Interview with current examiners, Shirley Chan and Ginny Bowbrick
Which exams do you currently examine for?
Shirley: I examine for the Intercollegiate MRCS Part B. I started about five years ago.
Ginny: MRCS England and I am about to start FRCS(Vasc) after my training next month.
What made you want to start examining?
Shirley: Before I was Return to Training lead for KSS School of Surgery, I was a College Tutor. I spent a lot of my time supporting core trainees and taught on Basic Surgical Skills (BSS) courses and on the St Thomas’ MRCS course. Becoming an intercollegiate examiner felt like the next step. At that time, the College was having a recruitment drive for female examiners. One of my colleagues was also an examiner and encouraged me to apply.
Ginny: For MRCS, it was because the College was having a recruitment drive for women and I had colleagues who were examiners who encouraged me to apply. I hadn’t really thought about it before because I had been very involved with National Selection which is a similar sort of process, and I had put my energy into that. With my colleagues’ encouragement, along with the enthusiasm from the College, I applied.
With the FRCS, through my role as the Vascular Surgery SAC Chair, the examiner role is a part of being Chair. I initially hadn’t applied to be an FRCS examiner before this as I didn’t think I should apply, coming from a district general hospital and not being an academic. That is probably an element of my own imposter syndrome, as they were actually very positive about me applying for the role. They had previously asked me to do it as a member of the SAC, but I had been reluctant to. However, now that I am doing it as part of my SAC Chair role, I’m really excited to get started with it. My training was meant to be earlier in the year, but I deferred it as my wife was going through her own FRCS at the time. It will be one day in Edinburgh in October.
How did you become an examiner?
Shirley: I was put in touch with the head of the Court of Examiners, but now it is actually an online form and they are currently advertising for more applications. On starting, you have a training day during which I remember discussions around equality and diversity and unconscious bias, and they also tell you about the format of the exams and marking schemes. You can also sit in and be an observer on an exam on the day.
Ginny: So for FRCS it was basically through me becoming SAC Chair! For MRCS it was an application form, which I believe, if memory serves me right, required you to have two referees who were already examiners, which can also be tricky. Our trust has a number of examiners working there, and it is very supportive in us undertaking these roles, but this is not the same for every trust. You were also required to show evidence of previous work and interest in medical education, which I had.
How time intensive did you find the training process, and now your current examiner role?
Shirley: The training day was one day, with us observing the exam in the afternoon. They previously advised that you should then examine at least five days over the course of a year, over the three diets of examinations. You therefore normally did two to three days per diet. Since COVID, it has been a bit different, and they now ask you to volunteer the days you can do in advance. I personally try to do at least two diets per year as it doesn’t take me away from my clinical work for too long. The days themselves are long, with briefing at 7.30am then examining starting at 8.30am.
Generally, I use study/professional leave to enable me to take part. I have also used my own annual leave or zero days in the past. Travel expenses are reimbursed, and they put you up in a hotel if required.
Ginny: The training was one day at the College which was enjoyable. They have changed how they allocate the examining, so you now volunteer your free days to examine, meaning essentially you can do as many as you like above the bare minimum. The days themselves are quite intense, with not much free time or chance to network within the day. In contrast, the Annual Court of Examiner days at the College, where the Court of Examiners gets together and has talks and lunch, are a bit more relaxed and allow for much more socialising and networking.
You have also been involved in national selection. Can you tell me how you got into that, what it involved, and whether you feel it faces the same gender discrepancies?
Shirley: I am also involved in Core National Recruitment and started when I was a College Tutor. As well as the interview, which now happens virtually, people are needed to score the applications and review appeals. The people looking at the appeals are in lead education roles such as Programme Directors or Heads of School. Proportionately there are definitely more male surgeons interviewing than women.
Ginny: I was very interested in getting involved with National Selection during my role as training programme director. One of the reasons for doing it was because of the scarcity of female representation. It is obviously difficult picking from a smaller pool of female consultants in the first place, but it had been particularly dire back then when it was perhaps only two or three women out of a group of 50. I felt it was important to be there as representation, and I believe in the 'if you can see it you can be it' mentality.
Following on from this, because I was then a member of the Vascular Surgery SAC, I was then able to take a role on the steering committee and that graduated into a role as National Selection Lead for vascular. My 'parting gift' in this role was to successfully apply to separate vascular from general surgery recruitment, but I then had to demit from my role as Lead as I became SAC Chair. I am still involved with the process of National Selection and it is something I feel very passionately about.
What have you enjoyed about these roles, and what have you found difficult?
Shirley: It makes me feel like I am giving something back to the College. It also allows me to meet new colleagues from a variety of specialties. MRCS in particular has a broad range! I wouldn’t normally meet these people in my clinical practice. It is interesting to see everyone’s examining styles! Overall, it is very fun and well organised.
The questions are very fixed with a script. It can be frustrating when the candidate doesn’t understand the question as it is difficult to help them as we cannot really elaborate further. Also, it really can feel like an early start in the morning!
Ginny: I have loved everything I have done in medical education. My current role as Head of School of Surgery in KSS has been my favourite role yet. I would hope to be able to help make a difference to trainees. I am not doing it to act as a role model as a woman, or as LGBTQ+, I am doing it because I feel I can contribute to medical education as that is where my strengths lie.
The logistics of where you live can be tricky. For MRCS for example, I examine in London which is straight forward. But for FRCS, it will be all over the country following the training in Edinburgh, and I think this is why it is difficult for women particularly with children to coordinate this into their schedules. I have four children, the youngest is two, and my wife is also working full-time. It can take a lot of juggling to balance these roles with childcare and also with the work schedule of my wife. I initially also had issues balancing these roles with my clinical commitments, but I am now part time clinical and part time medical education which has made it a bit easier.
For MRCS, part of the difficulty is trying to remember your own exam knowledge when examining this in a station! Exams are so crucially important to your development as a trainee, I just want to see people do well despite their nerves. I think we need to make sure we are comfortable with the subject we are examining on in order to give candidates the best experience.
The other challenge has been my own imposter syndrome. I remember an early experience in SAC where I was sat at a table with professors and senior figures from universities, and a question was asked following which everyone turned to look at me for the answer, and I found that very daunting at the time. But again, this has slowly become easier with my own acceptance of myself in these roles, and believing that it is possible for me to be the expert in the room on some subjects!
In your opinion, why are there not more female surgeons becoming examiners? Can you identify any potential barriers to this?
Shirley: I have discussed this with colleagues previously. I think some of it is that there are just many more male surgeons then female, although the discrepancy seen within examiners outweighs this. I think some of it is also that if women have families or other commitments outside of work, they are less likely to give up days of their time to go and examine whilst also juggling childcare for example. One of my friends is also an examiner, but her kids are now older, and I cannot imagine that when her kids were much younger she would have happily left them for several days at a time to examine. I also wonder whether there is a slight unconscious bias of men considering it to be a good thing to do, whereas women are more likely to doubt whether they’re good enough to do it. I think women often don’t apply for roles because of their own self doubt, or certainly they tend to consider things for longer before applying.
Ginny: I think it is the difficulty balancing multiple work roles with responsibilities at home such as childcare. I have held these roles in the past whilst being a single mother to three boys, which has been not only a time commitment, but also a financial one with needing to organise childcare. This is not something that is possible or feasible for everyone. More simply, you are also just choosing from a smaller pool, with fewer female consultants in general.
Do you think it is important to get a broad representation on the examiner board, and if so why?
Shirley: I completely do. For example, pre-COVID I was examining a female candidate, and we finished the station early. According to the rules you have to just sit there with the candidate in a slightly awkward silence. The candidate got up to leave when the changeover bell went, and she stopped at the door and said, 'It’s really nice to see a female examiner, because it shows me I can do this'. I hadn’t really thought about it like that, but it is important to see someone who represents you in these roles. If you can see it then you can be it.
I have turned up to national recruitment before when they have had too many people show up, and I have offered to leave but have been asked to stay as so few women were there. I probably hadn’t really considered it before, but now that I do it becomes a lot more noticeable.
Ginny: Definitely! It’s really important to have representation and see these role models. I remember feeling excited to see and work alongside female surgeons early on in my surgical career, and to see that it is possible for you to make it.
People talk about positive discrimination and whether there is a role for it, and in general terms the people who tend to make the arguments against it are individuals in the majority group. When thinking about positive discrimination, you have to look at the barriers people have had to overcome to get to these positions. For example, there have been men who have had to balance childcare, and increasingly this is an issue, but on the whole the majority of childcare has been undertaken by women which is why this remains a barrier. I do feel that there is a place for positive discrimination and encouraging more women into these leadership roles.
If there are surgeons interested in becoming examiners, how would you advise them to get involved?
Shirley: We are currently looking for new examiners, and I think it would be nice to have some new examiners with more diversity. You can apply online through the website with an online form. The ICBSE then reviews your application and puts you on a waiting list if successful. So essentially if too many eligible people apply for the spaces available, you will be placed on a waiting list and they will get in contact with you in the future. You need a reference, and to show that you have been interested in medical education. I enjoy it very much and would encourage people to apply and join us.
Ginny: Application is through the College to the Court of Examiners, with a form that needs to be filled out. They will advertise for applications at certain time points, and you will see this on the College website and through email correspondence. This year they have a number of people who have been examining for many years who are now retiring, so they are looking to recruit replacements meaning it is an excellent time to apply.
For FRCS, the applications are through the JCIE. Or you can go the long way round and become SAC Chair first!