Surgical Research Society of Australasia Meeting 2015, Sydney

I initially signed up for this research meeting without putting too much thoughts into it. I mean, I like research, I want a good platform to present a colonoscopy audit which I did last year, and I get to meet many like-minded people from all over Australia to learn from their experience and work.

I then got an email from the organisers saying that my research has been accepted for oral presentation. Yay! This is going to be fun. Then the organisers said after scoring by three independent surgeons, unfortunately my research wasn't eligible for prize. What?! My registrar presented the same research at the ASC Perth this year and won the general surgery best paper prize. Hmm.. Whatever. Maybe I was not pitching it to the right audience. Still I was going to make sure I do a good job in presenting. If anything, this would be a good practice for my own development.

On Thursday we had many speakers discussing on the topic of academic surgery, which is very fascinating topic. It seems like, to be an academic surgeon who operates, it's not quite the same as being a surgeon who happens to do research. The former has invested much of his time and energy in first getting a PhD, then building his research portfolio, and then being extensively involved in university roles of teaching, publication and mentoring, and somehow still be able to fit in some clinical work and operating. Sometimes this means taking a paycut to achieve these things, especially in his or her early days of starting the academic career. But the journey, they promise, is an extremely rewarding and satisfying one.

Professor John Windsor, an academic hepatobiliary and upper GI surgeon from University of Auckland, Professor Peter Choong, an academic orthopaedic surgeon from St Vincent and Professor Joe Hines from UCLA were the three distinguished speakers who shared about their life work.

On Thursday night, we had the academic forum. There were three short talks and a three-course

dinner. To my pleasant surprise, the director of surgery from my hospital - Dr Ratna Aseervatham who is also my mentor, turned up for the forum. We sat in the same table with Suzie, theatre coach from my hospital, Fiona - a surgeon from Armidale (who sits in the generic surgical science exams committee) and another ENT surgeon - Dr Hamish Sillars from Auckland and his wife. Dr Sillars was there to receive supervisor of the year award for his contribution to education. We had some interesting conversation in our table about some quite controversial topics which I shall not reveal much. I also got to tell Dr Aseervatham an extremely busy, chaotic and interesting night I had 2 days ago. He is my mentor, and I value what he says about how I can further improve.

On Friday, it was the surgical research presentation day. My presentation was in the last session at around 4pm. The chair - Dr Andrew Hill started by saying that this is a premier platform to present one's work. Yes ASC is good, GSA is also good, but this is truly the best. I chuckled. I thought he meant it as a joke to make us interested.

As the presentation proceeded, it became quite clear he really meant what he said. Highly specialised research, well thought-out question, advanced methodology, equipped with sophisticated statistical analysis were the type of research that were presented. To be quite honest, I probably only understood about 50% of what was said, but I pretended I did, laughing at joke which I didn't quite get and clapping my hands in agreement when I saw everyone else doing so. 

I met Siobhan Fitzpatrick, a final year medical student from Griffith University who is also the chairman of SURGIA (students surgical association)- an extremely bright and industrious young lady who aspires to be a plastic surgeon. We both sat at the back and lamented on the lack of emphasis on research that is inherent culture in QLD. Too bad she is moving back to NSW to begin her internship in Royal Northshore Hospital. I can't believe she couldn't get her first choice hospital in QLD, and was to be sent to Townsville Hospital instead. It's a loss to QLD then. But I am really excited for her for the opportunities that lie ahead.

At the end of session 3 just before the final session, I was ready to run away. Compared to what others have presented, mine is like child's play. Why did I submit my abstract in the first place?! Everyone is going to laugh at my miserable attempt! I went to the chairman of the final session, Marc Gladman, Professor of Colorectal Surgery at Concord Hospital, and told him how I felt. He kindly reassured me and told me to never look down on my own work. He said there is a value in outcome-based research (which was what I was doing), good stuff can come out of small studies. 'This is a friendly audience' he said. 'You will be fine'. 

Right. 

For the last 10-15 minutes before my presentation, i started to visualise everyone in the room as my best friends and family to help to calm my nerves. I had been in similar position before. There is no turning back now.  'Should i take along my script?' I was debating with myself. 'What if i forget what to say?' The thing is, in all my previous presentations, i always have my script with to me. But i also realised this was a crutch which was hindering my presentation. I made up my mind at that point that i wasn't going to rely on my script. If i don't step out of my comfort zone, i would not be able to improve. 

The hardest thing for me in any presentation is usually the beginning - the first sentence. You need to get the tone of voice, the enthusiasm and scene right. But the problem is, once i realised i was in front of a group audience a lot more senior and smarter than me, i usually freaked out. I would go on an autopilot mode, stared intensely at the laptop, and just fired memorised words from the script without truly communicating with the audience. 'I need to get the beginning right!'. The first 20 seconds will determine how the rest of the presentation go. 

I made a mental note to take the first 5s to just look and smile at the audience before i started talking. This is a mental checkpoint for me, to remind myself that effective communication is just as much the non-verbal as the verbal. It's more an art than a science. It's also to slow myself down psychologically so i could ease into the beginning seamlessly.  

Marc Gladman said at the beginning of the session that according to sales psychology, we only have 60s to convince people if they were going to buy the idea. I was going to use my first 60s well. 

The presentation went well. It was quite well received by the audience. I have kept my points as simple and as interesting as possible. Some remarks during the Q&A were 'this is one of the most politically correct conclusion you have made', 'your mentor must be very proud of you' etc. 

Alas, i had made a break-through. Whereas previously i would be crippled with fear before and during a presentation, i am now able to look at the audience and communicate. Wow. What  a feeling!

The meeting concluded with prize presentation. The young investigator award went to an orthopaedic surgeon from Victoria, Dr R Mittal on his topic of CROSSBAR (combined randomized and observational study of surgery for type B ankle fracture treatment): Results of a multi-centre RCT who, at the time of the prize presentation, had left. The chairman of the meeting immediately announced that he was disqualified from the prize because the rules had clearly stated that prize winners must stay till the end. Another surgeon from NZ - Dr Mohammed Amer, won the prize on his topic - Preoperative carbohydrates for enhancing recovery after elective surgery: A multiple-treatments meta-analysis. I was especially impressed with a presentation by a medical student - Chen Bi Yi from NSW on Radiation-induced gene expression of Tissue Factor, Thrombomodulin, Cadherin 5 and Catherine 13 in cerebral mouse endothelial cells. I later asked her if she was also a phD student, since there were many of them in Sydney. She told me no, that she was doing her MBBS in Albury - a regional area in NSW, and travelling to Sydney during her holiday to complete her honours in research. Amazing! 

I spoke to Professor John Windsor at the end of the meeting and told him my interest in Academic Surgery. Professor Windsor is one of the most well-regarded academic surgeons in Australasia, and the thing that attracted me is not so much his achievement (although it was massive), but his ease with people. His humble nature makes it easy for anyone to approach him. 

'Do you want to be an academic surgeon?' He asked me. 'It's a little too early for me to be absolutely certain if this is the path for me though i really enjoy attending meetings like this and i will continue to attend future meetings to be inspired by people around.' I said. 

'Well, i can see that you are being infected by the research bug now. The best advice i can give you, now that you are in the surgical training programme, is to work for a year, and then take 3 years off your training to do a PhD, and then resume your training again. Time and time again i see people making the mistake of leaving their PhD till after they complete the surgical training, and they lose out of the benefit of being equipped with these skills early in their career. Doing a PhD during your fellowship will also mean that you won't enjoy your fellowship and you can't fully focus on the subspecialty training. Besides, a lot of the fellowship programmes out there are very competitive, and having a PhD will certainly help you when applying to these programmes.'

'It's risky business i know, to interrupt your training, take a pay cut to do your PhD. But in the long run, this will be extremely beneficial. Trust me, i know.' He said. 

'Well, i don't know what your family circumstances are, but if you are interested, i would be more than happy for you to come to Auckland to work with me. Currently I have 46 PhD students in my department. I would be happy to mentor you in this process. Here is my name card. Just email me if you have any questions.' These were his parting words. 

This is a very difficult decision to make. Is this the path God has set for me? Whilst i love research, i don't want research to take me away from patients, who are the reasons i set out to be a doctor in the first place.

Taking three years off work and formal surgical training also means i have to take a significant pay cut to do this. Would I still be able to feed my family? Three years seem like a really long time. I would surely forget a lot of my surgical knowledge and operating skills. Will i struggle when i resume surgical training?

Anyway I am glad I don't have to decide now. 

All in all I had a really great time at the surgical research society meeting. I came home being inspired by the people that i have met and the high quality research that were presented. I am more determined than ever to produce a stunning piece of work too in the near future!