An Interview with Professor Ronan O’Connell

Interview by Miguel Cunha & Dorottya Turu 

ESCP is dedicating this time to colorectal surgery training. We are interviewing experts and educators from around the world, aiming to assess current colorectal training status globally, highlighting pros and cons, and identifying sustainable pathways for improvement.

MC DT ROProfessor Ronan O’Connell (right) graduated from Trinity College, Dublin University, in 1979. He trained in general surgery in Ireland and undertook a fellowship in Colon and Rectal Surgery at the Mayo Clinic, Minnesota, USA. He held the roles of Consultant/Senior Lecturer at the London Hospital and Consultant Surgeon at the Mater Misericordiae University Hospital, Dublin before moving in 2007 moved to St Vincent’s University Hospital as Professor of Surgery and Head of Subject in University College Dublin.

Prof O’Connell was a foundation member of ESCP having been a member of both EACP and ECCP. He served as the National Representative of Ireland on ESCP Council (2006-2009), Secretary of ESCP (2009- 2011), President in waiting (2011-2012), President elect (2012-2013) and ESCP President (2013-2014). He was the local organizer of the ESCP Scientific Meeting in Dublin in 2015. He become an Honorary Member of ESCP in 2019.

Prof O’Connell has recently demitted office as President of the Royal College of Surgeons in Ireland (2020-2022) and President of the European Surgical Association (2021-2022). He has been awarded Honorary Fellowships of the Royal College of Surgeons of Glasgow, the Royal College of Surgeons of Edinburgh, the Royal College of Surgeons of England, the College of Surgeons of Hong Kong, the American Surgical Association, the American Society of Colon and Rectal Surgeons, the Hungarian Society of Surgery and the Japanese Society of Colon and Rectal Surgeons. He is an elected member of the International Surgical Group, the Society of Pelvic Surgeons and the James IV Surgical Association.

Professor O’Connell has published widely in the areas of inflammatory bowel disease, pelvic floor physiology and colorectal cancer, authoring more than 300 publications. He was editor of the British Journal of Surgery (1999-2006), Bailey & Love’s Short Practice of Surgery 25th – 28th editions, European Manual of Coloproctology 1st and 2nd editions and Operative Surgery of the Colon, Rectum and Anus 6th edition.

In this interview, Prof O'Connell speaks to Miguel Cunha and Dorottya Turu about the importance of mentorship and coaching to young surgeons in the field.

Miguel Cunha and Dorottya Turu (MC & DP): Before we start, thank you for agreeing to participate in this interview! It is a pleasure to interview you about such a special topic.

Prof Ronan O’Connell (RO): Miguel and Dorottya thank you very much for the opportunity to participate and congratulations on your initiative which is bringing the ESCP educational activities to the attention of the members

MC & DP: As an emeritus professor of surgery and an international leader in the field, you have gained great expertise in mentorship. How would you define mentorship and coaching? Are these the same?

Prof RO: The terms mentorship and coaching are often used interchangeably. While both support individual career development there are differences. A mentor is an individual with specific knowledge and experience who is willing to share that knowledge and experience with another. The mentor is necessarily a more senior figure and is usually assigned to the mentee who is in a training programme. The mentor guides the mentee through predetermined achievements necessary for career advancement. In surgery the old maxim ‘see one, do one, teach one’ of the apprenticeship model is increasingly superseded.

Coaching, as defined by the International Coaching Federation, is a partnering with an individual in a thought-provoking and creative process that inspires them to maximize their personal and professional potential. Coaches are skilled in enabling the coachee to become more proficient when performing required responsibilities, which in surgery are of course not limited to technical proficiency in the operating room.

It is clear that not all more senior colleagues, even those designated as trainers, can act as either good mentors or good coaches. That being said, most good trainers are also good mentors, but to be a good mentor requires awareness of the needs of the mentee and the requirements of the training programme. This is why many training bodies have established ‘train the trainer’ programmes. Mentors accompany the mentee through the required training and are responsible for ensuring the required proficiencies are achieved.

Coaches on the other hand, can be internally or externally sourced for a particular purpose, often for a limited time and usually are employed to assist the coachee to master the skills / knowledge needed to achieve a particular professional goal. Examples, include coaching in leadership skills, developing new programmes or adopting new technologies. Coaching can be applied in a variety of settings to improve clinical performance, as an adjunct to traditional surgical education for both trainees and attending staff. There are considerable data to show that coaching improves professional development and reduces burnout.

MC & DP: As a mentor, and an academic surgeon - What are the main characteristics you think a Surgeon should develop during his Life of work? Does the learning process finish at the end of the residency? What is the importance of research for a Surgeon?

Prof RO: This could be a week-long discussion. In brief I believe surgeons need a deep understanding of human anatomy, physiology and the systems biology of the organs they operate on. They need high levels of psychomotor skills to visualise and perform the intricate tasks required of them. They need to be calm under pressure and to possess problem-solving skills. They must be able to work effectively within a team, to communicate well and to demonstrate empathy and compassion. Above all, surgeons must have attention to detail and uphold high ethical and professional standards.

Surgery is constantly evolving – in my professional lifetime so much has changed that it is hard to imagine that when I started in 1979 – endoscopy was in its infancy, CT was not widely available and reserved for neurosurgery, MRI and PET scanning had not been invented, minimally invasive surgery would have been unconscionable. So, a surgeon needs to be committed to lifelong learning and to be prepared to allow those, often younger, with new skills to take their place.

We all use research – everything we do in surgery is based on the ideas and work of those who have gone before us. Most of us can support research programmes, for example the ESCP snapshot audit studies which are very informative. Some, in more academic environments, can participate in clinical trials. Relatively few can initiate and supervise original research which often can only be undertaken as part of a multidisciplinary collaborative.

Personally, the opportunity to work with others in a research capacity has been exhilarating, particularly our work on obstetric injury to the pelvic floor and anal sphincters. I like to think that our work has improved the outcome for young mothers so afflicted.

MC & DP: What is the significance of having a mentor in the field of colorectal surgery? How can mentorship contribute to the professional growth and development of a surgeon?

Prof RO: Good mentorship is essential to the success of any training programme. The quality of any programme or fellowship reflects the quality of the mentorship provided. The traditional apprenticeship model does not entail mentorship. Nor do all trainers make good mentors. Of course, there are always aspects of professional, technical, clinical or administrative practice that can be learnt by observation, however the mentor must be directly engaged and committed to the professional development of the trainee / mentee in a structured and formative manner.

MC & DP: Are there any potential pitfalls or challenges that mentees may encounter in a mentor-mentee relationship? How can they be addressed or mitigated?

Prof RO: This is potentially difficult where either the mentee or the mentor is uncomfortable with the relationship. It is important that while the mentor is assigned, the mentee is also exposed to other trainers in the programme, usually by means of quarterly rotation within services. Regular – weekly or fortnightly - meetings with the mentor are important, however summative assessments, particularly those on which trainee progression is dependant, should be undertaken at six monthly or yearly intervals by independent or external review. In this way the programme, the trainee and the mentor can be assured of objective and unbiased assessment.

MC & DP: In your recent paper “So you want to be a Surgeon?” you reflect on the importance of adapting the teaching mode to different generations of Surgeons. Can you briefly explain to us what are the different challenges of the new generations and how one can surpass them?

Prof RO: Across Europe healthcare systems are struggling to keep pace with scientific and technical advances while providing for an aging and increasingly co-morbid population. Patient expectations and regulatory oversight are difficult to satisfy in systems that are under resourced and permanently short of capacity. We face great challenges in adapting training curricula, progression assessment and trainee support to the needs of such an environment.

The burthen of emergency general surgery is increasingly falling on coloproctologists as breast, vascular, HPB and upper GI surgeons withdraw from on call rotas. There is therefore a need to ensure our trainees are ‘emergency safe’ with the knowledge and skills to manage undifferentiated general surgical call. Perhaps this need will in time be filled by ‘emergency general surgeons’ who will deal with the bulk of minor and intermediate emergency cases and triage those who need subspecialist care. We are not there yet, and it remains a challenge to train a ‘general surgeon’ in an era of sub-specialization, even within a discipline such as coloproctology.

MC & DP: As you´ve mentioned in the same paper: “training for the top of the Pyramid requires competence that can only be achieved by long hard training and by staying current with the rapidity of change in knowledge and technologies”. If I may, I believe a surgeon’s career is somewhat similar to a Highly competitive sport but longer lasting. What do you think is the role of family and social life in this demanding pathway?

Prof RO: You raise the really important issue. I believe we have for too long focused on a pyramidal system of surgical training, in which the expectation in the Halsteadian model is to reach the top of the pyramid. Yes, to reach the top in any sub-speciality requires years of long, hard training. Yet 90% of surgical workload in the community is for minor and intermediate procedures.

I believe in a more tiered construct of specialization, that better provides point-of-care access to surgery for the community it serves, with excellence of care as its goal at each level. Surgeons within this construct must have parity of esteem with those who choose to undertake more specialized workload. Such a construct offers the community what is required and equally offers many surgeons a satisfying career in their community with a greater work / life balance.

MC & DP: Can you share a personal experience where mentorship significantly influenced your journey in Surgery?

Prof RO: I was fortunate to have been exposed to outstanding role models during my undergraduate and post graduate training. Not all were outstanding mentors, but I learned from all. The opportunity to undertake a Fellowship in Colon and Rectal Surgery at the Mayo Clinic was truly formative. I spent one year in full time research followed by a second year as a clinical fellow. I learned so much including academic rigor, surgical technique and practice management. I based my later career on the three pillars of the Mayo ethos, patient care, education and research.

MC & DP: In your opinion, what steps can be taken to encourage more experienced colorectal surgeons to actively engage in mentorship, coaching, and sponsorship?

Prof RO: I believe highlighting the changes in teaching practice, as you are doing through this series of webinars is a powerful tool. Much depends on having a structured curriculum and training programme that incorporates a ‘training the trainer’ component. Sponsorship is also promoted by ESCP through fellowship opportunities – we have had several wonderful ESCP sponsored trainees come to Dublin for 3 – 6-month fellowships.

Coaching is somewhat more difficult as it is more a departmental activity that requires specific training and often external input. I have no doubt this will be a growth area in continuing professional development as new techniques become available.

MC & DP: How can institutions or professional societies support and facilitate mentorship, coaching, and sponsorship opportunities for colorectal surgery trainees?

Prof RO: I believe ESCP has provided leadership in this regard by promoting exchange opportunities with the Japanese, Korean and American Societies as well as the training fellowships I have mentioned. The Masterclasses and webinar series are excellent means of reaching out to the membership. Young ESCP provides an important forum to guide ESCP policy and use of resources in ways that best address the needs of the next generation.

MC & DP: In light of technological advancements and the evolving healthcare landscape, how do you foresee mentorship and coaching evolving in the field of colorectal surgery education in the future?

Prof RO: Clearly yes – it is important that both are seen as supportive in training and lifelong learning, just as virtual reality training will assume greater importance. However, clinical and technical skills, practice management and patient engagement are learned primarily on the ground. As the golfer Gary Player famously said –‘the more I practice, the luckier I get’.

MC & DP: That brings us to the end of this interview! Thank you for sharing your insight and expertise with us.

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