Mr Eric Farrell - ST8 - Otolaryngology, Head and Neck Surgery
Can you tell us a little about yourself and why did you choose surgery as a career?
After school I studied Speech and Language Therapy and after graduating I worked in a hospital setting for the best part of 2 years. That was my first exposure to hospital work and I really enjoyed it. I was always jealous of the junior doctors getting to move on after a few months. As crazy as it sounds now I loved the idea of moving around and I still had energy for exams and studying at the end of my undergraduate degree. So I went back to study graduate Medicine at UCC. I absolutely loved it, what a great place. I never once felt like it was a chore. When I was at UCC I did several electives with ENT and general/vascular surgery. I loved the pace of surgery, the collegiality amongst the teams and the practical element to surgery really appealed to me.
Why did you choose ENT?
My background in SLT gave me a good understanding of what ENT was all about and I kept being drawn to the specialty. The procedures were so specialised and the emphasis on quality of life was really appealing. I attended one of the RAMI meetings in my final year and found everyone was so friendly, the talks were fascinating and there was a great collegial atmosphere and that was something that I knew would be really important for me in a future career. The depth to which you can pursue each subspecialty also promised a career of lifelong learning, something I still have an appetite for!
Training & Experience
What has been the most challenging aspect or your surgical training?
Looking back over the last 8 years the biggest challenge has been balancing personal and professional life. Getting up early, home late and then trying to do some work for work. Ideally there would be more hours in the day and we wouldn’t need to sleep. But since that is not the case, being organised and planning for the long term rather than just the short term allows me to keep meeting goals.
Can you describe a typical day as an ST8 trainee?
The typical day involves getting up at 0600, usually I cycle to work as parking is a challenge in most sites, it’s also the only way I’ve found to ensure getting exercise in and it makes such a huge difference to energy levels. Get in to work for before 0700, shower and then review the inpatient bloods/any admissions from the night before. Do a ward round by 0730 and then commence clinical activities for the day, that might be clinic or theatre. Depending on the sub specialty you can be operating in such a variety of circumstances. Once theatre is finished we’ll do a ward round and then prepare for any cases the next day. I’ll cycle home to try and make bedtime for our son and once he’s asleep we’ll eat something and usually I’ll start working on something, whether it’s a paper or reading up on the cases for the next day. Head to bed and repeat!
What has been the most rewarding time over the past 8 years?
The last few years where you step in to a more senior role has been a challenge but also fulfilling. It’s amazing to look back on where you started and where you are today. The satisfaction in seeing patients benefit from treatment plans you put place is extremely rewarding.
My wife completed her fellowship at the John Radcliffe Hospital in Oxford and I was fortunate to spend a year working in Oxford University Hospital Trust. Going abroad was enlightening, working in a familiar clinical context but a different health care system gave me a unique experience and skillset that I was able to bring home. It also fuelled my appetite to pursue an overseas fellowship. The link I established with Oxford has meant that trainees who have come after me have been able to avail of a unique opportunity to spend some time training there as part of their HST. It’s a great feeling to leave a legacy like that on the training scheme.
Skills & Growth
What are the key skills that you think every surgical trainee needs to develop?
Patience! The process is long and often times it only feels like you are making small steps but ultimately these small step all come together and after 8 years of training you see the difference.
Being open to learning something from everyone and every situation. I remember a great trainer of mine saying that “there is an art to being trained”, I thought about this for a long time and figure it came down to being receptive to feedback, being prepared for the cases in front of you and demonstrating you have taken on advice.
How has your confidence as a surgeon evolved since you started training?
This is an interesting thing to reflect on. I remember brimming with confidence when I was starting off as an SHO, there was nothing I felt I couldn’t do. As time went on I felt less confident almost taking a dip mid training. Through reading, gaining experience, fantastic trainers and having a great group of trainees around me this has increased again. After attending a recent grand rounds at Beaumont Hospital I realised this was the Dunning Kruger effect in operation!
Can you share a case or experience that had a significant impact on you?
One of the earliest procedures I remember seeing in ENT was the insertion of a speaking valve for a patient who had undergone a laryngectomy. I had met the patient in the outpatient setting and remember the frustration not having a voice was having on them. I met them again at the end of my elective and they were speaking, all the tension and frustration had melted away, they were like a totally different person. The impact this procedure had on the patient’s quality of life was inspiring.
Mentorship & Support
Have you had a mentor who influenced your career? How did they shape your journey?
There are so many great people I have met during my training. Each and every one of my trainers have had an impact on me, shaped my practice or how I approach things. Sometimes these might be small comments or bits of advice that they might not even remember bestowing!
What advice would you give to medical students considering surgical training?
It’s highly rewarding and very demanding. Go and see for yourself, try and spend some extra time with a surgical team, do electives in a specialty that interests you. College rotations are often too short and the time and exposure you get are limited. Getting to spend more time on a service like an elective embeds you in the teams activity and gives you a better feel for the work.
How do you support your fellow trainees in difficult times?
I feel we are very lucky, particularly in ENT, that we have such supportive peers. I’ve picked up the phone on numerous occasions to talk to other trainees during difficult times. It’s a privilege to be able to answer the phone in return. Problems shared are problems halved and talking through things always lightens the load. There’s not many people who understand the pressure and share the experiences of this high intensity training so it’s great to have a network of supportive colleagues who are going through the same thing.
Work-Life Balance & Well-being
What strategies do you use to maintain your well-being and mental health?
I can definitely improve on this, I dedicate a lot of my time to work, the days are long and there’s only so much time in the evening. One of the best things I started doing was cycling to work (not on the e bike!) just getting that burst of energy in the morning and after a busy day can have such a positive impact on everything. I always keep time for friends and family as well, it’s always rejuvenating to spend time with the most important people in your life.
How do you balance your personal life with the demands of surgical training?
Just like being organised in work, I try to be organised in my personal life too. Essentially I try to block off time each week where I take a break from work related things and focus on something else. This might be scheduling time with family or friends.
What do you do to relax and unwind outside of work?
A few years ago a friend of mine had an old vintage bicycle he was getting rid of so I took it and refurbished it as a project. This started a love hate hobby with restoring and maintaining vintage bikes. There was something addictive about taking something rusted and non functional and bringing it back to life. This also taught me a lot about bicycle maintenance. It takes concentration, patience and skill, just like surgery. It’s a great way to clear your mind though because while I’m doing it I can switch off from other things.
Future Plans
What changes or advancements in surgery excite you the most?
Without a doubt it is the merging of surgery and technology. I recently went to the Surgeon’s Hall Museum at RCS Edinburgh and looking at all the artefacts from 19th and 20th century surgery, they’re all steel, cogs, nuts and bolts. To see now that we have things like cochlear implants, robotic surgery, laser surgery and an unbelievable array of endoscopes is simply incredible. If we could put ourselves in the shoes of the surgeons who were operating at the turn of the 19th and 20th century I don’t think they could have ever imagined the tools at our disposal now. By the time my cohort is passing on the baton to the next generation I have no doubt things will look very different.
If you could change one thing about surgical training, what would it be?
The job is extremely busy and the pace is fast, that’s something that I really like. Sometimes this doesn’t leave much time for planning how to maximise training experiences for different levels of trainees. Teaching and training is something I really enjoy. Planning and dividing out portions procedures is something I will place a big emphasis on.
Final Thoughts
What’s one piece of advice you wish you had received before starting training?
One of the best bits of advice I got before starting training was to read and keep reading. That took the fear out of the unknown for me. On a practical note, surgical skills courses are excellent and often you feel like you have covered months worth of training in 2 days. Don’t underestimate courses and pick them out far in advance to ensure you get a place!
If you could give one message to first year trainees, what would it be?
Everyone is running their own race, focus on your own performance by setting realistic goals. Don’t forget to look back on your achievements at the end of the year and be proud of them.
What’s next for you?
All going to plan I will finish on the training scheme in July. After that I am going to Princess Alexandra hospital in Brisbane, Australia. They have a world renowned training program in Head and Neck Surgery there. While there’s no place like home, going abroad and getting experience in different health care systems is invaluable as a surgeon but more importantly to the communities we serve.
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