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ship who is a consultant in burns and plastic surgery. And she's been training program director in West Midlands. Denree. She is on plastic surgery Training committee. Uh, so, um, she's a process surgeon in Birmingham. She's specializing in burn surgery, both adults and Children. Uh, so I'm gonna I'm gonna I'm gonna leave it here. I'm going to, uh, hand it over to this chicken conquer for being here today. We'd love to hear from you. And if there's anything I missed three. Please do that. Thank you very much indeed. High. Thank you so much. The invitation to come and speak to this evening. It's It's great to see so many people in line at this time on a on an evening. So you obviously will Really keen. And it sounds like you had some great speakers ahead of me, so I'll hopefully follow that up with something that very, slightly different bear with me while I share my screen. Okay, so I've been asked to come talk to you this evening about women in surgery. Onda my backgrounds here. I work here. So the picture on the top left is the queen lives with hospital in Birmingham on the bottom left is burning in Children's hospital. That's not me in the middle. That's just a generic female surgeon looking like she's ready to do something important. So so why do we need to talk about women in surgery? But I must admit, when this topic comes up, I always feel a bit of a fraud because personally, I don't feel that women in surgery and read any different to anybody else been surgery. So why do we need to talk about this? So I started to bit of a bit of research. But of homework on this data is from the rule College of Surgeons of England, looking at the number of consultant female surgeons, a supporter of the whole workforce. So you can see that back in 1991 just 3% of consultant surgeons were female, and this is increased significantly by 2020. But it's still only 13% so there's definitely progress there, but probably still quite a long way to go. So the status from women in surgery on again that begs the question. Why do we need an organization called Women in surgery? There isn't an organization called Men in surgery. So why do we need it? Is it really necessary? So I thought I'd go back in a little bit of history. So this picture here is somebody who was known as James Barry. But actually born is Margaret Bulkeley. She was, ah, lady who was born in island to a large family, and she actually studied a Edinburgh medical school back in the early 18 hundreds, but always discolored yourself in past herself off for a Zometa. She managed to pass the exam of the Rule College of Surgeons and then serve for many years as a very successful Army surgeon at performing many procedures, including the first Cesarean section, which was known to be the first successful one in the mother and baby, both survived. It was only after she died of dysentery in 18 65 that she was actually discovered to be a woman. A child lady laid out her body on, noticed that she got stretch marks, publicize the fact that she was a woman and furthermore had probably had a baby at some point. So, you know, quite a shocking revelation that she practices a man all this time but was actually probably the first practicing female surgeon. So since then there's been an increasing number of famous female doctors. Elizabeth Blackwell was the first woman to to gain an MD in the States back in 18 49 and in 18 74 the London School of Medicine for Women was formed. So there's a need for a whole school of medicine just for women. But interestingly, the board of examiners at the Royal College actually resigned in 18 76 in preference to letting three women set the deploring midwifery. So there's still a lot of reluctance to let women into the profession, the first woman to receive the F. R. C s Fellowship of the Real Cold Decisions of England. Back in 1911, there were just four fellows by 1919, and you can see that the numbers have increased over time. So are we heading in the right direction with gone from 3% to 13%? But it's taken 30 years to do that, and we're still only a 13%. So what's going on and why we not getting a quality with our male colleagues? So I'm a plastic surgeon specializing in burns, but I do all sorts of plastic surgery, and I thought I'd have a look at the date according to a specialty. So like a plastic surgeons on, actually, we beat. About 13% is like 21% of plastic surgery consultants or women. You know, we're doing pretty well. You see the pediatric, so quite a female friendly specialty. Some of the other such a strong man. Orthopedics and neurosurgery have even lower than average number of female consultants. But plastic surgery is a better but Viagra subtle. You know, we seem to be doing quite well. There, quite a leading specialty. But actually, when we look further, 64% of medical school, entrance or female, my time you look a plastic surgery registrars, higher surgical trainees that's just 44%. And plastic surgery consultants it was 21%. So what is causing that sort of attrition of females from the point where the entire medical school to the time when they become consultants. So it was mentioned beginning on the program director training prone to Erector for plastic surgery? Nice Midland's on a part of that role. I haven't annual appraisal with the head of School of surgery. So last March I sat down with my for my appraisal on, but we talked about all sorts of things affecting our trainees in the West Midlands. What's happening with a, uh, CPS with the annual appraisal process, recruitment things that are going on in the various training units? And of course, no appraisal at this time would be complete without Children effects of code. So we talked about all of these things That's, well, fairly standard and nothing out of the blue there. And then all of a sudden, the head of school of surgery said to me, So what proportion of your trainees of female And I looked like this. I was genuinely flabbergasted. Well, I I don't know. I actually I have no idea. As a female consult myself. I have no idea what proportion my training is a female, But actually, why do we need to know? Is it really important? So I thought I'd better go and find out. So in the West Midlands, in our regional training scheme, we've got 25 of trainees and 11 of them a female, so 44%. So we're buying on that national average for plastic surgery trainees and two on becoming a 23 trainees when one returned from a 10 to leave work less than full time, ranging from between 60 and 80% of the whole time equivalent. And when I look at our training committee, so I was a little bit of a cheap because I take both roles of both the chair of the program, that chair of the training 20 on the program director. So there was a female chair and TPD but actually looking at the rest of our 10 committee members, only two of them in women. So we're not doing very well here where I work at University Hospital. Blaming, um, is probably the largest plastic surgery department in the country. We've got a total of 42 consultants between burns, plastic surgery and having surgery. So certainly one of the largest, if not the largest, departments in the country. And when I looked on our our list of consultants again, it wasn't something I thought about before. I was surprised on day, shocked, really, to see that only 12%. So any five of our consultants or female um, including myself, all of them work full time on our stuff includes Ruth Waters, the lady on the right of your screen here, who is the current president of Bad Press, the British Association of Plastic Reconstructive Anesthetic Surgeons. So we've got really the leading plastic surgeon is a female surgeon in our department, But despite that, we've only got a very small number of very small proportion of women. So what's my experience? And I have to say that I've never that I know off experience any difficulty is a female surgeon. I've had a pretty straightforward career so far. Maybe that's look, I like to think it's because there is generally no difference between male and female surgeons. But maybe I'm being naive. So I went to Birmingham Medical School back in the last century, rather depressing Li. I completed a foundation year on, then moved into basic surgical training just before the foundation program became fully established on I did various jobs in the West Midlands and in Yorkshire and then up in the Northeast before getting my training number back here in the West Midlands. I trained between 2008 in 2014, including school fellowships, and then I was looking up to a point. It was a substantive consultant in burns and plastic surgery here in Birmingham in 2014, I discovered just several weeks actually have to take it. That consultant post that I was pregnant with our first daughter, who came along in 2015 on our second daughter Two years later, in 2017. I've always had a strong interest in teaching and training. Um, I took up the role of training program director in 2018, and I've worked full time throughout my career. Apologies lost my slide, but people often ask, you know what? What's your what is your day? What is your Wheat look like? And certainly when I was ah, medical student and even a surgical trainee, I thought that being a consultant surgeon was all about operating on. I went quite a shock when I took my A consultant post and realized that actually, that's not the case. So this is my my sort of typical weekly timetable. If I'm not on call for that week and I work 12 sessions, so 10 sessions is considered to be full time on. I work 12 sessions, but despite up because of the sort of a breeze of the job plan I managed to have. Mondays is my Nana, and each cast a. So Monday is my day for child care or bit of time to myself take you off All the things I enjoy being out of work. Tuesdays are mainly abdomen and and other activities. What the calls SP a supporting professional activities. So all the things that go into making you a consultant Wednesday's either work at the Children's Hospital or I do a peripheral clinic in a local hospital and do some skin cancer. And Thursday is my only real full operating day, where I create mainly on patient with acute burns, a country construction and general plastic surgery that Friday is then multidisciplinary team meetings. That's parts of pediatric list and then a clinic, and we currently do a one C actually, one in 5.5 on call right at the moment, covering both pediatric and adult burns for jury. So sometimes my week is a lot busier if I'm on call, but generally that's how my wheat looks, and only one day of that is operating. So what else do I do? this All these sorts of things on here, Really? My week is busy and varied and no two days of the same, which I love. So you know, most days will include a ward round. We have a very strong willed he disciplinary working attic and burns. We are involved in teaching and training in research in clinics on I also have some other roles within the trust, which I really enjoy aside from my clinical work. So I'm currently the chair of our hospital clinical ethics group. To the fascinating roll on, I've also got an interest in intensive care, which I was lucky enough to develop. Look, look enough, perhaps to develop, drink over it when I was redeployed to I to you for a period of several months. So what about life? Outside of work? People often think that surgeons, you know, worked very hard and indeed they do. The hours could be long. Onda job is not necessarily a job that finishes at five o'clock. But what about life outside of work? I think it is important to keep a work life balance. So this is a picture of one of my favorite places looking between the years of a horse cross, um, rolling countryside. And that's one of the things I I really love to do, particularly when the weather's a good is that I'm quite Akeem runner on This is me finishing Birmingham Half Marathon with a close friend of mine. And the other thing that keeps him very busy at the moment is my two Children have literally just want to get into bed before this talk, Which is why it's a least relatively quiet in the background. That's my two young daughters who are in absolute pleasure most of the time. So a question that's often asked is, How do we support female trainees on again? I would throw that battle say, Well, actually, how do we support trainees? Because if we support all trainees, then we're supporting female trainees on. I don't think that generally female trainers require any additional extra support, but we should be supporting all of our trainees. So actually, there are lots of ways with in the trust that you work. You'll find a whole range of people to help support. You have clinical supervisors, educational supervisors and if you're a surgeon in training a college tutor, who is employed by the trust. A swell a college. A couple of relatively new roles are the guardian of safe working on the freedom to speak up guardian. And these are people employed with in the trust, recognizing that there may be issues, conflicts, problems, difficult situations that people feel it's difficult to escalate or they don't feel confident to escalate. And so these people are really here to take those things forward on your behalf. So the guardian of safe working is mainly related to rotate patterns, making sure that people are working safe. Our they're not exceeding the European working time directive, for example, and that's the person to go to. If you're having difficulties with schedule shifts and rotor patterns and the freedom to speak up, guardian is actually much wider rolls. There. Anything that anybody is concerned about, you don't have to be a medic. This is for all members of stuff. Any concerns that they have about patient care, about working relationships, all sorts of things, the freedom to speak up Garden will be there to take those issues forward on your path and then, outside of the trust, their also several roots to get help and be supported. So in the West Midlands, we have to training reps. Relatively senior registrars who've been elected by their peers to again take forward any issues concerned. They're basically actors. The to weigh conversation between myself is the training program director on all of the trainees. The TPD themselves might be somebody that you can approach if it's an issue that you feel need to go higher than that. The head of School of surgery on were incredibly looking in this region to have a really excellent professional support and wellbeing unit, which I'll talk little bit more about in a moment. You're probably aware of the Borrower Garber case a few years ago, and there's a direct result of that very tragic case was formed. A system called Support so supported Return to Training, which is essentially a scheme a national scheme run by health education England, which comes with a huge amount of financial backing to help people returning to work whether they've been off on perhaps parental leave for a period of six leave with the napping research, for example. So that's really aiming to avoid those situations where somebody returns back to training in a sort of thrown back into a busy road without any chance to acclimatize. And we do have representatives who will help support particular groups of training. So, for example, training is working less than full time, and that's no longer a position that's necessarily exclusively occupied by female trainees. There is a big drive to making less than full time working, more accessible to anybody for for any reason, whether that's for caring responsibilities, health care reasons or just the trainees who want to establish a better work life balance. So our professional sports and wellbeing, you know, as you say, is a really gem in the crown of the West millions we nationally renowned to be probably one of the best units in the country on this is set up that trainees come refer themselves or by their trainers. And it's for any training, really, who's struggling with anything inside or outside of training things in their personal life or their work life. And it's a confidential process, and that's very closely aligned to this supported return to training scheme that we've already mentioned. So there are lots of lots of ways of supporting our trainees on within that that includes, or female trainees. A document called Enhancing Jeannie Doctors Working Lives was produced. Recognizing the fact that I junior doctors working I would consider to be improved, say, less than full time working is much more common now on. There are various things that we do to try, make our trainees lives of the easier. So you know, we try and give them a much notice. It's possible about where they're rotating to next. Give them advance notice that their rotor and things like that, so that people can plan they congested, whether been to live, other going to move house. Do they need to read it somewhere to the need to arrange childcare, for example, and all these things much easier to do when you've got plenty of notice? Of course. And then more recently, in August of last year, a new surgical curriculum was established, moving much more towards a competency based rather than time based training program. So no longer do you have to serve necessarily a certain number of years, it might be that you're able to get to the end of training more quickly, or indeed, that you might need a little bit longer to reach those competencies. And so that's a recognition, really, that Ultram is a different and everybody takes their own time and some people will will get there quicker or slower than other people on. That's absolutely fine. So I think all of these measures are really important to support our trainees. So in conclusion, really, how How do we support our female trainees? How do we support our trainees in general, I think by supporting everybody, we will support those those minority groups who perhaps are less well represented on with time. I think I hope that the need for things like women in surgery and talks about things like this and hand how women managing said you'll become less necessary. I hope that as TPD on that all the members of my training pretty are approachable, supportive and sympathetic. Uh, this is another gratuitous picture of my two daughters here on my favorite pictures of them, and just to remember really that yes, many trainees will have perhaps Children of family. But also there are many other reasons why people need to have that work life balance, so they may have caring this once with you for family members. We've got a training, for example, who plays semi professional roping on. People have various hobbies and interest in things outside of work, so that tends to be associated with female trainees. But actually, many of our trainees have other pressures aside from work, and it's really important that we support all of them to make them the best surgeons that it could be, as well as the best person outside of work. I'd be delighted. Take any questions on this is my email address. If there's any questions, people have it a later date that I'm not able to answer or something you think of later. Do you feel free to drop me an email? Get in touch and I'll do my very best to help Thank you once again for the opportunity to talk. Thank you so much, Mr. That was amazing. And I think the very pragmatic idea behind that. If we all treat trainees same way, it doesn't really matter whether they're male or female. We just have to have another minute of support. And that's really all that matters. Because male trainees may need not support the same way female trainees, do you on da I? I like you guys have a great culture around that. And, uh, I think it's something that we need at this stage after the pandemic. I think Michael had a question that you wanted to ask Michael, invite you back onto the stage. Uh, if you've got a question there and keep a lot about I was really, really nice to see a what a supportive Dina really looks like. What would What would you say if the training is who probably or who come up against TPS who aren't so open who aren't so supportive? How what do you say to those training is what would your target to do? And so I like to think that maybe I'm naive. I like to think that that everybody in training is in training because they're very passionate about training, which is essentially to help guide trainees through the through the training pathway to make them the best doctors that they can be. You know, it would be disappointing to think that there are people out there who don't have that objective. But I think it's important for our trainees to know basically the different people who are available. So you know, for example, you have a training program director that you don't feel you can approach. For whatever reason, perhaps they're not supportable. You know, they haven't been terribly helpful, or you just feel, you know, you haven't particularly great relationship with them. Some people just gel that and some people don't that it's really important for trainings to know that there are other people to go to, so they will always be. Every training will always have their educational supervisor. They'll also have clinical supervisor is the work in a department undoubtedly, with many consultants on down almost any consult. I think we'll recognize that they've got to some sort of element of pastoral care in their job of the trainees. They'll be training reps. They'll be college tutors. They'll be the freedom, speak up guardian, so on and so forth. So I think it's important to know that there are other way around and you know, actually, TPS are, you know are human will be there will be three training. We should recognize the difficulties, but if you really finding that that somebody you can't approach where you've approached and you're not getting the answer you want, then there are lots of other avenues open to you, obviously, depending what what the issue is. And but I think, you know, I do feel very strongly that actually is like it genuinely surprised me when my head of schools it'll have any of the training is female. What I know because I don't see them is male female, like, you know, I personally really don't think it's an issue. Maybe I've just been very lucky that I don't feel I faced any problem. Was is a female surgery. I think surgery is difficult, you know. Nobody will ever tell you it's no, you know, it's a tough career. It is tough with your male female, black, white, straight, gay, you know, whatever. It's a tough career. It should be. You know, you're you're sort of holding people's lives in your hands at the end today. It should be tough. It should be difficult, but we should support people to manage those difficulties on get there and be the best surgeon that can be. And I you know, if you're really strongly about that. Yes, sir. Thank you for that question. Michel. Uh, I have. Ah, I have probably one slightly longest question as well, but it's quite interesting. I think, the fact that you had an experience where you sort of looked at it, look at what your objectives and goals were and went through, and, you know, uh, didn't have to face some of the other thing that people face. There's a question that someone's asked her about, um, practical life situation that we have. So what was your experience with having two Children and pursuing surgical training? Did that possibly seem like a challenge on the person? Asking is quite keen on surgery as well? And did you ever feel the need to go that central time? Which is something that's becoming slightly more understood and more common now, Um, I think that is essentially it on. They also touch on that they're scared about being able to cope with family medical projects, hobbies on the sides, on the fact that it's really challenging, being in four times training. So love to hear your view on that. Sure, so thank you for the question. I think my situations, but slightly different. And I had my Children when I was a consultant so my experience is a little bit different. I would start by saying, I think having Children is probably the hardest thing I've ever done. You know, surgical training is walk in the park and I'm being slightly slipping. You know, having Children is difficult. Having Social Cruise difficult on. Do you know, I think there's no doubt that combining the two is difficult, but it's perfectly doable. And I that's what I've been lucky to have lots of good role models when I went through my training. So the picture showed you earlier of roof daughters who the current president of Backcross and she has a family. I believe she had. She started her family, which was still training. All of the sort of female role models that I've worked with have always had Children had a family so intimate she's been a sort of normal thing that you can do. And what I would say is that life is a consultant is much easier than a training. So, you know, my working week that I put up there is much more flexible than the life is a training have much more control over your job plan over what you do. And so you know, absolutely the case. I think that having Children as a consultant is probably more straightforward than a trainee. But equally I know lots of trainees who combined that very successfully. As I say, we've got several training is in our region who got Children. Some of them were full times from the work less than full time. And and I think just about to the question in parts. So I'm very lucky. We've got a great set up. I think you're reliant on really good child care. If you're going to continue to work and you have Children, you know, reliant on on wood childcare. We're very lucky that we got a fantastic nursery within the ground to the hospital. Good opening. Our is really flexible. On DTaP woods, I had Children who sort of fairly robust in don't seem to come down with any coughs and colds. My husband is a consultant surgeon as well, initially in a different hospital now in the same hospital. So that helps because we've got a bit of flexibility and we don't have family nearby. You know, it makes things a little tricky, but we've got an absolutely amazing child mind. Now, my Children have just started school. The both primary school on were absolutely reliant on a phenomenal child minder. Really good wraparound care. And, you know, we pay a lot of money for the privilege. Other people might use family. You know, maybe their partner has different working hours that could accommodate that. So you you definitely have a plan on. I think good childcare is essential. And you just got except that sometimes your child will have a temperature. They're being well, you have to leave work to pick it up early or we have to stay at home, you know? And I think people are generally pretty accepting of that, Um, less than full time training. Yes. It's not something that I ever considered. I think it probably would have been something I would have considered more refined. Started. My family is a trainee. Is that I think is a consultant. You actually get a lot of flexibility, And so it's not something I've ever felt necessary to do, but it's something I would consider it. My circumstances changed on. It is definitely becoming increasingly common, So we've got three out of 25. Training is a less than full time on, but, you know, it's just very accepted. Now, I think, um, you know, it's definitely move away from your only lessen full time because you're a woman and you got Children. You know, there are multitude of reasons why you want to wait. Might want to work less than full time. And it could be Just say it. You know, we've got people doing high level sports having different hobbies. Maybe you care for family members. Maybe you just recognize that actually working full time is not what you want to do. And you know there's increasing recognition that that's fine. I think there's a big move towards realizing that people need to have a work life balance. There is life outside of work, yes, your training to be a surgeon. But that's not the only thing in your life. And so I think less than full time works really well for a lot of people. But I think you know if if you take out nothing from this is that it is possible to do a lease things I mean, I think we all have times when you you're juggling But, you know, having Children is one of those things to juggle, but it is possible it's difficult, but it's doable. I wouldn't change anything about my job or my family. And I think some of that is definitely look on be kind of circumstance and, you know, happening to find a good child. Minder. It definitely is quite an expensive thing to do with childcare. You need to be pretty organized. Um, and yet, you know, asked me again it 6. 30 tomorrow morning when I'm trying to get the kids at house and I'm screeching and for the shoes on. But, you know, it is it is doable. And I would say to anyone, if you want to do surgery, you have to want to do it for the right reasons, and it will be tough, but, you know, don't ever think you can't do it. Um, is Michael said, if you want to do something, you can do it. And if you want to do that with Children or a hobby or another career on the side, you know, absolutely condone it. If you want to do it, you will get there. You know, I I think that's Ah, that's thank you so much. That's probably Sensor. And I think one thing you might possibly be lucky on is the fact that you have a fantastic facility for child carrying in the hospital. I think I'd be amazing, maybe something Teo think about for for other places. But I think support. There's such a important thing to have around training because I think you might be very right being a training myself on Michael might agree with this. There's loads of pressures and currently, with things I collect of this being counseled, you constantly worrying about your numbers were just coming up for a six month mark and I'm counting. My case is, how many have I done? What's STS Uh, that kind of stuff. It's it's really raised wrestling. You're juggling everything else with it. Um, so I think that burn out is going to be a thing that people people will inevitably experience but to touch on less than full time surgery. Something very interesting that someone mentioned to be a few days ago is that we're moving towards a competency based system. Onda. People might actually, uh, you know, benefit from that. Where whether you're full time. That's the whole time. What you're doing is going to be assessed based on your competence. It's Onda. Uh, would be interesting to see how that progresses into the future. Thank you. Thank you so much for for a rather insightful, uh, talk. And we hoped about Have you and Michael back again on day way. Hope everyone enjoyed the top for tonight. If you have any last questions, guys, before we finish up, please pop them down in the chat. We'll ask them, and if not, we'll go through to closing remarks. Is there? Is there anything that our speaker's would like to say before we finish up? No, just just thank you for the opportunity and good look, probably listening with whatever. Whatever you end up doing in your future career, it's, you know, it's a fantastic career. Yeah, I think everybody has tough days, but, you know, the end of the day, it's It's an incredible job, very privileged to do so I hope everybody healthy opportunities that I've had. Fantastic. And I might go anything you'd like to say. Uh, just again, Thank you for having me. I'd like to say that we had our first kid. Ah, five year old straight out of that one. So we've got three kids at home when making it work. So it is doable on thank you again for having me. And I hope everyone enjoy special upsetting 50 Face is tomorrow. Fantastic. Thank you. Thank you guys so much on. Yeah, challenge your Children and challenge. Ah, conversation I'm having with my wife. And, uh, yeah, we'll see. But guys, that's for another time. Thank you so much for ah, uh, coming tonight. It is very late in the evening. We still have quite a lot of people from earlier. There's a couple of things I want to say before we finish up. The's feedback for me think will be in the check at the end of the event. It will automatically award use it, which is one of the reasons what made med also groundbreaking for the six PM Siris and why we still do All of our teaching through it is that you don't have to do the certificates. They just come like magic. Once you've done the the feedback prizes for the poster will be announced over the next week on we have on demand content available, and this will be available on the event page through next week to definitely check it out with loads of events available on. But I I think I think you would probably find something like s. Oh, yes. So that's it, guys. Any last questions? Anything at all? Please, uh, let us know or keep the conversation going on Twitter or whatever social media and we use on we will get back to you on. Yeah. Thank you so much to all of our speaker's tonight. I really enjoyed the evening on day. I hope everyone else has a great evening on. We'll see you again for the next IBM. See? All right, take care, guys. Thing.