Accessing AO: Network narratives

Though renowned as a research scientist and professor of small animal surgery at the University of Cambridge (United Kingdom), Matthew Allen is not immune to imposter syndrome—that gnawing feeling of self-doubt or incompetence—particularly in the AO community populated primarily by clinicians. But he knows the value that nontraditional perspectives bring to the table and is championing that diversity in his role as AO Access Task Force Officer and Faculty Selection Processes Task Force Lead.

Allen, who additionally is director of the Surgical Discovery Centre at the University of Cambridge, a member of the AO Program for Education and Excellence in Research (AO PEER) cross-divisional taskforce, and past chairperson of the AO VET Research and Development Commission, credits his AO mentors with bringing him into the organization. With support from those mentors—including AO VET International Board (AO VETIB) Past Chairpersons Carl Kirker-Head, John Houlton, and Ken Johnson—Allen found his place in the AO 15 years ago and has been contributing ever since.

“I knew what AO VET meant. My problem was that for most of my career I have not been what I would consider a full-fledged veterinary orthopedic surgeon. I came into things tangentially and ended up doing clinical work more as an extension of my research than as a primary pursuit,” Allen said. “So, because of that, I’ve always felt a bit of imposter syndrome with regard to being a ‘proper clinician’ because I didn’t take the traditional pathway into the career.”

 

The value of a nontraditional background

Allen believes his experience is evidence of the value people from nontraditional backgrounds can bring to the AO.

“We need to recognize the value of veterinarians who come in from outside of the AO and non-veterinarians such as research scientists, because in the same way that we talk about diversity in terms of gender, race, ethnicity, and other differences, we should be thinking about diversity of thought and background,” he explained. “For me, having a nontraditional background has been very helpful, and I hope I’ve been able to contribute because of that, rather than being just like everybody else. There is a difficulty that if everyone comes from the same background, you don’t really see what’s possible.”

It was from that perspective that Allen jumped feet-first into cocreating the AO’s early Opportunity, Diversity, and Inclusion Initiative (ODII) efforts in 2018, alongside AO VET North America (AO VET NA) Immediate Past President Amy Kapatkin, AO VET NA’s Samantha Morello, and Senior Program Manager Diversity, Inclusion and Mentorship Tatjana Topalovic. That group developed an evidence-based approach to increase diversity, equalize access to opportunity, and build effective mentoring pathways within the AO. 

“AO VET was pretty progressive early on: Our clinical division has a very significant membership at its grassroots level—the majority of veterinary schools certainly in the western world are graduating majority female classes, and that has been the case for a number of years now,” Allen said.

When Allen was in veterinary training, men and women were equally represented, but in the United States, female representation can be 80 to 85 percent.

“Here in Cambridge, we’re probably graduating 70 percent female classes,” he pointed out. “That throws up lots of challenges as well as opportunities. Obviously, there are many, many challenges to go with that, looking at pay gap, for example, and the pathway of working—the way people work can be very different than the way it used to be.”

 

What is a surgeon?

Allen said he has had the opportunity to work with many talented female surgeons during his career, so the term “surgeon” is as likely to mean a woman as it is to mean a man. 

“For example, if I’m talking about a surgeon, in my head, that’s as likely to be a woman as it a man,” he said. “It always was evident that within the AO  that wasn’t always the case and that’s partially people’s lived experiences, but I also think there were some obstacles and reservations about diversity. So, I started working with AO VET on this with Amy Kapatkin. That expanded out from being an AO VET-led initiative to becoming an AO initiative and—eventually—what is now AO Access.”

The AO Access Officer and Faculty Selection Processes Task Force that Allen leads aims “for the membership, leadership, and culture of AO to reflect the diversity and aspirations of its membership and the needs of the patient population that we serve.” Its objectives are to provide guidance to the AO clinical divisions and clinical unit to implement a clearly defined, fair, and transparent pathway and practices for officer and faculty recruitment that are harmonized and implemented across the AO, using best practices that promote inclusivity and ensure equal opportunity.

“Fundamentally, our work reflects the fact that having a leadership role—whether that’s at a local, regional, or international level—is very challenging when there are obstacles in the way,” said Allen. “Those challenges may have to do with simply knowing the opportunity exists, or it may be your access to opportunity, or there may be active blockades in the way. But the pathway forward is not transparent, and the way you historically got into the AO has felt a little bit like a select club.”

 

‘You have to pick the best’

While Allen said there’s nothing wrong with having a select club, the challenge is “if you want the club to be the best, then you have to pick the best members”.

“And unless you’re very ignorant these days, you’ll recognize that this means being diverse,” he emphasized. “If we continue to just pick from the same pool, then we’ll get the best of that pool—but that pool is not going to be the best that we can achieve. So with our task force, the goal has been to try to identify what the challenges are for individuals who want to progress into AO leadership and faculty roles.”

Case in point: The task force has often heard from AO community members that they “don’t understand how people don’t know about opportunities within the AO because positions are widely advertised, so why can’t you just do it?” 

“Well, the problem is that most of us didn’t come to AO the because we just applied for an advertised position. Most of us got in because someone sponsored us in some way, either by telling us about an opportunity or more actively just really helping us get in,” said Allen, emphasizing how Kirker-Head actively lobbied him to become involved with the AO.

“He encouraged me, and my immediate reaction was, ‘I can’t do that. I’m an outsider,’ and he told me I shouldn’t look at it that way and told me, ‘I think you could bring a lot. Let’s see what’s possible,’” Allen recalled. “I think we need active engagement and that’s not realistic for everyone: Not everyone is lucky enough to have the network, so entry and advancement in the AO shouldn’t be based on that. Your ability to progress shouldn’t be based around who you know.”

 

Fixing the problem

Allen said fixing that problem begins with making the AO’s pathways and their opportunities very clear, signposting them, and asking probing questions: “Where are the sorts of people we want to attract? Where are they looking? What’s their comfort zone? What groups are they working within? And why isn’t the AO message penetrating that environment? And, once they apply, what are the internal obstacles for being selected?”

While AO Access has had significant success in demonstrating that more transparent and merit-based—even blinded—selection processes can yield high-quality results, Allen said that continued change will require an ongoing investment from the AO.

“It will take time to change people’s perspectives but the best way to change them is to demonstrate where it’s worked really well,” Allen pointed out. “I don’t think anyone would argue whether AO Access has been successful. It has been wildly successful. The questions are going to be, ‘What’s the institutional perspective on keeping AO Access going and staying invested in AO Access?’ And then, at a leadership level: ‘What’s the level of uptake? Are there people behind us who are willing to pick up this initiative and run with it?’ One of the things you have to do as a leader is get out of the way in order to provide opportunities for others.”

 

Shaping the future, expanding the tent

Ultimately, Allen is intent on shaping a future where people from a vast array of perspectives can contribute to the AO mission of improving patient care.

“We should all be planning our legacies—and I think we do that even when we don’t realize we’re doing it. I’m looking to contribute in a tactical way and, in particular, by trying to assist younger people to be leaders, because that’s the greatest gift you can give in the long-term. I actually want them to be better than me—that’s the goal,” he said. “At the end of the day, I am a veterinarian, I am an orthopedist, I care about the specialty and I want to make it better.”

And, just as the AO proved itself to be a big enough tent to allow a researcher to join its leadership ranks, Allen wants to make sure it’s big enough—and bold enough—to embrace the next generation in all of its diversity. 

“Whether I was clinically trained to the nth degree or not, I absolutely have a place under this tent, I have a voice, and I’m lucky enough that it can be heard,” he said. “I think the young people who follow us will do a tremendous job, but we have to give them the tools and the lessons we’ve learned so that they don’t have to go through the painful processing of learning the hard way.”