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06.11.2020 | Interview

Ass. Prof. Dr. Gabriele Millesi on her career in CMF surgery and her function as President of the IAOMS

Ass. Prof. Dr. Gabriele Millesi

How did you discover CMF surgery?

During my studies, it was, and unfortunately still is, the case that CMF surgery is not known by many people. It still has a marginal position. As a medical student I was enthusiastic about every speciality, but I had a friend who introduced me to OMS surgery. He advised me to take the subject of dentistry, as it had the shortest training period in Austria at that time. To be honest, I was not really interested in dentistry. I wanted to do something surgical. For this reason I tried to combine both. That's how I came across the clinic for cranio and maxillofacial surgery at the University of Innsbruck. I worked there for many weeks during my student days and discovered my fascination for the field. I had no idea that OMS covered interventions from the base of the skull to the collarbone, and I can still remember it clearly when I saw my first down-fracture during the Le Fort I osteotomy. That's when I was really excited about the possibilities of the field. When I saw the result of this beautiful aesthetic correction of the patient's face the next day, I knew that this was exactly my discipline and that I wanted to pursue it further.

What is it in this field, you are passionate about?

We work on what is actually the most important part for the social life of a person - the head. This is why CMF surgery has an extreme importance for the quality of life of patients. The CMF surgeon is the specialist who is familiar with bones and soft tissues and, like the dentist, is also very much concerned about the occlusion. The rehabilitation of the occlusion and thus the chewing function is the focus of every intervention. This is something that the CMF and OMS surgeon can easily do thanks to his/her training and which gives us an advantage in comparison to other medical specialities.

In many peripheral areas, however, we also see overlaps with neighboring subjects, from which everyone can benefit, but that also require an exchange among the specialists. In my opinion, two factors are central for good cooperation. The first is your own expertise and excellence. One can only earn recognition from the other disciplines and thus be appreciated through excellent performance. The second is the personal component, the diplomatic strategy of how you deal with your neighbors. Here it is important to express mutual appreciation and to involve the other person in difficult cases. 

In this country, a CMF surgeon needs a double approbation in the field - as a dentist and medical doctor. That means a long study. Compared to other countries, where a single approbation is sufficient, do you see this as an obstacle to entering the profession?

In my experience, students are so enthusiastic about the field that the length of their studies is not an obstacle. Moreover, some universities offer the possibility of a shortened course of dentistry due to overlap with medicine. So I don't see any problem with junior staff at the moment. In contrast, I feel that the double licence is an additional opportunity. As already mentioned, our medical speciality covers a very broad spectrum, but this is not practiced to the same extent in all countries. With a single approbation to practice medicine, the focus often shifts, and specialties such as craniofacial surgery or microvascular reconstruction tend to be omitted. The decisive factor is the perfect education at the universities in every practiced specialty. That is what counts, that your own work is of the highest quality.

What would you have liked to know before you started this career?

In my generation, residents were not allowed to do practical work themselves, but only assist. I assisted hundreds of clefts before I was allowed to operate myself. Then there was the fact that osteosyntheses were new at that time and the older colleagues had to learn the techniques themselves. Nowadays, fortunately, every young surgeon is allowed to perform trauma procedures and that is absolutely right. You could say that I had a long dry spell before I was allowed to do practical work myself. 

After I had traveled internationally and also worked with well-known professors, I realized: "To become a guru you have to attend a guru.“ Every famous surgeon today had another famous surgeon as a mentor. This shows how important it is to pass on knowledge. In the beginning, it is basically the case that you cannot assess what you should focus on in your training in order to become good. That was no different for me. As a young surgeon, you need someone to give you support and explain facts and contexts. Of course, as a young surgeon you also have to make your contribution and show commitment. Then it is beneficial for both sides. In addition to manual surgery, you also have to deal urgently with theory and the respective case. One must always be up to date with the literature. Here too, the recommendation and subsequent discussion of a mentor is important. This is the only way to understand the context and obtain a broad knowledge of the field. 

In addition to this knowledge transfer, the mentor also is a role model and plays an important role in motivating his protégés. I also see this in my international fellows or guest doctors. The joint open discussions in the out-patient area on case planning and the results are always highly appreciated. 

What is the secret of your success and what is your advise for your younger colleagues?

You cannot be good at everything. You need basic training, you need know-how - but to be really good, you have to focus on one field. CMF surgery is otherwise too broad for that. If you only deal with one field, you will of course be better than someone who tries to cover everything. In this area, you should try to become excellent and stand out through sound theoretical knowledge and practical experience. 

In addition to this excellence, your own character and private environment also play an important role. I myself had two children relatively late in life and thus left the profession for three years. During this period, I was particularly concerned that other colleagues might overtake me and that time might be detrimental to my career. This is of course the bottleneck in the careers of all women. In our field, many drop out after parental leave because they can't make the leap or because they lack a supportive environment. For me, my mentor, who supported me very loyally at the time, came into play again when I returned. It certainly also played a role that I had already established a certain standing for myself through my many years of experience and was respected by my colleagues even before my parental leave. I also had support from my family. My husband is also a CMF surgeon and therefore knows exactly what that means. In the future, it will be very important, also internationally, that women receive more support. Especially in the Scandinavian countries this is already being lived. Compared to the past, however, a lot has already happened.

Do you have a particular "surgery ritual" or a lucky charm?

For me it is very important that the atmosphere in the operating room is right. The worst thing for me is to go into the OR and notice that the team is in a bad mood. To lighten up the mood, I like to tell a nice joke or something else that makes everyone laugh. That way you strengthen the team feeling. Here it is also important that the anesthetist is involved. You are a team. 

Then we have a somewhat bizarre ritual. In the OR I always wear a headlight with a free-running cable, which is fixed to my back by the scrub nurse and covered with a sterile drape. She sticks a cloth on my back, which we call "Superwoman Cape". We always laugh about it together, it breaks the ice and everyone comes to the operating table in a good mood.

Another ritual has crept in during my pregnancy. I operated until shortly before giving birth and therefore I always had to drink something in between. Of course, this is not so easy in the operating room, but we helped ourselves with a suction tube. To this day, I still drink a sip of Coke after the Le Fort I osteotomy, for example. The others joke from time to time that they want a Coke too.

At the beginning you were probably nervous before an operation. How did you overcome that?

The better you dealt with a case, the calmer you are. Nowadays, virtual 3D planning also gives you great opportunities to plan all the steps in advance. This is a completely different dimension than before. Nowadays, we know exactly that the lower jaw is swivelled 8 mm and that there is also an obstacle in the lingual area that needs to be removed for example. The second thing that helps to reduce nervousness is the practical surgical experience. The more you operate, the better. 

How do you manage to balance work and leisure? 

I do admit that after a long operation, one is physically tired from time to time. But when I know that the intervention went well, that everyone at the table was enthusiastic and that the patient gets a nice result, then I am so full of endorphins that I am not exhausted but really happy. I just love my job and that is also very important. I like to work and I also like to work a lot. Additionally I have the backup from home. It is very important that the family environment understands this. The more natural this is, and this brings us back to Scandinavian countries where household and family care are shared equally between men and women, the easier it is to combine both. Fortunately, I have always been in a comfortable situation in this respect.

Is there ever a surgery after which you feel like you actually wanted to solve the problem differently, or where the fate of a patient burdens you? Do you have any tips on how you can process this for yourself or put it into perspective?

That is absolutely correct. Every surgeon has difficult situations or complications to think about. The biggest mistake is to try to ignore them. If a mistake happens, you have to break it down into its individual parts and think about how to correct it. But when you realize that a mistake has happened, that is already the first step to get out of the spiral. You have to constantly re-evaluate your results. You must also have the greatness to seek advice from someone else if necessary. If I think that it would be good to talk to someone else concerning a specific case, I ask for advice. That is human. During my mentoring of an international group, one participant reported that he always had problems with his plastic colleague. From the time he asked the plastic surgeon for his opinion on a case, the relationship between the two departments was much better. This shows once again how important it is to have the courage to discuss a problem. Then acceptance between the departments increases as well.

Now we would like to learn more about your experiences as President of the IAOMS and this exciting function. When did you know: I want to become President of the IAOMS?

To be honest, I believe that the inner circle of the "Board of Directors" knew earlier than I did. I was a member of the international society and it all started in 2005 with our world congress ICOMS in Vienna. These big congresses require a long preparation time - on average two years. My boss at the time was the "Chair of Organization", but I was the one who planned and implemented everything. I had everything under control and the congress was very successful in financial, scientific and social terms. Some participants still talk about this congress today. For me it was, so to speak, the stepping stone for my career in the international society. I was responsible for various "task forces", took on various functions and obviously the other members then saw that there was potential in this Viennese. There is a ladder to become President. It is not like saying, "Now I am going to be President.“ There are already certain preliminary functions and positions that one must hold, from which one only then becomes eligible for election. This is decided through committees with almost 90 different nations. First I was a "Member at Large" for six years. From there you can be re-elected to „President-Elect“ and then to President. It was only from the time on when I held the position "Member at Large" for 6 years that I realized that this could move in this direction. But I must also say that I did not pursue this career doggedly. I don't want to say that the position has flown to me, but I have received very positive feedback from all sides and I have taken advantage of that. From the moment I became "Vice President-Elect", I knew of course that it was going in that direction.

What are the duties associated with your function as President?

This is something that an outsider, and perhaps not all of our members know. IAOMS is a professional society with 4,000 members and is run like an American company. There is the "Executive Director", the "Board of Directors", "Treasurers", "Past Presidents" and so on. One has to make decisions that are not necessarily only professional, but also extremely important for the existence of the company and the management. It is also a prerequisite that you are fluent in English. For example, I have to read and assess English-language legal contracts. This is one side and the other side, which is much more important to me from the heart, are the members. It is very important that you really try to be an ambassador. So that the 4,000 members know that they have someone who not only runs the business up in the clouds, but who is at their side. I am sure that my down-to-earth, natural and open character gives me the opportunity to show this to them and it is already appreciated. People know that if they have a problem, they can come to me and I will try to find a solution. We are there for the members and that is certainly the most important thing above all. But of course it is an international business that needs appropriate leadership, management and strategic planning. It is not entirely uncomplicated.

What has been your most exciting experience as IAOMS President so far?

The most exciting thing for me is the incredible affection and emphatic feedback I receive from all over the world. That really touches me. Before COVID-19 I was constantly travelling, whether in the Philippines, Asia, South America, Mexico - everywhere I was received incredibly friendly and my mere presence or a lecture was highly appreciated. There again the role model function comes into play. Four years ago I founded the "Next Gen Committee" with Alfred Lau, our "Chair of Next Gen", with the aim of supporting the young generation in IAOMS. It is very important to me that we are not the "Old Boys and Girls Club". Of course, this transformation process takes a while, but we are already seeing positive changes and are also receiving a lot of encouragement from the young people, which I think is really great. Of course, there is also the fact that I am a role model not only for Next Gen, but also for women. For example, there has never been a woman in the American Association or the EACMFS for example in my position. That is inspiring and important for the young female colleagues. This feedback is incredible for me. It tells me that I'm in the right position and that I can make a difference. 

What new insights have you gained from your time as IAOMS President?

When we talk about success and success models, I have learned that communication is an essential factor in every area. Another point is the own network, which can only be built up through communication. I also believe that this is completely underestimated in the school education of our children. Only through communication and the openness to approach others, one can become successful. This applies to professional life but also to IAOMS. 

For the IAOMS, Next Gen is crucial and I wish I could make this clear to everyone. As a young person I always travelled a lot, had friends everywhere and thus a large network. Exactly this network formation we would like to support with the Next Gen by different programs. On the one hand, with the "Red Book" we provide an overview of the various centers that the young colleagues can go to. On the other hand, I hope that one day we will be able to offer the possibility of an Observership in which the Fellows can exchange their apartments with each other so that they can save on accommodation costs. That would of course be a step further to enable perfect networking. Financial obstacles often limit the young doctors. My big thanks also goes to the KLS Martin Group, which is a fantastic, incredibly generous supporter of our society. We are very grateful for this connection. Only in this way it is possible to implement these great programs, even though the measures have come to a standstill with the current COVID-19 pandemic. I hope that we can continue them soon. 

How did you adjust the IAOMS strategy due to the Corona pandemic and what impact will this have on IAOMS after the pandemic?

I travelled a lot and was always on site for special meetings. Face-to-face, the spirit and friendly interaction with each other is incredibly important for the IAOMS. For example, when you give a lecture in front of an audience and have the direct feedback and exchange with the audience, that's really nice. This atmosphere is difficult to transmit on a screen. We humans are designed to be sociable and to want to surround ourselves with others. The fact that this is currently missing is a sad side effect that everyone suffers from.

But for the continuous exchange and transfer of knowledge we have tried to switch directly to "digital". In a very short time, our communications team has set up micro-learning sessions, virtual conferences and webinars, which was truly amazing. We will continue to pursue this strategy for the time being.

There will be virtual sessions for the Next Gen. Unfortunately we can't offer anything else at the moment. But I hope that we will soon be able to continue with the Fellow and Observerships and thus the international exchange.

In the future, events will be hybrid. In other words, there will be participants on site, but there will also be some who will join in online.

In the current situation, I would like to wish everyone good health and stamina. As OMS surgeons, we in particular are exposed to the situation in our work on the patient's head. But I would also like to encourage everyone once again not to hide in the current situation, but to continue to share knowledge and keep in touch with each other on a virtual base.

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