AWS BLOG

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.

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.

The History of the Match and the Perspective From One Medical Student’s Journey

By Hilary McCrary, MPH

Throughout all of medical school, I always looked up to the current fourth year students. They seemed so seasoned and prepared to make the transition from student to doctor. The fourth year of medical school is also highly anticipated, as it is what medical students perceive as the first time they are solely focusing on their chosen career and traveling across the country for either away rotations or interviews. Now that I am towards the end of this process, I have had time to reflect on all of the components that go into the Match and what is takes to get there.

The Match process was created in 1952 as a way to address concerns related to institutions offering a spot for residency training earlier than other competing institutions.1 This previous design put pressure on applicants to accept multiple appointments, as positions were typically offered over the phone with the intent of providing the institution an immediate answer or losing that training spot.1 This process was followed by attempts to make a uniform time for institutions to release intern positions. Ultimately, F.J. Mullin from the University of Chicago School of Medicine suggested that both students and institutions create rank-order lists that would end in a match between that individual and a hospital.2 There were growing pains associated with this transition, but the Boston Pool algorithm created a stable process in which the rank-order lists were updated as each student went through the matching process. This program became known as the National Resident Matching Program (NRMP) and is the program that is still used today.3 The most recent change to this matching algorithm came in 1998, which was aimed at making the outcomes as favorable as possible for the applicant.4 In fact, in 2012 economists Alvin Roth and Lloyd Shapley would go on to win the Nobel Prize in Economics for their contributions to creating a stable match process through their work on match theory.5 While some controversy surrounded the inception of the Match, it does provide applicants and hospitals a sensible system to determine where new physicians will spend several years of training. As attested by several students, even though not all individuals may get their top pick on Match Day, the system has a way of finding the program best suited  for each individual.

While every specialty has its own unique aspects to the Match, there is one piece of advice that I always listened to – apply broadly. As a student applying to Otolaryngology, I knew that I needed to apply to a large number of diverse programs. This serves two purposes. It allows the student to see enough programs to know what aspects of a training program will most suit their needs and it sets you up for success statistically, as the more programs you apply to the higher your odds are of matching. I applied to 70 programs across the nation, which seemed daunting at first. The process of receiving interviews was exciting and stressful. In the fall months, students receive a flurry of interviews via email, and typically must respond within minutes or that interview spot may be taken. As someone who was on a surgical rotation during this time, I found it hard to be in the operating room without worrying about what emails were popping up on my phone.

Then comes the fun part – the traveling. As someone who loves flying and exploring new places, I was most excited for this aspect of applying to residency. In total, I attended 17 interviews, in 13 different states, over the course of three months. What no one prepared me for was how exhausting this process is. There were periods of time where I had four interviews in just five days, often associated with several flight delays and arriving at my destination city in the early hours of the morning. Furthermore, this process was financially difficult as well, as this entire process cost thousands of dollars. While in the thick of the interview trail I felt challenged, however, looking back it was an incredible experience that I felt lucky to partake in. Especially since I was given the opportunity to meet my future colleagues that I will collaborate with in the future, whether this is clinically or on research endeavors.

Now I join thousands of other medical students and wait to see where this process leads me on Match Day – March 17, 2017, which happens to land on St. Patrick’s Day this year. After a lot of thought and reflection, my rank-order list is certified and waiting for processing. What I have learned is there is no right way to navigate the Match and at the end of the day it’s best to go with your gut. Really listen to what your intuition is telling you on an interview day and make sure to ask questions that are important to you. Take risks, as programs you never thought would be what you are looking for or be within your reach might be the perfect fit for you. Finally, seek advice from your mentors who understand your career goals; their insight can be invaluable in helping create your rank-order list. Best of luck to all medical students and future surgeons participating in the Match this year!

 

References:

1)    Roth AE. The Origins, History, and Design of the Resident Match. JAMA. 2003;289(7):909-912.

2)    Mullin FJ. A proposal for supplementing the Cooperative Plan for appointment of interns.  J Assoc Am Med Coll.1950;25:437-442.

3)    Roth AE. The evolution of the labor market for medical interns and residents: a case study in game theory.  J Political Economy.1984;92:991-1016.

4)    Roth AE, Peranson E. The redesign of the matching market for American physicians: some engineering aspects of economic design.  Am Econ Rev.1999;89:748-780.

5)    Rampell C. “2 From U.S. Win Nobel in Economics”. The New York Times. Published October 15, 2012. Accessed on February 11, 2017.

 


 

Hilary McCrary is the Chair of the AWS Medical Student Committee and is a fourth year medical student at the University of Arizona College of Medicine – Tucson. She is currently applying to otolaryngology and hopes to practice in an academic setting where she can operate, teach, and conduct research. hcrees@email.arizona.edu

 

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 Greenberg Spike: How speaking out on implicit bias and gender equity in surgery continues to trend

By Marissa A. Boeck

When #ILookLikeASurgeon went viral in August 2015, many expected a short lived hashtag. Yet Dr. Caprice Greenberg, the president of the Association for Academic Surgery (AAS), has shown the conversation on diversity, inclusion, and equity in surgery is far from over. During the recent AAS and Society of University Surgeons (SUS) 12th annual conference in Las Vegas, Nevada around 2,000 medical students, residents, fellows, and attendings gathered to network, mentor, collaborate, and discuss academic surgery. Despite the abundance of stiff competition, the AAS Presidential Address “Sticky Floors and Glass Ceilings” by Dr. Greenberg stole the show.

All those packed into the large event hall immediately knew the focus: women in surgery. This subject continues to be pertinent and necessary to discuss despite many notable advances, such as both the current and incoming presidents of the AAS and SUS being female. Yet Dr. Greenberg steered the conversation away from traditional topics of “women in surgery” as she asked us to rethink what issues actual female surgeons face. She argued the challenges do not boil down to only those associated with parenting. This is especially true since 40.5% of female surgeons do not have children, while 91.8% of male surgeons do, which is why we need to talk about parental challenges and leave versus simply maternity. She then spoke about widespread biases and discriminations against women seen throughout society that also resonate in medicine and surgery, using the Audi #DriveProgess 2017 Super Bowl ad, Huffington Post Pinksourcing video, and The Daily Show’s American Soccer’s Gender Wage Gap video as poignant examples. She showed data from a study of academic science faculty exemplifying hiring gender biases for lab managers based solely on applicant names.

Dr. Greenberg then honed in on specific items most relevant to surgeons: differences in salaries, promotions, and grant funding. The fact that in 2017, based solely on gender, with all other factors held equal or superior in females, women still earn less, fill fewer leadership roles, and have lower grant funding than men is unacceptable.

The impact of Dr. Greenberg’s talk was palpable. From individual goosebumps and frequent murmurs, to occasional outbursts of disbelief and, finally, tears. No one in the room appeared unaffected, women and men alike. An objective measure could be visualized on social media, where metrics for the conference hashtag showed a large spike of almost 750 tweets during the 45-minute talk, greatly overshadowing the other subjects of the day (Figure 1). The diversity-championing hashtag #ILookLikeASurgeon showed a similar increase during the same period (Figure 2), disseminating Dr. Greenberg’s important message to a global community that has likely faced similar challenges in their careers.

Figure 1.


Source: Symplur

Figure 2.

Source: Symplur

Besides firing everyone up for action, the most important part of Dr. Greenberg’s talk was the discussion of potential solutions. The global social media community agreed, as this appeared to be the most shared slide from a quick glance of the Twitter feed. Her suggested systemic interventions for surgery included:

  • Transparent, objective compensation plans
  • Blinded manuscript, grant, hiring, and promotion practices
  • Explicit, purposeful, and fair distribution of uncompensated teaching and service workload
  • Equal leave policies and tenure clock extensions
  • Objective measures of success and milestones for promotion that are defined a priori so everyone knows the rules
  • Institute educational programs on implicit bias and its impact

Only through the wide adoption of targeted actions that aim to recognize and address surgical workforce inequities, such as those listed above, can we actually hope to erase them. This includes organizations speaking up, such as the Association of Women Surgeons’ Statement on Gender Equality. Although frequently labeled as women in surgery problems, these issues cast a wider net, encompassing all those affected by implicit bias; in other words, potentially anyone. Yet together we can make surgery a field that accepts and promotes anybody who has the passion, stamina, and drive to succeed within a challenging but rewarding profession, irrespective of personal characteristics that have no bearing on one’s potential or worth.

Photo credit: Dr. Danielle Sutzko @LoupesLoveMD

Dr. Greenberg’s final slide starkly projected #ILookLikeASurgeon and #HeForShe in large white font on a black background, inviting the audience to continue the conversation, both on social media and in real life, until we all receive equal compensation and consideration for opportunities for professional and personal success.

From left: Nelly-Ange Kontchou, Heather Logghe, Caprice Greenberg, Marissa Boeck. Photo credit: Dr. Susan Pitt

Resources:
2017 AAS Presidential Address By Dr. Caprice Greenberg, Introduction by Dr. Rebecca Sippel
Ladies Get Paid (@ladiesgetpaid) – Helping women advocate for themselves to get recognized and rewarded
He For She (@HeforShe) – United Nations Women’s mission for gender equality
Why So Slow? The Advancement of Women by Virginia Valian
Carnes, Devine, Baier Manwell, Byars-Winston, et al. “The Effect of an Intervention to Break the Gender Bias Habit for Faculty at One Institution: A Cluster Randomized, Controlled Trial.” Academic Medicine 2015; 90(2): 221-230. Link


Marissa A. Boeck MD, MPH is a general surgery resident at New York Presbyterian Hospital – Columbia. She is passionate about diversity in the surgical workforce, the power of social media in medicine, and global public health, especially as it relates to injury prevention, emergency response, and trauma and surgical system strengthening in low-resource settings.

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.

How do you take care of YOU?

By Patricia Martinez Quinones, MD

As over-achieving female physicians we strive for perfection in all aspects of our lives. We are not satisfied with being mothers, wives, daughters, (insert noun here). We aim to be good mothers, good wives, good daughters, etc. Besides the pressure we place on ourselves we also took an oath to take care adequately for the sick, but how can we take care of our patients if we don’t know how to take care of ourselves?

With the demands of general surgery residency, a husband and household, I did not consider my well-being a priority. I slowly found my physical, emotional and mental health starting to deteriorate. I grew up in Puerto Rico, where cardiovascular disease and diabetes are two of the three most common causes of death. All of my grandparents have had complications of heart disease, diabetes and obesity. In an attempt to prevent these complications in myself I changed my lifestyle.

I embarked on a health and well-being journey. I am sharing with you some of what I have learned and done along the way. My first step on this journey was a diet overhaul. I was eating cafeteria food, or fast food at least three to four days a week. I made a commitment to myself that I would only buy lunch once a week. I tried meal subscription delivery services (for more information refer to Dr. Miner’s recent blog post) and learned new recipes that I have now incorporated. Eventually I settled on meal prepping as my go-to. I pick one day a week (my off-day usually) and prepare several vegetables, grains and at least two different protein sources. This change led to improved eating habits, extra free time on weeknights and one less thing to worry about.

Not only did my diet undergo a much-needed overhaul, but so did my non-existent self-care routine. Fearing burnout, as I have seen in some of my colleagues I tried to find ways to cope with stress. I settled on the idea of a “self-care week.” For an entire week, I did one thing a day that would allow me to relax and improve my overall sense of self. The week kicked off with a trip to the salon for a pedicure. During the week I also started reading a fiction novel, had a massage and even a dreaded visit to the dentist, who I must admit I hadn’t been to since starting residency. My “self-care week” felt like a vacation, although I invested about an hour a day. I realized how little emphasis I was placing on me-time and how a few minutes a day could lead to an improved version of me.

My journey of self-care continues. I’ve learned to prioritize my health, along with that of my patients. This has translated into improved relationships with my family and co-workers. Taking an entire “self-care week” often is not plausible for most, but I do hope that my experience inspires you to do something you enjoy and learn to take care of you.


Patricia Martinez Quinones is a general surgery resident at the Medical College of Georgia at Augusta University. She is a wife and doggy-mom who is on a well-being inspired journey to learn self-care. She is interested in trauma and critical care and academic medicine. She hopes to inspire other female residents and medical students to learn how to take care of themselves as well as their patients – and themselves.

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 Osteopathic Match Day

By Aileen Larson and Grace DeHoff

Every spring, fourth year medical students anxiously await “Match Day”. Students in both allopathic (MD) and osteopathic (DO) programs submit a rank list of their favorite residency programs and order them according to their preference. Residency programs also create a list of their top students and rank them accordingly. For allopathic medical students, Match Day is typically the third Friday in March. Every February, osteopathic medical students also await their fate in a similar match algorithm. This year the DO Match Day is held on February 6th, 2017.

As an osteopathic student, there are many choices to make when applying for residency programs. While the MD match is open to both MD and DO students, the DO match is exclusively for DO students and organized under the American Osteopathic Association (AOA) National Matching Services Inc. A student may decide to attempt the match only in allopathic programs, in which case they withdraw their application from the AOA match and continue with the National Resident Matching Program (NRMP) in March. However, if they decide to stay with the AOA match and end up matching in a program in February, their application is automatically withdrawn from the NRMP match. If an osteopathic student does not match in February, they can decide to “scramble” for an unfilled AOA residency spot or wait for the NRMP match results in March.

Osteopathic medical students undergo a similar application process for the AOA residency programs. Many programs require osteopathic medical students to spend two to four weeks at a residency program “auditioning” to be considered for an interview. Osteopathic medical students must travel around the country for four to five months in the fall of their 4th year completing an audition rotation at programs of their choice. Expenses related to these rotations are typically paid out of pocket by the medical student. An “audition” rotation is very similar to a “sub-internship” rotation in regards to student responsibilities and there are minimal differences between the two.

Recently, the ACGME decided that all residency programs (allopathic and osteopathic residencies) will be accredited under the Single GME Accreditation System (SAS) by 2020. Unfortunately, some AOA residency programs are closing their doors on osteopathic students this year due to limited resources to meet the new accreditation requirements. Many of these programs are either in smaller communities, rural hospitals or are smaller surgical subspecialty programs.

As an osteopathic student, navigating these changes presents a unique set of challenges. Those AOA residency programs that are 5+ year programs, including all general surgery and other surgical specialty programs, had to apply for a pre-accreditation application by January 1st 2017 to participate in this year’s match. Those that did not apply will not be accepting osteopathic students this year. Osteopathic students also need to understand that they are taking a leap of faith when selecting a program that has not received full accreditation yet but only a pre-accreditation approval.

There are many important decisions that medical students face when deciding a specialty. For those students who choose an osteopathic path from the beginning and now facing new obstacles with the single accreditation system, I wanted to give encouragement to osteopathic students and show our support for them in the upcoming match in February.

 

Aileen Larson is a fourth year osteopathic medical student at Pacific Northwest University in Yakima, WA and currently finishing her rotations in Portland, OR. She is pursuing otolaryngology and facial plastic surgery and participating in the AOA Match. She is on the Student Osteopathic Surgical Association National Board and is the West Representative on the Association of Women Surgeons National Medical Student Committee. In her free time, she likes to practice hot yoga, snowboard and spend time with her husband and her two dogs.

 

Grace DeHoff is a third year osteopathic medical student at Pacific Northwest University and is interested in pursuing a career in Neurosurgery. She is a Denver, CO native but currently lives in Boise, ID with her husband and one-year-old son. She is the Diversity Chair with the National Medical Student Committee for the Association of Women Surgeons. In her free time, she enjoys running and has completed several half marathons and relay races.

 

 


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.

Never overdressed

A resident’s perspective on dressing for success

By: Danielle Henry

The New Year brings new goals and personal improvement is always on the list of priorities. This month we are exploring the impact of professional attire on professional and personal achievement. Oscar Wilde once said, “You can never be overdressed or overeducated.” I have taken this to mean, you should never stop learning and can never be overdressed when you look your best. We are in a profession where we are always learning, and even though we wear scrubs often, we can still find ways to look our best.

Ditch the scrubs when you can – When given the option to wear something other than scrubs, I always take the opportunity. One example is when I am presenting at the Morbidity and Mortality (M&M) conference I will often wear business professional attire. It is not required at my institution, however I have found that dressing up accomplishes the following: it makes me feel more confident at the podium, that changes my body language during the presentation, therefore improving the quality of delivery of the presentation. Coupled with a well-prepared presentation, dressing up makes even the worst complication look just a little better.

Accessorize – Since a vast majority of time is spent in scrubs during my training, I will admit that it can sometimes be difficult to stay true to my mantra. My mentor in medical school gave me great advice about accessorizing, like wearing a cute headband or a string of pearls. This can automatically improve the way you feel, the way you look and the way others perceive you. I am never short of compliments on how nice I look when wearing my pearls. Socks are another way I find to accessorize on a more personal level, which can elevate my mood on certain days. If I am on a particularly challenging service or preparing to perform a challenging case, I put on my “Notes to Self” socks that say, “you are smiling” or “you are confident”.

With all that being said, when given the chance to dress nicely, go the extra mile and “overdress”; this will make you feel better and you will ultimately do better. Style is personal, and so is success! Define your own success, dress for it and reach for the sky!

 

DanielleHenryDanielle Henry is a chief resident at Orlando Health General Surgery Residency Program and currently serves as the administrative chief resident. She is planning to pursue her passion with a career in breast oncology after residency. She completed her Medical Doctorate at Florida State University and Baccalaureate degree in Applied Physiology and Kinesiology at the University of Florida.  She enjoys playing soccer, a good game of scrabble and time at the beach. She also enjoys community service projects and mentoring medical students.


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 Road to Wellness

By Jaime Lewis

The road to wellness is often less than straight and narrow. Some stretches are full of potholes and construction barriers, causing delays, requiring tolls and taxes for passage, while other sections are smoothly paved, wide open, and headed straight into the sunset.

However the journey proceeds I have found it is peppered with choices and opportunities to make myself a little happier, a bit healthier, and perhaps a little more “well”. Some moments it’s a choice of how to respond or react, how to understand my own emotions, or how to interpret the actions of another. Other days it’s making the choice to eat the healthier meal, to run the extra mile, to play with my children, or in my professional sphere- to finish up my charts, respond to a committee request, or spend a few extra moments with a resident.

Recently I have worked to formulate goals which I believe will help me progress on my journey to wellness. While I may stumble along the way, I will strive to:

  1. Understand my place in this world in the many roles I play. I will be true to myself and not pretend that I can be everything to everyone.
  2. Focus my efforts where I believe I can make a difference and work to understand the opportunities and limitations as they exist. I will not try to change the world overnight.
  3. Align my actions with my core values and central beliefs while allowing them to evolve. I will attempt to act in ways that are expressions of who I am rather than who I am expected to be.
  4. Be physically active on a regular basis, eat a healthy diet of real food, and enjoy the benefits of relaxation and regeneration. I will relish my time running rather than regretting what I’m not otherwise doing. I will be mindful about the nourishment I choose. I will make time to rest.
  5. Understand my own value and worth without comparing it to others. I will work to accept that my path is different and uniquely mine. It’s all about the journey.
  6. Challenge myself when I need to grow and forgive myself when I have failed. I will not be satisfied with stagnancy and will give my heart time and space to heal when necessary.

And I will remind myself that in order to care for others, I must be well myself. And the lessons I learn will be used to help my family, friends, and patients care for themselves and others.

As we head into this holiday season and the New Year is upon us, I wish that all of you may find a little wellness each day in the hustle and bustle of it all.

Namaste.

 

jaimelewisJaime Lewis practices breast surgery at the University of Cincinnati where she also completed her general surgery residency. After residency, she also completed a one-year fellowship in breast surgical oncology at the Moffitt Cancer Center. Outside of the hospital, she enjoys running, cooking, and time with her family.


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.

An Open Letter to Young Women Considering a Career in Surgery

This post originally appeared in Hot Heels, Cool Kicks, & a Scalpel

 

Dear Young Woman Considering a Career in Surgery,

It was lovely to meet you the other day. Many times a month, a young woman just like you comes to me with similar interests and concerns. “I really love surgery,” she says, ” But I am afraid of the lifestyle and I really want to have a family.”

Oh, and thank you for also inviting me to speak at your seminar the other day on Women in Traditionally Male Dominated Fields. I have been speaking at similar panel sessions since 2005 when I was a bit of a novelty at my training program as a clinical PGY-4 with an infant daughter. Your collective curiosity on what my life must be like is of great interest to me because to me it’s just my life. It’s the only reality that I know because, like you, I was young (just a few days into my 25th year, just 5 days into my first ever surgical rotation) when it occurred to me that I really loved surgery. It was unexpected; but every day since then (from the remainder of that MS3 rotation, to my sub-internships, to my years in residency, to research and clinical fellowships, and to these past 6 years on staff) I have crafted a reality, as tenuous as it is, that works for me and my family in any given moment in time.

And I am here to tell you that you can do the same too if you, in your heart of hearts, can think of nothing more exciting than surgery as your professional passion.

People outside of surgery will tell you that it’s a career that is too hard to integrate with family life. They are correct that it is generally harder than other fields in medicine; but, ask yourself if you truly want a career in general pediatrics, or dermatology, or invasive cardiology or anything in between. If the answer for whatever alternate field(s) you are considering is no, then no matter how many fewer hours your profession requires, no matter how much more flexible those hours may be, your family will be left with a present, well-rested, yet bitter wife and mother.

[NB: I use the word integrate very purposefully here. Anyone from a demanding profession, surgery or otherwise, who tells you that work-life balance is possible is conning you. Your life will never be in balance. Something will always have to give: your work, your family, or yourself. It’s in how you integrate these things in a shifting, fluid professional and personal lifetime that you will craft your own reality.]

The same can be said of those who encourage you to enter surgery training but then offer that you may consider a career in breast surgery or start an exclusive vein clinic or choose some other presumably less time sensitive and/or less time consuming surgical practice to balance your professional work with your desire to have a family. Again, ask yourself  if you can truly be happy in such a practice. (I personally would be bored with only a few kinds of procedures in my armamentarium and the absence of physiologic chaos; but everyone is different.) You may not know the answer until you are well into your training; but, choosing a medical specialty in the first place, or a surgical subspecialty in the second, simply because you presume it will be easier for family life is fraught with potential for professional dissatisfaction. I promise you that professional dissatisfaction will always stand in the way of overall family life satisfaction. Always. Forever.

Finally, as hard as it might be to envision yourself as a surgeon who wants hobbies, and a spouse, and a smoking hot body, and children of your own someday,  remind yourself that divorced parents, widowed parents, disabled parents, parents with deployed military spouses, and parents with far fewer socio-economic resources than practicing surgeons, and trainees for that matter, somehow get it done. Every life has it’s particular challenges when it comes to parenting but surely being a surgeon is not the most insurmountable of them all.

So think long and hard about alternatives to surgery; but choose one only if it speaks to your professional soul. No matter what career you choose, you will likely spend more time at work than on any other aspect of your life be it parenting, self-care, love-making, you name it. Therefore, it is critically important that your choice of career light the fire in your belly to show up every day leaving behind, at least temporarily, everything else including your children. Because one thing is for sure: when you are practicing surgery, your head needs to be in the game. You cannot be distracted by guilt about not being with  your family or about delegating some of the more mundane aspects of childrearing or homemaking to others. You must love the work enough to drop the guilt and create practical solutions to raise your children and provide them with a safe and loving space in which to grow while reimagining whatever stereotypes you hold about being the perfect parent.

Because you know what: There is no such thing as a perfect parent, surgeon or otherwise. So there will never be any point in beating yourself up about it. Know that you will love your children more than you could have ever imagined loving anything, including surgery, but that you will still be a great surgeon. The two are not incompatible, but it takes some effort and creativity.

So, now that I have convinced you to choose the career of your dreams here are some thoughts on the effort and creativity it will require.

Do not underestimate the importance of choosing a life partner who gets the soul inspiring nature of your career choice. He/She may be another surgeon, or physician in another specialty, or a non-medical professional, or a skilled laborer; it doesn’t matter as long as your life partner understands that, when you are tired from the long days and nights, or sorrowful for the lost lives, or otherwise distracted, it is not because you love work more than you love them. Bottom line: as awesome as any career may be there is something messed up about your priorities if you really would choose work over loved ones. So your life partner needs to get that you aren’t messed up; you just have a demanding career.

With the demands of that career comes the need for a real partnership in planning life. That doesn’t mean a 50:50 split or a 80:20 split or anything conscribed; it means a constant openness to splitting however it needs to be split or not splitting at all to ensure that life outside of work happens. It means making the most of precious few waking moments together through physical contact and communication. It means having a very user friendly calendar/shared to-do system. It means providing feedback without judgment for the practical things in life and making space for shared emotional and spiritual needs. If you find yourself paired up with someone who can’t work with you on life this way, then consider dumping him/her. Seriously, it’s not worth trying to make them happy if they just don’t get this hugely important part of what makes you whole.

[NB: If a life partner is not your thing or things just don’t work out, that’s okay. The same principles of reimagining, outsourcing, and dropping the guilt apply. It’s just that your village, or metropolis as may be the case for some surgeons, has a different population structure.]

Choose your job based on both professional and personal needs. Training is finite and there is always an end from which to take on a new direction. However, even though many surgeons change jobs, think of your job as your forever job so you don’t accept a situation which will turn out to be toxic for you. Choose partners who will have your back, and you, in turn need to be willing to have theirs. Choose geography that at least satisfies some of your desires for commute time, distance from extended family, lifestyle, weather, etc. and makes life easier. You can’t blame surgery if your long commute destroys your soul, or if having your parents thousands of miles away makes you sad, or if humidity, piles of snow, or whatever your most dreaded weather phenomenon is drives you crazy, or if it takes a flight to get to your favorite past time of hiking, biking, skiing, etc. That’s on you and the choices you have made as a surgeon and not on the profession itself. Finally, choose a practice type and setting that will make you excited to show up every day (for me it was research, teaching, and a level 1 trauma center in a university based system).

If you do have a life partner and working is important to him/her, don’t pick a location that will railroad his/her career. As much as being a surgeon defines you, your soul mate is similarly defined. Please don’t create a situation where he/she will be susceptible to resentment about having his/her professional goals squashed. (I’ve been there. It puts a real strain on a marriage. It sucks.) It’s already hard enough to be paired up with you, a surgeon. Both your jobs may be equally demanding, or one may be more demanding; it doesn’t matter as long as together you negotiate a mutually satisfying life-long give and take about who prioritizes what and when depending on the stages of your respective careers and the ever evolving needs of your family.

When is comes to family, do not waste too much mental effort over-thinking when you should start it. Fertility, along with finding the right person with whom to test your fertility, is a complex and unpredictable thing. No pregnancy is guaranteed to proceed smoothly. Given these inherent limitations and unknowns, along with the demands of a surgical career, there is no perfect time to start a family. This is about as certain as death and taxes. I will spare you the perceived pros and cons to having children during training compared to while in practice. Just know that every time period poses challenges and every passing year makes infertility more likely; so if you are ready in your personal life to try to get pregnant go for it; because, if you choose to wait for a perfect time, you will be waiting for a very, very long time.

And, if having children in a traditional sense is not possible for whatever reason, there is also no perfect time for assisted reproduction, adoption, or surrogacy either even though the salary increase a staff surgeon or faculty job may be necessary for these options. In the end, whatever approach to becoming a parent will be required,  you will figure out a way to get through the challenges because you will have mentally and emotionally committed yourself to the idea of being a mother who also happens to be a surgeon.

[NB: If you choose to not have children-by this I really mean choose as there are myriad other mishaps of life and physiology that prevent women who want to be mothers from becoming mothers-, please do not make that choice simply because you want to succeed as a surgeon. You will never forgive yourself. Not ever.]

When it comes to family there are various options to manage childrearing and homemaking. A nanny, two nannies, an au pair, daycare, a nearby grandparent, a neighbor who is a stay-at-home parent, or various combinations of these may be required to keep your children loved and safe. It’s different for every family and I promise you that you will find what works for  you. It will be a source of stress but it is doable. And, no matter how much time others spend rearing your children on your behalf, those kids somehow know that your are their mother, that you love them in a way beyond any other love, that you would give your own life if it would save them, and that you also happen to be a busy surgeon. Trust me. They will. And, they will be really proud of the uniqueness of their surgeon mom. They really will.

When it comes to your home, be it your 600 sqft rental in residency or your 2500 sqft grown up home in a cul de sac, outsource any jobs you and/or your partner simply do not enjoy. I cannot emphasize this enough. You will, in fact, have precious little time with your family. Ask yourself how you want to spend that time. Do you want to being cleaning and doing laundry? Or do you want to plan a family outing? If hopping on your John Deere and showing your lawn whose boss on your Saturday off is a fun activity for you, then by all means go for it, otherwise someone else will be happy to mow your lawn for a fee. If you love cooking, knock yourself out planning, shopping for, and preparing gourmet meals along with the associated clean up, but if you don’t then find a meal service. You get the point. If you don’t love it and it can be done by someone else outsource it. Even on a trainee’s budget you should strive to rid yourself of any household obligations you abhor. (For me the $55 spent every other week during residency for cleaning was well worth never having to spend a day off cleaning a toilet and now the extra hours we pay our nanny to do all of our laundry has spared me a monthly power weekend of washing and folding 10 loads of laundry because we just could not get to it all with the many kids’ activities, call nights, etc. that prevent daily washing.)

Remember: as little time as you will have at home to spend with family, you must also prioritize time for yourself. Don’t expect it to just happen. Just as you schedule elective OR cases, you must schedule elective you time. It may not happen very often but if you don’t take the time for self care in the midst of the stresses of the job and the stresses of parenting you will be cranky and miserable to be around. How you spend time away from family when you have so little time with them will change over time and you may even develop hobbies incorporating your family (we have taken to family bike rides and kayaking trips as the kids have gotten older to combine wellness with family time) but remember to schedule things that feel completely selfish to you. A girls’ night, date night, a pedicure, reading a trashy novel, going to a Zumba class during bath/bedtime, or whatever you enjoy is totally not selfish but you will feel that way; so a good barometer for whether or not you are making time for self care is how selfish it feels. My advice is feel selfish at least once a month.

[NB: If your selfish thing is not a fitness thing then you have to also figure out how to fit that in because your patients and your family need you to be healthy.]

Being a surgeon is not incompatible with being a good wife, mother, athlete, whatever else; it’s just trickier. But, if young women keep being scared away from surgical careers then these same fears will linger generation after generation; we will never achieve a critical mass of women surgeons in the profession who can set good examples for one another and for future surgeons. With the same focus we apply in the OR and the same organization we bring to rounds and the same compassion we bring to patient encounters,we can create a life strategy that overcomes these perceived barriers for both a happy family life and a successful surgical career. The barriers will change depending on the stage of the career you love so much and the needs, wants, and development of what and who you love outside of work; but, take it from this surgeon mom: they are barriers to be overcome, not shied away from.

I am pretty sure that’s why you showed up at my door and asked me to that seminar, to make what seems impossible to you at the moment seem possible. Let me tell you: if I can do it, you can too. Go forth, be a surgeon, be a wife, be a mom, be good to yourself and craft a reality that works for you. Then, pay it forward so that someday these meetings and seminars might be rendered obsolete.

Sincerely,

@surgeoninheels

Not just a token surgeon-mom-wife-runner

PS. Here is some inspiration. Your potential in surgery is limitless. https://www.womensurgeons.org/in-practice/leaders-in-surgery/

PPS. The Association of Women Surgeons is an invaluable professional organization whose goal is to: ENGAGE current and future women surgeons to realize their professional and personal goals. EMPOWER women to succeed. EXCEL in those aspirations through mentorship, education and a networking community that promotes their contributions and achievements as students, surgeons and leaders. https://www.womensurgeons.org/

PPPS. I have been fortunate for the last 10+ years to be a part of the American College of Surgeons Women in Surgery Committee working towards improved gender parity, opportunities for professional development, and better work life integration in our careers.https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee

dg-strappysAbout @surgeoninheels: I am an acute care surgeon specializing in trauma, emergency general surgery, and surgical critical care. I am married to an incredibly supportive husband who is the primary childcare provider, homemaker, and diy’er in our home. I began running with him two years ago and we plan to run many half marathons together. While navigating the abyss between work and our two children and small dog, I also do as much Zumba, Stott Pilates reformer, and shopping as I 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.