Mentor Spotlight: An Interview with Dr. Silvania Klug Pimentel
Wednesday, April 4, 2018
As I volunteered to write this edition of the AWS Mentor Spotlight, I couldn't think of a better female surgeon to interview than the person I consider to be my mentor, Dr. Silvania Pimentel. She and I met during my third year of medical school. Since then, I have had the privilege to observe and assist in some of her surgeries, as well as witness how much she cares for her patients. Not only an exceptional surgeon, she is also an outstanding professor to medical students and residents in training. She has always inspired me and encouraged me to follow my dreams. I am sure her words will be just as valuable to other surgeons-to-be as they have been to me!
Silvania Klug Pimentel is an Adjunct Professor of Surgery and the vice chair of the Surgery Department at Universidade Federal do Parana. She is also the General Surgery residency preceptor at the Hospital do Trabalhador.
She was born and raised in Curitiba, a city in the south of Brazil. She holds degrees from Universidade Federal do Parana, MD, Master and Doctorate. In 1998, she completed her residency in the same institution in General Surgery, and in 2000, her fellowship in GI Surgery. She was a transplant clinical fellow at the Mayo Clinicin Rochester from 2001 to 2003. In 2015, Dr. Pimentel completed another fellowship in simulation and medical education at NYU.
What do you find most rewarding about being a surgeon?
I believe that everything in surgery is rewarding. You have the possibility of improving the patient's condition in a very objective manner. In an elective surgery context, you may have a patient with gallstones or a resectable tumor. These are conditions that cause great discomfort to the patient and you might be able to literally take that problem out of the patient with your hands. And they will be well.
In trauma surgery, I feel that the surgeon plays the role of a hero. You come across someone in a very critical condition, close to death, and you are able to revert this, which is extremely rewarding. You feel a little bit like a superhero, almost with superpowers.
Let me tell a story. I once took care of a 15-year-old patient who had been shot in his abdomen. He was walking back home from school passing by a gas station, and he suddenly found himself in the middle of a shooting. He arrived in an extremely critical state of hypovolemic shock. When I saw that boy arriving in the ER, his family was right behind him, and I saw the torment of that family. The patient was taken to the OR, and we identified that the bullet had penetrated the inferior vena cava. You clamp the IVC, you suture, you transfuse, and the patient gets out of the hospital in this seventh postoperative day. That to me is priceless and gives you the feeling that you have some sort of superpower. I don't expect surgeons to be some sort of God or divine presence, not even close. Just the feeling that you are able to help and change someone's destiny, that is the most wonderful feeling in the world.
Nevertheless, you will also come across many situations in which you can't do anything for the patient. So at the same time that it can be very rewarding, you also need to know that it can be very frustrating at times. That same boy that arrived in the hospital, I might have tried to help him and not have been successful. Therefore, you need to carry the good experiences with you. They are what make you wake up every day and go to work.
What were the main obstacles you have had to overcome throughout your career? Did you come across any barriers related to the fact that you were a woman pursuing a career in surgery?
I think it would be unfair to say that I didn't go through anything. Many important changes have taken place over the last years, which means that the context in which women in surgery train today is much different. But at the time when I was in residency, we suffered great pressure and discrimination. My resident colleagues, who were all male, wanted me to give up. I was the first woman to pursue and complete the GI Surgery residency in my institution. And at that time only exceptional surgeons could become GI surgeons. Therefore, it was believed that only men could do it. When I got in the program I once heard, "There were two other women who became surgeons before you, but none of them were able to do GI surgery, and neither will you." To me, this sounded like a challenge and only made me more eager to continue.
Although this type of pressure didn't prevent me from continuing, many women with the same potential gave up their training. What hurts me the most today is to see women that have been through similar pressure and discrimination, some of which I witnessed, denying it. It is as if they are trying to minimize something that happened to them that was extremely serious. If you deny your past and someone is going through some something similar today, they will not tell you and the situation will perpetuate. We have to talk about it so that it does not happen again.
I am very thankful that I was able to go the whole way. And ever since I became a professor and started training new residents, I have been trying to change this scenario. Women don't need to have any different behavior from men. Gender does not play an influence and everyone should to be just as good.
During your training, did you have any female mentors?
No. I wish! I looked at my attendings, all male at the time, and I thought they were good surgeons. Yet, I had neither a role model nor a mentor, and I definitely missed it. I still got where I wanted to be, but having some guidance would have definitely helped me save time and choose the best way to get there.
Much of your research focuses on medical education. In the OR, what do you believe are important ways to improve resident learning and training? What about engagement with medical students?
I love to teach. I am extremely happy being a surgeon, but I would not be complete if I weren't a teacher as well. Teaching completed me as a person. I believe that surgery and teaching should walk together. Surgeons should be always teaching and learning, even if they don't work in an academic center or in a place that demands them to teach. Surgeons should also know how to teach. If they don't have this ability, they should develop it.
I also don't believe in teaching with negative reinforcement. Even though my colleagues and I were trained in this way, I believe we would be much better today if we hadn't been. We got where we had to, but not through the best way of learning. And that is what I try to develop and show other staff – teaching with positive reinforcement.
If you are in the OR and you see that the resident is doing something wrong, you don't need to lose your temper. You should ask if they believe if it could be done in a different way instead of the one they chose, not focusing on the error, but transferring attention to the correct way in a smooth manner. The same should be done when teaching medical students.
When teaching is performed with positive reinforcement, fear is not generated. Fear is something very dangerous in medicine. If residents are afraid of you, they might do something wrong and hesitate to tell you. As a result, the well-being of the patient is put at risk, which should be the utmost goal of surgery and patient care.
What do you believe are important personality traits and characteristics in order to become a surgeon?
A surgeon should be passionate, proactive, and determined. You should like to see situations being solved in a more practical and objective way. In addition, it is also just as essential to be compassionate. You should always be able to put yourself in the place of your patient, student, or resident, and try to understand what that person is going through. Although surgeons may be seen as superheroes, they are also very human.
Despite what was believed in the past, being cold, stiff, restrained, and unemotional does not make one a good surgeon. It is the more of the opposite. If you show empathy to your patients and really try to improve their condition, that contributes to your will to help the patient, to research and to study as much as you can – not for your ego, but for the patient's well-being.
You are not allowed to cry during a surgery, otherwise you can't see the operative field, but if you drop a few tears later that is all right. That reminds you that you are human, it brings you closer to what is essential to you. And that is a great thing.
Lastly, a surgeon should be able to work in a multidisciplinary team. You should know that you are not alone. And this is something that changed exponentially over the past years. Back in the days, there was this idea that surgeons could do everything by themselves, which is certainly not true and only increases the chance of error.
Do you believe a surgeon's manual ability have more to do with talent or is it all related to practice?
Until not too long ago it was believed that a surgeon's ability was something innate. Either you are born a surgeon or you are not. Manual ability is not the major determinant of whether your will be a good surgeon or not, but rather the characteristics we just talked about. Will and determination, these are the characteristics that determine if you are born a surgeon or not.
Manual ability is something you acquire with practice. This is something that we widely discuss in medical education. Ability is something that can be developed in a surgeon-to-be. Some might take longer, or might need more time using simulators, but they all get to the same point of technical ability. What will make a surgeon stand out is what they needed from the start: the emotional and psychological abilities, and knowing how to work on a team.
Years ago, technical ability was the aspect on which people focused the most. Before the advent of simulation, manual ability was trained straight in the OR, in a patient, with negative reinforcement. That was a very inefficient form of teaching.
Having been through all you have until now, if you were to decide what career to pursue, would you have done anything differently? And what is your advice to women pursuing a career in surgery?
No, I would certainly have done it all over again. However, there were times I felt like I wanted to give up. So if I could go back and talk to myself at that time, I would like to tell her that it would all be ok. I knew that becoming a surgeon was not easy. But I didn't have anyone to tell me that it was very difficult to be a women surgeon but that at the end it would be all right. So that is what I would like to say to any aspiring surgeons that ask me that question.
Becoming a women surgeon is still harder than for a male colleague, unfortunately. Women still give up on becoming surgeons because they think it will be hard, that they won't be able to marry, have children, or take care of their houses. What I would like to tell them is that of course it will be hard, there is no way out. But it works out and you are extremely happy being a surgeon. If you give up being a surgeon to choose another career that gives you more home-time and that does not require emergency shifts, you might think you have everything that makes you happy, but there will always be something missing.
Camila Guetter is original from Curitiba, Brazil. She is a fifth-year medical student at Universidade Federal do Paraná, and the general coordinator of the Trauma Surgery Interest Group at the Hospital do Trabalhador. In her third year, Camila received a scholarship to study at University of California, Los Angeles. Subsequently she worked as a research student at Beth Israel Deaconess Medical Center (Boston, MA) on pancreatic cancer, HPB surgery outcomes, and patient education. Camila is passionate about pursuing a career in academic surgery and is very active in AWS. She is a member of the medical student, publications and communications committee.