AWS BLOG

When Disaster Strikes

By Dr. Minerva Romero Arenas

#HoustonStrong #HurricaneIrma #FuerzaMéxico #PRstrong #VegasStrong

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

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

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

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

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

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

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

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


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

 

Golden August

By Camila R. Guetter

Created in 1992 by the World Alliance for Breastfeeding Action (WABA), the World Breastfeeding Week completed its 25th edition this year. During the first week of August, campaigns and partnerships take place in order to support and raise awareness on the importance of breastfeeding. It is an international effort that currently involves 150 countries.

This year, to celebrate World Breastfeeding Week’s 25th anniversary, the Brazilian government announced the expansion of this campaign from a single week to a whole month dedicated to the cause, the Golden August. Initiatives include public talks and events, community meetings, advertising on the media, and illuminating monuments and buildings with golden lights. All in an effort to spread even more knowledge and awareness about breastfeeding in Brazil.

The name “Golden August” relates to the fact that breastfeeding is the gold standard for newborn feeding. Compared to Pink October initiatives for Breast Cancer, it intends to make society aware that breastfeeding is a primary preventive measure for many diseases, for both mom and child.

As I  go through my OB/GYN rotation in medical school, I now understand the extent and importance of the benefits of breastfeeding. For mothers, breastfeeding contributes to postpartum weight loss [2,3]. It has also demonstrated risk reduction on ovarian cancer [4], endometrial cancer [5,6], and aggressive inflammatory and invasive forms of breast cancer [7,8].

When it comes to the newborn, breastfeeding plays an important role in the development of the dental arches [9,10], speech, and breathing. It is also a protective factor for allergies [11], infections [12,13,14], gastrointestinal illnesses [13] such as gluten intolerance, obesity [15], and reduces neonatal mortality [16]. Last but not least, it contributes to the effective bond between mother and child. Another recent blog by Nickey Jafari highlights more the benefits of breastfeeding.

Given all the well-known benefits of breastfeeding to both mother and newborn, the WHO recommends exclusive breastfeeding for at least the first six months after the birth of the newborn. Nevertheless, this practice still encounters many barriers worldwide, mainly due to lack of information. Globally, only 38% of newborns receive breast milk until six months of age. The goal set by WHO is to increase this number to 50% by 2025.

Discrimination and criticism over breastfeeding in public is still a major issue in Brazil. In this regard, the Golden August has partnered with public and private companies to empower their employees who are new mothers. Some companies now offer special rooms for breastfeeding, showing recognition of its importance. They offer private and adequate environments for mother-infant interactions and bonding as well as for pumping breast milk, if needed, during work hours. These conditions may lead to less work absenteeism as they improve the ability for women to return to their work routine more easily. They also maintain breastfeeding as a unique and special experience, as it should be.

Happy Golden August to all parents out there!


Camila Guetter is a fifth year medical student at Universidade Federal do Paraná, Brazil. In her third year, Camila received a scholarship to study at UCLA. Subsequently she became a research student at Beth Israel Deaconess Medical Center (Boston, MA) on pancreatic cancer, HPB surgery outcomes, and patient education materials. Camila is passionate about pursuing a career in academic surgery and is currently a Teaching Assistant for Principles and Practice of Clinical Research, a Harvard T.H. Chan School of Public Health course. She currently serves as International Representative for the 2017/2018 AWS Medical Student Committee. Outside of medicine, Camila enjoys playing tennis, playing the piano, and traveling.

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.

 

 

BLOG for FINDING FRIENDS

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.

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.

Life in an Instant

By Sasha Adams, MD

I am a multi-tasker. I thrive in chaos. Managing multiple projects, people, jumbled schedules – that’s when I’m on my game. And that’s a good thing, because I’m a surgeon, a wife, and a mother of 2 wonderful kids. I have an amazing husband who is an incredible stay-at-home Dad, but there is always more to do. So I multi-task: 2am waiting for my OR case to start, I jump on my phone and order diapers, confident that they will be delivered before we run out in 2 days. I check my emails (both work and home!) and rapidly respond while walking down the hall from the OR to my office. During morning checkout, I hear reference to a book I should probably read, and surreptitiously jump on my phone and order it for my Kindle app within a minute. Heading back to the office, I look at the calendar and notice the kids birthday party next weekend! Quickly I go online and order the gift so it’s delivered in time! All this while being on the go! Like I said, I thrive in chaos-#Ilooklikeasurgeon!! We live in a world where technology has made this possible: if you think of it – you can get it done, check it off your list, and move on to the next task. It’s all about instant gratification.

At work, however, I see a different kind of instant, and it is not gratifying. I’m a trauma surgeon so I see how in an instant, lives and families are changed forever. A moment of distraction while driving leads to an MVC, and they come to me, facing injury, or even mortality, the loss of loved ones, the shattered dreams of the future. I see the shock and pain in the eyes of the families that come wide-eyed to the ER, anxious and afraid to hear if their loved one is okay. As I tell them what has happened, I watch their well-planned, organized, happy world crumble around them. My heart breaks for them, and sometimes I cry with them. Some of their stories haunt me for years. In the Trauma Bay, there is no judgement, just resuscitation of the injured patient. But the stories unfold over the coming days. Yes – some are obviously intoxicated, but others seemingly innocent. Headed to /from work or dinner, some on the phone. “I never saw the other guy”, or “I just looked down for a second”. In 2014, over 400,000 people were injured from distracted driving, and over 3,000 were killed. 78% of them were on the phone, and although the “novice” drivers (15-19yo) get a lot of attention in the media, they are only 20% of the problem. The other 80% of us “experienced” drivers think we can just look down for a few seconds and we’ll be fine. But 4 seconds at 60 mph is the distance of a football field!

So as I drive to work this morning, my mind starts running – what do I have planned today – meetings, cases, appointments, catching up on the ever-behind notes, wondering how many emails are waiting for me. I should check on the patient from yesterday. The To-Do list grows as I quickly become preoccupied with my day before I even arrive. The multi-tasker in me is awake and on the move! Suddenly my phone notifies me of an incoming email. What could it be this early in the morning? Can’t be good. As I reach for my phone, one of those faces come to mind – a life changed in an instant of distraction. I see the faces of the family looking at their loved one in my Trauma Bay, damaged, hurt, with an uncertain future. The multi-tasker in me takes a breath and pauses. I put down the phone. Now is the time to focus on driving. I turn on the radio and sing along, enjoying the sunrise over the Texas landscape and my 20 minutes of off-the-grid peace while I watch carefully for the other drivers who don’t have the benefit (or curse) of knowing what can happen when they aren’t focused on the road around them.

The chaos can wait.


Dr. Adams is a Trauma Critical Care surgeon at the McGovern Medical School in Houston, TX. In addition to her clinical duties at the Level 1 Trauma Center, she runs the Surgical Clerkship for rotating 3rd year medical students, and is an inaugural Society leader and advisor for the McGovern Society, mentoring 8-10 students per year throughout their med school career. Dr. Adams’ research is focused on improving the care of geriatric trauma patients, through earlier identification of those at increased risk, changes to inpatient care practices, and early rehabilitation efforts to improve long term outcomes.

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.

My First Delivery Was My Own: A Medical Student’s Journey into Motherhood

By Grace K DeHoff, MS III

I had my first child in November of my 2nd year of medical school. My husband and I tried to plan for a winter break baby but were surprised a little earlier. With plenty of open communication with my school, an unbelievable support system in my husband and my classmates, and more multitasking than I ever knew was possible, I had my child and was able to return to school full time after two weeks off. I was able to make up the missed work over Christmas break. The experience taught me a lot about why so few women decide to have children during medical school. Unfortunately, the alternative to waiting until after residency leaves many women delaying pregnancy to their their late 30s to 40s. Complication rates, infertility and genetic disorders all increase with increasing maternal age. This leaves female physicians with a difficult decision in terms of attempting to balance a career as a physician and the desire to have a family. This piece is meant to highlight this struggle and my own journey with my decision to have a baby in the thick of medical school.

Challenges women in medicine face with family life
My mentor, a male neurosurgeon, once told me I needed to have my children while in medical school. When I asked him why I needed to have kids in medical school he explained that as a woman I would face a challenge that none of my male colleagues would face, especially in the field of neurosurgery. I would most likely be in the minority as a female in the program. In addition, if I had a child during residency, when I left for the labor and recovery, my colleagues would be faced with picking up my workload and shifts, resulting in probable resentment from them. They would be working while I was home with my baby. They would be getting more hours in the OR, seeing more cases, honing their skills as surgeons, and adding to their resumes by further expanding their experiences. Meanwhile, I would be at home, knowing that I was falling behind in my program, which would drive me to return to work to get back on track sooner than when most new mothers usually return to work. He posited I’d then face continuous guilt over leaving my child and missing out on the joys of being a mother. The thought of motherhood in medical school still terrified me, how would I have the time?!

Though he drew a very simplified scenario with many assumptions, I took it to heart and did constantly wonder about how I would manage to have both a family and a career I loved. Even if I do not end up in neurosurgery, I knew any residency, particularly a surgical one would pose a significant challenge on creating a family. Regardless of the residency, there is only a finite amount of time any resident can take off in a calendar year before they are considered to have missed too much to graduate on time and are required to repeat a year or complete a research year. In the best scenario, it is quite possible for a woman to have a baby and get back to work in only a matter of days or weeks. From our experiences in medicine, unfortunately we know that best case scenarios don’t always happen. For those women who do not have the optimal pregnancies, deliveries and recoveries, they face the very real possibility of sacrificing their medical education and accepting that they have fallen behind and must take time off to graduate later than expected. This can have longer term consequences affecting finances, future job offers and marital stress.

Medical school policies for time off
Most medical schools have no official maternity leave policy in place, owing to the changing curriculum throughout medical schools. In the vast majority of US osteopathic and allopathic schools, the first two years are didactic years requiring lecture attendance and regular exams. It is challenging to have a child during this time because of the rigorous schedule and lack of time available to make up missed work. Some schools will allow a certain amount of time off–usually no more than 2 weeks before requiring an official Leave of Absence. Others require students to either take a full year off or to complete a research project during their postpartum period without an option for attempting to keep up with the required schoolwork. My school, Pacific Northwest University of Health Sciences, was more lenient in their policy. The time off that I took for my postpartum period was excused as an “illness” would be and the coursework was understood to be made up at the end of the academic year before I would be eligible to take my board exams.

The clinical years in the last half of medical school are out of the classroom and occur on the wards with variable schedules and hours. Again, each school is different in how they handle requests for time off during this period. Some schools have established electives appropriate for time needed both pre and post partum. Certain medical schools schools permit a breastfeeding elective to support a pregnancy. My school allows up to 6 weeks of a newborn elective (available to both mothers and fathers) as long as the student’s child is less than 1-year-old. In the absence of any of these options, many students will save vacation time, taken as a maternity leave; others will pack their schedules with light rotations, like research rotations to allow flexibility and less clinical responsibilities and to create more time during the newborn period. In general, there seems to be more flexibility for having a child in the last two years of school when compared to the first two.

Breast feeding time commitments
The American Academy of Pediatrics recommends all infants be breastfed exclusively for the first 6 months of life. For new mothers attempting to breastfeed, this introduces a major time challenge, especially upon returning to work in any field. On average, an infant eats every 2-3 hours around the clock or roughly eight times in a 24-hour period. The amount of time the baby spends actually at the breast varies greatly, but averages to about 20-30 minutes. In addition to the physical time it takes to nurse or pump, a mother in medical training must also factor in her study schedule around her nursing schedule.

I found myself pushing past natural study breaks in my study schedule to wait until I nursed, using the time to nurse as a study break. On long days on the medical school campus, I would take a headset intended for those hard of hearing to use during lecture so that I could continue to listen to the lecture while I pumped in a separate room. This allowed me to still hear the information, but it was impossible to take notes or do any active learning while I pumped since it’s actually a pretty hands-on task. I would often have to be very careful about my exam schedule and change my pumping times to ensure I would not have to leave an exam to pump because that would result in time lost from the exam. Additional factors such as the baggage needed to pump, logistics of storing cold milk and the stress of making sure I produced enough milk every day to send with my son to daycare the next day, were some of the biggest challenges of being a mom in medicine. I know plenty of women who chose not to nurse for long or even at all due to these difficulties. Even so, their time commitment was no less than mine, but without the obstacles to pumping during the day. I think any time saved from the decision to formula feed comes specifically from the pumping time commitment.

Male colleague responses
I was on my first rotation as a third year medical student when I found myself with a male resident who had four children, his last child was born within only a few months of beginning his first year of medical school. He went on to tell me that he “completely” understood how difficult it was to have a baby in medical school. When I hesitantly pointed out the difference between becoming a father in medical school versus a mother in medical school, he scoffed and said that he had taken his fair share of the midnight feedings, enough to understand the difficulties of being a new mother. His response hurt me more than I cared to admit and though I know his attitude is not representative of all fathers, the comment left me feeling resentful and intolerant of my male colleagues. In reflecting on this topic, it is difficult to tell any father that he doesn’t understand what it’s like to be a parent, and to a point, it’s impossible. Fathers are invaluable pieces of the family dynamic and I would never have been successful without my son’s father in our lives. Men often want to be valued for their contribution in parenting, which they justly deserve. Women want the same thing. We want support and recognition for the role that we play in carrying, birthing, and nursing a child. Mothers in medicine keep the same schedules as fathers in medicine, the same workload and the same standards, but the gestational and postpartum part of our parenting journey cannot be ignored or brushed off.

“Statistics” When women have a baby in medicine
In an unofficial Facebook survey taken in a private group of physician moms totaling over 61,000 members, over 2000* women responded to the question “when did you have your first child?”. Of those respondents, only 15% of them had their first child in medical school. 25% of women waited until residency and 25% waited until they were in an attending position. The remaining 35% had their child outside of these time frames. These statistics reflect that women chose to have children all throughout their medical education and career and no one time seems to be better than another. The challenge can significantly affect family planning and many female physicians and students feel that waiting sometimes up to 10+ years after beginning medical school to actually start a family is their best option.

Policy Change
As a whole, medical schools in the US do tend to support women who decide to start a family while in school. There are a variety of options available to help students complete their studies on time and most schools are willing to be flexible so long as there is open communication along the way. The women who choose to take on motherhood and medical school are often some of the most driven and hardest working students, but even so, a little help can go a long way. Schools can encourage and support mothers by providing lactation rooms, providing child support resources and being a child friendly campus. Many schools allow children to be on campus but do not allow them within the lecture halls during class time. Some schools allow the option of following along with lectures remotely, which can be invaluable with a newborn. There are even schools that provide childcare on campus for parents!

As a new mother who is not able to be a stay at home mom, childcare is probably the most important planning point in terms of successfully returning to school after having a baby. Planning early for daycares and inquiring about waitlists as well as the minimum age that the baby must be before they can start is an essential part of your family planning. In medical school the financial burdens often make hiring a nanny or in home child care too expensive but enroll family and friends to help out in the early stages. If you plan on nursing, make inquires early about nursing accommodations at your school. Be sure to see how far away nursing rooms are from classrooms to be factored into your pumping schedule. The combination of a newborn and medical school will definitely cut into dedicated study time so the most honest reflection you must make before embarking on this joint path is whether you are in good academic standing and not struggling to be in good standing. If you are a borderline student, having a baby can easily tip you below the passing line. At the end of the day, every second as both a student and a mother is worth it in my humble opinion.

*Statistics:
Total number of respondents: 2037
** This survey specifically asked only about when women had their first child to attempt to determine when women felt prepared enough to start a family.

 

 

 

 

 


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.

How Medical School Turned Me into a Runner

By Hilary McCrary, MPH

Prior to medical school, I considered myself athletic but never a runner. I could not run more than a few miles without an overwhelming sense of discouragement. When I began medical school in 2013, I found myself surrounded by individuals that had been running most of their lives. It was inspiring that people were able to juggle the demands of school and still properly train for a half or full marathon. Before long, I had set my first goal of running a half marathon. This race took place during my second year of medical school, which for me was the most academically challenging year with USMLE Step 1 looming in the distance.

I was lucky to have a group of classmates that became my running buddies. We called ourselves the “wolf pack”, meeting after studying to run on the local river path. I found that training runs were always easier to complete with a group of friends. It is this companionship that keeps you going when you have a double-digit training run to accomplish. After several weeks of training, I ran the A-Mountain Half Marathon in Tucson, Arizona. This scenic trek around Tucson also takes you up a small mountain at about mile 6, which at the time was less than enjoyable, but once up the mountain you gain great panoramic views of the city. After completing the race, I distinctly remember thinking to myself, “Well, that was horrible. Maybe running isn’t for me”. Hours later, I was texting my running group to plan our next half marathon. That is the thing about running – no matter how difficult a race is, it always has a way of bringing you back in to go for another.

Over the next two years of medical school, I completed six half marathons in various locations across the United States. Some of my friends and I even traveled to San Francisco for the Nike Women’s Half Marathon, which awards each finisher with a Tiffany’s necklace – a prize I still cherish today (Image 1). At first, my goal was to get through each race, yet I found myself gaining a certain level of competitiveness with myself. This led to me signing up for my first full marathon – the Nashville Rock n’ Roll Marathon. Not only is this hilly race known for the great live music along the course, it was also conveniently at the very end of my fourth year of medical school. With up to three months off during the end of fourth year, I knew I would have the time and dedication needed to properly train for running 26.2 miles.

Among all things, having a realistic training schedule might be the most important. I used a Hal Higdon (http://halhigdon.com) novice running schedule, which I found to set weekly goals that I could accomplish. I also learned that it is okay if you miss a run; after all it’s a marathon not a sprint. It is the work you put in over the course of several months that matters, not days. One thing I did prioritize was my weekly long runs. I strategically placed those runs on days I had off, knowing it would take several hours out of my day.

 Image 1: The Nike Women’s Half Marathon in San Francisco with four medical school friends.

I also relied on my wolf pack during these long runs; an 18-mile training run didn’t seem possible without the support of friends. Each long run was harder than the last, but you learn how to emotionally outrun the joint pain and mental exhaustion you experience, knowing that it is making you just that much better in the end.

Soon after the flurry of Match Day and a post-match vacation, April 29th was here. I traveled to Nashville alongside some of my closest friends from medical school. Arriving at race day was invigorating and terrifying. The forecast for the run was 90 degrees with 70% humidity, which are conditions that even for someone from Arizona found brutal to run in. The first half of the race was about as expected. Running several half marathons gets you conditioned to become comfortable with this distance and type of race. It is the last 13.1 miles that I experienced a whirlwind of emotions. I went through feeling like I can finish the race to thinking I had made a massive mistake signing up for this. This is where running really becomes a mental game, which I found similar to some of the mental struggles I faced during medical school. What really got me through the race was walking when I needed to. Finishing a marathon doesn’t mean you need to run the entire race – in fact regular walking breaks can bring you to the finish line at nearly the same time as if you had run the entire race, typically with fewer injuries and pain. The feeling of crossing the finish line is a feeling you will never forget, because at that moment you are officially a marathoner (Image 2).


While I initially would have never imagined myself finishing a marathon, I learned a lot about myself through this process. First, I can accomplish much more than I thought I could. Having a goal is the first step. Second, having an outlet from a busy, stressful life in medicine is healthy and necessary. Even though running takes a great deal of time out of my week to train, the rewards to my physical and mental health are well worth it in the end. Last, it is ok to not be so hard on myself. Taking a week break from running if I need to, walking if I need to – we all have different paths to get to the same place.

Image 2: After finishing my first marathon in Nashville!


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 will begin her Otolaryngology – Head and Neck Surgery training at the University of Utah this summer. She 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.

Knocking on the Door of Disparity

By Danielle Henry, MD

Before the end of National Minority Health Month, I am compelled to take the opportunity to talk about how a disease I’m passionate about affects black women – breast cancer. National Minority Health Month gives us another chance, outside of October, to focus on breast cancer’s impact on the black community.

After being introduced to the Sisters Network by one of my patients, I gained a greater understanding of breast cancer’s impact on the black community. During one of the events I attended, “Stop the Silence”, there were women who traveled from near and far who were currently battling breast cancer, survivors of breast cancer, loved ones of those who previously passed away from breast cancer and simply supporters coming together to raise awareness. Many admitted that cancer was a taboo topic growing up, and went on to share personal stories of struggles, triumphs, and loss due to breast cancer. As a part of the event, we also walked door to door asking to speak with the women of the household to share breast cancer facts and invite them back to the event site for free mammograms. This part of the event stood out the most, as it took an active role of going into the community instead of passively waiting for them to present to the clinic.

Below is a list of statistics shared during the walk, in addition to a few others, which resonated with me on the topic of breast cancer:

  1. Among black women, breast cancer is the most commonly diagnosed cancer and the second most common cause of cancer deaths.
  2. Although the incidence of breast cancer is lower in black women, they have a 42% higher mortality than white women.
  3. Only 52% of breast cancers are diagnosed at a local stage in minority women.
  4. Twenty-two percent of breast cancers among black women are triple negative (loss of receptors for estrogen, progesterone, her-2-neu), which behave more aggressively, have a poorer prognosis and lack targeted therapy.

I am motivated both by my experience with this grassroots event, as well as the overwhelming data that shows disparity in black women, to address and shed light on this disparity. With National Minority Health Month and this blog offering a prime opportunity to bring awareness, the rest of the months can be spent “Bridging Health Equity Across Communities”. Through the Office of Minority Health, you can find many resources for working with minority populations related to education, prevention and treatment strategies.

Resources:
www.cancer.org
https://minorityhealth.hhs.gov

#NMHM17


Danielle 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 degree at Florida State University and undergraduate 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.

Grey’s Anatomy: 5 Reasons to Aspire to be Like Seattle Grace Hospital

By Sristi Sharma MD, MPH

I confess–there are days when I like to unwind and binge watch Grey’s Anatomy. I revel at the personal drama, root for certain characters (Jackson!), cringe at medical atrocities and then spend (my precious) hours on the internet looking up this mythical hospital, that I can assure you, does not exist in the United States.

All real-life medical doctors, especially surgeons, have several issues with Grey’s Anatomy: the medical science in the program is all wrong, interns in the show have an impossible life, the attendings have a severe I-need-to-do-it-all complex-and don’t even get me started on the hair! However, what Grey’s Anatomy does get right is the alternate reality of gender roles in the field of surgery. Here are 5 things that Seattle Grace Hospital Department of Surgery can teach the real-life surgical community:

  1. The number of female surgery residents: As per AAMC 2016 residents report there are a whopping 163.4% more male surgery residents than female ones. This reflects the general surgery residency application figures which during the ERAS 2016 cycle had around 4870 males vs 2600 females. That is 187.3% more male applicants to these programs. The female heavy residency program at Seattle Grace Hospital does not reflect residency programs in the US. All programs in the country should make a better effort to recruit qualified women surgical residents.
  2. Miranda Bailey as the Chief of Surgery is an outlier. There are 271 general surgery residency programs in the United States. Of these only 16 programs are headed by women. That number was 1 in 2014. So although it looks like we are headed the right way, a lot still needs to be done. The ACS recently hosted a webinar on Principles of Leadership for the Young Surgeon. The fact that it was presented by an advocate for gender equity in general surgery was a great step in the right direction.
  3. In Seattle Grace Hospital the chiefs of cardiothoracic surgery, neurosurgery, orthopedic surgery AND pediatric surgery are all women. Time and again, the show reiterates the high degree of technical skill these women have in their respective fields. So clearly, Seattle Grace Hospital is promoting people based on their qualifications and not on their gender. In the real world however, there exists a glass ceiling that is quite difficult to break, particularly in fields like surgery.There are many reasons why there is a scarcity of women in surgical leadership roles, however inherent systemic biases are some of the most unaddressed reasons that hold women surgeons back. We need to address these biases one at a time and do away with the barriers that prevent women surgeons from achieving their fullest potential.
  4. This year during the International Day of Women and Girls in Science, the UN deplored the bias and stereotyping against women in science and went on to make a bold statement “The world needs science and science needs women”. Melinda Gates has made it a personal mission to increase the number of women in science. Now here is a list of research studies that the women surgeons of Seattle Grace Hospital do: Cristina Yang’s Conduit Trial, Meredith Grey’s Alzheimer’s drug trial, Miranda Bailey’s diabetes research, and Callie Torres’ limb simulation trial, to name a few. Clearly, this hospital has great policies that support research activities among these surgeons. This in turn makes them great academic surgeons, which in turn explains their promotion as department heads. It is a cycle that keeps on going and growing.
  5. Mentoring opportunities: The mentoring relationships portrayed in Grey’s Anatomy is what we all hope to have and give at some points in our careers. The deep bonds (although sometimes over-the-top) that every mentor has with their juniors explains why it seems every surgeon in the show is so successful. The show demonstrates men mentoring the women to rise to the top. A report published recently by Harvard Business School showed that male champions can change the workplace culture so that women actually get what they deserve. The women in turn mentor not just other women but also men (Arizona and Alex anyone?) and the entire system self-propagates. The report shows that companies which adopt gender diversity did better than others,which then kind of explains why Seattle Grace Hospital would be one of the ‘top choices’ for competitive residents.

So yes, while interns going berserk with LVADS and a gunman roaming around loose in the hallways may not bode well for a successful setup, Seattle Grace Hospital has some great qualities which surgical communities in the country should aspire to if they want to be considered a success overall.


Sristi Sharma MD, MPH is an aspiring surgeon, a clinical researcher at the Brigham and Women’s Hospital, a previous Paul Farmer Global Surgery Research Associate and a proud alum of 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.