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How I Became a Breast Surgeon and Educational Supervisor

Sep 01, 2021

Marios Konstantinos Tasoulis, MD, PhD, FEBS, FRCS, is a consultant breast surgeon at The Royal Marsden NHS Foundation Trust and honorary clinical senior lecturer at the Institute of Cancer Research, London. He is the educational supervisor at The Royal Marsden for the National Advanced Training in Oncoplastic Breast Surgery Fellowship, which offers integrative interspecialty training in breast surgical oncology and plastic surgery. Dr. Tasoulis joined the Breast Unit at The Royal Marsden in 2016, initially as a fellow and later as a locum consultant breast surgeon before taking up his current substantive faculty position. After finishing his surgical training in Athens, Greece, and before joining The Royal Marsden, he worked as a visiting assistant professor in the Breast Unit of Smilow Cancer Hospital at Yale University, through a scholarship awarded by the European Society of Surgical Oncology (ESSO).
Dr. Tasoulis has served in a variety of ASCO volunteer roles, including as a member of the Trainee and Early Career Advisory Council, mentor for the Professional Development Committee Virtual Mentoring Program, the ASCO Educational Book Expert Panel, and the Publishing Research Group. Follow Dr. Tasoulis on Twitter @marios_tasoulis
How did you initially choose your current career path? Were there any unexpected detours along the way?
MT: I decided to become a surgeon during the final years of my undergraduate medical training when I was on my rotation in surgery. Most of my surgical training took place in Athens at a tertiary referral hospital with a focus on multidisciplinary treatment of patients with cancer. This exposure to cancer surgery was a major determinant for my choice to follow a career as a surgical oncologist. Oncology is an exciting, rapidly evolving field, providing endless research opportunities, while the fast-paced advances have a significant impact on the lives of millions of people diagnosed and living with and beyond cancer. For me, surgical oncology was the ideal career choice as it would allow me to combine two of the things that I love: surgery and research. 
During my training, I was fortunate to have the opportunity to receive training in the whole range of cancer surgery, but my experience as fellow in breast surgery at Imperial College in London set the spark. The placement played a major role in my decision to dedicate my practice to the management of breast cancer and to choose oncoplastic breast surgery as a subspecialty. This decision was reinforced during the time I spent as visiting assistant professor at Yale and especially during my fellowship training at the Breast Unit of The Royal Marsden. 
Who has helped to shape your professional journey and lead you to where you are today?
MT: There have been quite a few mentors and trainers that influenced me, shaped my professional journey, and helped me reach where I am today. It is too long of a list to name them all, but I would like to mention two of them. 
First, Emmanuel Douzinas, MD, professor of intensive care medicine at the National and Kapodistrian University of Athens Medical School. Professor Douzinas was the supervisor for my doctorate degree and he is a longstanding mentor on professional and personal life matters for 15 years. He instilled in me the love and passion for research and guided my early steps in academia. I still vividly remember one of his most significant pieces of advice. When most of my medical school alumni were trying to get into clinical training posts as soon as possible, his advice was different. He told me to follow my passion for research and wait, to consolidate and invest time in my research and academic skills. On reflection, this advice and the decisions that followed likely changed my career trajectory.
Secondly but not least, Fiona MacNeill, FRCS, MBBS, MD, consultant breast surgeon at The Royal Marsden. Miss MacNeill was my fellowship supervisor and reinforced my love for breast cancer surgery. Apart from being my trainer and helping me refine my surgical and non-technical skills and shape my clinical practice, she has been an extraordinary mentor who helped me set professional and academic goals and gave me valuable guidance and advice on how to achieve these goals and get to where I am today.
Describe your typical week at work.
MT: My working week is a balance between the clinic and the operating room. During the clinic days, my schedule typically starts with a debriefing meeting with the trainees to discuss the patients who are coming to clinic. The workload mainly consists of patients with a new breast cancer diagnosis or patients who would like a second opinion on their management plan. The clinic also includes follow-up appointments with existing patients and post-surgical consultations to assess surgical outcomes and discuss the results and next steps. At the end of clinic, there is typically discussion of interesting or challenging cases with the team, using this as an educational opportunity. 
The rest of the working day usually involves administrative work, and teaching or research activities. These include teaching or mentoring meetings with trainees, writing and reviewing manuscripts, preparing and submitting research proposals, grant applications, and working on collaborative research projects. 
Theatre days start with the pre-operative ward round and a debriefing meeting with the wider team including surgical, anaesthetic, and nursing colleagues, with an aim to foster effective communication, collaboration, and smooth operation of the theatre list. The intervals between cases are useful for short breaks and allow productive, educational discussions with the trainees on all aspects of surgical planning and technical skills. The day typically ends with the post-operative ward round and a last review of outstanding clinical commitments.
If you have to pick one aspect, what part of your job is your favorite? What part is the most challenging or frustrating?
MT: I consider myself lucky as I love all aspects of my job. These include my clinical role as consultant breast surgeon, being a researcher, and also my teaching/mentoring role supervising breast surgery trainees. It would be difficult to pick only one aspect, but I would probably say the favorite part of my job is the direct patient care. Seeing patients in clinic, discussing with them and drawing an individualized management plan, performing their cancer surgery, and supporting them all the way in their cancer journey is truly rewarding. 
The most challenging part of my job is balancing my clinical, research, and teaching and mentoring roles, which at times can be very demanding. However, I think the advice and guidance from my mentors and the support from all team members in the department help me achieve this, while also maintaining a healthy work-life balance.
What do you wish you had known before you chose your career path?
MT: Looking back, I believe I made a very conscious decision to follow this career path and I was very well prepared with what to expect. I owe this to my trainers and mentors, who have been extremely helpful with their advice and guidance all these years.
Why would you recommend this career to someone starting out in oncology?
MT: I would have no reservations recommending this career to someone starting out in oncology. It is a challenging path, but ultimately it can be a source of great professional and personal satisfaction. Looking after patients with cancer as a surgeon can offer great meaning, a sense of offering and having a positive impact on people’s lives which can be truly rewarding. Surgery plays an important role in the management of cancer as it is expected that approximately 80% of patients will require surgery at some point during their treatment journey. Surgical oncologists, as members of the oncology multidisciplinary team, have a pivotal role not only in cancer treatment but also in prevention, diagnosis, restoration of function, and palliation, which are all extremely important in the fight against cancer. In breast surgical oncology we are actively involved in all these aspects, advocating for breast cancer prevention and screening, performing risk-reducing mastectomies in women with high breast cancer risk predisposition genes, and restoring function and body image through oncoplastic surgery. In addition, this career path provides significant opportunities for research and roles in academia as well as opportunities for roles as clinical educators. 
What kind of person thrives in this professional environment?
MT: Surgical oncology is a challenging specialty that requires focus, dedication, determination, resilience, and empathy. The discipline requires the surgeons to master a complex array of medical knowledge as well as surgical and non-technical skills. In particular, oncoplastic breast surgery requires the surgeon to combine the principles of cancer and plastic surgery to offer the best possible oncologic and aesthetic outcomes. To thrive in this professional environment, a surgeon must be able to make high-stakes decisions under pressure, especially in the operating room, and demonstrate leadership qualities. It is also important to be flexible, and open to new opportunities or pathways as they appear and constantly push the boundaries, working outside their comfort zone to achieve professional growth. In the modern era of multidisciplinary management of cancer, a surgeon must function within the wider oncology team and therefore additional attributes and qualities include excellent communication skills and a collaborative nature.

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