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.

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.

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.


By Beth Shaughnessy

This lifestyle we have chosen seems to come in 4-5 year runs, Each new phase of training means we may have to pick up and move somewhere else, again. At least until we get that first real job. And with that comes a little loneliness. What if we have never lived there before? What do I do to find a friend?

Before I left for my fellowship in Los Angeles, I had lived in Illinois nearly my entire life – and was lucky enough to complete medical school and residency training close to home. I knew NO ONE in California except for my husband. As I started fellowship, he appointed me his social secretary! What to do? The social culture was a bit different in L.A. as compared to Chicago, as compared to Cincinnati where I now live. In California, people tend to live farther away, commuting long distances. Gone were the days of spontaneous get-togethers with co-workers. Locating friends nearby was not so easy. People kept to themselves more. Obviously, this was one of those times I would have to take matters into my own hands and be proactive. So, how did I find like-minded individuals? The easiest way for me was to find some common ground. These are some of the ways I was able to make new friends as an busy professional in a new city:

  • Take a class: My yoga friends have been around 12 years now. We support each other, we network, celebrate weddings, suggest restaurants, etc. No one else in this group is in medicine, and it is refreshing to get a different perspective. Find something that you are interested in, such as yoga, spinning, cooking, photography, painting/art, bee-keeping.
  • Volunteer: I helped to organize the Susan G. Komen Affiliate in L.A., then contributed to the new one in Cincinnati. Met lots of people through this organization.There are many ways to donate your time, such as putting on a running race or bicycle race, or help with the handicapped, or be a big sister through the “Y”.
  • Join a club for running, hiking, bicycling, book club, or an organization like Sierra Club, a club for a cause.
  • Neighborhood meet-ups.
  • Network with existing friends to find names of people they know in this new city. You are more likely to meet a potential new friend in someone who knows a friend of yours.
  • Become active in an alumni organization or chapter. In Los Angeles, I met up with women who had been members of my same sorority in college. They came from a wide variety of ages and backgrounds, from many parts of the country.
  • Get a dog and walk that dog. They don’t call it a people magnet for nothing.
  • Go to a fund-raiser that is meaningful to you, and introduce yourself to a lot of people, and/or volunteer to do something for that charity.

In reading articles on new websites, meetup is supposed to have notices of multiple meetings that you could possible go to. Bumble is supposed to be a new way to find your next BFF. I haven’t tried it, mostly because they are new.

Finding new friends as we get older becomes more challenging as we age. This is well-documented, but not impossible. Think about it; making a friend takes time and emotional investment. It takes a certain level of commitment, albeit as small or as large as you are willing to commit. And it usually starts with finding common ground. As the demands on our time grow, and we might get a career, get married and might start a family, the extra time shrinks. So does theirs. Friendships through classes or activities help to serve you in participating in an activity, but also having a friend with whom you have something in common. You can keep the commitment at the level of the activity only, or you can expand beyond it, depending on your time constraints.

But take heart; remember you have made friends before, and you will make friends again. They don’t come prepackaged. Try to remain loose, flexible, and open to conversations and meeting new people. One lasting friendship I made casually through a discussion in a grocery store, commenting on the person’s sweatshirt design, and the individual became like family in time.

Beth Shaughnessy was born and raised in the Chicago area, leaving to go downstate for college at the University of Illinois at Urbana-Champaign, but returning for medical school at the University of Illinois at Chicago. After residency at the University of Illinois’ program, she felt she became too inbred, so she left for Los Angeles to complete a fellowship in surgical oncology at the City of Hope National Cancer Center. She is currently a professor of surgery at the University of Cincinnati, in Cincinnati where she lives with her husband and son. She enjoys cooking, yoga, the arts, choral singing, and gardening.

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.

Breast is Best, Supporting Mothers Is Better

By Nickey Jafari

My rotation in obstetrics & gynecology (OB/GYN) was full of emotional moments, and the first time I witnessed a mom breastfeed her baby was one of my favorites; in a culture that so overtly sexualizes women’s bodies, it reminded me that breasts had evolved for the purpose of nurturing a new human life. Of course, breastfeeding is not always easy, and the decision to breastfeed is a deeply personal one for a woman. Mothers who are unable or unwilling to breastfeed should never be shamed for it. However, the health benefits for both mom and baby are plentiful. We should seek to strike a balance between educating people on the myriad of reasons to breastfeed, while not making women feel pressured to do so.

The World Health Organization recommends exclusive breastfeeding for at least 6 months and reiterates well-known benefits, such as reduction in gastrointestinal illnesses for baby, increased neonatal immunity to infections, and reduced newborn mortality. For mothers, the WHO states the reduction in risks of both breast and ovarian cancers as other reasons to breastfeed. Some of the contraindications to breastfeeding can be found here, and include galactosemia and untreated, active tuberculosis.

Given all its benefits, breastfeeding is a public health priority. The CDC Breastfeeding Report Card 2016 shows that most mothers do want to breastfeed, but rates of exclusive breastfeeding through 6 months are as low as 22.3% throughout the U.S. Barriers to Breastfeeding in the United States frames the issue of expectations on breastfeeding very well – “even though breastfeeding is often described as “natural,” it is also an art that has to be learned by both the mother and the newborn”. Thus, education on breastfeeding techniques, such as the best way to achieve a proper latch, should be provided to moms. Empathy and encouragement go a long way, too. I remember on my pediatrics rotation, when we would check in on our new babies, a lot of moms would get frustrated if the process was not going smoothly because of this societal expectation that breastfeeding is an easy and innate process from the get-go. I noticed some moms who gave up because they felt like, since it was not going well, they were failing at being a mom, and others who switched to formula soon after because they were worried about their baby getting enough nutrition. Their decision did not come from any selfishness, but genuine concern for what is best for their child, and thus I always get upset, as someone who does enthusiastically promote breastfeeding and its benefits, when I see someone judge a woman who does not; we have no idea what her journey was. A little encouragement from clinicians to new moms that it is also “natural” for it to take some work, that they are doing a great job and should keep trying, that their milk amount will continue to increase after the first few days of colostrum, can make a world of difference.

Overall, there are far too many impediments to breastfeeding to address in a single blog post, but in addition to better education to new moms by their clinicians, they include changing societal norms and expectations, increasing social and family support, and creating work policies that allow women to breastfeed. Grace DeHoff wrote about her journey into motherhood as a medical student and touches on breast feeding time commitments. A great post about experiences pumping as a surgeon mom can be found here. The fact of the matter is that “many women face barriers to breastfeeding; poor breastfeeding environments where women work, live, and obtain health care are among the biggest barriers” (read more here). One critical policy area where the U.S. lags far behind other developed nations is the issue of maternity leave. The Family and Medical Leave Act only allows for up to 12 weeks of unpaid leave. The AWS maternity policy for surgeons in practice can be found here.

We can and should promote breastfeeding while not making women feel less than as mothers if it is not the best choice for them. We should be especially careful about promoting “breast is best” if we are not simultaneously working to create more flexible work policies, change societal expectations for new moms, and provide the tools that can allow women the chance to successfully breastfeed!

Nickey Jafari finished her third year of medical school at the University of Kansas this past spring and is currently pursuing her Master of Public Health at the Johns Hopkins Bloomberg School of Public Health.

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.

June is National Safety Month

By Doreen Agnese

I have always been a woman of few words. Always a good student who got A’s on exams, but when my classmates were filling blue book after blue book with elaborate prose, I struggled to fill a single one. While many of my colleagues document patient encounters with lengthy notes, my notes are very brief- but I do believe just as thorough. Despite all of that I find myself here composing a blog. So what do I say? What do I discuss? It turns out that June is National Safety Month. It seems to me as though every month should be a safety month, so I think that this is as good a topic to blog about as any other. We are surrounded by the culture of safety at work, but what else should I be thinking about? Just what is a “National Safety Month?”

Google is a useful tool, and it brought me to the National Safety Council website. It probably comes as no surprise that many deaths are preventable. But what is shocking to me is that there are 140,000 preventable deaths in the United States every year. That’s a death every 4 minutes caused by things like car crashes, poisonings, and falls. What can we do to keep each other and our loved ones safe?

Poisoning? I had no idea that this was the leading cause of unintentional injury and death over motor vehicle accidents! I guess it’s not surprising with the current opioid crisis. Every day, 52 people die from opiods. Perhaps I can be more observant of how many Percocets we provide patients after relatively minor, or even major, surgery. On one occasion before leaving for home after breast surgery, my patient requested a prescription for FEWER Percocets, as the resident had written a script for 90! Ninety! After a lumpectomy and sentinel lymph node biopsy! Most of my patients tell me that they have only taken a few Percocets after their surgeries and have adequate pain relief with Tylenol of Ibuprofen. Rather than leave the mundane tasks of providing scripts for post-operative pain relief to the resident, I can do a better job of providing education so making sure that they provide adequate pain relief to patients without and don’t over-prescribing narcotics. That won’t solve the opioid problem, but at least we can have fewer pills circulating out there.

Every day about 100 people die in motor vehicle crashes and more than 1,000 suffer life-changing injuries. Motor vehicle crashes are the #1 cause of death for children and young adults ages 5 to 24, and the #2 cause of death for adults 25 and older and for toddlers, according to the ​Centers for Disease Control. What steps can I take to prevent car accidents? The first thing that comes to mind is reducing distracted driving. We have to remember that nothing is so important that we need to check our phones while driving. I can avoid it and encourage my friends and family to not text and drive. What else? I can also remember that it’s better to be late to an appointment than to not make it at all. We are always in such a hurry, which may contribute to aggressive driving and road rage. Maybe it’s OK to slow down (OK, honestly one of my partners often ends up driving behind me on the way into the hospital and often makes fun of how slow I am—driving the speed limit. This one won’t be much of a stretch for me!).

OK! Next…falls. Apparently, more than 30,000 people died in falls in 2015. This is the third leading cause of unintentional-injury-related deaths for all age groups, but number one in those 65 and older. I think that I sometimes lose sight of this, since everyone on the entire surgical floor seems to be at high risk of falls! I already do a few things in the clinic to try to prevent falls. We always have a team member to help the patients on/off the exam tables. Hate to hear a crashing sound when I leave the room. What else can I do? I could encourage my patients to practice Tai Chi. Several studies have shown that Tai Chi can significantly decrease the risk of falls in inactive older adults. One study demonstrated that a three-times-per-week, 6-month Tai Chi program was effective in decreasing the number of falls, the risk for falling, and the fear of falling, and improved functional balance and physical performance in physically inactive persons aged 70 years or older (J Gerontol A Biol Sci Med Sci. 2005 Feb;60(2):187-94).

There are so many other causes of preventable deaths to consider: choking and suffocation, drowning, fires and burns, natural and environmental incidents and so many others. I can’t possibly address them all. I can spend some additional time considering how to keep myself, my family and friends, my colleagues and my patients safe. So as a woman of few words, please consider these. Don’t use your phone while driving, be mindful of overprescribing narcotics, and spend a few extra moments figuring out how you can contribute to a culture of safety, this month and every month.

Doreen Agnese, MD is Associate Professor of Clinical Surgery in the Division of Surgical Oncology at The Ohio State University.  She was born and raised in New Jersey.  She attended Drew University in Madison, NJ, and completed medical school and surgical residency training at Rutgers Medical School in Piscataway/New Brunswick, NJ.  Dr. Agnese completed a surgical oncology fellowship and training in clinical cancer genetics at The Ohio State University.  Her clinical practices focuses on care of patients with breast cancer and melanoma and those with significant personal or family history of cancer.  She cycles in Pelotonia every year to raise money for cancer research.

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.

March is Colorectal Cancer Awareness Month!

By: Heather Yeo, MD, MHS

March is Colorectal Cancer Awareness month an important time to talk about Colorectal Cancer, because it is a time of national focus and provides an opportunity for education and prevention for a common, but often “hidden” form of cancer.

One of the reasons that I decided to spend my life treating colorectal cancer is because of the exciting progress that has been made in its detection, understanding, and treatment over the last decade and the potential for even greater progress on the horizon. While I deal with colorectal cancer every day, as I am caring for my patients, I am always researching ways to improve their care and quality of life.

A few key points I would like patients to think about:

Prevention is Key.
There are certain risk factors that we know put individuals at higher risk, for example, consumption of red meat, smoking, and obesity all put patients at higher risk. Understanding family risk factors is important as well, first degree relatives with colon cancer, BRCA mutations, or any hereditary cancer syndrome should discuss their risk with a genetic counselor. There is some evidence that frequent long term aspirin use in individuals at risk may slow polyp formation and decrease the risk of colon cancer.

Screening Matters.
Colorectal cancer is the second most common cancer in the United States, affecting men and women of all ages. While it is most common after the age of 60, due to screening, it has been decreasing overall in the US population. Screening colonoscopy is recommended for all adults starting at the age of 50 or 10 years before any first degree relatives were diagnosed in those with a family history.

However, for unknown reasons, early onset cancer is on the rise, so don’t ignore symptoms in young patients, particularly those that don’t go away after treatment.

Treatments are effective for localized cancer.

The good news is that cancers that are detected early are often cured with surgery alone. Those that have spread locally still have very good cure rates, but may require chemotherapy (you usually don’t lose your hair with newer medications available). When cancer is found at more advanced stage, medication can help slow their spread and certain measures can help people have good quality of life.

There is nothing to be ashamed of.
Colorectal cancer is not sexually transmitted or contagious, people of all ages, races and cultures are at risk. For many people there is a stigma associated with it because they are embarrassed to talk about digestive problems. I think the most important advice I can give, is to not ignore your symptoms. Colorectal surgeons and surgical oncologists are specially trained to deal with surgical problems of the GI tract and will treat you with respect and dignity. Because this is a common cancer, there are resources, support groups, and integrative therapies that may help you deal with the disease. Don’t be afraid to ask your physician for some of these resources. I have included some helpful links below.

Additional Resources
Society of Surgical Oncology Colon and Rectal Cancer Page
American Cancer Society
Colon Cancer Alliance
National Cancer Institute – Surveillance Epidemiology and End results

Heather Yeo, MD, MHS, is Assistant Professor of Surgery and Assistant Professor of Public Health at Weill Cornell Medical College and Assistant Attending Surgeon at New York-Presbyterian/Weill Cornell Medical Center. She is board-certified in general surgery, colon and rectal surgery and complex general surgical oncology. Dr. Yeo has a Master’s in Health Services Research and is focused on surgical outcomes and quality improvement in Gastrointestinal Cancer Surgery. Dr. Yeo became involved with AWS after receiving the 2013 AWS-Ethicon Fellowship Grant and is currently a co-chair of the AWS Communications Committee.

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.


Negotiating Your Worth

By Melany Hughes

Hiring Entity
“No. That won’t work for us.”
Job-Seeking Physician
“Ok, that’s fine then.”
I’m not going to cry.
I’m not going to cry.
Ugh, are those tears?
Am I crying?
Did they notice?

Hiring Entity
“Do you need a minute?”
Job-Seeking Physician

In our worst nightmares, this is the scenario we think could unfold if we dare make demands during contract and business negotiations. Of course, in reality, it will never happen but the fear of lacking control and losing dignity can be so strong that it compels contract seekers to make no demands and to agree to everything that is proposed; just because it is easier. Women have a tendency to internalize all the cultural, societal, religious and historical characterizations that define us as the “fairer” sex. But let me make it clear that although there is a time and a place for taking a backseat, meetings with potential employers at the negotiation table should not be one of them.

It may seem hard to make demands when you feel that you are approaching the contract process from a place of inferiority. You may even feel that you lack sufficient knowledge to leverage any control in the process. But you have to muster the confidence to serve as your own advocate.

I attend annual meetings and conferences for medical professionals and the horror stories people tell regarding their contracts and work situations would make your hair stand on end. The situations can be downright criminal when there are special circumstances like visa requirements, malpractice settlements or negative hospital inquiries, etc. I know a very competent practicing female surgeon who makes under $100,000 and was required to cover the hospital surgery call schedule 24 hours a day for 4 months at two 200+bed hospitals all for the promise of a sponsorship for a US green card and permanent residency. It is mind-boggling that this beautiful, brilliant, hard-working woman did not think that she was worth more and even more disturbing that despite all our medical training, we are not provided with more business savvy and insight. Happily, through some back-door nudging that I am proud to say I encouraged, she was able to get her contract renegotiated and is living with a slightly better quality of life. But you cannot trust that contract renegotiation will be an option. Sometimes, it is two years later and you are so burnt out that leaving active practice seems a viable option.

Medical school and residency don’t include business classes. In certain cultures, women in the forefront making demands is frowned upon. It is clear that medical training should include more education that relates to contracts and contract negotiation, reimbursement, incentives, malpractice coverage, billing, etc. It’s preposterous that the first time you hear about a non-compete clause or tail coverage is when you are signing the next few years of your life away.

So how do we do this? How do we even approach this?

  1. You are a trained professional. You are a “hot” commodity! You are doing them and their patient population a favor by working for them. You do want to let them know what you can do for them and their practice. You should approach this process and the contract negotiations from a presumed position of power.
  2. Be sure you understand your own desires and needs (lifestyle, family plans, desired salary range, geographic preferences, career interests, work schedule, paid research hours, tenure options, etc).
  3. As a new graduate/physician, you will need to make some compromises to get more experience. But do not give up everything. Keep your soul! If you need two weekends every month to go river rafting or skiing or want two weeks in summer to travel through southeast Asia, then make sure you negotiate for that.
  4. MAKE A LIST. For first-time negotiations, renegotiation or any changes, do not approach the meeting without a written list of both needs you have and compromises you are willing to make to come to a satisfactory agreement. For my last contract re-up, my current employer just took one look at the list and agreed to every single thing.
  5. Read and Empower Yourself. Here are some suggestions:
    • Women Don’t Ask: Negotiation and the Gender Divide by Linda Babcock and Sara Laschever
    • Getting More: How You Can Negotiate to Succeed in Work and Life by Stuart Diamond
    • AWS Job Negotiations Resource by Dr. Margaret Dunn
    • Read the AWS Navigating Your Surgical Career Guide
  6. Have walkaway terms
  7. Lastly, make sure you have a contract lawyer familiar with physician contracts.

Melany Hughes, MD, MPH is a 2005 graduate of the Howard University College of Medicine. She completed her General Surgery internship and residency in 2010 at Howard University. She received a Master of Public Health Degree in Disaster Management and Emergency Preparedness (MPH) from Tulane University (TU) in 2012. While at TU she received a research appointment with the World Health Organization’s Center for Research on the Epidemiology of Disasters (WHO-CRED) in Brussels, Belgium. Her work focused on the analysis of both man-made and natural disaster-related trauma and injury patterns resulting in contributions to several multi-national collaborative research projects and publications. Following completion of her MPH degree, and with a continuing commitment to public service and humanitarian work, she served as a General Surgeon and Medical Officer with the U.S. Indian Health Service; providing healthcare to the Hopi and Navajo Nations in northwest Arizona. Dr. Hughes strives to practice “socially-conscious” general surgery and is currently employed as a private practice surgeon with Hafa Adai Specialist Group in Guam, USA.

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.


Residency Applications: The Curriculum Vitae

By Mary Brandt

This article originally appeared on Dr. Brandt’s blog, the wellnessrounds.

student at computerOther than the personal statement, there is nothing more distressing to medical students applying for a residency than putting together a Curriculum Vitae (CV).

So, what exactly is a CV?

 “The original Latin meaning of curriculum was a course, but of the kind that one runs around (it came from currere, to run).   Even more recent — dating from 1902 — is curriculum vitae, literally “the course of one’s life” (from World Wide Words)


Your curriculum vitae is a document that serves as a summary of what you have accomplished as a professional.

What’s the difference between my CV and what I put on my ERAS application?erasnav1

Your CV and what you put in ERAS differ in two important ways – the content and the format. ERAS will generate a CV from the information you enter, but it’s not in a format that is usually used for a professional CV.  In addition, the ERAS generated CV will not have the same information you will want on your CV.  For example, ERAS “experiences” don’t translate well into a professional CV.

Why do I need a CV in addition to what I put into ERAS?

  • You will need to give your CV to any faculty writing a letter of recommendation.
  • You may be asked to send a CV when applying for away electives.
  • It’s a good idea to take your CV with you on interviews to provide a copy to the program, especially if you have updated it since your application was submitted.
  • If and when you send emails to programs after you interview, it’s a good idea to attach your CV if it has changed at all. Bcc yourself when you do – if there is a problem with the email or the attachment, you’ll know it quickly.

What do I need to include in my CV and what should it look like?

There is no absolute “standard” format for a CV, both in content and in style, but there are some guidelines. In general, in addition to the “heading” with your name and contact information, the following sections (if they apply to you) should be included in the order they are listed.

  • Education (degrees, institutions)
  • +/- Place of Birth
  • +/- Citizenship
  • +/- Languages
  • Military service
  • Work experience (this is not summer jobs unless the pertain to your application i.e. don’t list being a waiter, etc!)
  • Volunteer experience (make sure it’s significant. There is no advantage to listing 20 things that all lasted a week or two …. again, unless it’s specifically related to your application… see “don’t pad your CV” below)
  • Other training (eg BLS, ACLS, special courses to learn a skill)
  • Professional memberships (including leadership positions, committees)
  • Honors and awards
  • Publications
  • Presentations
  • +/- Personal interests (drop after you match if you include it)

mentoring brown

It’s a good idea to show your CV to mentors in your specialty to get their feedback since there can be subtle differences in CVs between specialties.

What should I do to avoid common mistakes in creating my CV?

  • Pick one font and stick with it. (11 or 12 font and something really standard).
  • List items in each section in reverse chronology (most recent first)
  • Number your publications and presentations.
  • Leave plenty of “white space”
  • Don’t “pad” your CV with trivial events or accomplishments – it’s more important it’s accurate and appropriate than long.
  • Go ahead and list “hobbies and interests” as your last topic for the residency application, but remove it as soon as you match.
  • Double (no, triple) check spelling and formatting. Your CV is often the first impression a program will have.
  • NEVER put any designs, photos or logos on your CV.
  • If you put your personal email address, make sure it’s a professional email address. If it’s not, it’s time to get a new one.
  • Don’t EVER lie or exaggerate.

Where can I find examples or templates for my CV?

Many medical schools have examples on line and all schools have help in the Office of Student Affairs or through other faculty mentoring programs.  You can also sign into Careers in Medicine to see examples of CVs, which are also here.

nrmp shes met her match

What should I do with my CV after I match?

Remember, your curriculum vitae is a record your professional life… so it’s a “living” document that will need to be updated as new things happen. There is no one else who will every know exactly what you do and what’s really important more than you will. Keep a list somewhere of everything new that should go on your CV and sit down at least every month or so to review and update your CV. After residency when you “graduate” to having an assistant of your own, it’s still probably better to update your CV yourself. The AAMC provides a good example of a typical Faculty CV here which gives you an idea of what your future CV will look like!



4171_1095770688051_1640107282_214823_5256875_n1Mary L. Brandt, M.D. is Professor of Surgery, Pediatrics, and Medical Ethics at Baylor College of Medicine and a practicing pediatric surgeon at Texas Children’s Hospital. She has held numerous educational roles including Program Director of General Surgery and Senior Associate Dean of Student Affairs. She actively blogs and tweets about medical education and self-care for students, residents and practicing physicians. 

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.

Coming soon! AWS on Facebook

By Cornelia Griggs

Like most surgical residents, I used to think of social media as an easy way to connect with friends, to discover interesting articles, and a way to occupy my hands during the (few) idle moments of my day. Whether it was scrolling through Instagram while waiting for an elevator or checking out articles on Facebook before I fell asleep at night, social media was just a casual time filler. Over the past year, however, social media has played an increasingly important role in my professional world. Shortly after I had my daughter in October, one of my attendings added me to a secret group on Facebook for surgeon mothers. The group is an offshoot of a hugely popular community that many of you may have heard about- the Physician Moms Group, which now has over 60,000 members. As Dr. Stephanie Bonne described in her blog post last week, these communities have created a (semi) protected space where physician and surgeon mothers can go to vent, seek advice, share tips and find other amusing and useful information about navigating life as a physician/surgeon mother.

At first I was just a lurker in these groups, casually scanning through pages and posts while I was up nursing my daughter in the middle of the night. But as my maternity leave drew to a close, my anxieties about returning to the operating room loomed large. Pumping at work and in between cases seemed overwhelming if not impossible. The idea of being away from my daughter for twelve or more hours a day made me want to bawl. But suddenly I had found a group of women who had done it.

These women had not only survived but appeared to have built happy families despite the demands of being surgeon. So I reached out. I sent a few Facebook messages and posted asking for tips on breastfeeding while in surgical residency. Within minutes, multiple women had written back to me and shared their stories. A resident from another program in Boston sent me her number and we bonded for over an hour about surgery, residency, motherhood, and the juggling act it takes to manage it all. She assured me that there would be days when I would miss my daughter so much that I would question my career choice. She also assured me that a few weeks back into residency I would find a new normal — that making it home to give my daughter her bath and put her to bed would feel like a little victory, just enough to keep me going. We comforted each other by reminding ourselves that residency is temporary and one day we would have a modicum of control over our schedules. Suddenly, the whole endeavor seemed not only possible but manageable.

With this new community at my fingertips, I became motivated to get involved with the AWS and signed up to join the Communications Committee led by Dr. Stephanie Bonne and Dr. Heather Yeo. I co-hosted a mixer at my home for women medical students interested in surgery. When some of the students asked me how I was managing the transition back to residency with an infant at home, I was brutally honest. I was scared, overwhelmed and knew that the first few weeks away from my daughter would probably be torture. Now, almost three months into PGY-4, there are definitely days that I ache for the long, lazy days I spent with my daughter on maternity leave. When cases run late and I come home after she’s already asleep, I feel defeated. I open up Instagram and feel sorry for myself when I see posts from the “mom friends” I made on maternity leave. Many of them have more flexible jobs where they can take off days during the week. I’m overcome with “FOMO” (fear of missing out) when I see posts of them at the Boston Children’s museum or the sprinkler playground on a sunny day. given everything I’m missing out on at home, social media can sometimes make me question whether the path I’ve chosen is really worth it .

But then I dream of the woman I hope my daughter will become some day. I know that I must lead by example if I want her to believe that she can set ambitious goals for herself and follow through with them. When I’m reaching hour 80 of my week and the fatigue makes me doubt my choices, I open up our Facebook group and look at pictures of all the women surgeons who have come before me. Surely if they can do it, I can do it too. These women are posting tips for passing the boards, the best shoes or music to have in the OR, or even just sharing little successes from their day. In this community I have found a small tribe of women who have walked in my clogs. While there are great women role models at my residency, somehow this online community feels more accessible.

Our hope on the AWS communications committee is to create another group  where all women surgeons and trainees, not just mothers, can come to find friendship, advice, support, and even a daily dose of humor from like-minded women across the country.. Be on the lookout on our Facebook page in the next month or two. If you have interest  in joining our group, you can also reach out to me on Facebook, Instagram or Twitter (@cornelialg for Instagram and Twitter). I look forward to connecting with many of you!
C briggsCornelia Griggs, MD is a PGY-4 General Surgery resident at the Massachusetts General Hospital (MGH) in Boston, MA. She completed a surgical critical care fellowship at MGH from 2014-2015.

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.