AWS BLOG

Defining the Resident Role in the Operating Room

By Heather Logghe, MD

In recent years, expectations and requirements for attending supervision of residents in the operating room has increased. This has led to ambiguity for both residents and attendings as to how and when operative autonomy is earned, appropriate, and safe. Another area of uncertainty is when, how, and by whom the resident’s role should be described and explained to the patient. Research in thoracic surgery by Meyerson et al. showed that while trainees’ and attendings’ expectations of resident autonomy did not differ, both groups expected higher levels of autonomy than were observed.
The January #AWSchat will explore these issues through facilitated questions led by three distinguished moderators:

  • Dr. Shari Meyerson (@lungteacher), thoracic surgeon and Program Director for the General and Thoracic Surgery Residency Programs at Northwestern, Feinberg School of Medicine
  • Dr. Nell Maloney Patel (@MaloneyNell), AWS member, colorectal surgeon, and General Surgery Residency Program Director at Rutgers Robert Wood Johnson Medical School
  • Dr. Rebecca Hoffman (@drbeckyhoffman), Vice Chair of the Resident and Associate Society of the American College of Surgeons Executive Committee as well as Research Fellow at the Center for Surgery and Health Economics and Chief General Surgery Resident at the University of Pennsylvania Perelman School of Medicine

In the chat, scheduled on January 15 @ 8PM EST using the hashtag #AWSchat, we will explore the following questions:

  1. As a resident, how much should I “do” in a case? Who gets to decide?
  2. As an attending, what metrics do I use to decide how much a resident does in a case?
  3. How should the discrepancies in expectations of autonomy in the operating room between resident and attending be resolved?
  4. How much transparency is owed to patients regarding the resident’s role in the OR?
  5. Who should discuss the #surgresident role in the #OR with the #patient?

Dr. Logghe is a longtime member of AWS and currently a Surgical Research Fellow at Thomas Jefferson University. She graduated medical school at the University of California, San Francisco and has completed two years of general surgery residency at the University of North Carolina, Chapel Hill. As founder of the #ILookLikeASurgeon social media movement, she is passionate about creating an inclusive and supportive environment for surgeons in training and practice. She believes that supporting physicians in optimizing their own physical and emotional health enables surgeons to take the best possible care of their patients.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

When the Storm Clears: A New Perspective

By Dr. Ainhoa Costas-Chavarri

For 14 days after Hurricane Maria hit Puerto Rico, I had no way of knowing if my parents were dead or alive. They’re fine, I told myself. Our house is not in a flood-prone area. The roof and walls are solid, and won’t blow away. I’m sure they’re ok, I replied to the rising tide of emails, texts, and phone calls from concerned friends and colleagues – there’s just no lines of communication. I’m sure they’re fine, they have to be, I reassured myself, resting my hand on my second trimester and growing belly.

I grew up in Puerto Rico. Every summer my mother would unearth the free NOAA hurricane tracking map and place it on the bulletin board we had hanging in our kitchen. She’d catch the coordinates on TV or the radio and my brother and I would fight over who got to place the pushpins on the map. Pin by pin, every morning we followed the hurricane’s trajectory, and then went about our school day.

As surgeons, we live with similar daily acknowledgements of looming potential complications. We learn anatomical variations and control for risk factors, following the steps that will hopefully see the twin storms of morbidity and mortality veer off course. When I last heard my mother’s voice, we were going down a checklist: batteries? Check. Electronics charged? Check. Radio? Canned food? Water? Check. Candles? Mama? Mama?

For the next two weeks the only things I could pretend to control were the news and my Facebook feed. It was devastating to watch: 3.4 million Americans living on the island without water, electricity, and telecommunications. The images of massive destruction and flooding filtering through unable to fully capture the scale of this humanitarian disaster. Even after 40 days, the statistics are mind-numbing: less than 30% of all people have electricity and ~70% have access to drinking water. More heartbreaking, however, is the reality down at the individual level –  stories of families that are still without food, of people washing their clothes in and drinking from polluted water sources, and in hospitals, surgeries compromised as the power goes out in the OR. On Facebook, there was a new-found sense of community: my Puerto Rican friends and I ranted over government officials placing politics above human lives, commiserated over losses, and celebrated whenever any of us had good news.

Finally, it was my turn: 14 days after we’d lost contact, my mother called to say she was in the hospital. A small inflamed area had morphed into an angry abscess, necessitating an I&D and IV antibiotics. “It’s like being at a spa,” she proclaimed, ecstatic, “they have light here and clean water and wifi…that’s how I was able to call you.” She had been seriously considering, she also revealed, traveling to Colombia. Colombia? Para que? Well, she explained, I’ve always wanted to go – and your father and I, we have worked so hard, we did all these things to prepare for the hurricane, for the worst, and still we suffered all these unforeseen problems. Y sabes que? I think we need to put in just as much effort into living.

A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.


Dr. Ainhoa Costas Chavarri is a General Surgeon and Hand Surgeon who does full-time academic #globalsurgery. She has been living and working in Rwanda for the past four and half years, teaching Rwandan surgery residents and medical students as part of the Human Resources for Health Program. Her focus is on surgical oncology, especially breast and gastric cancer. She enjoys foreign films, modern art, poetry and now more than ever, the beaches of her home island of Puerto Rico. You can follow her on twitter: @ainhoac63

 

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

 

Why I Joined AWS

By Dr. Tom Varghese

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” – Margaret Mead

I have been incredibly blessed in my life. My parents have been, and continue to be amazing role models. One of my Mom’s favorite sayings was, “Always seek and surround yourself with people who are smarter than you. They will stretch your viewpoints of the world.” My dad on the other hand had colorful proverbs and parables to emphasize learning points (I continue to joke with him about writing a book entitled, ‘My Father the Philosopher’). One of his favorites, loosely translated from our local Indian language of Malayalam, was “Beware of continuing to climb up the same coconut tree behind a baboon. Your view will always remain the same.”

Diversity is a buzzword these days. There are numerous examples of the power of diversity in multiple fields of work. Heck, the United States is a testament to the power of immigrant diversity (or at least it has been till date). The conversations traditionally have centered on ethnicity and only recently, gender. This of course is important. But, can we have true diversity when we only pay attention to how we look? What about diversity in thought? This has been difficult to do in healthcare.

In the field of Medicine, it starts with the admission process. High Board Scores – Check. Volunteering to work in clinics – Check. Recommendation letters from those in the field – Check. Straight A’s, Honor Rolls, and Dean’s Lists – Check, Check, Check. Admission committees, overwhelmed with an ever increasing volume of applicants, have to make difficult cut-offs for admission. With the knowledge that certain types of students have succeeded in the past, this knowledge flavors the admission criteria of today. And we as students embrace this mission and mantra. Study hard, deep dive into our books, relentlessly try and figure out the the various signs and symptoms of disease. Along the way we are influenced by various specialties, which ultimately lead to our final paths of training and establishment as Attendings. But where’s the time to diversify our thoughts?

In Medicine, the world around us was historically encountered one patient at a time, one workplace environment at a time, one organization at a time. Experience was solely a personal journey. And this worked in a world that succeeded (and made lots of money) by homogenization, decreasing variation, and converting aspects of healthcare into assembly lines. Departments in Academia prided themselves on success in the form of traditional metrics – papers published, grants received, Blue Ridge Institute for Medical Research (BRIMR) rankings and clinical reputation as publicized in traditional media reports. Past success influenced the current metrics, all of which are important, but should they be the only ones?

Social Media has turned the learning experience on its head. There is no longer a need for your views and experiences to be confined to the walls of your institution. You can connect with anyone in the world at any time. However, there is a downside. Though you can find differing opinions, it is so easy to confine your experiences and thoughts to like-minded individuals or groups. Finding your tribes of course is reassuring and empowering. But the same traps of ‘homogenization of thought’ can occur on social media due to evolving algorithms aimed at user-targeted ads and personalized experience. If your timelines are filled with those who echo your same thoughts, who don’t offer differing opinions, are you truly diversifying?

My journey to AWS came predominantly from social media. I was able to connect with many thought leaders who shared their wisdom with the world at large. They opened my eyes to the struggles they had in their work environments. Many of these struggles transcend boundaries – whether they be gender, ethnicity, or social backgrounds. Several took the step of forming groups, and transforming existing organizations to more pragmatic and powerful instruments of change. I was able to learn at a distance of the efforts of AWS, including their work on gender pay inequity, work-life balance, and how to empower others. I was thus inspired to learn more about their work up close. I had live-tweeted their conference last year, and hence thought, why not?

I turned to one of my close friends, who I first met on social media – Dr. Amalia Cochran (@AmaliaCochranMD ). Amalia and I had first connected when we were at different institutions. Our first in-person meeting was when I had the opportunity to give Grand Rounds in Salt Lake City. One thing led to another, and now I’m on faculty at the same institution. I brought up how I had admired AWS from afar, and admitted that I only had a superficial knowledge about several issues such as inequity. Amalia, in classic Amalia fashion, had a mischievous grin on her face while she asked, “So why don’t you become a member?” My response – “I can be a member of AWS?” Hers – “Why not?”

Image of #HeForShe support at the AATS annual meeting 2017

My only prior experience with issues on inequity had been with the #HeForShe movement. The speech that Emma Watson gave is inspiring. This past year, the department of surgery at the University of Michigan embraced #HeForShe and challenged others to follow. Quickly, other organizations such as SAGES, ASE and APDS followed suit. In Thoracic Surgery, our national AATS meeting was about to take place in May, and hence I turned to the Women in Thoracic Surgery organization to ask about interest. With overwhelming support and the help of then president Dr. Jessica Donington and the leadership team, we were able to pledge our support for the movement by our specialty. Awareness is of course the first step. But what happens next?

I joined AWS. Their creed – Engage, Empower, Excel – is something that all of us can benefit from. Engaging with those who have lived and overcome barriers is uplifting. Learning the skills to empower those around you to reach for greater heights is inspiring. And relentlessly applying the skills you learn to excel in your environments can change the world. We’re assembling a #HeForShe task force within AWS, with the goals of teaching the skills for men to effectively mentor and sponsor women surgeons. I personally am still learning, and in my heart believe that many men want to help. They just need to be taught how to do so effectively.

I want to close with some quotes from those I admire:

Reminder to us all in healthcare. We do not do this alone. Ever. I love having a team of superheroes to work with.” – Dr. Amalia Cochran @AmaliaCochranMD

Even those above you have knowledge deficits.” – Dr. Julie Silver @JulieSilverMD

If you want to know the secret of success, it is not being better than everyone else. It is showing up more than everyone else.
– Dr. Sasha Shillcutt @SashaShillcutt

Embrace diversity at all levels. Connect with those who come from different backgrounds. Constantly seek to diversify your thought. And of course, join us in the work ahead.

Dr. Thomas Varghese Jr. is the Head of the Section of General Thoracic Surgery, Co-Director of Thoracic Oncology, and Program Director of the Cardiothoracic Surgery Residency at the University of Utah. Dr. Varghese holds leadership positions in the Society of Thoracic Surgeons, Thoracic Surgery Directors Association, American College of Surgeons and the Surgical Outcomes Club. Views expressed in this post are personal, and do not represent official positions of these organizations. You can follow on Twitter @tomvarghesejr.

 


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

 

AWS 2017: A Few Ships By The Bay

By Natalie Tully

The AWS Conference on October 21st was a full day with a scientific session, professional development panels, and a broad range of networking opportunities that originated as a simple sign for a breakfast with women surgeons 36 years ago.

This year we took mindfulness and self-care from the abstract into practice with a yoga session and run along the San Diego Embarcadero. With the excitement buzzing around the day’s events, I deeply appreciated having a moment to appreciate the sunrise and to sync breaths with other attendees.

This past year we accomplished new milestones and new trends on social media. We had the opportunity to realize how much better we truly are together. The conference made broad use of multimedia, including an introductory video by student member Emily Chen.

 

Members’ academic endeavors were highlighted in the Starr Research forum, AWS/AJS Best Manuscript Session, and a presentation from AWS Foundation Fellowship Awardee, Dr. Nasreen Vohra. Projects from a broad range of topics were presented, including “SOX9 in irradiated rectal cancer: a potential marker for tumor regression?, and Evaluation of TRB-N0224”, by Lindsay Nowak, “Improving Outcomes with Minimally Invasive Aortic Valve Replacements” by Anna Olds, and “A Chemically Modified Curcumin for Osteoarthritis Treatment” by Josephine Coury. Likewise, the resident forum featured excellent projects from a variety of surgical research areas. To complete the scientific session, Dr. Nasreen Vohra spoke about the project she’ll be working on with the AWSF Ethicon Fellowship “Relationship between the transcriptional profile of the sentinel lymph node and outcomes in triple negative breast cancer”.

The keynote speaker, Lara Hogan, Vice President of Engineering at Kickstarter, challenged us to “Be a Mentor, Find a Sponsor”. She encouraged all in attendance to critically evaluate how we seek out and provide professional guidance and support. She spoke to the value and crucial need for senior surgeons to sponsor their trainees and more junior surgeons for leadership positions. While the seat women earn at often unfriendly tables, she underscored She highlighted that for surgery to move toward gender equity, there must be increased sponsorship but also self-assertion that women belong at the table based on merit.

There is a reason why we are the Association of Women Surgeons, why we are not tied to a country or geographic region. It is because our international collective of members experience the same themes globally as women in medicine. The global panel on women in surgery highlighted the social exclusion, implicit bias, challenges in mentorship, and pathways to promotion we all inevitably encounter in the spectrum of medical training. Featured speakers included: Dr. Suad Abdul (Kuwait), Dr. Ainhoa Costas-Chavarri (Rwanda), Dr. Vikisha Fripp (USA), Dr. Avril Hutch (Ireland), Dr. Kazumi Kawase (Japan), Dr. Sherry Wren (USA), and Dr. Cheng Har Yi (Malaysia).

The official conference activities ended with a networking event in the new-for-2017 “Surgeon’s Lounge”- with a ribbon cutting ceremony by AWS President Celeste Hollands. The event offered a unique opportunity for all attendees to relax and network with each other and with our generous corporate sponsors. Following the conclusion of the conference, residents and medical students headed to a local restaurant for a taco-infused mixer. Medical Student and Resident Committee Chairs Shree Agrawal and Andrea Merrill spoke to the group to welcome all to San Diego and to encourage anyone interested in becoming more involved with AWS to take take the leap in becoming a member and make their mark on AWS.

As the day ended and American College of Surgeons Clinical Congress (ACSCC) began, AWS members continued to show the incredible work they are doing in advancing the surgical field, having myriad presentations, panel discussions, and leadership positions given by members. To highlight this and make use of the “Amplification” strategy used by other groups of women, appearances by AWS members were posted with #AWSatACS. This allowed for an extra level of visibility of the number of women speaking at ACSCC, and as a result, greater visibility both of each individual’s message and of women as leaders in surgery overall. Another trend that began during the Congress was a surgical #HeForShe– which started by Tom Varghese joining AWS subsequently followed by many other male surgical colleagues. The AWS conference’s close temporal and spatial relationship to ACSCC provided opportunities to engage with our biggest allies in our plans moving forward.

As the Clinical Congress continued on, there were myriad wonderful moments for women in surgery-Dr. Barbara Bass being installed as the 3rd female President of the College, Dr. Eileen Bulger installed as the first female chair of the Committee on Trauma, and Drs. Leigh Neumayer and Diana Farmer installed as the Chairs of the Board of Regents and the Board of Governors, respectively, just to name a few. On the evening of October 23rd, AWS held it’s AWS Foundation awards dinner, recognizing remarkable accomplishments by members at the medical student, resident, and attending level, as well as non-member allies. It was a truly spectacular evening celebrating how far we’ve come as women in surgery and reaffirming our commitment to the AWS mission. The next morning, AWS activities wrapped up with our annual Stryker Networking Breakfast, in honor of the origins of AWS and Dr. Pat Numann’s original breakfast meetings. The morning gave those still in town one last chance to come together in an informal setting and network…or be gently encouraged to take on one more AWS committee project.

This was my second ACSCC and my first of what I hope to be many AWS conferences, and for all of the things I imagined the experience would be, somehow it exceeded them. AWS seeks to inspire, encourage and enable women to realize their professional and personal goals. For at least this n=1, I left San Diego inspired by the accomplishments and ongoing work of #Sheroes I was surrounded by, encouraged by friends new and old, and enabled by new opportunities to lead and to pursue a career in this field, so that someday I may have the joy and privilege of being a surgeon.


Natalie Tully is a 3rd year MD/MPH student at Texas Tech University Health Sciences Center in Lubbock, TX. She plans to pursue a career in surgery, and has particular interest in applying her dual degree in Surgical Research, Pediatric, and Trauma Surgery. In her free time, she enjoys running, cooking, and playing with her 4-legged study buddy, Sadie.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.

Lessons About Healing After Hurricane Harvey

By Jackie Olive

I hail from the foothills of Los Angeles County, where natural disaster comes in the form of forest fires and droughts. Having lived in Houston for over four years for college and now medical school, I’ve learned that disaster here comes in practically the opposite form. Hurricane Harvey was the first significant tropical storm that I have experienced.

Initially, my colleagues and I hadn’t predicted the magnitude of the devastation that our city and neighboring Texas coastline would ultimately face. I remember we first became worried when we heard of friends who were leaving town and grocery stores that had completely empty shelves. We later became shocked when we couldn’t leave our homes because the water levels had dangerously risen and cars had been deserted in the middle of streets.

The immediate aftermath of the hurricane was devastating, as homes were destroyed, families relocated, and stress levels rose high. However, the road to recovery appeared bright, as the volunteer response was overwhelming, even to the point of being in excess at times. Temporary shelters at George R. Brown Convention Center and NRG Stadium actually had to send potential volunteers away. The positive energy and generous spirit of the Houston community were palpable, and it was absolutely vital to cultivate such camaraderie in these most trying of circumstances.

We may think that the biggest hurdle has been overcome. After all, months have passed since the hurricane wreaked immense physical damage on our city. Yet, I’ve learned to appreciate that healing is a dynamic and lengthy process. Sustainable recovery of this kind requires months, even years.

As members of a service-oriented profession like medicine, we anticipate the days when we can discharge our patients after witnessing their labs return to normal or wounds fade. And as surgeons and surgical trainees, we, in particular, feel encouraged when the procedure goes well and we are able to acknowledge the immediate fix and patient’s relief of symptoms. Subsequently, however, what happens after he or she is discharged? Where is home? How will he get there? Who will take care of her if there is a complication? I observe a parallel between post-operative care at some public hospitals and post-Harvey relief efforts: those with fewer resources, including various indigent groups, have a longer road to recovery. Houston’s diversity is one of its strengths, but we must also recognize that it comes with a heightened responsibility to maintain the health of this community.

We are continuing to rebuild homes on the ground in Houston, but I would like to offer the opportunity for others to help in a variety of ways. Most charities prefer monetary donations, as these are more flexible to accommodate changing needs. Please visit this site for specific references to organizations that are supporting the post-Harvey relief effort. I am personally also raising funds for the hurricane relief efforts as I train for the Houston Marathon in January 2018. Any form of support is dearly appreciated and will make a positive long-term impact on our community!

Ultimately, while donations of this kind are always welcomed and productive, it is also important to care for one another on a daily basis. It shouldn’t take a tragedy to build compassion and empower generous acts. I’m humbled by what’s already been done to rebuild our amazing city, and I hope that we may all stay engaged in the future stages of healing from Harvey and other natural disasters throughout the world.

A message from the AWS Blog Team: This is part of a series of blog posts from surgeons who wish to share their experience during these trying times. If you wish to share your story, you may email blog@womensurgeons.org.

 

Jackie K. Olive is a first-year medical student at Baylor College of Medicine. She graduated from Rice University in May 2017 with degrees in biological sciences and policy studies. Jackie is an aspiring surgeon and researches surgical outcomes and therapies in cardiac regeneration. She is also passionate about healthcare and public health advocacy initiatives.

Twitter: @JackieKOlive

Blog: jackiekolive.com


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

The Ideal Team Player

By Jean Miner, MD

In all aspects of our lives, we are members of a “team”. We are members of our family “team” first and then head to school at a young age and are paired off on the playground. Many of us joined teams throughout our lives for sports, debate, math, dance, etc… As we get older, we start to value the importance of teamwork to accomplish goals or projects. Think about the college chemistry lab partners or the members of a committee who helped (or hindered) meet deadlines or complete tasks. As surgeons, we are always members of a team- in the operating room, clinic, and patient wards. Ultimately, in life we belong to numerous teams.Recently, the members of the AWS Clinical Practice Committee (CPC) held a book club discussion using The Ideal Team Player by Patrick Lencioni. Our lively discussion quickly turned into a focus on leadership and building the ideal team. Based on the importance of this topic, we will be hosting a tweetchat on November 27th focused on Leadership and The Ideal Team Player. Three virtues, humility, hunger, and people smarts, are what we look for in those alongside of us taking care of patients, in our office, on a committee and even at home.

  • Humility: Characterized by lack of excessive ego or concerns about status. Humble team players share credit and emphasize team over self.
  • Hunger: Defined by self motivation and diligence. Hungry team players are always looking for more things to do and learn.
  • People Smarts: Depicted by possessing common sense about people. Smart team players are intuitive around the subtleties of group dynamics and the impact of their words and actions.

What do we do when we lead a team with members deficient in one, two or maybe all three areas? Should we give up on them? Are we able to teach these qualities or is it nature vs nurture? If we want to be good and effective leaders, we need to try and help our team members before kicking them to the curb. First, we should assess our colleagues to establish where they rank on the three traits. As both team leaders and members, we should do this ourselves. Other key members of the team can (and should) also be included. Next, we meet with the teammate to discuss our findings and develop a game plan. Often when there are deficiencies identified, people are unaware and improvements can be made just by bringing it to their attention. For more challenging situations, we need to set small achievable goals paired with frequent feedback. Finally, after a set period of time, we must reassess the situation and determine if we now have a set of ideal team players. If not, just like in professional sports, we must consider trading members to other teams where they would be a better fit and acquiring new players that fit the project.

Most importantly, we also need to turn the microscope on ourselves. Are we good team players? Most of us would like to think we are, but it is definitely worth a few minutes of self-reflection or use of a self-assessment tool in determining if we are indeed good team members. Or just like we did with our own team, we can ask a leader or mentor to evaluate us. After identifying areas to improve, we need to set our own goals based on the three virtues. If humility or people smarts are issues, we need to make a point to listen and learn more about our team members. This allows us to exercise humility but also gain insight into our counterparts as we take the time to hear their opinions. Hunger can be more difficult to achieve without an interest in the project. If this is a deficient area, we must consider alternative methods for achieving the same outcomes with a process that will motivate us. Or we may need to request off of a project in exchange for one which inspires us to do our best work.

Ultimately, for the development of a high performing team ALL members should embody the virtues of humility, hunger and people smarts and the process of building our team can be as enlightening as what we accomplish together.

Please join the CPC on November 27 at 8pm EST for a tweetchat on “The Ideal Team Player” to discuss your own strategies and experience as a leader and ideal team player.

https://www.tablegroup.com/books/ideal-team-player


Jean Miner is Assistant DIO at Guthrie Hospital in Sayre, PA and a Surgical Attending with Guthrie’s General Surgery Residency. She also has a Masters in Medical Education Leadership from the University of New England. Her work life is in equilibrium with her personal life as a mother of three girls who loves spending time with her husband and family traveling the country and world. In her “spare time” she loves to cook, be outdoors and read as many books as she can.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.

So you want to be a Surgeon in the United States? 6 Tips to Succeed as an International Medical Graduate (IMG)

By Sristi Sharma

Congratulations! Your ambition of becoming a surgeon in the United States has finally brought you to this country. You have left your family, your life and everything behind to train in an environment that is completely new to you. You know that you have a steep learning curve ahead of you-be it clinical, personal or social. So how do you navigate this new phase of your career?

There are unique challenges that come with being an IMG in the States. Here are 6 tips that will help you become the best surgical trainee you can be:

  1. Be good…no excellent…at what you do! Know your subject inside out and practice your surgical skills . Challenge yourself to learn more everyday. There is no substitute for hard work, and as a foreign medical graduate you will have to work even harder to prove yourself everyday.
  2. Learn the system: Do everything you can to understand the system you are trying to enter. Surgery is a very fast paced specialty and it is unforgiving to those who are slow to catch up. The goal for foreign medical students intending to start their residency should be to be at the same level as a US 4th year medical students. You are not necessarily behind on the clinical knowledge, however the medical students here know how the system works-right from electronic medical systems to how patient care works. To get upto speed familiarize yourself with the lingo. Observe how everyone behaves in their work environment. It does not matter what country you come from, things are different in the United States. As a trainee, you need to be able to hit the road running when you start. Your preparation will go a long way.
  3. Find a mentor: A common piece of advice you will get right from the beginning is to “find a mentor who can guide you”. I cannot stress this enough. Your life will become much easier if you find someone who has been in the same place as you recently. It may be a student from your country who has successfully matched into a residency program or an attending who now has a successful setup. This person may not necessarily be the mentor you are looking for, but they will be your first step to finding one. Ask questions, ask for help. Many people want to help and will even go out of their way if you just ask them. This is especially helpful as you start talking to your potential mentors. The surgeons you meet are busy people who wear multiple hats in their careers and personal lives. They are open to mentoring you as long as you prove that you are in this for the long haul. You are also not limited to one person. You should work with several mentors to achieve your goals. Your motivation will show through in your actions.
  4. Value your uniqueness: One of the worst pieces of advice I received when I first landed in this country was, “make sure you do not tell people what you went through in India. The clinical community will not appreciate it and will think you are not adequately-trained and incompetent”. For the next 3 months I wallowed in doubt and self-hatred. It showed in my interactions with people. I came across as an under-confident individual who was unsure of herself. Very quickly I realized that my approach was wrong. My experiences were unique, and for the most part doctors and surgeons were curious to hear about how I practiced medicine back home. At institutes such as Hopkins and Harvard, I have been working with and learning from the surgeons who share my goal of making the surgical systems better in my country. At every step they want to learn about my experiences to effectively understand the changes that are needed. This experience has taught me it is very important to find a mentor who will appreciate your unique experiences and will encourage you to learn new things while being yourself.
  5. Speak up and take a risk. While working towards my MPH at Hopkins, I was looking for a job. I had heard that one of my professors was looking for a student to help out with his project. But his requirements for the job were very specific. I didn’t have the technical skills that were needed for the job but I had enrolled in classes to learn them at the very moment the job was being advertised. The fear of not getting the position was crippling and I hesitated even to approach the professor. When one of my friends heard about my dilemma she gave me advice that has completely changed my life. She said to me, “You may not get the job if you ask him, but if you do not ask you will definitely not get the job”. Since then, I have made this my mantra. There have been many moments when I have been turned away, but there have been many more when people have gone out of their way to help me out. All that stood between me and them was my willingness to ask for help. It is by speaking up I have found the best of my mentors. Oh and for those of you still wondering-I did get the job!
  6. Don’t fake it. Insincere stories, praises, gifts and fake accents? Just…no!

Being a foreign medical graduate in the US is tough. Being a foreign medical graduate AND a surgeon in the US is even tougher. So, if you want to be a good resident and a successful surgeon, work hard, reach out for help, be genuine and embrace your uniqueness.


Sristi Sharma MD, MPH is a General Surgery Resident at University of Colorado, Denver. She is a previous Paul Farmer Global Surgery Research Associate, Harvard Medical School, a graduate of Johns Hopkins University and a proud alum of Sikkim Manipal University, India. She is an passionate about advocating for global surgery. She was born in the Himalayas and is a Gorkha to the core.

Twitter: @drsristisharma

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

 

For When the Pipe Bursts

By Shree Agrawal

Approximately half of matriculated medical students identify as female with numbers in surgical training steadily increasing to potentially also account for half of postgraduate trainees. Unfortunately, these figures are still dismal for underrepresented minorities, who at the medical school level may, at best, represent one in twelve students. I can only hope this changes for my underrepresented peers in my lifetime as we continue to redefine the culture of medicine.

Within AWS and in medical training, the metaphor of “building a pipeline” represents creating greater access and entry to medicine among women and underrepresented minorities. In this context, I often wonder about the students and trainees who currently have the courage to enter fields in which the majority is homogenous. Advances in gender equality and diversity representation within other fields of medicine, such as pediatrics, OB/GYN, psychiatry, and geriatrics, has not yet translated to inclusion in leadership and academic positions. I believe mentorship is key to addressing this paucity of diverse role models.

This brings me to some of the great posts I have recently seen on Twitter about mentorship within academic surgery. My feed has been populated with retweeted clips, links, or visual abstracts from Dr. Caprice Greenberg’s address, “Sticky Floors and Glass Ceilings”, Dr. Keith Lillemoe’s address, “Surgical Mentorship: A Great Tradition, But Can We Do Better for the Next Generation?”, and “Characteristics of Effective Mentorship for Academic Surgeons: A Grounded Theory Model,” by Drs. Amalia Cochran, William B. Elder, and Leigh A. Neumayer. In 2017, I view these pieces to be the first sign of preparation for when the pipeline to surgery eventually bursts.

As more diverse medical students develop interest in surgery, dynamic and supportive mentorship becomes even more essential. From Drs. Cochran, Elder, and Neumayer’s work, four major themes for effective mentorship emerged: the need for multiple mentors at different points in a professional lifetime, mentors who provide strategic advising, who are unselfish in their attitude, and engage with diverse mentees. In addition to these basic principles, self-awareness of implicit bias and efforts to reduce its effect, as stated in Dr. Greenberg’s talk, is paramount in effective mentoring, especially of non-traditional mentees.

In medical school, this may translate to finding a mentor who is willing to meet often and create plans for successfully matching or perhaps engaging in academic research. An unselfish attitude may be a sincere interest in helping achieve one’s potential, regardless of institutional interests or personal/professional gains for the mentor. Finding mentors who engage with diverse mentees does not mean identifying faculty members who represent similar backgrounds, but finding someone who understands distinct challenges faced by students from wide-ranging backgrounds. A single mentor may not be able to espouse all of these characteristics, but finding individuals who can contribute in each area facilitates personal and professional development.

What are your strategies for identifying and establishing effective mentee-mentor relationships in your medical training?


Shree is a fourth year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Currently, she is completing a clinical research fellowship in genitourinary reconstruction at the Glickman Urological and Kidney Institute at Cleveland Clinic and serving as the Chair of the AWS National Medical Student Committee. Shree is passionate about research surrounding patient decision-making and medical education. In her free time, she enjoys blogging for AWS, practicing yoga, and boxing.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

AWS Day of Service 9/9/17

By Simin G. Roward

Being a medical student is challenging: between studying, rotations and research, it seems there isn’t enough time for everything. Often, it’s easy to lose track of why we chose this profession in the first place. Community service and engagement are put on hold amidst other pressing responsibilities. The goal of the AWS National Day of Service is to designate a day on which medical students from all over the country would come together with residents and attendings and make service to others a priority.

The members of AWS are compassionate, humanistic leaders, who chose the field of surgery because of the ability to make lasting improvements in people’s health and to provide a vital service to communities. These positive characteristics were exemplified in last year’s AWS National Day of Service event, where students nationwide provided much needed services and donations to their community. These service events differed from state to state- some schools put on educational sessions with high school and middle school girls to talk about medical school or to provide mentorship to students from disadvantaged backgrounds. Other schools organized clothing drives to provide supplies for shelters helping domestic abuse survivors or immigrant .

Each service event was specific to the needs of the community: in Washington, students raised funds for a local non-profit organization after it had been broken into and vandalized. In Arizona funds were raised to provide pre-employment TB testing to refugee women. In Texas, cookies were baked with the residents of the Ronald McDonald house, and students in North Carolina helped girl scouts earn badges by teaching them First Aid. Students in DC spent the day packing meals at a local food shelter and Boston students volunteered at a clinic for the homeless.

The participating schools should be proud of the events they organized and the important contributions they have made to their communities. The spirit of volunteering and community service are well aligned with the mission of the Association of Women Surgeons. As the AWS day of service will become an annual event, each year will build on the strengths of the previous year. This year’s AWS National Day of Service is September 9th, 2017, please contact us for additional resources or questions about participating!

Pictures:

 

 

 

 

 

 

 

 

USUHS put together bags of food donations at Food for ALL

 

 

 

 

 

 

 

University of Texas Medical Branch  hosted a Valentines cookie baking event at Ronald McDonald house

 

 

 

 

 

 

 

Paul L Foster School of Medicine (Texas Tech-El Paso)-organized a clothing drive for Anunciation house, a migrant shelter

 

 

 

 

 

 

 

 

 

University of Arizona- Fundraising for pre-employment TB testing for Syrian refugees

 

 

 

 

 

 

 

Boston Chapter-Hosted a game night with patients from their clinic


Simin G. Roward is a recent graduate of University of Arizona college of medicine.  She is currently a general surgery intern at University of Texas at San Antonio and she is planning to pursue a career in pediatric surgery.  She served as the community service chair for the Association of Women Surgeons during the 2016 school year and began the AWS day of service event. Her interests include global health, running marathons, traveling and participating in community service.   

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

Perception of Personal Success in Burnout

By Shree Agrawal

In the preclinical years of medical school, the idea of burnout among healthcare workers is more of an abstract concept. The unique environment of healthcare, regardless of specialty or academic/private practice settings, has been shown to make all healthcare providers vulnerable to burnout.(1)(2) In my observations on clinical rotations, it seems highly successful peers, trainees, and faculty, who may have multiple publications, excellent clinical skills, and a strong work ethic, can also be the same individuals who unexpectedly experience burnout. Interactions with someone who does not realize they may actually be experiencing burnout are challenging, even for individuals who are at the fray of most clinical situations.

Some of the key manifestations of burnout include emotional exhaustion, cynicism, depersonalization or isolation, feelings of ineffectiveness, and lack of accomplishment, as shown in Figure 1.(3) Some of these features are difficult to fully notice in brief professional interactions with peers and superiors. Instead, common outward defining behaviors in burnout may be a focus on professional survival, fewer reflective practices, reduced desire to be at work, and/or a diminishing appeal of clinical and non-clinical activities.(4)

Figure 1: Factors contributing to and subsequent manifestations of burnout

For all the successes visible to the outsider, the relevance of personal and professional accomplishments to the person, who may be burned out, appear less significant. A component of this perception could be individual focus on future goals and milestones. Regardless, I am curious. Does the perception of personal success change in the process of burnout? Do achievements seem less worthy in the face of factors contributing to burnout?

Even though I would posit my observations are a multifactorial outcome, studies would imply this is not an uncommon phenomenon. Research within healthcare settings demonstrated insufficient recognition of employee contributions corresponded to healthcare providers feeling less respected and valuable to their organizations. This belief alone can cause providers to experience higher levels of emotional exhaustion, feelings of ineffectiveness, and subsequent burnout.(5) Another study suggests individuals who identify as a minority in society may receive less recognition and credibility for their accomplishments/capabilities when compared to their counterparts. Many minority participants in this study expressed already feeling burned out in their training. They stated their role on the team was not viewed as meaningful, or worse, unsatisfactory. Alarmingly, some minority participants not only revealed their feelings of inferiority to their peers but also doubted their own accomplishments, abilities, and personalities.(6) The infrequency or lack of recognition in healthcare both contributes to burnout and reduces individual perceptions of professional competencies and capabilities.

On the blog, we have talked about practicing gratitude and cultivating resilience in the face of burnout.(7,8,9,10) While these are important tools, I wonder if we should also encourage the practice of acknowledging both our own success ladders and those of the people working alongside us.

Outward recognition, while not common within medicine, is crucial to defining individual success. It facilitates finding value in our professional responsibilities, validates personal efforts for growth, and positively changes the perception of personal success. Recognition ultimately nurtures essential skills, traits, and resilience required in the practice of medicine.


Shree is a fourth year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Currently, she is completing a clinical research fellowship in genitourinary reconstruction at the Glickman Urological and Kidney Institute at Cleveland Clinic and serving as the Chair of the AWS National Medical Student Committee. Shree is passionate about research surrounding patient decision-making and medical education. In her free time, she enjoys blogging for AWS, practicing yoga, and boxing.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.