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Um So our next speaker um is Miss Fig, who I believe is online. Um And I would just invite her to the stage now and we how is gonna inform me, introduce her. So, so we have uh M Vigg speaking next on uh leadership and surgery. Uh MS Vigg is a consultant vascular and general surgeon at Croydon University Hospital where she's also Clinical Director of Transformation. Uh She also works as the National Medical Director for Secondary Care and National Clinical Director for Elective Care for NHS England and uh is a member of the Royal College of Surgeons of England Council. Uh So we're really grateful to have MS Vick talk to us about uh leadership opportunities in surgery. I think we're just getting MS Wick on stage. Hopefully you can hear me. Yeah, we can hear you. Nice and clearly. Fantastic. And now you go through that bit where you're gonna try and share slides and what's gonna happen. So let me have a go. Um No, I'm hoping I've done that right. And you've got me. Yeah, that looks great. Thank you. Yeah, brilliant. OK. Before you start, we just had a question whether you'd be happy for us to record your session. If not, that's absolutely fine as well. Yes. No, of course. That would be absolutely fine. Lovely. The floor is yours? Thank you. Um Let me see. Can I put this on a slideshow? Let me have a little look and just make sure it doesn't create chaos. OK. Let me just go with the flow as it is. Otherwise, I think I have to unsure on start again. Um Thank you very much for inviting me. Um Moynihan Academy is always one of my favorite groups. So it's lovely to come to come in and talk to you all. Um So what I wanted to do was to talk to you about surgery and leadership and possibly get rid of some of the myths that exist out there which are that um you can only do leadership uh at the end of your career um that it is as written down in books from, from the past, you were born with leadership. Um And that it was for a specific demographic of the population rather than for all. So, what I'd like to do is take you through a mixture of my journey, but also some of the lessons I think I've learned as I've gone along. Um Sarah Jane, can I check? Is there a good way of putting this on to full screen as in slideshow? Should I stop sharing and share then? So I think, I think you've done the right thing. Um Have you hit the bo the bottom, bottom right of your powerpoint presentation next to the sort of slider? Let me have another go because I thought I heard and don't worry, let me just go with the flow. We can, we can see your flow is nice and clear. That's the main outcome screen. It's still clear. OK. Well, look, that's the main thing. Um OK. So hopefully you can see the slides moved on Sarah Jane. Yes, we can. Thank you. Right. OK. Now, then I'll just crack on. So, um this picture is interesting and it always reminds me um of life. So at the moment, the world is in disarray, there are lots of things going on. We feel that we can't make a difference whether it's in our day job, um just managing the on call or whether it's, you know, looking at what's on the news. But I always think that each individual, one of us is like that little droplet in the middle and around us, we can create waves and we can create change, but we don't realize that we can do it. And I think that's what leadership is about. So, um I stand here in front of you and, you know, I've got some grand titles. So I'm the National Medical Director for Secondary Care. Uh I'm a vascular General surgeon in Croydon. Um I'm the National Clinical Director for Elective Care, but I'm also a mom and a wife, um, and part of a family. And sometimes you look back and think, well, how did I get to where I got to? And the answer is it wasn't a planned journey. But if I was giving myself and I often do to, I was a core training program director for many years in South London and high surgical training director. And anyone who's been through my hands, I will say to you, I would love you to sit down today after this event and think about where you want to be in the future, what you want to be. So do you want to be a consultant surgeon that is just a consultant surgeon or do you wish to be something else but in a surgical career? But what are the other things that you want to do in terms of management, leadership, teaching training, quality improvement, charitable works, your personal life. And it would be great if you would put into the chat as you go along. Uh in this talk in terms of what you see your unique selling point. The the plus one if you were at interview and I was appointing you as a consultant surgeon because you've got to start thinking about it now and I certainly didn't. But it's a lesson I would ask you to have and my background. Um at the top, you've got me and my brother with my dad. I was born in North Wales in Bangor and had a very normal upbringing. Um, I've got a, a younger sister who has been fundamental in my career development because she helped me bring up my two Children. Um, but certainly the one thing that came from my mother and father was very much, doesn't matter who you are, what you, um, you know, what your aspirations are. The main thing is that you have a go and you say yes. And that's lived with me all the way through my life. So there's a really good quote from Richard Branson that says, um if someone offers you an opportunity and you're not sure whether you can do it, just say yes and then learn how you do it later and I can promise you still in meetings. Now. Um I sit there thinking, am I really the right person in this job to do what I need to do? And the answer is if you're in the job, you definitely are. Um And there's a real, really good um quote that or a story that came from, er, it's on tiktok and it's also on, on um youtube where someone is presenting and they're talking about their child. And they're saying, you know, my daughter was drawing a, a picture and I said, what are you drawing? And she said, I'm drawing God and he said, but no one knows what God looks like and they, she said they will in a minute and it's that child innocence and the child confidence that we start to destroy. As soon as we take people through academic, university, medical school, we start to give you rules and guidelines, which mean you start to think you can't do things, you can't change the rule and the norm around you. But my ask of all of you is that you do and you hold that clinical curiosity, the child like curiosity because it's important and what's important along the way is that you have advocates that support you in what you are doing. So, um I'm a vascular and general surgeon uh when I came through um so I qualified in 1991. But as I was going through medical school, there weren't female surgeons around me and I almost did medicine because I thought that would be the closest to what I wanted to do, but always wanted to be a surgeon. Um But actually it was the people around me that started to change what I did. So, um you've got Ahmed Shanel, Ian Lane and Kieran Horgan, who are three of the people who literally shook me and said, of course, you can do surgery when I doubted myself. And Kieran Horgan also introduced me to my husband who is and the gentleman there was Kiran's research registrar, but actually the advocates around you and they won't always be of the same gender of the same ethnicity. They will be people that you meet, um, and get on with along your way. And if you wish to, um, ensure that you have success than actually ensuring that you keep those relationships going and take an interest in keeping the relationships and those relationships are not just those above you, but it's those around you. Um, and those people that you are training with because they're all important. No. And for me, that conversation which has come from my parents and which I'm asking you to um think about which is just to say, yes, it is really interesting how small things start to make a big difference. So I could show you this in education, in management and leadership. But it's really interesting how small things start to build up. So when I started as a medical student, I enjoyed teaching medical students and my colleagues around me and my nursing staff and anyone else in reality who would listen around me. But in doing that, I got a reputation that I enjoyed teaching and probably that I was quite good at it. But because of that, I was invited to the train, the trainers at the Royal College of Surgeons. And I did the course and then I was invited to faculty and many of you will do course surgical training and um you'll do basic surgical skills and then you'll do ATL S if you get invited as faculty, just get on and enjoy it. But through that, I became the foundation program director, I did college training and assessment in practice became the core surgical training program director, higher surgical training, program director and on and on it goes and the opportunities once you say yes and people know that you're interested but also can do things, they will make you um do more and I mean make you do more but they will invite you to do more and it is your choice whether you do it. But my answer is say yes. And don't worry if the people that you are working with do not look like you and you feel that you can't do it because of that because times are changing and we do need to change the norm and times are changing in leadership. The picture at the top here is the joint surgical training committee when I was chair of the core surgical training committee. But below, it is um or was my core surgical training committee, which as you can see is multi diversity and multi gender. But actually, you can see if you look at the asset committee, your Moynihan committee, you can see that leadership is changing and you need to be part of that game. This again just shows you how we are changing. So the Royal College of Surgeons Council previously, the leadership there was very male and stale. Um And the picture that you see in front of you is the leadership then of the Court of Examiners and in front of the picture you've got um I, when I was a um a houseman, uh my housemen, my Sh Os and my registrars here and we were just reflecting when we were at the college that actually things had changed to such a degree, but still need to carry on. And leadership here in terms of that multi diversity is gonna be really important because the thoughts that come from multi diversity, leadership just grow an organization far more than people just thinking the same way. And as you can see, we have uh the college, the college Council of Royal College of Surgeons of England and again, more females. But actually, now what you can see in in council is actually the age, we've got much younger people coming in and the thought there is incredible in driving change. But remember, leadership doesn't mean that you do the same thing all the way through your career. What happens is you get married, you have Children and you can see here, I've got two Children, Arjun and Kis and you have my father in the middle. Um But you get married, you have Children, your, your parents get older. Um You have different different um aspects to your life as you go through. But this is important because we talk about a work life balance and in leadership, that's important. The work life balance is in your hands. You choose how much you do when you do it and don't feel that you have to do everything at the same time and it's important because life changes. So, um, you may see me as a leader, but actually, I often think I'm a bit like a swan. Um, you see the top half of me where everything looks like it's really good and absolutely fine. But underneath the legs are peddling and there's lots going on. And eight years ago this little thing decided to grow in my brain. I had an acoustic neuroma. I had to take six months off work and it doesn't matter because you take your life in the way that things throw, throw aspects at you. But what you do is you make your choices in terms of how much surgery you do, whether you carry on doing surgery all the way through to the very end. And that's the only thing you do or as I said before, you start thinking about your portfolios and what do your portfolios bring, including family, doing things differently and doing whatever you want to do that is outside of medicine. And I think for us, the COVID, which is what I'm showing you in the middle of the COVID experience has really changed the way we think about training and about, um, trainees that are in the system rather than um national training number trainees or trainees who are locally employed. It actually doesn't matter now as we go forward, everyone it needs to be treated the same. But what we found the leadership in COVID was really, really important. So if I can show you here, the diagram in the middle is what happens in any um any disaster. So what you have across the bottom is time and what you have here is emotion. So what happens is, and we saw it with COVID, COVID impacted and actually you saw everyone come together and there was that honeymoon period where every, everyone was trying their best to manage COVID to um ensure everyone was looked after and it was hard. It, it was emotionally hard, but actually we did it. But what happened afterwards, everyone became very disillusioned and you know, that we've seen industrial, industrial action across the piece. Uh We've had people saying, you know, training isn't good enough. Um We've got the standard of care that we deliver in our hospitals every day is really hard because it doesn't feel like we can do, you know, 100% and deliver the best of us every single day. And we know that this is where we are. But actually, although we've got all these things that are now different that are coming through. So we've got, you know, surgical hubs and we've got community diagnostic centers, we've got, you know, new training with all the things that are coming through, new training reviews. Actually, if I go to the other side of what was it that actually made us manage COVID. That thing at the top, which is grassroot innovation, which is leadership at the shop floor, which means leadership through medical students, trainees, housemen or F ones, resident doctors all the way through to consultants, but also the multidisciplinary team. People saying, why are we doing things in this way? Why shouldn't we do it this way? People asking uh are these rules fit for purpose? That's what made the difference in COVID And that's what we need to have now as we go forward in terms of where we are with the NHS, which is really, really difficult. And as we are now, you know, we have the new elective reform um uh constitution that's come through. And although, you know, all of you have done unbelievably well in making sure that our patients are getting the right care at the right time. It's hard and we're not doing it completely right. And there's this conversation that's going on that the NHS is broken but not beaten this movement from hospital to community, analog to digital and sickness to prevention. Well, the question is, what does that actually mean for you? What can you do in leadership roles? And I think for me, this slide is, is quite a good slide in terms of the simple things that make a difference rather than the big things um that we are talking about. So, um I've got here the total waiting list for gynecology. Uh I could put on here, orthopedics and trauma, general surgery, anything you want. But actually what's really interesting with the waiting list is that before COVID? So, in gynecology, uh, the waiting list was about 300,000 people. And what we know is that it grew, uh, just past COVID and we're now sitting at 600 but actually, since about August 2022 to now, we're making no difference that waiting list, it's not growing, but actually, it's staying the same. So it means that what we are doing, if we carry on doing it, we're never going to make a difference for our patients. So now we've really got to start doing things differently and that's where quality improvement comes in and local leadership comes in. And so if we look at theater productivity, um there is a conversation every single day about theater productivity saying, you know, we need to start on time, we need to finish on time. That's absolutely fine. But if you walk into your theater scrub room into your theater changing room and there are no um theater blues to where you will not start your theater list on time. So actually, that is what needs to be solved rather than making sure that that patient is there at the right time. And in fact, there are so many little steps that we can all be involved in that quality improvement and the leadership there, but it doesn't just stop there in terms of surgery. We often think about surgery as, um, being operating and we talk about, um, operating skills. But actually, we need to start thinking about the other stuff that we need to do. So, the waiting list at the minute is about, um, 6.3 million people. Um, and all the people are waiting for surgery. Actually, 80% of those people are waiting for an outpatient appointment. And so in surgery, uh, for us, if you are involved in outpatient care, it's really interesting, uh the things that we could do that would make a difference. So if we um changed the way that we do outpatients and you are not involved in these things at the minute because uh we just haven't opened the doors to you because uh triage and advice and guidance at the minute is still a consultant responsibility. But we need to invite you to see what we do and we need to start training you in terms of what we do. So we spend a lot of our time doing advice and guidance, which is when patients are referred into hospital, then instead of developing a face to face appointment, we do advice and guidance and we give advice to primary care and um avoid an appointment. So if we did that and actually we did that more by 15% and we did more of those that would free up 60,000 patient appointments. Um This one is important at the bottom. So at the moment, we know that patients, every single clinic we do, there are patients who just don't turn up, you miss their appointment. Well, if every single consultant in this country saw one more patient in every outpatient clinic, we would free up 3.5 to 4.5 million uh patients lots. And that's huge numbers. If you think about our waiting list is only 6.3 million people. The other conversation is those missed appointments, the patients that miss appointments when you start looking into why they've missed appointment. And if you did an audit and even three clinics to phone the patient and say, you know, why did you miss your appointment? You would find that there are reasons such as they can't afford to come or the appointments at the wrong time or it's on the day that they've got, um you know, their only day they work in the week and therefore they don't come. But if we started to look at it and made a difference, we would start to change um the way we deliver our outpatients and we would change that waiting list. So our patients get the right care at the right time. But leadership is also um about teaching, training, nurturing those who are around us. And I think that is really, really important. And in terms of my leadership, one of the things that I have enjoyed all the way through is teaching and training and the reward that I get from interacting with people around me. And I would thoroughly um ask you to, to consider leadership in that. But also in terms of leadership, you have a responsibility. And um I was awarded the Doctor Rose PVI wellbeing award in 2018. Um And many of you may know or may not know Rose was a resident doctor in Brighton who took her own life um as a foundation doctor. Um and I feel very strongly that what we do at work, our leadership at work includes making sure that those around us are ok and actually just asking each other if someone's a little bit quiet, just saying to them quietly, are you ok? Is there anything going on? Can I help but listen with curiosity when they, when they reply and just check in on each other. And my last conversation to you is you've got a long way to go as you are starting in your careers in surgery. Um, your lives will be very different. Your careers will be very different to the way that my career and others that you see our careers have worked through. There is a wonderful book that I quote regularly, which is called a 100 Year Life and it talks about um our lives and how long we are likely to live. Um My father is at the top. He was born in 1925. Sadly, we lost him eight years ago. He would have been 100 this year. Um But he, you know, describes his life when at school, he literally was using chalkboards and oil lamps. And you have my two Children there below you who are now 27 and 29 they are likely to live to 100. My goddaughter is likely to live to 100 and 25. Your lives are going to be very different and your leadership is not going to be into surgery and always doing surgery all the way through. You will have portfolio careers. You will step in and step out. You will enjoy life in a very different way to where we were, which is a third of our life in education, a third of our life in work and a third in retirement, you have so much more time to enjoy and do things in a very different way. So don't be scared to step off and do things in a different way. And remember, although you might be a small drop in the ocean, you will generate so many ripple effects and so many other um leaders by what you do. So I'm going to stop there by May. Um, and I'm gonna see if I can come back to you. Wonderful. And I would love to see in the chat. Uh I'm gonna see if I can get to the chat. Let me go there. I would love to see um your thoughts in terms of your leadership, your portfolios, what you think you might do outside of uh surgery or inside of surgery as you carry on through your career. So, Sarah Jane and Michael, I'll stop there if I may. That was brilliant. Thank you very much, Miss Big and I think most of our listeners, most of our morning and academy members are trainees. Um So I think that was a really poignant talk, especially for our sort of junior cohort, um, or resident cohort. Um I will open up to the chat for any questions. Um There is a, I think about a 15 to 22nd delay. So while people are typing in the chat, um I might ask a question if I may, um, what piqued your interest in leadership and what got you involved in some of the roles? Oh, we sort of saw your pathway. But, um, what made you think that that was something that you would like to do in your career? So, Sarah Jones, you know, genuinely, it was never something I was going to do it. It's really odd. It's funny when you, you know, I'm 58 now and, and I look back and I look back and, um, Kiaran Horgan, who I showed you on, on screen, Kieron Horgan has now retired and he was clearing out his office and he sent me my application when I was because of course we then were housemen. Um, and house people. And, um, he sent me my application and I look back and think, you know, none of this was contrived. It just sort of has developed. Um, and there are times now where people, you know, say, oh, you know, you're a leader and you think, well, I am, but it, a lot of it has happened by default. And my one ask of the, of all of you on the call is do that because it's important. But actually, you can shape your journeys um in a way that I wasn't able to. But with hindsight, I think that would have been an experience. But do I enjoy leadership? So Jane, the answer is yes. You know, I was always that trainee who got fed up of being pushed on the, the rota and would take the rota and sort it out and make sure it w it worked better if you see something that is not working. I think you just sort it out. And I think if you're in a mindset that you want to sort it out Sergey and you're a leader, thank you very much. Um I can't see any questions that have come through. Does anyone just wanna hop on stage and ask questions for me? How did you have any questions? Cos I can see you and I don't wanna hog. Thank, thank you for your talk. I think the part that resonated with me especially was about sort of dealing with setbacks. And I think as you said, sort of as a junior trainee, it's sometimes very difficult to sort of look forward in the future and, and try to imagine how your career will be because there's a lot of uncertainty around. Uh, so it's really, really inspiring to see that, you know, despite it's, as you've said, whatever the life throws at, you just need to deal with it. Uh, so I guess the question from this would be what would be your advice to someone who is very early on in their career and is not really sure how to answer your question, which is where do you see yourself going? Uh What is your advice to, to, to people in that position and, and how to sort of have those opportunities come to you? Lovely. And, um, can I just go back to your piece about setbacks? I think my other piece of advice to everyone is don't be scared to ask for help. And I think surgery sometimes you feel it's very doggy dog and, and do you know what it is? Um, there are some really unsavory characters. Um, you know, Moynihan asset, the colleges, you know, the conversations about bullying, harassment, all the stuff that, that we know is it's very much less so than when I was training, but we know there are still pockets of it. Um I think the one thing that I would say is just to make sure that you've got your go to people that might not be someone senior, it might be a surgical registrar, it might be a medical registrar. It might be someone outside of work. It doesn't matter. But I think Michael, the conversation, which is, I'm not ok and I need help is really important and, and people must not worry about that doesn't mean that you're less of a surgeon, less of a leader. Uh, it's important. So I think that's number one second is, um, I'm just gonna pop into the chat. Um, there's something called the, it's on the NHS Leadership Academy. It's free, it's called the Edward Jenner program and it's a really good way of starting that leadership conversation about, you know, who am I, what, what are my strengths? Um, uh, I would do it. My, what I've said to all my trainees along the line is don't do any free time when you're on call and when perhaps you get one of those days, that's a nice day rather than a busy day. Um, just log on and do a bit then that's what I would do. I just do it in work and actually, you know, just do it when you can, it will probably take you about six months of just logging in and logging off, but it's really good and also it accounts for your portfolio. So it's really helpful. Um, the conversation which you've had, which is how do you start thinking about it, Michael. What I, what I always say when I was the core training, when I was doing my, my educational roles, uh every trainee had a 1 to 1 with me. And what I would say is draw a timeline, draw a timeline that just says from here to where I want to be, you know, in 10 years time, whatever it is you want to do um and then start to come back, which is, you know, in the next six months in the year, put in all the things that are really, really important to you, your holidays, all that kind of stuff, exams, end of rotation, end of put all those things in and then start to think about underneath it under those titles, management, leadership, teaching, training, uh quality improvement, you know, stuff outside personal start to put things in that you think you would like to do. So if you love teaching and training, then as a core trainee, you can get involved in medical student, teaching training into exams, um medical student appointments, you can do foundation one and two A CPS. If you're a registrar, you know, there are so many things that you can do that will start to build you up, but that's what I would do. But it does take um you know, some time to sit down and think about it and think about it as a group. One last question. If we may mistake I think it's from, I think, you know, GM, goin, she's popped it on the chat. She's asked, did you find it a bit disconcerting to realize that clinical work is not the be all and end all? So, I feel there's a point in everyone's career where they think about branching out, but it might take a while to do so. Yeah. No, absolutely. Um, do I find it disconcerting? Um, I can tell you, I um I still have a bit of a palpitation moment where I realize where I am now. So, you know, I've, I'm a female surgeon. I feel like I've had to do all female surgeon is also Asian. Uh I feel like I've had to do 100 and 30% of some of what some of my colleagues have done to get to where I am and I've got scars on my back from, from what I've done. Um Do I enjoy my clinical work? I absolutely love it. I love being with my patients and my trainees. Um I still do a clinic on a Monday morning but in November last year when I became National Medical Director for Secondary Care, I had to give up on call. Um At that point, I was divisional director and I was still doing on call. I'd taken, you know, more junior colleagues off the on call as a general surgeon because they felt that they were getting too tired and didn't want to do it. But II carried on because I loved it. But I had to stop because I didn't have time to carry on. And I haven't operated now since last November. Uh, just because there is no time. And, uh, groomer does that make me feel really uncomfortable? Yeah, it does. I still haven't got it in my heart that I've done it and it's still even, I had my appraisal this week and even in the appraisal, I was saying, you know, do I go back to doing some? And actually I think now I'm at a point where, um, there isn't any point in doing that because I can offer a lot more at national level to protect the trainees and protect patients and lots of other stuff and really do proper national service improvement. Um, but did I love the clinical work all the way through? Yes. And, and you know, you'd have to pull my eyes out and my fingernails off to, to stop me doing clinical. So you will enjoy the clinical, that's not an issue and there is plenty of time to do that, but don't worry or forget about the other stuff that makes you happy. So if you think back to what you did at medical school or um foundation is more difficult because you were working hard, but at medical school or just in the things that you've done, if you enjoy your teaching and training, do it carry on just do parts as you go on, it will work alongside what you're doing. If you love, you know, going on holidays or trekking or whatever, um just incorporate it into, into your daily life, the conversations that used to happen. So if I had been in a talk like this as an sho back in the day, the conversations that would have happened, the underground conversations that happened were that Estella. There's no point even thinking about having family or Children, you will be doing surgery that, that if you want to do it, that's what you have to do. That's the sacrifice you have to make. That is not a conversation for all of you. The conversation that would have happened was that you cannot do anything outside of medicine and getting married is a, is a no, it's just not a conversation now. So I think the um the brilliant opportunity that you all have is to really enjoy a, a job that has that clinical aspect. Remember, surgery is changing. So when I started the vascular surgeon, I was doing vascular in general, everything was open. Now, things are more um endovascular. But in a general surgery, we're moving to, you know, robotic assisted lap surgery. Well across menu. So, and actually, we may get to a point where we are doing prevention in such a good way that, you know, if we really had people who were fit and well and possibly not obese and, and did things in a different way. Would we have gallstone disease and pancreatitis in the way that we have it now? Possibly not? Does that mean that we could reduce, um, cholecystectomies and the numbers we do by about 50%? Yeah, we could. So remember that your lifespan and your careers as surgeons, you are going to be doing things completely differently. So, enjoy the clinical because it's why we are surgeons because we love it. But don't worry if you are doing other things alongside and actually I'm going to change what I said. Not about. Don't worry, please do things alongside because it will keep you active happy. And I think when you reach a stage where you're giving this talk in the future years, I hope you look back and think we've had a really fulfilling lifespan and it wasn't just all about the operating. Thank you very much, Miss that was really enjoyable. Um And if I may, it's wonderful to see someone with so much warmth and compassion in a leadership role in a very, very senior leadership role. So thank you for your time. Thank you for all that you do. Um And thank you for giving up part of your Saturday afternoon for us. Always my pleasure, take care and good luck everyone. Uh I'm gonna drop my email address in the chart and if anyone wants to follow up in any way, you would be more than welcome. So I dropped it in. Take care, take care. Bye. Thank you.
