Dr Rob Knox was a recipient of the 2024 RACS Rural Surgery Fellowship for Provincial Surgeons. He used the grant to attend the Surgical Leadership and Management Program jointly run by Harvard Business and Medical Schools and the London School of Economics.

"I'm grateful for this opportunity,” Dr Knox says. “One of the key takeaways was how the program distinguished between technical skills—traditionally emphasised in medical and surgical training—and adaptive skills, which are often more complex.” 

Adaptive challenges, involving behavioural or cultural change, typically lack clear solutions and can feel deeply unsatisfactory. But the program, he says, offered practical strategies for navigating them.

Broadening skills 
Having stepped into a management role within his health district of Orange in New South Wales, Dr Knox found the Fellowship crucial for building a broader skill set. 

“It covered financial literacy—which is often underemphasised in our training—along with interpersonal and leadership skills. I gained a deeper understanding of my strengths, weaknesses, and leadership style, and how best to apply them in practice.”

One of the most valuable aspects of the course was the calibre of instructors. Some had been directly involved in investigations into major disasters, including the space shuttle tragedies. They introduced concepts like the 'Swiss cheese effect', which describes how small, seemingly unrelated failures can align and cause major harm.

“It became clear that organisations, including in healthcare, respond well to obvious threats but often miss the smaller risks that quietly build over time. Surgery has learned from aviation—and is now learning from the space industry too.”

Leadership in regional context
Dr Knox believes surgical leadership is ultimately about driving meaningful change. That means identifying stakeholders, building consensus, and taking practical steps to solve problems that often seem insurmountable.

“The program took a problem-based approach with rich case studies. It was engaging and immediately applicable,” he says.

He says regional hospitals have their own unique challenges, particularly due to limited infrastructure support. “Without access to business analysts or administrative teams, you rely heavily on your own skills—and those of your medical colleagues—for non-clinical initiatives.”

That’s why formal training in leadership and management is valuable. “It was also reassuring to realise that many of the issues we face in regional settings are mirrored in institutions around the world. 

“The course helped me approach these dynamics with greater confidence and clarity.”

Returning with new tools
Now back in Australia after the Fellowship, Dr Knox feels better equipped to handle matters like resolving conflict and managing differing opinions within a team.

He describes the RACS Fellowship as invaluable, providing both personal growth and practical skills that clinical work alone rarely develops.

Journey into Colorectal Surgery
Why medicine? Dr Knox says he doesn’t have a non-cliché answer. “It just felt right.”

He chose colorectal surgery because “it is a fascinating area. It’s technically interesting—widely applicable and offers a lot of variety.”

He always knew he wanted to return to a regional setting. After completing his medical degree at the University of New South Wales, he undertook his internship, residency, and registrar training at Prince of Wales Hospital in Sydney and its affiliated hospitals. He later completed a colorectal surgery Fellowship at North Shore Hospital.

Life and work in Orange
Working across the public and private sectors in Orange, Dr Knox splits his time between consulting, endoscopy, and operating. “I’m part of a private group practice with several excellent general surgeons here, so it’s a very collaborative setup,” he says.

Outside of work, Dr Knox is a keen cyclist—although a recent injury has temporarily sidelined him. “Orange has a great cycling and trail-running community, which I really enjoy.”

He’s also a musician who plays piano and guitar.

His current challenge? “My bike’s still with insurance. But the bigger hurdle will be convincing my wife to let me ride again!”