Interview with Deena Harji

  

Explore academic surgery with Deena Harji, an associate professor and consultant in robotic and colorectal surgery, as she shares her experiences and career path. As part of the Women in Surgery (WinS) Forum's commitment to spotlighting women and highlighting career pathways where women in surgery are underrepresented, this interview offers valuable advice and guidance to those considering a career in academia or research. 

Can you run through your career to date, including your academic and clinical roles?

I graduated in 2007 from the University of Birmingham and did my foundation and core training in and around Birmingham. I had completed 18 months of my core training when I got offered a PhD in Leeds, so I left core training early and spent three years doing that. After completing my PhD, I couldn't get back into core training because the rules changed, so instead, I embarked on a six-month standalone core training post in Scotland.

At that time, I was obviously looking at where I was going to do my higher surgical training and whether I was going to go down the academic clinical lecturer path. I chose not to do that because I really believe we're a hands-on specialty, and first and foremost, I'm a surgeon, so I wanted to focus on my surgical and technical skills. I chose to go back into full-time training, and I went to the North East of England. I had six amazing years in the North East!

However, during my registrar training, I probably burnt the candle at both ends. I carried on with my academic work, and at that point I had actually started getting a lot of grant income, so I actually had to deliver the work. I used to wake up at ridiculous o'clock at like 5am and go to bed at past midnight. I managed to finish my training and CCT, and then went to Bordeaux for 12 incredible months and got to experience a different academic landscape compared to the UK.

I decided that I wanted to come back to the UK as a consultant, but at this point, I really wanted to truly embrace academia, so I applied for a NIHR Advanced Fellowship. This was successfully awarded, and so I am now a 50:50 academic surgeon.

I think my career has evolved organically over the years. I was initially really into clinical trials, complex interventions, complex trials development, and then I was obviously into robotics and becoming a robotic surgeon. Robotics goes hand in hand with digital surgery and med tech, so now I'm really interested in innovation. I currently hold lots of roles, both academic and clinical, but also within innovation.

So I feel like I have a real portfolio career and I think that that is the only way to survive in today's NHS. I think if I had a full-time clinical career, I would be really disenchanted and disenfranchised.

So, if there is such a thing, what does a standard working week in your life look like?

Officially, I split my time 50:50, the first half of the working week I spend doing academic work, and I'm usually at the university or working remotely. During that time, I do a lot of my innovation and med tech work. The other half of my working week, I do my clinical work.

In reality, I probably do some clinical work in my academic time and some academic time in my clinical work. It just varies; I think there's no such thing as a normal working week and I kind of like that. If you like routine and structure, having a portfolio career is probably not for you. If you like doing lots of things, if you like variety, if you want to remain curious, then having a portfolio career is definitely for you. Some days, I might be at the College with the innovation hub, and some days, I might be working with industry.

Some days, I might be having big meetings with my trials team, and some weeks, I might do, you know, three robotic lists. It varies.

What initially drew you to academia, and got you interested in research?

When I was a trainee coming into surgical training in the late 2000s, it was kind of the done thing and everybody was supposed to do a bit of research. But when I started, I really just enjoyed the curiosity of what research allows you to do. It allows you to be curious and creative, and I think surgery doesn't always necessarily allow that. It allows you to explore a different side of you.

I really like methodology and I like understanding how you can apply different approaches to surgery and get interesting answers. I suppose the bigger benefit of being an academic surgeon is that you can affect a much broader range of people because if your research shows benefit, then it can be applied to thousands if not millions of people, whereas as a surgeon, you actually only affect the lives of those that you immediately treat.

You have an Associate Professor role at the University of Leeds. What does that entail?

You can become a professor or an associate professor in many different ways. Because I am now an advanced fellow with NIHR, I automatically get this position with a university post. That means that you have to deliver a portfolio of research and help to develop the next generation of clinical researchers or academic researchers while considering how to build infrastructure within research. It's kind of a stepping stone to becoming a full blown professor of surgery. But from an academic standpoint, it's not an honorary chair; it's an academic appointment.

If I wanted to become a professor, I would follow the current track I am on with the NIHR academic pathway. The next post would be to apply for NIHR research professorship. I would then be expected to develop the landscape and be a cutting-edge expert in academia. I would be expected to develop infrastructure to deliver the research and mentor and lead a huge team, so it's a natural evolution.

How has the academic landscape changed during your career, and why should a surgeon consider a career in academia?

I think there are generational shifts. My generation was sort of the collaborative research generation. We began to understand that big data is important.

Pooling resources is important, and academia in whatever sense, whether that's big cohort studies or data collection exercises, or just original research or trials or basic science, really started to become collaborative, and people were working together. 

That has now changed again, and this academic generation is much more into entrepreneurship, innovation and med tech. I think a portfolio career for them is slightly different from a portfolio career for someone like me. I think that the key to ensuring the longevity of our NHS is to ensure that our workforce is engaged and doesn't burn out because, obviously, that's a huge issue.

Introducing the concept of a portfolio career early is really important because I think it maintains engagement with your career, whether that is academically focused or otherwise. We should be encouraging people to identify their own skill sets, develop these skills, and apply them within their NHS job role. This will make the NHS much richer while also improving job satisfaction and reducing rates of surgeon burnout. 

Why do you think there aren’t more female academics within surgery? Do you think there are any obstacles specific to women?

Whether you're male or female, I think being an academic surgeon is difficult because you must excel at two jobs, and people don't realise that. You have to build your surgical skills and meet clinical targets, and then you also have all these academic targets and academic outputs and academic pressures like continuing to attract grant income, continuing to publish in high-impact journals, etc. You're working for two employers within a set of time, and that's quite difficult.

I'm perhaps a bit unique; I don't have any children, and I chose not to have a family, and that comes with its own prejudices and misconceptions. But I think that women often feel that there is no time. You know, if you want to have a family and you want to then be an academic and you want to be a surgeon, how do you do three jobs? I think that perhaps that is a perceived barrier, but lots of these are misperceptions in some regard. If you want to, you can be whatever you want to be, and you should have and forge the career path that you want that suits you and your lifestyle. All you need are some allies and mentors to help you with that.

There are some really interesting people coming through and some very well-established female academic surgeons. They are few and far between, but you just need to reach out to them, and they'll help you. I think you have to accept that if you're going to become an academic surgeon and you're a woman with other priorities, your pressures are going to be greater. But it's about understanding how to manage that pressure and you'll be fine. We should encourage everybody to do whatever they want.

I represent intersectionality, being British Asian and being a female. Sometimes, that's been challenging, but I don't think it would be any different if I chose not to be an academic. The thing that has been most interesting to me is that I only considered my race and my gender when I became a consultant. I find the younger generation suddenly starts to say to you, "It's so cool that you're a consultant and you're an associate, Prof". I hadn’t even considered it until I had young female British Asian trainees come and say this to me. There's a huge amount of responsibility because suddenly you become a role model and you don't expect to be a role model! I'm like I'm not sure I am a role model, but OK, now I understand that I have to almost represent and try to make life a bit easier for the ones that are coming behind me. I think it's so much more complex than just being a woman in surgery.

What skills do you think someone requires to be successful within research?

The most important thing is to have a really open mind and be really curious.

Ask yourself 'What does the landscape look like? Where are the issues? Where are the problems? What sort of solutions do we need?' This continual horizon scanning, both internally and externally, is really important. Being a lifelong learner is vital because there is a lot that you don't know that you will want to find out.

Also, obviously being collaborative and probably being a bit organised, practical and pragmatic is really important because you have to be able to switch between two gears. You shift between your clinical work and your academic work.

You also have to be able to take the wins with the losses. Academia can be quite a rollercoaster. They say most people's grant success rate is around 25%. That's a huge amount of work for a small amount of gain. You have to be able to laugh at yourself and enjoy the process. Lifelong learning and being able to pivot are probably the most important. You can't just do one piece of research for your whole life; you have to be able to allow it to evolve and change direction. 

What advice would you give someone wanting to embark on an academic career? When should you think about doing a PhD?

Do a PhD whenever it is right for you. Some people do it in medical school, others during core training or registrar years. I have a colleague who is doing one as a consultant. It has to be right for you, your life, and your circumstances.

If you're a young trainee and you want to understand whether research is for you, there are a lot of initiatives. Every region now has a collaborative, and there are a lot of national and global collaboratives. It's really easy to get involved in research. People are so much easier to approach now. Social media makes it simple for you to just send a DM to someone and say, "Hey, have you got any projects?". You could also do smaller things locally before getting involved with big global projects. 

If you want to forge an academic career, you have to think about whether you want that to be formal or informal and whether you're willing to give up other stuff. It's not about what your training life looks like; it's about what your consultant life looks like. Are you willing to give up half of your consultant time to become an academic?

If you are, do you want to go through a formal academic training process with an organisation like NIHR or MRC, or do you want to go through an informal training process and get involved with little projects and build up your skills over time and then just do ad hoc research?

You have to think about three things: the people, the place and the project. Firstly, who is your supervisor and what is their track record? It could be an established professor or a rising star within the research community. Then you may want to look at their track record, both personally in terms of their own professional development, but also have they supervised anybody else? What did that trainee or that person achieve during their working life with this person? Are you their first mentee, or are you their fifth? How many other people are you competing with for their time? Because, you know, supervisors get busy. And finally, do you get on with them? Do you have shared values?

Next, where are you going? Is that geographical location convenient for you?

Are you going to have to relocate? Is it abroad and do they have the infrastructure and resource to be able to support you? Do they have desk space for you? When I started my PhD there was no room for me, and I had to source my own desk. 

Finally, does the project excite you? Are you a small piece of a bigger pie, or is this project the whole thing? What are you expected to do? Is it already written out, and is it a standardised project, or are you getting free rein and able to develop it yourself? I think those are probably the three key things that you have to think about when you're starting out on your academic journey. Lastly, I would just say enjoy it. Have a great time and actually have some work/life balance. I did not have any balance during my PhD! Understand the other things in life that are important to you and make sure that you give them enough time in your schedule.

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