This article is based upon the content of the International Women's Day Address delivered by the Author at the Royal College of Surgeons of England on 8 March 2023 (https://youtu.be/W1jxFSmuLOs). I would like to dedicate my presentation today to the ordinariness of being a woman surgeon. And that may seem an odd thing to say, but let me tell you about the first time I met Dame Clare Marx. It was at the Royal Australasian College of Surgeons Annual Scientific Congress in 2016, in Brisbane, Australia. Clare was attending as the President of the Royal College of Surgeons England and had delivered the opening Oration as well as a plenary presentation. At the time, I was a Younger Fellow, and while I admired her greatly from afar, I was too much in awe of her to introduce myself to her in person. Some of you will know that I take my crochet to surgical conferences, because I am neurodiverse and my attention is better if I can keep my hands busy. There is actually good science behind this, as being required to sit still causes motor overflow, and channelling this overflow into low-cognitive motor activity improves attention.1, 2 This is why, even for those who are not neurodiverse, it is common to doodle, spin pens or fidget. It has taken me many years to become sufficiently confident to weather the strange looks and remarks that crocheting causes in surgical settings, because the traditional gender mix in surgery is such that fidgeting seems far more socially acceptable than crocheting, even though the movements are very similar (and only one of them produces baby blankets). Nowadays I just sail on, but back then I wasn't quite so confident. I'd only pull out my crochet bag when the lights were dimmed. So on the third day of this conference, I arrived about 5 minutes late to one of the sessions. I poked my head into the door of what I thought was the conference room, only to realize I'd actually poked my head into the front of the theatre and that everyone was staring at me instead of the speaker. So, burning with embarrassment, I withdrew and scuttled around to the door at the back of the conference room and slid, with burning cheeks, as unobtrusively as I could into the last seat of the very back row. And, after a few minutes, once my embarrassment abated enough, I took out my crochet to help me concentrate on the presentation. Just as I was getting settled, someone else entered from the back of the room, and I heard their footsteps coming closer to me and then a woman's voice with a British accent said ‘could you move over one seat?’ And, I looked up to see THE Dame Clare Marx. I was, as you might imagine, fangirling wildly but too stunned to say a word. So, I moved over one seat, she sat down, and then, ignoring the glances of the people around us, she said ‘oh, what lovely crochet. I'm so glad you bring it to conferences’. And then we both sat there side by side, and watched the rest of the presentation. If you know anything about conference conventions around ‘how distinguished guests always sit in the front row’ and ‘how we mind our own business when sitting next to strangers’ and the aforementioned ‘how we behave in [male-normed] conference-y ways and fidget instead of crocheting’, you will understand how many barriers Clare smashed with those few, simple actions and words. You will understand how choosing to sit in the back row, rather than the front row, flattened the hierarchy and how a simple comment made a huge and lasting impact on me, someone junior who she had never met before, by entirely normalizing my presence there – both me, and the hook and yarn in my hands. She was making me very ordinary. It is a privilege to be ordinary in a space. To be ordinary means to be so normalized that it does not require additional comment. To belong so much, that work arrangements are fashioned to fit around your needs and not that of a different stereotyped norm. To be true to yourself at work and to simultaneously be considered a good fit for the job at hand because of that truth, not in spite of it. There has, of course, been a relatively narrow segment of society that has enjoyed that privilege of being entirely ordinary in surgery, but until that moment when I met Clare, I had not ever felt very ordinary in a surgical space, and I must admit, even as a senior consultant now, that sense of being ordinary is frequently interrupted by events which emphasize how much I am considered different in a surgical space. The way we have to make special requests for equipment that is sized for my hands. The way patients will ask me to thank their surgeon, not realizing that I am their surgeon. The way my title is omitted in conference programmes even when other colleagues are appropriately addressed as Doctor or Professor. As I have become more senior, become an educator, and then become involved in the work of addressing professional competencies in the Royal Australasian College of Surgeons, I have learned that what Clare did is actually supported by a great deal of literature. It's not just about ‘feelings’. For example, in a simulation study where an actor anaesthetist asked trainees to give blood against a patient's wishes, hierarchy acted as the strongest negative influence on patient safety, trainee learning, and team functioning.3 In the St Bart's Nightingale hospital in London near the start of the pandemic, a lack of hierarchy evolved naturally because the emergent nature of the threat meant that no one person could claim to have special knowledge or seniority, and this flexible team structure facilitated communication and rapid knowledge dissemination, so that changes to management protocols that would ordinarily take months in fixed hospitals occurred within hours or days.4 Similarly, we know that there are benefits to belonging. A lack of belonging contributes to isolation, emotional distress and lessened effectiveness.5 I use the word belonging deliberately, because it goes beyond mere inclusion, which is sometimes only a grudging permission to be able to be in the room. By contrast, belonging, which is a sense of not just being included but also accepted and valued, requires more deliberate work. It is not just opening the door. It is opening the door, taking time to introduce the person to others and making sure they can participate in all the activities that they would like to. And not just that, but ensuring that person could, if they wished, propose a modification to the activities and be taken as seriously as anyone else who had been there for some time already. In other words: being made ordinary in that space. If it feels like this would require a lot of work and effort, be reassured that simple actions can be effective. Just as Dame Clare Marx welcomed my crochet with just a few words, my own research about the reasons why women choose to leave surgical training show that simple actions such as a well-timed cup of tea or some early positive feedback can have a significant impact.6 And we can all, each of us, commit ourselves to more deliberately doing those actions for others. But we cannot recruit and retain women in surgery just with a mountain of individual small actions. Larger systemic and cultural changes are also required, and this is one of the reasons I was delighted to contribute to the Kennedy Diversity Review.7 There have been many excellent pieces of work already initiated since the review, but I would implore the leaders and Council of the Royal College of Surgeons England to look again at the governance recommendations. There is a moral injury in asking trainees and members and fellows to do these multiple pieces of diversity work, and yet to say that the work is insufficiently important to make the necessary changes in the space where the most consequential decisions are made. It implies that diversity is only a matter of convenience, mere embroidery when significant changes to the fabric of surgery need to be made. When history looks at previous social progress, such as women's suffrage or marriage equality, it looks kindly on organizations who did not wait until they were sure there was wider support, who did not wait until they knew they could more easily go with the flow, after others had already taken the same path, and receive the social recognition with minimal risk. History looks kindly on the organizations who have the moral courage to do hard things because they are the right thing to do, not because they are the popular thing to do, or the thing that requires the vote of the existing hegemony. I would like to think that I have just become a Fellow of just such an organization, but until the governance recommendations of the Kennedy Diversity review are implemented, I must remain unconvinced. In the meantime, while we wait for that change, note that none of the research I've referred to requires participants with formal leadership roles or qualifications. These are actions that we can all do no matter what our role in the team or level in the hierarchy. I have had opportunities to multiply this evidence across multiple educational courses developed for my College, the Australasian College, and in my various roles in other professional colleges and higher education institutions. But I have had those opportunities because other people have done small actions for me. Perhaps my most impactful piece of work was helping to develop and deliver the educational material for the Operating With Respect programme. I am told that, in the midst of the discussions in 2015 around the initiating sentinel event, which related to sexual harassment, in a random room in the College building in Melbourne, Australia, which 3 hours flight from my home on the Gold Coast, someone unnamed said ‘what about that woman on the Gold Coast who's always noisy about such things?’ It is only through something so ordinary, so accidental, that I have had the privilege of contributing to a programme of work that has delivered mandatory universal training to every surgeon, every trainee, every applicant to training and every Specialist International Medical Graduate in Australia and Aotearoa New Zealand, and to upskill every surgeon in a leadership position – executive, committee members, selectors, supervisors and examiners – to better address bullying, discrimination and harassment in our profession. It is frankly mindblowing when I consider what can happen when there is a confluence of brave leadership, many people working together, and proper investment of resources. I think The Royal College of Surgeons England has two out of the three. This work is ongoing, but we already have evidence that it is working. The programme was launched in 2015, and the Phase 2 evaluation report of the Building Respect programme in 2021, 6 years later, shows a significant increase in recognition of what constitutes disrespectful behaviour, and a significant decrease in overt disrespectful behaviours such as shouting and inappropriate physical contact.8 This is not something I could have imagined that I could have achieved when I was a trainee. I was so conflicted between my love of surgery and the punishing hours which made me feel I could not provide care safely in the days before work hours restrictions. I was similarly conflicted between my desire to help patients and my desire to be there for my own young children in the days before flexible work structures. I was also conflicted between expressing my compassion through my emotions and being told simultaneously to be more coldly professional – and yet to also smile and bake for the staff. When I think about what got me through to consultancy and what has kept me going through 2 decades of advocacy, I return to those small ordinary acts. The consultant who made a special request for me to assist him because he needed a more experienced pair of hands. The colleague in a meeting who quiets another member from speaking over me, so that I can have my ideas heard. Complete strangers at conferences who smiled at me as I breastfed a fussy baby outside conference rooms. These things showed me I belonged and was valued, but I was lucky that something lovely like that would happen every time I was getting close to feeling so excluded that I was ready to leave surgery – and this happened on multiple occasions. Many colleagues have not been so lucky. We need to make these experiences of belonging commonplace if we are to recruit and retain the best in surgery. Those of us who have been given the responsibility of leadership, should work towards larger structural change, even when it may require that we give up some of our own privileges. But all of us can continue the work of doing small acts to make others feel ordinary, as though a person being there is exactly where they should be, requiring no additional questions about whether they can ‘have it all’ or ‘balance their responsibilities’ or ‘are a good fit’ in a field that has been such a poor fit even for the people who are supposed to fit the stereotype. We cannot claim that we select and train the best for as long as we subject people to bullying, discrimination, harassment, inflexible training, punitive working conditions and a thousand other things that have nothing – nothing at all – to do with competence or excellence. We cannot set up a system where those who have compassion and a balanced life are discouraged from continuing, and then wonder why we end up with difficult colleagues and toxic units. We must act on the substantial literature, stretching back several decades now, that shows us what we must do to create the conditions for delivering the best patient care. So, to conclude, I ask you all to commit to making women in surgery completely ordinary through small acts to welcome and normalize all our wonderful diversity. And, because our feminism is not feminism unless it is intersectional, let me also ask you to do the same for people of every race, gender, sexuality, age, ability and class. When we talk about the patriarchy, we talk about a structure that has preferentially benefited cis-hetero able-bodied white men from privileged backgrounds, and if we only support women without addressing these other dimensions of discrimination, we will only create the ‘feminarchy’, identical to the patriarchy in all respects apart from gender. Women can do it differently. At the risk of resorting to stereotype, women excel at working in teams, at balancing multiple competing tasks, and at navigating complex social frameworks. We are ideally suited to bringing the surgical profession into the modern era, and we can choose to bring everyone with us and to create something entirely new. This is our challenge; to create a surgical workforce that reflects the population it serves, that contains enough capacity in its diversity to meet the many unexpected challenges of the past few years, and to meet as-yet unknown future challenges in a rapidly changing world. We can make everyone – no matter their diversity – feel like they belong. We can make surgery ordinary for everyone. I thank you for coming today and I thank you for giving me the opportunity to deliver the International Women's Day address for 2023. This article has been co-published with the Bulletin of the Royal College of Surgeons. The articles are identical except for minor stylistic and spelling differences in keeping with each publication's style. Either citation can be used when citing this article. Open access publishing facilitated by Bond University, as part of the Wiley - Bond University agreement via the Council of Australian University Librarians.