Dr Christopher Maguire is a surgical service registrar in paediatric surgery at the Queensland Children’s Hospital. Dr Maguire is passionate about education, and teaches about surgery and productivity on TikTok (chris_r_maguire) and YouTube (bit.ly/chrismaguire).

What made you decide on surgery?

It was a combination of the experiences of seeing what was done and the transformative effect you can have on people’s lives in a very short time frame. 

The second component is you always gravitate towards people you admire and what they do. Some of the surgeons I worked with as a student and as a junior doctor were very impressive people to me – both in the way that they conducted themselves and what they did on a day-to-day basis. That inspired me to become more involved. Every rotation and job I had in surgery made me gravitate more toward it, and I enjoyed it more and more as I went through. I think it was more of a reinforcement process rather than a snap decision.

What has been the highlight so far of this journey?

Working in Townsville Hospital as a surgical principal house officer (PHO). As a rural surgical PHO you get a lot more exposure than in a lot of metropolitan centres. The operative experience and latitude that the department gave us to learn and to practice and to push ourselves was unparalleled to anything I experienced before that. It was a really supportive group of surgeons there. Some of the work we were doing were extremely complex, but it was more the department’s attitude of helping you to get as far as you possibly could in your professional role in as short amount of time as possible.

What are some of the main challenges in your career so far?

Probably the most important one is maintaining momentum, and what’s required to maintain momentum when you are pushing towards where there’s a lot of competition. To be competitive for surgical applications, you need to fulfil the baseline criteria, but also your CV has to look like it’s moving forward at all times because if you stagnate for too long, things become irrelevant or not valued as highly as they would’ve been.

Personally the most challenging part of my journey was having to move to Townsville while my wife was completing her psychiatry training here in Brisbane, so we had to live apart for that 12 month period. Although the work was very rewarding in Townsville, being separated from your family is difficult for that time frame. That’s a pretty common story – a lot of people who I know have similarly considered a PHO or unaccredited position to maintain their professional development but that comes at a cost.

Can you tell me about your involvement with surgical education?

I’m very passionate about this area because I feel like there’s so much opportunity for knowledge now and for teaching that we don’t take advantage of in medicine very well. There’s so many different pathways to get access to information. I started a YouTube channel that deals with surgery for junior doctors and medical students – bit.ly/chrismaguire. I have a TikTok channel (chris_r_maguire) which I use to pass on knowledge. I’ve been active in medical student societies to put people in touch with resources and opportunities. Also, trying to give medical students opportunities in the hospital is something that we all constantly have to keep working at.

If you look at the difference between you now and a senior consultant surgeon, there’s only 3 differences:

• Knowledge level
• Technical proficiency
• Experience

Knowledge is something that you can modulate now.

Let’s say you want to learn how to do a laparoscopic appendicectomy. You can go onto YouTube and find examples of how it should be done. You can check surgical websites which tell you how to set up the procedure. You can find free textbooks online, create your own database of information and create flashcards which you can use to learn that knowledge in about half the time as it would’ve taken from a textbook 10 years ago.

It’s not just your knowledge level but also, it’s about efficiently using your time out of hospital to make your time in hospital as valuable as possible. With every patient you see, you’re not just learning the basics. When you go in, you can focus on the small things and ask more more detailed questions, as opposed to “what is this and how do I treat it?”

How do you balance time for research with clinical work?

If it’s research you enjoy, it’s not too difficult to do. I think about the balance being less about what I need to do on the day-to-day basis to maintain my mental health, as opposed to what I want to do in my life to maintain my mental health. Would it be a regret of mine to not publish that paper if I had the opportunity to, let’s say 10 years from now? If I build that now then it will make me feel better having gone through the process and being successful in doing it. 

At least for me, there’s a great amount of satisfaction from just doing the work. A lot of the time, the reason why people feel terrible is because they have avoided the work. I don’t think anyone ever got to the end of a study session and regretted having done the study. But I know a lot of people who have ignored study and regretted ignoring the study. The hardest thing always makes you feel better, and you get self-pride and confidence from that. For your mental health, sometimes the most important thing is to spend more time doing the difficult thing. Even though it’s hard at the time, you always feel better at the end of it.

What is something that you would like to see change in medicine and surgery?

I think culture needs to change. We need to be aware of how fatigue and stress influence our behaviour. The reputation that surgery has is being a difficult place to work, which can be very hostile to family and individuals who don’t fit a particular mould. This largely comes from people’s unrecognised stress. If you take even the most difficult people who you might work with, and you put them in a holiday environment – most of the time, they’re friendly. We underestimate the impact that has on people’s experiences in the field. How many people are turned away from the field because we’re not cognisant of those softer but important skills like leadership, team management, and dealing with changes in personality when under stress. I would like to see research done into that and making people aware of that and combatting it to make it a more enjoyable place to work.

Do you think that is changing?

I think now people are more aware of it but there’s also a lot more work that needs to happen. I’ve talked to a lot of people who’ve come through surgical rotations, love surgery and want to become a surgeon, but don’t want to deal with the culture of the place or feel it is not conducive to family. I think there’s opportunity to change this – it’ll take time, and we have a role to play in that.

There are some people who say you can’t pursue excellence unless the culture is such that the job is primary at all times. But it is a fundamentally flawed concept to say that somebody can’t pursue excellence while also valuing other things in their life. We are complex people. You can value family but still want to pursue excellence in surgery, or you can value time doing an outside hobby and pursue excellence in surgery. The key is that you want to be exceptional, not what other interests you have. If you’re willing to put in the work, then to me it doesn’t matter what else you want to do with life.

I have a great deal of hope. The generation that’s coming in now – the group of medical students and junior doctors I see are extraordinary people who are more aware of these sorts of things even more than I was years ago. I think it will change, but one of the issues with an ingrained culture is that it fosters itself over time, so people change themselves and their own perspectives to be accepted. That’s the risk – that people who know better and have other experiences assume that they’re wrong or change their perspectives to fit in with the pre-existing culture, as opposed to bringing their new ideas to it.

You have to remain optimistic about these sorts of things. It’s really easy to become jaded – seeing tragedy everyday, feeling like you’re not good enough or that should’ve done something better – it’s very easy to fall into that trap. But, I think we need to become better at practising aggressive self-care – having empathy for yourself and for other people. I think that is the fundamental missing ingredient in a lot of these discussions. 

How do you allow yourself to be as good as you possibly can be, while at the same time recognising that there are things that are out of your control? How do you step out of yourself, and say I’m feeling horrible because I’m being treated horribly, but also feel empathy for that person, understanding that they’re coming from a place where they’re fatigued and stressed? How do we find a way to do that consistently, and inculcate that at every level of the processes? That is the challenge.

Dr John Quinn is the Executive Director for Surgical Affairs at the Royal Australasian College of Surgeons and Director of Medical Services at St Vincent’s Private Hospital in Brisbane. Dr Quinn was the Director of Vascular Surgery at Princess Alexandra Hospital until he retired from clinical practice in 2018. In 2017, Dr Quinn was appointed a Member of the Order of Australia (AM) for his significant service to medicine in general and vascular surgery, and to professional organisations.

Why did you choose vascular surgery?

I was doing general surgical training when I was exposed to vascular surgery in its infancy as a specialty. I was in the first cohort of specialised vascular surgery training – there were 3 of us chosen in Australia and New Zealand. That has been the best decision.

Vascular surgery is complicated and difficult. Vascular surgery patients have disease everywhere – coronary artery disease, carotid artery disease, diabetes, smoking-related lung problems, renal problems, peripheral vascular problems, and age. To work your way through all of that, to work out what is going on and what is the best treatment, and then be able to do the treatment – that is challenging, and that is also one of the charms of vascular surgery.

How have you seen vascular surgery change from when you started until now?

When I started, it was all open surgery. Now, it’s changed in that most vascular procedures are performed endovascularly. The original endoluminal graft was a straight graft, and then developed into a bifurcated graft. They were initially one-piece, then it became clearer that a three-piece graft would be better. They were all infrarenal, but now aortic aneurysm grafting with fenestrations can be used suprarenally. Aneurysms and dissections in the thoracic aorta were a very difficult situation requiring complicated operations, and now we can do those endoluminally in a relatively quick and straight forward manner.

Carotid arteries are still mostly done open because that’s shown to be better and have better outcomes than endoluminal treatment of carotid artery stenosis.

The surgery principles are much the same but the way they are undertaken are different. It has come a long way with the techniques used to access arteries, along with the changes in radiology practices and abilities, and the device companies that are able to produce stents. The first endoluminal aortic aneurysm repairs occurred in the 1990s, and we thought that was strange, but it has shown to be wonderful.

What have been the main challenges in your career?

The biggest challenge is keeping up with changes in the field and staying on the leading edge of new devices and techniques, diagnostic means and therapeutic endeavours. Making sure that Australian vascular surgery remains the best in the world.

How do you keep up to date with these changes?

Reading journals, going to meetings, talking to other people. Sometimes you can go to different places to visit surgeons and learn about advances in the field.

What are the most memorable moments in your career?

Achieving competency and expertise in difficult operations is the first thing. The other thing that I particularly enjoyed about my career is promoting medical students and junior doctors who want to do surgery. The stimulation I receive from bright young doctors has encouraged me and given me hope, wonderment and enjoyment in my career.

Do you have any advice for medical students who are interested in pursuing surgery?

Medical students in general should get as much experience in everything that they can. If they want to do surgery, they should get as much experience as they can. But the first aim should be to gain knowledge to pass the exams. If they focus just on surgery and forget the other things, then they might not get through.

When medical students graduate, they need to get as much experience as they can and to make sure that they’re not looking at surgery with rose-coloured glasses. Get as much experience and exposure, ask questions, and get in the operating theatre. Though, remember, surgery isn’t just about the operating theatre. It’s also about making diagnoses and dealing with people – colleagues, patients and their families, and doing that in a respectful way.

Do you have advice for dealing with the transition from medical student to junior doctor?

That’s an interesting transition and is scary for lots of people. You go from not being able to make decisions to being in a position where people depend on you. You are supported by more senior doctors but you are also making decisions and treating people. I think you need to do that with gusto, enthusiasm and confidence – but not overconfidence. Talk to people, get advice and, again, gain as much experience as you can.

In your intern year, you need to do some medicine, surgery and emergency medicine to get full registration. These terms may be better or worse than you thought, or reinforce your opinion. In PGY2 or 3, if you still want to do surgery, then you should get exposure to as many different types of surgery as you can. There are 9 different streams in RACS. Some have prerequisites. For instance, if you haven’t done a term in neurosurgery, you won’t be accepted into the neurosurgery program. Know what the prerequisites are.

There’s also a program called JDocs, which the College of Surgeons runs. It isn’t available for medical students but it’s available to young doctors as soon as they graduate. Part of that is developing a portfolio of experiences to make yourself a more attractive candidate when applying for surgical training. There’s educational materials, information about what courses are available, and access to webinars. It’s run mainly for surgeons, but there are aspects that also apply to emergency radiology, radiology or O&G – certainly the procedural specialities.