Paediatric Surgeon, Dr Ross Fisher, currently works as Lead Surgeon for Oncology at Sheffield Children’s Hospital. Dr Fisher has extensive experience in Neonatal Surgery, Paediatric Trauma Management and Paediatric Advanced Life Support Skills. As well as operating, he spends a lot of time teaching and discussing Presentation skills and Clinical leadership ; a good surgeon should also be a good communicator. We are happy to bring to you our exclusive interview with Dr Fisher. In this interview he shares his thoughts on managing stress and also gives encouraging advice to aspiring surgeons and undergraduate medical students.
1. Why did you decide to become a doctor?
I feel sorry for prospective Medical Students having to write this in their personal statement as it really isn’t clear to me why I decided. Sometime around the age of 12 I remember thinking I might like to be a Doctor but not really having any experience of what that meant. Then I broke my leg skiing aged 13 and I think my experiences there definitely influenced my choices. The cliche is true though that I enjoyed helping people and that caring seemed a natural extension of who I was. That said, what I considered I would be later when I was 18 really was unknown to me.
2. As a paediatric surgeon, what is the most difficult aspect of your job?
I’m Lead Surgeon for Oncology at Sheffield Children’s Hospital. One of the amazing things about Paediatric Oncology is an overall survival rate of 80%. The most difficult time of my week is our weekly Multi-Disciplinary Team meeting. My colleagues are lovely, don’t get me wrong, it’s just that the nature of that meeting is to review new patients and those who have recurrence or deterioration. Seeing and understanding the horror for families of a new diagnosis of malignancy in a child or the nightmare of terminal disease in the 20% can sometimes overwhelm me.
3. How do you manage stress?
Better than I used to!
I think stress means different things to different people. When I am in tricky situations during surgery I get very quiet; I never saw the shouting and screaming approach work for others. When I’m worried about a patient I go over and over things in my mind and try to be methodical about the realities of the outcome not the nightmare scenarios as I used to imagine. Clearly experience plays a part in both of those.
Over time I have slowly learnt that people are more willing to listen to me and not judge me than I was to talk to them. Introspection and self criticism are hugely destructive in Medicine whether that is because of a perfectionist personal approach or a culture of criticism. Recognising that we are all fallible is a very important part of the support structure around me in my current post and so talking about problems and difficulties with colleagues and friends I find is a very useful way of managing my stress.
So whilst I’m convinced I portray Zen like calm in all situations, I know that isn’t the case. My theatre team in my old hospital were brilliant with me though and whenever they recognised the needle moving toward “red” they would put on my “Comfort” playlist on the iPod. It kicks off with “A Walk Across the Rooftops,” by The Blue Nile. And relax…
4. If you could give one piece of advice to medical students, what would it be?
Stop listening to gossips. Anyone who starts a discussion with “I’ve heard that they do” x,y or z is talking rubbish.
Whether it be how they always fail good people at the exams or that you must get an academic job to stand a chance of selection for higher training or that surgery is so competitive that you couldn’t do it or that women never succeed in orthopaedics or that the training is really bad in Yorkshire or anything like that. I’ve spent too much time trying to talk people down from opinions that they’ve heard from someone who heard that someone had said that in their experience…
If you want to know something, ask the people directly involved at the top, not just the bottom. We are approachable, we have email addresses, we drink coffee and are more happy to chat than you might think. Things like Twitter offering amazing opportunities for interaction that some folk would not believe. Perspective changes everything and gossip forgets that. So yes, I know good people fail exams but that will be because they didn’t examine the heart in the clinical viva. And Foundation jobs really don’t make or break your career. And surgery is competitive but actually General Practice is just as competitive. And there are some perfectly normal women being extraordinary in Orthopaedics. And yes you can get an excellent training outside of London (particularly Sheffield!).
5. You run the blog prezentationskills. On your blog you explain the quality of a presentation using a mathematical model. Can you briefly explain this model.
It is more analagous than truly mathematical. Our presentations are the combination of the presentation, the presentation and the presentation. I have classified the script of the story (presentation) as p1, the supportive media, the (powerpoint) presentation as p2 and the delivery of all this as a presentation p3. What the audience makes of all of this a whole presentation is p cubed. Each of the factors works with and influences the other factors and to express interaction I have suggested that the result is not simply the sum of those parts but the summative interaction of those parts multiplied together, in other words p cubed.
My aim of the blog and lectures is to highlight the madness and tedium that simply writing everything as bulletpoints (p2) makes this the story (p1) and subsequently directly limits its delivery (p3). If your presentation is essentially your .ppt and a bad one at that, its value can be no better that a bulletpointed list.
6. What are the most common mistakes undergraduate students make when delivering a presentation?
Having thought about this long and hard I don’t think people, whether they are students or professors actually make mistakes; we have become indoctrinated into believing that the ONLY way to present is with a bulletpointed list. That is wrong but it is how we “believe” things should be.
The science behind why this fails is strong but the simple reality is that as recipients of such deliveries we all know that it fails. So the mistake I would suggest is that, knowing how you hate such presentations, why do you replicate them?
There are lots of ways to improve a presentation. Quick positive thoughts on ways to improve; consider what the audience need; tell a story; illustrate don’t annotate; it’s about concepts not facts; your presentation should be useless without you; practice out loud.
7. Are these presentation skills transferable into other parts of our lives i.e relationships, networking?
I firmly believe that good presentation skills are an unfair advantage in life as they make such a huge difference. The Sensei, Garr Reynolds, suggests that the best presenter is naked! What he is getting at in his book, “The Naked Presenter” is that the best presenters engage with an audience in a way that is direct, honest and clear, stripped of pretence and arrogance. That’s an aspiration for presenting, clinical practice and life surely?
8. What role do you think social media will play in the future delivery of health care?
Who knows what the future holds! Five years ago very few people were on Twitter and look at it now. Tutorial and workshop based education is clearly an area for future development. My friends Fi Douglas and Natalie Silvey developed the Online Twitter Journal Club. There is a Twitter Finals Revision group, an Infectious Disease workshop, an Emergency Medicine tutorial group and those are just the ones that I’m aware of.
Sharing of knowledge and skills similarly can easily be web facilitated and that must include patients and their carers. Issues of security, confidentiality and record need addressing as social media does not support that currently. I’m excited what the future holds but I have no idea what it will be.
9. If you could change one thing about the medical education system in the UK, what would it be?
Lectures. Currently, far too much time is wasted by students listening to people reciting lists. If we valued understanding over knowledge transfer I think we would see dramatic changes in medical care. This is my dream.
10. Are powerpoints and other digital formats the best medium for medical educational lectures? Are blackboards/whiteboards ever a first line of choice, and if so, when?
It has nothing to do with the media and everything to do with the way that the media are used. A tagline I use in lectures on presentation skills; “Guns don’t kill…bulletpoints do.” An excellent presentation can be delivered without any supportive media or with a black/white board or with any presentation medium you choose.
11. Is it ever possible to bring back an audience halfway through a bad presentation?
Yes. If you watch even the worst presentation, the audience sees every turning slide as an opportunity of hope. Presentations are not cast in stone, they are living, creative things.
If you recognise what is bad, then stop and change it. The audience are with you.