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Inspiring the Next Generation

Some of you may remember my post from a couple of years ago when I gave a talk as an alumnus of York House School. During that talk I outlined my path to becoming a surgeon and took questions from the all-female student body. That experience made me think about what to tell young people that are considering a career in surgery, namely was I being too honest about how difficult the road is?

But the feedback from the students (age 15-17) was really positive and included comments such as:

"I feel like I learned a lot at this. I saw 2 MD's who had very interesting, different insights into the medical career. I feel that this gave me a new perspective on this profession. For me, a speaker that really stood out was the plastic surgeon. I enjoyed that she didn't sugar coat the fact that her job was difficult and not for everyone, but also highlighted the fact that she could really enjoy it. I think the way she presented her job was really effective."

"I loved hearing about the plastic surgeon. It gave me insight into what the life of a surgeon might look like and the road that was taken in order to achieve what she has. Also just hearing about the success is unhelpful so I liked that she outlined the work that was involved as well and the sacrifices she had to make and how they have affected her."

"I went and saw the plastic surgeon. The plastic surgeon was amazing. She had a full on powerpoint which she organized and was able to talk to us about so much. We got to see photos of reconstructed breasts which was incredible to see, as well as hear about how satisfying the job is when the patients are overjoyed with their surgeries." I really enjoyed doing that talk and so this year when I was asked to speak again by a group of high school students that formed "Quantum Leaps" I immediately said yes. I was so impressed with these young women who planned and executed this conference with their goal being to inspire women to pursue careers in the "STEM" fields (science, tech, engineering and math). I thought I would share a bit of what I spoke about. I hope it gives more people insight into what it takes to become a surgeon.

Back when I was in high school in the 90’s it really seemed like there wasn’t a lot of guidance in terms of how to choose a career path. We were essentially divided into those that were good at science and those that were good at “the arts”. I liked both but I was especially good at math and science and so it seemed a natural path for me to pursue that at university. At the time I didn’t really know for sure what I wanted to be, but I managed to get on a path that led me to a job that brings me immense satisfaction and I think a large part of that has to do with luck and a few pivotal opportunities and experiences.

Dr Sheina Macadam graduates from York House School

Once I made the decision to pursue science, and most likely medicine, I finished at York House (that's me, my mother and sister on my graduation day above). I left my family and flew to Montreal where I completed a BSc in Biochemistry and then applied to medical school across Canada and the US. Looking back I would suggest a Bachelor’s degree in preparation for medical school because the first year of my medical training was a repeat of what I did at McGill which made the transition easy.

The path from there was a long road. I completed my 4 year Bachelor’s degree then 4 years of medical school and was looking towards a 2-5 year residency after completing medical school.

Dr Sheina Macadam graduates from Medical School

The day that I decided to apply to Plastic Surgery I was working on a case with two surgeons that would eventually become my primary mentors and supporters. It was a case of a man who had an amputated arm. As the medical student I was relegated to dissecting a vein graft from the leg while the surgeons methodically worked their way through the steps necessary to replant a limb. They did this with skill and finesse and the success of the surgery seemed to make them genuinely happy. I decided that day that this was the type of career I wanted: a career that would be unpredictable and challenging and require varied know-how including technical skills, communication skills, an understanding of business administration and common sense. So I decided I wanted to become a surgeon and applied to Plastic Surgery.

After a rigorous interview circuit across Canada I secured a Plastic Surgery residency position, but this position was in Edmonton, my friends and family being in Vancouver. I moved there alone to enter a program where of the 30 surgical residents I was the sole female. There was also a paucity of female surgical mentors which was difficult. Here is a photo of me with the Division of Plastic Surgery in Edmonton where I made friends and colleagues for life.

Dr Sheina Macadam with the Division of Plastic Surgery in Edmonton

Part way through my residency an opportunity to transfer to the Vancouver program arose, I applied and was able to make the transition smoothly.

When I stepped onto the path that would eventually lead me to a career in Plastic Surgery I did not anticipate the sacrifices and tenacity that the job would entail. The road to becoming a surgeon involves intense focus. While I advanced technically, my personal growth was limited due to the demanding nature of the training which took place during a time when many of my friends were traveling the world, reading philosophy, accepting jobs that pulled them out of the red and into the black, getting married and starting families.

But what I found as I advanced through my training was that Plastic Surgery was going to be a challenging job which I wanted and it was going to offer a huge amount of variety. Many of you may not know the breadth of work that we do as plastic surgeons. Once you finish residency you can choose to specialize in a whole array of specialties. These include pediatric surgery where we perform repair of cleft lip and palate and repair hand deformities among other things, burn surgery where we perform skin grafts to burn victims, microvascular surgery where we take part of the body and move it somewhere else like in a face transplant, hand surgery where we repair tendons, nerves and bone and facial surgery including broken bones of the face. We also perform cosmetic surgery all over the body.

While I loved the variety that plastic surgery offered I wanted to be really good at one thing. I wanted a niche. In my third and fourth year of residency I developed an interest in breast surgery and decided to focus on that. So from there I went on to complete my royal college exam which is a very big deal – 1 year of prep and a 2 day examination in Ottawa. I then did my American certification because I wasn’t sure where I would get a job. I then traveled to Baltimore and Winnipeg to complete extra training (which is called a fellowship) and then did a Masters in Epidemiology and Research Design at Harvard School of Public Health, as I had been asked to come back and lead on research within our division.

After 13 years of preparation I am now 9 years into practice and I can honestly say that I love my job. Since starting my practice I have been able to develop a niche, but within that niche I perform a large range of procedures. One of the most popular is the DIEP. I also perform implant reconstruction using cadaver skin (Angelina Jolie), reconstruction using back tissue, breast reduction, augmentation and tummy tuck. I also perform a lot of breast asymmetry surgery for women born with breasts that are different sizes or shapes and revision surgery for women that have had unsuccessful surgery elsewhere.

If I had known how long and hard the path would be, would I have made the same choice back when I decided to go into medicine? If you had asked me during some of my toughest times I might have said no, it really is a hard path. But I truly believe I have one of the best jobs out there. I know that I make a difference in people's lives, I love my patients and I love the challenges and variety. So if you are thinking about surgery hopefully this gives you a little insight into the light at the end of the tunnel. It's shining pretty bright 9 years in!

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