But if you can, I would definitely recommend it. There's nothing that can replace, you know, a good mom, a good dad, a good aunt, a good anybody that you've known for years and you can trust, especially once you start forming the family, you know, there'll be days where a case may drag on and there's nothing, you know, if your mom lives down the road or somewhere close by and she can, you know, Nip in it and do that bit for you. Honestly, I wish somebody had told me that a while back that, you know, even though you're a doctor, there's a lot of things until you have kids, you don't realize they get sick at random times and I've got two of them and they go and sick at the same time. So, you know, if you happen to have a mom, aunt or somebody, you could at least ring to say, oh, would you mind just dealing with the next batch of vomit? Um That's fantastic. If you can't, then there are other ways there are nannies, there's other paid health care. Obviously, the more remote you are probably a little bit more difficult than if you are close in a city where there's more access to almost everything, including, you know, I've got colleagues, I've got au pairs colleagues who've got full time nannies. It doesn't matter. The important thing is that there are solutions to almost every dilemma that you may face in your lifetime. Um But do chat to people ask people, I don't think it's something that should be done alone. We should do it as a community. And I spend half of my life asking everybody everything from. Where do you get your cleaner from or what did you do with this? And can you recommend an electrician for me? I definitely recommend, don't do things alone if you've got help or you've got people you can trust, you can ask, ask them. Oh, that's Steve. Basically, I call him the godfather of everything. And that's my team from New Zealand and from home, you know, having a good team behind you is everything to go to work no matter how hard it is. If you've got people who you care about and they care about you, honestly, I would take on any job if it meant the pay is crap, but the team was fantastic. It makes your world a lot, lot easier than, you know, having to work somewhere where either people are miserable or they give you a hard time or you just don't happen to click with them and that's absolutely normal. We're not everybody's cup of tea and we won't fit everywhere. But if you can find somewhere that you fit, you go for it, it may not necessarily be in the area you want to be, It may not even be in the country you want to be in. But, you know, just remember you have options and the world is your oyster. Seriously. I think that's something that I didn't fully appreciate until I left the NHS. And I went across the pond to realize that, that there is more to life out there and there are many options. You've just got to go and search for them. Oh, yeah, I, I'm supposed to say I'm not trying to encourage you to leave the country. Ok? Because we need you guys. But it's the truth. I'm not going to lie too much to you. Um, the weather is better elsewhere. So I think, um, we're saving questions for later. So if you know, if there is anything you want to ask me, you know, feel free, sorry if I've spoken too much because I haven't got the powerpoint. I haven't got a timer so I'm left to my own accord to just waffle on. Can you hear me? Bella? Yeah. Oh, perfect. So yeah, I think everyone we can give an applause now. I'm not sure if you can see me, but um I'm on behalf of everyone here. Thank you for that. That was really insightful. I was very honest. Um and it was a really nice uh experience to hear. Um So yeah, thank you very much for that. I'll make sure perfect and on to Tara. Yeah. Thank you very much. Well done, Bella. That was really lovely. Um I am, thank you. I think when you title in the evening Inspiring Women uh in surgery, is that what you're calling it? That is very aspirational and I very much feel like I shouldn't be here. You might have titled it a little bit lower for me, like um encouraging women in surgery or being hopeful that you might get through. Um So I'm a vascular surgeon. My name is Tara, I'm Canadian. I grew up in Canada. Uh and just to give you an idea of what that means. Um the Niagara region, home of Niagara Falls is uh where I was born right there and it's very far away from where I am right now. Uh And that journey was in the mo unbelievable adventure and I totally agree with Bella any chance you can get, you should travel. Uh So if you want to know where I live, uh or at least my parents live now, it's right there. I went to school in Hamilton's about an hour away, got the taste of distance. And so then ended up after school, uh moving down to Cleveland, Ohio. So I've worked both in the Canadian healthcare system in the American healthcare system. And then I moved here um uh and worked in the UK, which has been very interesting. So my path to medicine is probably gonna look different than yours because I grew up in a different system. Uh in Canada, you have to do a biochemistry degree or some kind of degree first. So we did um I did uh four-year biochemistry degree and then moved into medical school and my medical school was three years cause we skipped summer holidays uh which was brilliant. Uh II really, really loved medical school and I picked this one because it was more problem based, less didactic and it kind of um suited my needs during medical school. I got to take a lot of time off because I was president of the Canadian Federation of Medical Students, which I know um makes me the biggest geek in the room. But um it was where I kind of started to get my idea that I wanted to do more than just medicine and do some community service. And uh I really wanted to do something to the community. And so this really kind of wet my palate, I had to go back and um and do my training obviously, but I'm s slowly starting to kind of realize that side of, of my character. So in Canada, after you finish medical school, you go directly into whatever specialty you want. But if you want to be a vascular surgeon, you have to go into general surgery. First, the honest truth is I thought I wanted to be a general surgeon. Uh So I did my five-year general surgery and about midway through, I realized, um that I love the aorta, like I love the aorta in a disturbing way. Like I really, really wanted to spend all of my time fixing the aorta. And um so as a result, um not surprisingly, the people in vascular surgery uh at N A were, were excited to have somebody who was quite happy to be in the hospital every minute of the day. And uh and so that's I, that's what I ended up doing in concurrent with my vascular surgery training, which is two years. Um I also did a master's degree where I did uh a bit of health research methodology because I knew I wanted to be an academic surgeon. And um, and in North America anyways getting an H RM is, is the way to do that. So after I finished um my vascular surgery training, uh endovascular surgery was just starting. So I think I'm slightly older than Bella. And um it was uh kind of in earnest. We were the first center in Canada that was doing it. And the guy I was working with, who was my hero and my champion basically said, if you wanna know how to do this properly, you have to travel. And so he sent me down to the thought leader at the Cleveland Clinic at the time, a guy named Roy Greenberg, who um turned out to be probably one of the best influences in my life. And um I spent a year doing my Aortic fellowship there and just loved it so much that they offered me a job and I took it and I ended up staying there as a consultant for eight years. And um if anyone would have told me at the beginning of medical school that I might have left Canada, like I literally would have tattooed maple leafs on my shoulder. Um uh It, it's uh and especially going to um America which most Canadians kind of um wouldn't want to do. Uh uh So it was a really big jump and a really big decision. Um But I went and uh didn't look back like it was just the best experience of my life and it was helpful that it was only four, my uh four hours away from home. I could drive home sometimes on the weekend. Um But it was absolutely brilliant. And Cleveland is what got me into uh understanding the kind of Medico industrial complex. I started consulting for med industry there. I there was an engineering lab that we worked together in and so we were making devices and creating patents. Um It was a really innovative place and it just made you really excited to be alive. And so endovascular surgery, I won't spend too much time talking about it, but just, um, because Bella mentioned it as well, I think you should know it's kind of the repair of blood vessels from the inside under x-ray vision. And um this is what I kind of spend um any minute of the day where I'm truly happy doing, um which is relining the inside of an aortic aneurysm to exclude flow from the um from the wall itself and, and giving people a very minimally invasive solution uh to what could be a pretty lethal disease. But the beauty part and I have to tell you this is where like life gets amazing is that we figured out how to make these stent grafts cross branches and we can make bespoke stent grafts that fit your aneurysm perfectly with a branch that goes to any branch vessel that you need. And uh it then it kind of becomes like playing a video game. Um All of my professional life, it now is working in uh the uh Cath lab or the, the hybrid theater as, as Bella said, um using fusion imaging, using machine learning A I to kind of understand um how we're behaving and how surgeons work to see if we can pick up things on the X rays that we don't see before. So I have this like extraordinarily exciting technical side of, of my life where I get to work with industry uh to kind of drive the field forward, which is great and really exciting and it does good things for the patients and it makes very funky pictures that you can post on days like this. So when I had the opportunity cause there was, you know, a bit of a glass ceiling, um especially when you're a young woman in vascular surgery at a place like the Cleveland Clinic. Uh there was gonna be no way that I get a leadership role there. And so I jumped over the pond and came and became the head of the Aortic team at the uh at the Royal Free in 2014 and then subsequently went on to become clinical director, which is my kind of taste of what medical leadership tasted like. Um Wasn't the nicest taste, I'd tell you, it certainly wasn't as sweet as uh doing endovascular surgery, but it did give me a better idea of population health. And I started to realize that in this country anyways and this country has a brilliant aneurysm screening program. Um If you look at the people who actually take up the invitation for screening and the incidence of aneurysms, the two graphs go in very different directions when you put it along the uh the axis of who is deprived and who's not deprived. And this kind of became an obsession with me, these two, these two graphs. And we did a bit of research at the Royal free looking at health um outcomes associated with deprivation. And I realized this is where I wanted to take my life. And so I moved to parts uh because there's no place better than East London to study deprivation. Uh sadly, but also thankfully, um and uh and we have the biggest heart attack center in the country. Uh, and arguably in Europe, we see 5000 heart attacks a year, we see, uh, 80 aortic dissections a year. Um, and, uh, and countless other, uh, aortic aneurysms and this is where I'm happily, uh, living right now. So I thought, rather than give you kind of a subjective idea of, of what, uh, a career in surgery would look like or, uh, uh, I would give you something slightly more objective and looking at the Royal College, um, statistics. You can see that the number of women in surgical subspecialties has increased from 1991 to 2022. And although those proportions are still not as good as in the medical uh, fields, it's, um, it's still kind of to me encouraging that the number of women in the field are going up. And if you look at all the different surgical subspecialties, you can see that, um, there are certainly some that are lagging behind others. Uh, but we're making kind of great strides in the area in a in a field that's typically kind of not seen as overly feminine. And this is visualized again in these consultants and registrar graphs showing that from 2011, up to 2 2020 the numbers are are really getting better, although not a majority still better than they were. And this is a projection that some smart people from somewhere in the UK um made about how long it's gonna take us to reach parity. And obviously, places like cardiothoracic surgery and trauma and orthopedics are gonna take slightly longer than general surgery or pediatric surgery or ophthalmology, which is already there. Um But um, it, it's kind of moving in the right direction and I think this should give us some cause for hope. This is what the membership statistics looks like for the European Society of Vascular Surgery. Uh You can see 25% of the membership are women. And if we break it down, um there are 42% trainees compared with the 24% consultants who are women. So there's no question that the field of vascular surgery is rapidly growing and becoming feminized if you like that word. Um In the annual meeting in Rome in 2022 though, it was a pretty depressing meeting because there of all the people that were there, there was only about 18% of the podium speakers who were women and we all agreed that something needed to change. Sadly, I'm one of the older people in the field now. And um, so we stood up, we wrote a letter to the editor, we called for more diversity in the European society and not only did it merit an increase in the number of podium speakers this year at the meeting in Belfast. But you are now looking at a proposal for the new Equity and Diversity uh committee at the European Society of Vascular Surgery, which is arguably a decade late. But um if we can get old vascular surgeons to start taking stuff like this seriously, it means that the field is definitely changing. There's no question that when it comes to academics, it becomes slightly harder to defend the position of women in in surgical subspecialties as the number of us that are making it to full professor and, and to chairs of departments is low. But I think it is getting better over time. And the one thing that I'll, the last statistic that I'll leave you with that to me feels like the, the best one is that if you look at um gender based outcomes. So looking at whether your surgeon is a woman or a man, in fact, based on the colleagues that we have right now, um you're statistically significantly more likely um to die, be readmitted or have a complication if your surgeon's man, um which um really pissed off all the guys in our department when I thought it was brilliant. Now, there are so many problems with those statistics that we could talk about it forever. But like there is good news, that's what I wanted to say. These are my first three fellows from um from the Royal Free, uh my in my Aortic fellowship program and this is the first consultant I hired. Um there's no question that the collegiality that the sorority that there exists across Europe. And these are um a group of brilliant European vascular surgeons that uh I get to see at all the meetings from all over the place um is great. And then this is uh myself and Alison Halliday who's a vascular surgeon from Oxford, uh who was actually the only female president of the European Society, uh who is helping me lobby for um more women in the society. And if you follow that Q QR code, um you can hear of really, really bad podcasts that the two of us did. And this is the department of Aortic Surgery at Barts right now. So 900 year old hospital and in the last five years, they've hired three female surgeons. I'm proud to say I was number three. And this is what we look like and it's uh actually a pretty spectacular group of people to work with um in a pretty spectacular setting. And I would highly recommend if you have an opportunity to float through Barts at any point in your training. You probably should. So couple of bits of advice before we go to questions. Um I have counseled and mentored a lot of women in my career. And I think one of the biggest uh things I see people doing is seeing failure as a barrier to success. I cannot even tell you how many times I've failed. Um which is something I probably wouldn't have had the confidence to stand up and say, uh perhaps when I was slightly younger, but there is no question that you can't get to success until you've tripped a couple of times. So just recognize that it's just a stop along the way to where you're going. The other thing I find, I watch younger women do in the field is constantly trying to prove themselves and you do not need to do this. There is absolutely no need to prove yourself. It will piss a lot of people off if you try and prove yourself. And I think one of the things that you need to do is ignore the inner voice that calls you an impostor and realize that you are as good as everyone else out there. You're uh marching at your own pa pace and you really don't need to prove yourself. I love this um Tim Urban drawing and I don't know if you've ever seen it about um the path that you're supposed to take. And there are so many different choices that steer you in the direction you are now and Bella talked about this as well and there are so many more choices that you'll have to make and there is, in my opinion, never a wrong choice. Um I think that the you are made of the decisions that you make and how to get to where you are. You can make every decision as good or as bad as you want it to be. And um II just don't think there's a wrong decision. I also help remind you daily that people care way more about themselves than they do about you. So just in case you start starting to feel like you should be judged, you definitely shouldn't be because you're probably doing fine. And one of the greatest compliments you can give to somebody is to ask them for help. I love it when people come and ask me for help. Um It is, it's a wonderful feeling. It's uh something that is a bit of a luxury to be able to provide in my old age. Um And I think that most people feel this way so you can find mentors anywhere. I totally agree with Bella. Um And that is what I've prepared a little bit of a time. So, no, no, no, no. Perfect, perfect. OK. Um Again, thank you for an amazing talk. Um And actually it's really nice to see this increased exposure of women in surgery. So, yeah, um if you take a seat actually. That would be great. Yeah, yeah and we'll lead on to the Q and A part now and we can put the men code on one more time if you guys have some more questions. How is balance? No. Ok. That's fine. Um Yeah, I don't mind. Um ok, we'll just have the ment code. We'll give you guys a minute or so to have a a few questions on that. Ok. Can I ask a question? What people are asking questions? So are you here because you've all decided you want to be surgeons? That would make me very happy, good stuff. Regardless of your sex. You need more surgeons, right? Yeah. Yeah. The other thing going on to. Ok. Ok. Yeah that's if you want I know. Yeah. OK. I work in you. OK. Water. No. Yeah. Much here. OK. They can it's like a exactly the Yeah sorry I couldn't hear you that you were saying to get ready. I just got the message. OK. OK. We could have that make a difference. You can hurt. Mhm. OK. The scale. Yeah. So if you ask questions speaking into the mic? OK. Oh no, I see. Should I ask first if anyone wants to ask? Ok. Yeah. OK. I'm better. Can you hear me? Yes. All good. Yeah. OK. Yeah. OK guys we're gonna go to the Q and a bit now so we'll um have a look at your mentor questions and read that out. Um So Bella is here as well, so you can address either questions. Um Just before we go to the mentee. Does anyone volunteer any questions now? Yeah, you so much. Um um I just want to ask uh Doctor T but this also um explains to Doctor Bella as well. How did you feel when you were hit the glass ceiling in Cleveland um that you spoke about? And how did you deal with it if you don't mind me asking? Um So when I was hired to Cleveland, and this should have been a red flag. Um The chairman of vascular surgery sat me on the couch in his office and said, no woman has ever contributed anything important to the field of medicine, but we're gonna hire you anyways. So I kind of knew the environment I was going into when I walked into that place and it, it's a highly testosterone driven place, you know, like it's a pretty high functioning thing. Um I work well in that environment. II really like to be challenged. I like to uh to have colleagues that I know that are working at their highest level. This type of thing does not bother me. Um Every once in a while you sit back and you just laugh because you think my God, these people couldn't get away with saying this at a bank, you know, and I, my partner is in banking and he, he's constantly laughing at the stuff that I've come home with. Um, but at the same time it's, um, I don't know, I, it, perhaps it's unfortunate but you kind of get used to it. So it's, uh, it's not a big deal. Um, I think the people who, um, have succeeded the chairman uh in vascular surgery when I was there are very capable and senior colleagues, they deserved to be chairman. Um, I was just way too young. I was way too far down the pecking order. So I, you need to, you need to realize what you want in life and find it. Have any questions before we get to 20. Oh, yeah, Bella, did you want to say anything on that as well? Sorry, I didn't hear it. II only heard Cleveland. II didn't work in Cleveland. But what was the question? Sorry. Do you wanna repeat it again? Um It was about um realizing when you might have hit a glass ceiling and how, um you might have worked with that and deal with it. Oh, ok. Um, now I've been lucky because I'm one of those that shares her problems with everyone. So whenever something comes along, II would ask somebody, um, like I mentioned to you, Steve had been there throughout my journey because I've known him since I was a trainee from going back and forth, not because of this just because he was doing other work with vascular surgery. So I didn't even know what he was shameful. I don't think he realizes that, but I didn't even know he was an IRI. Just thought he was a general medicine person. Um But it's just constantly asking people, there are things that you will still, even till today I'd come across situations where people are different and personalities are different. But sometimes you'll be like, oh my God, did he just really say that? Like, am I mad? But you can't dwell on it. You can't take it personally. You've just got to brush it off, let it be um pick your battles. That's something that somebody told me. I'd rather just not battle altogether. Um But I think just ask for advice. There's been people that have been through that situation before you and each one will have found a different answer. And so I'd ask different people and then find the answer that's more suited to me. Sometimes you'll find that you may have to create your own path that's completely different to the advice that's been given. But I tend to definitely go back and take it home, take it to friends, take it to other colleagues. Some are not even doctors, they're lawyers for a second opinion because you'll find that a lot of the crap that happens, it happens everywhere, not just in medicine. We get to the uh ment questions now. We've only got one. Right. Oh, there's two. Look how happy. OK. Yeah. Right. Um OK. So I think this question is relevant to both of you. Um, to what extent will vascular surgery be replaced by interventional cardiology, radiology? You wanna go back? Oh, nobody replaces anybody. That's madness in my world anyway, because I've worked in other countries in Europe where, you know, it's free for all and all exist. Like I said, it's all to do with training and capacity. If there's a place where there's adequately trained vascular surgeons and that's what's available, then that's who will do that. If there's another place, a region where the cardiologists are the ones who are trained and adequate and competent to do it. That's who it will be. The same with. I asked. Now, the only thing that I would stress is competency. I don't believe that you just waltz in and cherry pick something, train properly, have adequate training, know how to deal with complications, know how to deal with the bigger picture, know how to work as part of a team. It's never, I don't feel like it's a solo act. You will need other colleagues from other specialities. So personally, I don't feel that there's a need for anybody to take over anybody. I just feel work with the dynamics that you have. And then for you guys, you just then pick, for example, say you want to go into interventional cardiology, then you'll just revolve around the centers that do interventional cardiology. But I mean, I don't know what the future holds. That's just my opinion. So, II agree with Bella, I think it's not a territory war any anymore. Uh But I do think there will be a triumph of technology over traditional um approaches to, to the way we treat things. And specifically the market is pushing minimally invasive medicine is pushing molecular based medicine and personalized care. So I think if you look at innovation of new things that are coming out right now, um If any of you have the opportunity to get in early understanding, machine learning models and um other different ways of looking at imaging, uh that will um help replace some humans in some areas. I think that is personally, I think that's the future and I think we're, we will all be better for it. Thank you both so much. Um The next question is, um could you tell us more about your thoughts on the different healthcare systems you have worked in? Um given that you've both worked in the UK and abroad. Um Just some pros and cons of each. Do you want to go first? It's going to be hard because I have no anything against New Zealand other than the distance, I probably wouldn't have come back if it weren't for family. That's the honest truth. There's nothing bad for me to say the food was amazing. The weather was amazing. My job was amazing. My pay was bloody amazing. I'll never get it here ever. And you know, the workplace. I was, was just fantastic. Like I said, if my family hadn't dragged me back, I wouldn't be back. So nothing negative to say there. So I'm from the northwest where it rains the most. So the weather is shit. There's nothing positive to say about that. However, I do have amazing colleagues and I love working with them. I've got great support. So that's positive the pay. Well, now, since I've come back from New Zealand, nothing will ever be the same. Soever, no matter how much pay increase I get. So we should. No, I'm not going to lie to you about that. But overall I'm happy because my colleagues are great and I get to be with family. So um NHS wise, I think you all can see that it's a difficult time because there's just not enough of anything for the patient group. Like I think we cover maybe 2.2 million, our vascular center or maybe 1.8 million. I can't remember each time they keep adding more patients from district regions and there's just not enough bed spaces, there's not enough wards, there's just not enough anything. And that's what makes it difficult. I think if we had the same resources, same money as New Zealand. Remember New Zealand is a small population with vast bigger lands. So there's more to go around. Maybe if I had the same resources, maybe things would be better except the weather. So um I love public health care, which is my bias. I mean, I moved 4000 miles across the ocean to get to a public healthcare system. Uh, the, the Cleveland Clinic broke my soul. Um, I have patients that had to sell their houses and lived in the parking lot in order to afford their treatment and they just kept building more parking lots. Um, it, it just, it, it wasn't for me. I got paid a disgusting amount of money there and, uh, it was lovely. I had a really nice house, lived on the lake, but, um, I just the day to day of going in and out of work, it just wasn't worth it for me. So when I did the calculation of about what I value, um, what I valued was taking a massive pay cut and moving 4000 miles away from my family in order to work in a system where it felt like I was doing more good. Um, uh, but that being said, you can do a lot of great stuff in a well resod system and you can really drive the field. So regardless of where you land, there's a role for you in the future of, of medicine, in the future of surgery. Um, whether it be that you're digging deep in the Cleveland Clinic's pockets and finding the latest and greatest thing and just making it work, or if you're over here trying to figure out how you can get all that on the cheap. Um But still do good things. Uh Either way is a rewarding career, I think. Thank you both so much. Um This question is for uh Bella, how would you advise getting more ir exposure during medical school? That's a bit tricky because um s when I was in medical school, there was no ir in the curriculum yet. When you look at a lot of, I don't know if different universities do different things, but Edinburgh and Manchester were doing case based type learning and a lot of the cases would involve some sort of imaging and a lot of the management now would have been through an endovascular approach. Um So the thing that I would suggest depending on the universities that you are rotating through or you're part of is to ask for that support and that taster weeks because there's many places that hold taster weeks and I wouldn't just go through one. I would go through the whole lot. So I'd go through interventional cardiology because there's a lot to learn from them, even though they're currently just dealing with the heart. But they've really expanded radio access, for example, then I would rotate through and go into interventional radiology, see the other aspects because a lot of the IRS will do other stuff like fibroid embolization. A lot of amazing workers go no endometriosis. It's not my thing. I don't do that, but I'm just saying that just expand your knowledge of what's available. And then I'd iate through and go to vascular surgery. Have a look at all the other things because they don't just expand on endovascular. They also do the open part because that might also interest you. And then I would rotate into a neuro because the four of them, they do things that kind of interlink sometimes and it's nice to have a broad picture of all of them And then see which one you feel closer at. You find that you may like a bit of everything and that's fine. But I would suggest rotating through all and you can ask your best to do that because taste of weeks are available. Yeah, I agree. And I would also add to that do do research cause there's always time in the day you can write up a case report. You can, you can do some form of research. Most of the patients on any rotation you go through are gonna need some form of diagnostic or interventional imaging. Go down, hang out there be present. Um Most people like people who take an interest in what they're interested in. So when I have a medical student hanging out with me a lot, they get to write the paper, they get to scrub in and do things um do research. OK, great. And this question is for Tara. So you said that there was no way you'd be given a leadership position in Cleveland. How bad do you think this sort of discrimination occurs in London? Um, I think I was too young, frankly. Uh, I think, uh, it probably would look different if I was there now. So II don't want to disparage Cleveland Clinic. Uh, especially if you're making this public. Um, uh, it is a good institution. Um, but, um, II think, um, there are a lot of different ways one can be discriminated against and in, in many ways you guys have the upper hand because you're coming from within the system, immigrants who come into the system who haven't been trained here, have a really hard time understanding um how to move forward or, or how to kind of um have a succession plan in, in uh in their field. So I think um uh I don't know if I'm answering the question properly, but uh uh uh yeah, II think you need to be strategic. OK, great. And uh the next question is for both of you. So what can men do to make the workplace better? Just be you as in, I don't think there should be a battle between men and women. It shouldn't be seen like that. It should just be seen for your abilities. Whatever you are a man woman, itchy hit. It doesn't matter if you're talented or if you're enthusiastic or if you have an interest, that's what we should focus on and what should be pursued. Now, for the senior male colleagues who already exist or in a male dominated environment, there should be a little bit more sympathetic to certain things that in our current climate, only a female is able to do. For example, only a female right now is able to get pregnant and carry a child. So sometimes you will find um so where I work, the majority of nurses and radiographers are female, um There's a lot of lack of understanding to, you know, emotional outbreaks when they're pregnant or all of a sudden the cookie supply has gone and they just have no concept of that. Whereas I'm like, yeah, just throw her mouth bar and lifa to it, it's going to be fine, but I'm not saying that they need to do that, but there's a little bit of sympathy or empathy towards some of the females in certain situations of life that will only be attached with a female. I'm afraid it can't be given birth. It's not something that you just roll out of bed the following day and you can just go and do an aortic. I mean, kiddos are those that can do it, but certainly having given birth to twins. Yeah, I wasn't going to roll out of bed and be able to do that. I could just barely stand up was I found that a lot of um not all but many male colleagues didn't quite understand that. I'm not sure why not. Um I was carrying one was 3.2 kg. The other was 3.3 kg. I was like, it's more than lead to get that into perspective. Um And then there's other bits and pieces to that. You know, they can't be as good a father as they can be. They can never quite be a mother. And sometimes I find them where, you know, I'm like, really, I really need to finish this case quickly because I really, really need to go. Both of them are sick and you may find that maybe hope in your generation won't be the case. But certainly mine, the majority were men and they were the breadwinners and their wives were at home, taking care of the Children and the majority were not working. That made a huge, huge difference because I was always under stress to finish, to collect the kids and they never had that. So it's, it wasn't bad. It just meant I took time to explain to them that I didn't have any. But there was nobody that was going to run off or rush off. It was just me. There was no Mrs how there to collect the kids. It's just, it's me. And with time, you know, there is a change and that's all I would say that allow people time if they don't understand that to change. But we're seeing differences. Now, I'm seeing new consultants come in males who are going part time specifically for that. So they can take care of their kids. So maybe what I describe and explain now may no longer be issues for you guys because things may average out and even out and equal. Yeah, I think the the startling statistic for me is that 90% of men, um male surgeons are fathers and 40% of female surgeons are mothers. And um I think if, if we started to open our eyes to what being a good parent is, um you would see a lot of the male workforce wanting to take time to be with their kids. Um So, and, and this has been proven in countries where paternity leave is now mandatory, you know, um once society gives men the freedom to choose a path where they have a larger role in their children's lives, um They do because people are people. So um uh yeah, what can a man do to make things better for a woman? I think all of us need to think about how can we be mentors to people that don't look like us. So I'm an immigrant. Um But there are quite a few English people that I met in the last 10 years who have helped me understand uh the climate and what the culture that I've gotten into. And I tripped on a lot of stones on, on this path. But um but I think all of us need to learn how to be mentors to people that don't look like us and that's probably the best thing that each of us can commit to. Great, thank you. I'm just gonna take a break for the mentee and open up to the floor. If anyone would like to ask a question or ask the question that you asked on the mentee. So I think about create an environment where you feel happy with your team. How would you go about actually building relationships when you started working? So to get to a position where you're very happy. So Bella, the question was, how did you get to a point where you were really happy with your team? Because you mentioned that your team was really important to you. So what are the things you did to um improve those relationships or build the team? Um uh The team chose me rather than the other way around because they pretty much existed before I came along. Um The thing that you have to understand and appreciate is we're all very different and we all have things that are good about us and things that are bad about us and there'll be teams that will accept you and find your good things amazing and your bad things, you know, tolerable. They're not a big deal that, you know, Bella eats half of the chocolate supply and doesn't leave anything for everybody else. They just accept it and carry on. Whereas, you know, you can work in another institute where they find that absolutely rude. Um So I think a simple answer to that is that the team chooses you now as you become senior and then you find yourself that you are there for a longer period of time. And all the people that were there when you came in retire and leave, then yes, it becomes a way where you start choosing people when they come for interviews and you find that you start picking again, the same thing, people that you would tend to get along with people that you tolerate, um, their habits and their ways. It's a natural human instincts. It's one of those, it's only your family. You can't pick, but certainly everybody else you can pick and choose. You know, if you had two extremely amazing candidates who are exactly the same, you'll just go to the one that you can relate more to and that's just a human bias in human nature. Um, in terms of my current team, the majority of people who've been there when I first joined. So I've been lucky with only a few have retired and the ones that have joined us have been people who were trainees and have gone through the system. So it's taken us time to get to know them. And that's because if you know the northwest, it's a pretty gray rainy place. So, unless you come from here, it's very difficult to get outsiders to come up here. I think the only two that we probably got from outside were from Scotland from even rainy, colder places, but certainly very rarely do we get anybody from the south coming north, I guess ta I don't realize this but people like me from the north, when we go down to London, we're also immigrants because I think anything beyond north of London is no longer the UK, as I'm told by Mo and Rob, they tell me no. Now anything beyond Birmingham doesn't exist in our map. So, in some, you to understand your accent. Well, just find where you click and it doesn't have to be, you know, um, somewhere you trained, it could be like, you know, I went into, um, to New Zealand and it just, II didn't know what I was getting into because II can't possibly have known unless I trained there and, and I didn't, um, and it's just by chance we happened to just click and I actually clicked more with the nursing staff, the trainees and the A&E department more than the actual my own department. And that's, that's fine. And it just took a bit longer to understand the system, figure things out there because it's, it's a, it's a national healthcare system there. So it's not private, but it took me time to understand concepts that we don't have here in the UK. There's no such thing as a, you cover patients that are six hours away. But that was really bizarre for me to wait for a patient who needs to leave home at 3 a.m. to come to theater. It's crazy, but it took me time to understand. And once I understood that I was able to integrate even more and I think that will apply to different regions as well within the country. Like if you go to work in Aberdeen is very, very different than Preston and I'm sure completely different to London. The, the, I feel like what you get out of a team is what you put into it. So the more you're genuinely invested in your coworkers wellbeing and in their interests and their um success, uh the better your team will be. I will note that one of the things I've experienced in my career is that if a woman is mentored by a man and she um turns out to behave like a man, um she will be judged very differently than a man. And I think that's something that we need to be aware of that um that our, our conduct and behavior and um general kind of existence in a work environment is going to look very different than our male colleagues. And I spent the first my career kind of being bitter about that. But then I realized that actually it plays to our strengths a little bit to um to, to own our femininity and, and own the fact that um we do, we are slightly different and, and we have a different work experience. Um uh They say, um and they say that um women that women who are in leadership positions are, it's noticed more when they don't say thank you. And um you could say, oh, how come I have to say thank you all the time. But then you could say, mm I'm a human then I should probably be saying thank you. So it's, it's a, it's a weird thing to be angry about. And, and so I II just will ask you to be cautious, um, especially when you're judging women who might be in leadership positions to you of how they're behaving and think about the influences they had that formed those behaviors. Uh because it is a, a path that we're all on. Great. Thank you. And um what advice would you give to medical students interested in a career in surgery? Do it? It's great. Such a, it's such a rewarding career. It's fantastic. I mean, you need to do what you love. Don't go into surgery cause your mom and dad thinks it's cool, you know, like do it. Like my parents still don't really understand what I do. Um But uh do it because you, you love it and it inspires you. And I had um a really great uh trainer back in Hamilton that, that used to say like, if you know, it's great to be inspired right now, but make sure that you also enjoy the day to day bread and butter like you, if you're gonna be a pediatric surgeon, you better damn well like doing hernias because you're gonna do a lot of hernias and the same with endovascular repair, you know, like it's great to love the thoraco but you better like the infrarenal as well, you know. So I think, um, I think that's, that's another good way of looking at what you wanna do with your career. Definitely agree. That's really important. That's basically why I went through a different u turn of what I did. You have to like the bread and butter with whatever you do or at least 70% that you're OK with it. And it's OK to go into a career and change. It's not, you're still a doctor, it's fine. It may take you a bit longer, but that's fine. We evolve as humans, you may start off liking, I don't know, dermatology. And then you find actually I want to be more invasive and therefore I want to do surgery, for example, that's absolutely fine. And you should pursue what you like because this is a lifetime career. Yeah, I think that flexibility is one of the most amazing things about medicine is that you can go in wanting to be a vascular surgeon and come out on the other end as I am slowly becoming, going into public health and social deprivation and working on social welfare. And um it's still medicine like it's brilliant. You know, II, there's no wrong term. Brilliant. Thank you. Um The next question is, do you have any advice for people who want to do medicine elsewhere outside the UK? Uh But are afraid of culture shock. Don't be afraid, just do it. Like there's no better education than moving. Um I would really encourage you to move if you can, at least once in your career. It's horrible. Like I II remember, I remember sitting in the grocery store when I first moved to London after my family who'd moved me over here left and I was all alone and looking at the brands of soap and not recognizing a single brand of soap and just thinking, oh my God, I'm in way over my head. Like, and it's amazing the things that will just like make you homesick. Uh but like seeing a tide detergent would have made me very, very happy. Um And, and so, but it, but you, it makes you stronger and you get through it and uh and then you understand the difference between a need and a want you understand all these different cultural things that are so important that makes you a better human being, a better person in, in the environment. Someone told me never judge the first three months of any move. And I don't mean even country move, I mean, even career moves, anything you never judge the first three months, it's called the settling phase. Um I think if you have the opportunity and you are able to go elsewhere, whether it's in medical school phase foundation training, pre post CCT after it doesn't matter. I think it's wonderful to experience a different culture, a different world, different everything and not to be scared because there's absolutely nothing to be scared about because you can always come back. Brilliant. Thank you. Um The next question is how easy is it to take time out and start a family while continuing to advance your career? Do you feel like you've had to sacrifice one or the other? Do you wanna go first? Um Yeah, I don't think, I mean, mine wasn't planned so um but I don't think having a family impacts anything. I think life decides as much as you think you're planning a family. I feel like the universe and life tends to plan that for you. I have colleagues that have tried for like 1013 years can have a baby and then randomly they have the baby. There's people like me who were told they will never have Children and then randomly you're pregnant with twins. It just, I think the universe is that so I wouldn't worry too much about it when if you want to have a family, go have a family. The work is going nowhere and having Children never impacted anything for me other than my sleep and my eye bags and wrinkles. But in terms of the career itself, no because the career just needs you and your passion and as long as that's there, then it doesn't matter when you have Children. Yeah. And if you're a high functioning, high achieving human being, whether you're a tenure track at a university or partner track at a law firm, like it, it's always gonna feel like it's the wrong time to have a family. You just have to do it and you can strategically organize things so that you do your phd at that time or you, you take on other, other projects. II don't think, I think surgery gets a bad rap in the whole family space. Um II think it's fine. God, all the men have all done it so great. Thank you. Um So second last question. Um Do you ever regret your decision about doing surgery? And what are the cons of your profession for me? No, I II did everything that, you know, if I could turn back time, I would do the same thing. Plastic surgery provided me with so many tools I still use today. Um And I love it. I've got friends for life there. I still communicate with them. We still do a lot of stuff together. Um Because II told you that there's a lot of intercross linking between subspecialties. So I never fully felt that I left it. I'm, I'm still part of it. In fact, I think I'm, I still have registration. I'm still paying them. Um So I don't regret that. And the current career I'm doing definitely love it. It's opened many fields. Taras touched up on the med tech, the material engineering, the patency and working with the industry, developing stuff. That's amazing. And that's another field as well that for those to find that they have a niche and corporate med tech. There is that field, there are a lot of colleagues after a while, they actually go and work with the med tech as chief medical officers or whatever names and titles they have. So, you know, there's just a lot. It's amazing. Yeah, I have zero regrets. Although I have to tell you at like two in the morning when the ruptured aneurysm is dying on the table. Um, you do start to question some of your life choices and think my God, I could have made an easier path. Um, but, uh, but 00 real regrets. Uh It, it's been a very, very ii feel I have been blessed the path that I've been allowed to take. Um, and it's been very rewarding. And would you say there are any cons of your profession at all? Uh, oh, I think it, it's quite, um, emotionally draining. Um, especially if you care about your patients. Uh, vascular surgery specifically is pretty high stakes. Um, people die, you know, and sometimes people die even though you're trying to get the not to die. Um, and, um, that can be hard, uh, especially when you like them, you know. Um So I think that uh uh for me, the hardest part has been learning to develop a passionate distance. So I love what I do. I love my patients. II love my colleagues. Uh But you need to be able to separate from that and not make it be your life. Uh Or else um when people die, you start to feel like you're dying too and that can be hard to take. Um Bella, is there any kind of your Yeah, amputation? I really, really, really cannot stand amputation. But I have to accept that that's sometimes the only way to save a patient. Um And that's still a difficult acceptance. I do a lot of leg work. I do aortic but II love leg work because I dislike amputations. So I try and do anything to keep a limb attached to the person. Um But sometimes you have to accept that you are a doctor, you're not God. And sometimes some things are just beyond our abilities at this stage. I'm still hoping that we will develop more things and more fantastic things that stem cell research, maybe things can maintain limbs to stay attached to human or redevelops. I don't know, but I'm opt for the future. I'm hoping that the things that I didn't like or the con I went through may not be necessarily problems that you guys would face. So they may not be like I mentioned to you that it's a little bit in a, in a world where it's full of men and it's only men that are leading. It's not necessarily that they mean it in a horrible way. They just don't understand but that I'm finding that that's changing. So probably these cons that work for me may not necessarily be cons for you guys. I don't know about you, Bella, but I got over my hatred of amputation at about mile 22 in the New York marathon. Um When I went the bilateral amputee with two blades, ran past me and I, oh my God, I wish I had his knees be doing a lot better than my knees. Great. Thank you. Uh Just one final question just to end things on a positive note. Uh What is the best thing about your job? Um Call head looking at you guys and thinking um they're the future like it's just, it's amazing to think this room full of women is going to go on to be vascular surgeons. Hopefully. Um Yeah, II don't know. I think uh II get a lot back from um being able to, to teach, although I might not be a great teacher and uh to, to hopefully uh people and uh that to me that's the best thing, the patient feedback, pain relief. So when you do, for example, patients come in with acute limb ischemia or chronic limb ischemia and all of a sudden, you improve the flow and they're no longer dangling their legs. So now they can walk when they haven't been able to walk. Or women who are literally hemorrhaging to death and you stop their fibroids and that relief the patient gets and they come back with it and they say they're able to go back to work. That's just amazing. And that's, you know, sometimes when my family ask me why I'm still doing it, I would say that the ability to provide pain relief and hopefully constant pain relief for the rest of their life is amazing. Amazing, great. Um I think that's all. Thank you both so much for patiently answering all my questions. So thank you. Thank you for the question. Everybody with whatever career you choose and obviously, you know, this is not the end if you have any more questions or you ever need mentors or support, find us social media, linkedin, whatever in Congress is, don't be shy, just come and ask and if we can help, we can help. And if I can't, I'm sure just don't ask any mortgage questions because this is what I'm currently texting and asking. So I'm sure we can divert you to somebody who will know and we can send your email address if that's ok to you guys when we send out certificates and you have the complex as well. Yeah, perfect. Um We'll just do the closing remarks now and then we'll have a pizza So guys, thank you so much for coming today. Just wanted to shamelessly plug Surgical Society's next event is the Foundation Skills and Surgery event, which will be on the ninth of December. So if you guys are interested in becoming surgeons and you want to practice some foundation skills on some medical me, then do come alo, come along. Thank you. Ok. So just to close everything up now, just again, just wanna give a nice special thanks to uh firstly Bella and Tara for such amazing talks. Um I think today amongst many things you've told us, I think just some really nice valuable life skills. Um I think whether it's us women or even just general medical advice. Um but I'll let them praise you in the feedback forms. But um yeah, so thank you for that. And then again, Alex in the corner there from Medtronic. Um He's been amazing in helping set this all up and he's given you all free pizza so big thanks to him. Um Just before I let you guys go, um I just need you to. Oh, no, there we go. Um So for the certificate, if you guys could all just fill the feedback forms in now, um and give lots of uh um kind of feedback to um Bella and Tara that'd be really helpful as well. Um Yeah, and once we have those back, we'll email you guys all out the certificates. Ok. Ok. Yeah, that's it. Well, thank you very much everyone and, um, just give us a few minutes and then we'll have pizza and drinks, um, at the back of the room for you guys. Ok, thank you. Thank you. Hi, Bella. I don't know if you can hear me. Oh, hi. Hi. Sorry. Sorry. Yeah.