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.

Building resilience in the wake of Sutherland Springs – How will we survive another mass casualty event?

By Lillian Liao, MD, MPH

For years now, our regional trauma system has performed scheduled drills of potential mass casualty events: an airplane crash, a stadium event, a nightclub shooting, etc. Our team is prepared to care for the injured patients “if” it ever hit us. Then came the dreaded text message on a beautiful Sunday morning: “Mass casualty incident – Sutherland Springs. Not a drill. More to come.” By Divine intervention or organized chaos, our trauma program had a meeting there that morning. In additional to the usual team of two trauma surgeons and the complement of residents, we had an additional five trauma surgeons in the building. Our most senior surgeon took the role of the triage officer. The teams of people required to care for the injured patients gathered like sections of a symphony orchestra. By the time the first patient came, everyone [the ER to the OR to the Adult and Pediatric Intensive Care Unit] was ready for what was to come.

Trauma clinical staff anticipating the arrival of patients.

A strong regional trauma system and a dedicated trauma program had prepared us to care for the injured patients. What it had not prepared us for is the sadness; the anger; and the helplessness felt when people die or become injured senselessly. These emotions are difficult to overcome. The nationwide outpouring of support from other healthcare providers certainly helped. Miami, Las Vegas, and Aurora all sent words of encouragement. How sad is it that we now belong to this sacred league of health care providers? However, surgeons are doers; we do not sit around and feel sorry for our plight. We find solutions! Moreover, we can recover from this tragedy by leaning on the resilience we have built up through years of surgical training to overcome all things difficult and seemingly impossible.

There are three major lessons I took away from the horrible tragedy. First, a strong trauma system is key to saving lives. Triage and transport of critically injured patients to the highest level of care is paramount, as there is really “no time to bleed!” Second, tourniquets save lives. When I look at the survivors and focus on the adults and children who came in with tourniquets in place, tourniquets saved their lives and limb! This should re-energize our commitment for regional STOP THE BLEED efforts. We must work to convert every bystander into a first responder. We must get our community leaders involved and help them to see that tourniquets and bleeding control supplies must be available in all public spaces because if this could happen in a church, it really can happen in just about anywhere. Lastly, we must also not shy away from dialogue about firearm availability and firearm safety. Our nation must build a consensus on how the need for freedom and liberty can coexist with the imminent need to reduce firearm related injuries. A good starting point is the ACS bulletin put forth by Dr. Deborah Kuhls and the Committee on Trauma Injury Prevention Team.

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. Liao completed her undergraduate training in Economics with Honors from the University of Texas Austin where she was a member of the Dean’s Scholars Program. Dr. Liao completed her medical training at the University of Texas Health Sciences Center in San Antonio in 2004 and her surgical residency in 2010. She pursued additional fellowship training in Trauma and Critical care and joined the Trauma Faculty at the Health Sciences Center in 2011. Dr. Liao is board certified in General Surgery and Surgical Critical Care. Her primary clinical and research interests are in vascular trauma, pediatric trauma and burn, and injury prevention/patient education. She is currently the Pediatric Trauma and Burn Director at University Hospital’s Level I Pediatric Trauma center. Follow Dr. Liao on Twitter.


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.

 

Clean Hands Deserve Two Thumbs Up

By Fatima S. Elgammal

The Hungarian obstetrician and a father of modern antiseptic techniques, Ignaz Semmelweis, risked his reputation when he took to stage at the Vienna Medical Society’s meeting on May 15, 1850. He was beseeching his colleagues to participate in a simple but a provably effective method of diminishing disease transmission: hand washing. The rates of puerperal fevers on wards covered by medical students, whose morning autopsies on women who died from the fever preceded examinations on the day’s laboring women, far outnumbered the rates on wards monitored by midwives, whose responsibilities did not include autopsies. Semmelweis attributed rates of the former group to poor hand hygiene. Ever the scientist-at-heart, he implemented a protocol whereby students and physicians washed their hands with a chlorinated lime solution after dissection. The results were groundbreaking: mortality rates of mothers seen on those wards covered by students and junior physicians plunged. Despite the evidence, Semmelweis’s conclusions were not as readily accepted, and would not be so for years to come.

Hand hygiene is one of the most important methods of preventing transmission of healthcare-associated infections. The Centers for Disease Control and Prevention asserts that hand washing prevents diarrheal illnesses by 30% and respiratory infections by 20%, for which antibiotics are, consequentially, overprescribed and overused, lending to a rise of antibiotic resistance. Rubbing alcohol-based solutions and washing with soap and water are the most popular and widely used techniques for hand hygiene.

Newer hospital wards are especially equipped with sinks and sanitizer dispensers inside and outside patient rooms, while older wards, especially emergency departments (ED) and intensive care units (ICU), are being similarly retrofitted. Still, low hand hygiene compliance plagues healthcare workers. Surprisingly, the World Health Organization (WHO) 2009 Guidelines on Hand Hygiene in Health Care lists physician status as a leading risk factor for poor adherence. The same set of WHO guidelines studied predictive factors for good adherence to hand hygiene, and cited peer pressure and the awareness of being watched as leading determinants. Another positive determinant for good adherence: being a woman. Few of us can objectively contest anything less than 100% compliance, especially when Infectious Control personnel are making their rounds, but consistent efforts to wash in, wash out, and wash in between encounters (for the double-occupancy rooms) can be more difficult to achieve. The five critical moments of a patient encounter during which hand sanitation must be attained are:

  1. Before touching a patient (e.g., prior to examination, or assisting patients to move or walk)
  2. Before a clean/antiseptic/sterile procedure
  3. After body fluid exposure risk (e.g., handling Foley bag, IV sites)
  4. After touching a patient
  5. After touching a patient’s surroundings (e.g., bed rails)

The above measures not only prevent exogenous germs on your hands from colonizing the patient or their room, but prevents us from carrying infectious particles to other patients or healthcare professionals. Cold weather and large crowds makes the holiday season an especially vulnerable time for germ spread, even just by walking through a hospital lobby, cafeteria, or the ED; pocket-sized sanitizer bottle come in handy when no wall mounts are available or should we become the unsuspecting victim of a wet sneeze, ours or someone else’s. The busyness of a surgeon’s day is on par with the delicate state of our patients’ health. The sense of criticality with which we adopt sterile techniques in the operating room should be translated just as readily in the clinics, inpatient wards, ED, and the ICUs, and beyond the weeks of Infection Control monitoring our movements. We do not think twice about it in the OR, we should not think twice about it outside it.

This National Handwashing Awareness Week (December 3-9), spread the word, not the germs. Alert those who walk in without washing into a patient’s room.


Fatima S. Elgammal is a fourth-year medical student from St. George’s University School of Medicine. She developed an interest in critical care and trauma/acute care surgery following four years of studying neuronal changes in traumatic brain injury models of epilepsy and her time at Hackensack University medical Center as an emergency physician scribe then later as student completing clerkship. An alumna of New Jersey Institute of Technology, she enjoys illustrating, baking, reading, 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.

ASSOCIATION OF WOMEN SURGEONS “TWEETCHAT” ON THE #IDEALTEAMPLAYER

 

This past Monday, November 27th, the Association of Women Surgeons (AWS) Clinical Practice Committee carried out a very insightful Tweetchat discussing The Ideal Team Player, a book by Patrick Lencioni (@patricklencioni). The Tweetchat was moderated by Dr. Sasha Adams (@SashaTrauma), current AWS CPC Chair, and Dr. Jean Miner (@Jfminermd), past CPC Co-Chair.

For those who were not present or missed any parts during the chat, you can find some of the highlights of the discussion in the Tweetchat storify.

Also, make sure to check out Dr. Jean Miner’s previous post on the AWS blog summarizing main ideas of the book that were discussed during the chat.

Thank you for everyone who participated and look out for the next AWS Tweetchat taking place in December!

 

Prioritizing Palliative Care in Surgical Management

By Connie Shao

During my third year rotation, I experienced the terror of an anastomotic leak. This patient had previously had a resection of his colon cancer and had undergone chemotherapy. Three weeks later, he was coming in with respiratory distress and was urgently taken to the operating room for an anastomotic leak. The surgery was done in two parts. The edematous bowel, of which some was resected, did not allow for a complete closure of his abdomen. Having never seen a Bogota bag before, I watched in amazement as we took him back to the ICU, sedated. The next day, the procedure was completed, his abdomen closed.

He remained in the surgical ICU for weeks, receiving treatment for complications that seemed to change every day. He remained on the service after I left my rotation, and months later, I saw that he had passed. Throughout his postoperative recovery, I had gotten to know him, his family, and how painful treatment could be. Our discussions with palliative care, his family, and himself helped me understand medicine beyond the naive understanding of a medical student, freshly emerged from board exam studying.

Oncologic care has been the subject of national discussion, as the cost of treatments become a financial burden to the survivor and/or their family. Treatment can be continued to the detriment of the quality of the patient’s few remaining days of life. Without sufficient conversation about goals of care, treatment options become oriented to flowchart algorithm for a much different patient with very different goals.

Palliative care focuses on management of symptoms and psychosocial support, providing patients with options to achieve their personal goals for their remaining days of life. In the 1950s, Dr. Cicely Saunders first articulated the concept that would eventually become modern hospice care. From careful observation of dying patients, she advocated that the ‘total pain’ of dying could be relieved by an interdisciplinary team in the context of the patient’s family (1). This concept of teamwork is very much alive today in palliative care, where teams consist of nurses, social workers, pharmacists, chaplains, physicians, and most importantly, the patient and their family.

Unfortunately, this can be mistakenly perceived as ‘giving up’ instead of an opportunity to have informed discussions between patients and providers. It has also been traditionally delivered late in the course of care when hospitalized patients have uncontrolled symptoms. In those cases, it is often too late for palliative care to alter the quality and delivery of care provided to patients.

Pancreatic and lung cancer are diseases that have a high burden of symptoms and poor quality of life. The prognosis for metastatic non-small-cell lung cancer is less than 1 year after diagnosis (2). Early introduction of palliative care has been found to improve both quality of life and mood, as well as leading to less aggressive care at the end of life with longer survival (3).

In a retrospective study done in 2016, McGreevy et al found that for the 205 adult, nontrauma patients who had gastrostomy tubes placed, there was an 8% in-hospital mortality rate and a 19% 1-year mortality rate. Of the patients who survived to discharge, 69% were not able to live independently. Of the patients who suffered acute brain injury or respiratory failure, 90% died in the hospital or were severely disabled at discharge. For the 205 patients who had gastrostomy tubes placed, only 12% of patients received a documented palliative care assessment preprocedure (4). Gastrostomy tubes are just one example of a ‘trigger’ that can be used for a palliative care assessment. Utilizing certain interventions that alter the patient’s quality of life as the impetus to have a discussion about goals of care can help patients have a better understanding of their condition and care to guide the course of interventions throughout their hospital stay.

Palliative care is challenging for patients and providers alike. Coming to terms with what the future has to offer, as predicted by studies and interpreted through experience, is an honest conversation that tests the patient’s and family’s self-knowledge, as well as the physician’s ability and knowledge to provide the best clinical support. In life and in death, suffering may be inevitable, but it is within our realm as physicians to lessen it to the best of our ability.

Connie Shao is a fourth year medical student at the University of Chicago Pritzker School of Medicine. She is originally from Michigan and enjoys swimming, reading, biking, and painting. She is applying to general surgery residency and has been meeting incredible applicants and inspirations along the way.


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.

When Disaster Strikes

By Dr. Minerva Romero Arenas

#HoustonStrong #HurricaneIrma #FuerzaMéxico #PRstrong #VegasStrong

Our world has been in the midst of what seems like an endless series of tragedies. This blog started out as an idea to write about how I was inspired and proud of the goodwill shown by my fellow Houstonians (and other Texans and neighbors) in the aftermath of hurricane Harvey. Much like this love letter. Much like my colleague’s reminder to look for the helpers when disaster strikes. However, it quickly became a seemingly insurmountable task. Just as I was trying to pen a few lines, another disaster was brewing in the Atlantic. Then the earthquakes hit México. Another set of hurricanes. Yet another mass shooting.

Staying safe. Trying to help. Then trying to keep up with everyone’s safety and figuring out how to help in the aftermath. Donate. Volunteer. Meteorological maps seemed like something that could only have come out of a Hollywood blockbuster. I can’t imagine that I would find it essential to follow @NWSNHC, @SismologicoMX, or @weatherchannel? And if I never have to sleep with an eye open for flash flood warnings or tornado warnings… it may be too soon.

To be quite honest, there were a lot of days the past 6 weeks that seem like a blur.

Thankfully, I had my work to help keep my mind (and hands) occupied! I am thankful for the teamwork shown at our hospital, where 1 in 3 employees were affected. Colleagues swam to work, camped out for days unable to assess the safety of their own families or homes, and everyone who boldly came back to offer relief as soon as it was reasonable to do so. It was amazing to see the “good neighbor” spirit that was showcased from Houston to the world – an example to be seen again in tragedy after tragedy.

On a personal note, I have found a way to turn these events into a positive by taking time to reflect on everything. I have made more time than before to actually consider important questions like, am I okay? Am I putting my best effort to live a meaningful life? How can I be part of the solution? Have I done everything I can to help others?

I am thankful for the human spirit and solidarity that continues to shine through disaster after disaster. I am thankful more of our ACS leadership continues to engage in meaningful discussion about firearm injuries. Most of all I am thankful for my colleagues, friends, and *my family* – their compassion, determination, and strength is truly inspiring and figuratively and literally helped me “weather the storm.”

A message from the AWS Blog Team: This is the first in a series of blogs 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.

Minerva A. Romero Arenas is an Endocrine & General Surgeon joining the faculty at the University of Texas Rio Grande Valley. She completed a fellowship in Oncologic Surgical Endocrinology at the UT MD Anderson Cancer Center in Houston, TX. She completed her General Surgery Residency at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate.
Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.
She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.


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.