Friday, July 25, 2014

2014 AWS Conference Details - SAVE THE DATE

Sunday, October 26 – Tuesday, October 28, 2014
Complete Brochure and Registration COMING SOON!


Sunday, October 26th | 2014 AWS Conference: Transitions – Thriving Amidst Change
Westin St. Francis | 335 Powell Street, San Francisco, CA
6:30 am - 3:00 pm 

Conference Highlights Include:
  • Sunrise Scientific Session
  • Medical Student and Resident Starr Poster Presentations
  • Green Solutions for the Operating Room Presentations  
  • Presentations: 
    • Challenges to Leadership in Surgery, Nancy Ascher, MD, FACS, University of California, San Francisco
    • The Changing Face of US Healthcare: How to Optimize Your Career, John E. Hedstrom, JD, American College of Surgeons
    • The Challenge: Transition to a Healthier YouCarol E.H. Scott-Conner, MD, FACS, University of Iowa Carver College of Medicine
    • Transitions and Resilience: Growing and Thriving Throughout Your Life and Career, Janet Bickel, MA, Janet Bickel & Associates, LLC
    • Directed Networking Sessions: Tools for Personal Success, Topics include: Strategies for Family planning, Work/life Balance; Success under Stress, Financial and Retirement planning, Private Practice: Navigating a successful career, Social Media “How-tos,” Alternate/nontraditional career paths, Successful negotiation strategies, Mentorship and Career advancement

Interested in participating in the 2014 AWS Green Solutions for the OR Contest? Click here for details. Deadline to submit is August 3, 2014.



Monday, October 27th | AWSF Awards Dinner & Reception
Westin St. Francis | 335 Powell Street, San Francisco, CA
6:00 pm - 10:00 pm  

The American College of Surgeons’ Women in Surgery Committee sponsors the reception for women surgeons attending the Clinical Congress and their guests. The AWSF Awards Dinner follows. The reception is complimentary. Individual dinner tickets must be purchased in advance. 


Tuesday, October 28th | AWS Networking Breakfast
Nordstrom Café| 865 Market Street, San Francisco, CA
8:00 am – 10:00 am          

Networking Breakfast for AWS members and non-members. No pre-registration required. The breakfast is complimentary.   

Hotel reservations can be made through the American College of Surgeons' travel agency. 

Stay tuned… a complete brochure and registration information is COMING SOON! 

Women Surgeon Leaders for the 21st Century

By: SreyRam Kuy, MD, MHS


Part I: The Status of Women in Leadership Roles, Changing Culture and Leadership Training



“If you're offered a seat on a rocket ship, don't ask what seat! Just get on.” -Sheryl Sandberg, Chief Operating Officer of Facebook, from Lean in: Women, Work, and the Will to Lead





“When you ask women, they do want these things [leadership roles] and they want them as much as men do.” - Patricia Numann, MD, Former President of the American College of Surgeons and Association of Women Surgeons Founder





“I used to walk down the street like I was a super star… I want people to walk around delusional about how great they can be – and then to fight so hard for it every day that the lie becomes the truth.” -Stefani Germanotta, entertainer known as “Lady Gaga”






Introduction

A century ago Orison Marden published, “How They Succeeded: Life Stories of Successful Men Told by Themselves,” describing the leadership and career success stories of prominent late nineteenth century US leaders such as Alexander Graham Bell and John D. Rockefeller.  Among these profiled nineteenth century leaders was Helen Gould, an heiress, philanthropist and a law school graduate.  Ms. Gould remarked upon the confines of nineteenth century America upon opportunities for upward mobility available to women, “I do not see, for my part, how any child from the poorest tenements could ever grow up and develop into strong, successful men or women…  And it is harder on the girls than the boys!  The boys can go forth into the world and probably secure a position… but the poor girls have so few opportunities.”  And yet, she had the prescient foresight to say, “But I don’t think it matters much what a girl does so long as she is active, and doesn’t allow herself to stagnate.  There’s nothing, to my mind, as pathetic as a girl who thinks she can’t do anything.”  A century later, the first woman to be inducted as president of the American College of Surgeons proved that “girls” can indeed do anything. 

Dr. Patricia Numann remarked on leadership roles that “When you ask women, they do want these things and they want them as much as men do.”  Clearly, there is a wealth of talent among women surgeons.  What is the status of women in leadership roles in medicine today?  And, what are the resources to assist women medical students, surgical residents and surgeons in advancing in leadership roles in their hospitals, communities, universities, and professional organizations?

The Status of Women in Leadership Roles in Medicine

In 1960, only 5% of medical students were women.[1]  Today, at least half of medical students are women.  Has the advancement of women in leadership roles in medicine kept up with the growth of women entering medicine?  In a cohort study of all US medical school graduates from 1979-1993, women were more likely than men to pursue an academic career (10% more women than would be expected with proportional representation of men and women, with women significantly over-represented among medical school graduates entering academic medicine).[2]  However, the percentage of women who advanced to associate or full professor were significantly lower than their male counterparts.  The percentage of women medical school faculty members holding full professorship has grown slowly over the years, from 7% in 1978 to 15% in 2005.(Nattinger)  This is in contrast to the fact that 30% of male faculty have held the rank of full professor consistently over this time period and that in 2005 only 11% of department chairs were women.  

Some of the factors that have been suggested for this gender disparity in leadership roles in medicine include less preparation for an academic career, fewer resources at the beginning of the career such as salary disparity either due to sexual discrimination or ineffective negotiation, lack of mentoring, less supportive institutional environment, and societal norms dictating home life and child care responsibilities which impact career trajectory.[3],[4],[5]  To close the gender leadership gap, a multifaceted approach is necessary.  A number of strategies have been suggested.  Changing the culture of medicine, disseminating knowledge about resources for leadership training, increasing awareness of promotion criteria, improving mentoring of junior women surgeons and developing negotiation skills are several other avenues that empower women surgeons in emerging as leaders in academic and organized medicine. 

Changing the Culture of Medicine

Valantine and Sandborg describe one institutional model which aims to change the academic culture to allow integration of work-life balance and flexibility policies into the promotion process, such as parental leaves and tenure clock extensions, which would enable institutions to better recruit and retain the best and brightest of both women and men.[6]  Fried et al. describe another multifaceted institutional intervention to address career advancement obstacles faced by women faculty.[7]  By targeting problem identification, leadership involvement, education of faculty, mentoring, reduction of isolation and increased integration of women faculty into the scientific community, they reported a significant increase in the number of women promoted to associate professor rank over a 5 year intervention period.  Other institutional change frameworks emphasize the need to increase the visibility of women and the work they do by tracking and publishing institution specific data on women in leadership positions and valuing women’s relational skills by training deans and other administrators to look for and recognize the value of women’s behind the scenes relational expertise in collaboration.[8]  The National Institute of Medicine (NIH) developed a tool to assess if an institution has a Culture Conducive to Women’s Academic Success (CCWAS).[9]  The CCWAS consists of four elements, equal access, work-life balance, freedom from gender biases and supportive leadership.  This can be a valuable tool for institutions seeking to reinvigorate their culture to enable women to flourish in academic medicine.      

Leadership Training

Sonnino describes valuable resources available for professional development and leadership training, available on the Association of Women Surgeons Website[10] and the American Journal of Surgery.[11]  These opportunities of professional development described include courses provided by the AAMC (Association of American Medical Colleges), the ELAM (Executive Leadership in Academic Medicine) program for women, ACPE (American College of Physician Executives) Leadership Development Program, Harvard University MBA training programs, and the Robert Wood Johnson Foundation Fellowships.  ELAM offers senior women faculty at medical and dental schools a year-long fellowship training experience to enable them to develop the skills need to competitively seek higher level administrative positions at academic medical centers.[12]  Research has demonstrated that women physician who participated in ELAM were more successful than non-ELAM women physicians in attaining department chair or Dean level positions.[13] 

Leadership training needs to begin early, in medical school and residency training.  Taking an active leadership role to enable effective teamwork and patient care during residency medical school is the training grounds the future surgical leaders.[14]  The American College of Surgeons hosts an annual Residents as Teachers and Leaders Course at their national headquarters in Chicago, Illinois at no cost to surgical trainees.[15]  Residents are taught effective teaching skills including learning how to give feedback to learners, establish time for teaching, and seeking teaching opportunities in the operating room and on the wards.  Residents are also taught techniques for successful leading such as conflict resolution, integrating diverse working styles, and leading productive teams.  The American College of Surgeons also has course of practicing surgeons, Surgeons as Leaders: From Operating Room to Boardroom.[16]  This three day course teaches surgeons about consensus building, changing culture, conflict resolution, emotional intelligence in order to have personal insight, and practical translation of leadership principles into daily action.    

By incorporating a multifaceted approach of fundamental change in institutional culture, leadership training, negotiation skills, development of mentoring relationships and awareness of promotion criteria, hopefully we can one day see more women surgeons following in the footsteps of Dr. Numann in leading our hospitals, communities, and professional societies.  Check out next month’s AWS newsletter to learn read the second segment of this two part article, “Women Surgeon Leaders for the 21st Century: Part II – Negotiation Skills, Developing Mentorship Relationships, and Promotion Criteria”.

Parting Thoughts from Women Leaders


“Always aim high, work hard and care deeply about what you believe in.  And when you stumble, keep faith.  And, when you’re knocked down, get right back up and never listen to anyone who says you can’t or shouldn’t go on.” - Hillary Rodham Clinton, Former US Senator, First Lady and Secretary of State



“I always did something I was a little not ready to do.  I think that’s how you grow.  When there’s that moment of ‘Wow, I’m not really sure I can do this,’ and you push through those moments, that’s when you have a breakthrough.” 
–Marissa Mayer, Chief Executive Officer of Yahoo



“As a leader, I am tough on myself and I raise the standard for everybody; however, I am very caring because I want I want people to excel at what they are doing so that they can aspire to be me in the future.” –Indra Nooyi, Chief Executive Officer of PepsiCo





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SreyRam Kuy, MD, MHS was born in Cambodia, grew up in Oregon, graduated from Crescent Valley High School as Valedictorian, and attended Oregon State University where she earned dual degrees in Philosophy and Microbiology.  Dr. Kuy’s passions are healthcare policy, physician leadership and health services research.  After college she worked as a Kaiser Family Foundation Barbara Jordan Health Policy Scholar in the Senate, writing speeches and policy briefs for Senator Tom Harkin on women’s health, coverage for breast cancer screening and treatment, and health care instrument safety.  She attended medical school at Oregon Health Science University, then finished general surgery residency in Wisconsin.  She earned her master’s degree in health services research at Yale University School of Medicine as a fellow in the prestigious Robert Wood Johnson Clinical Scholars Program.  She is also a writer.  Her first book, Soul of a Tiger, describes her family’s survival during the Cambodian Genocide known as the Killing Fields.  Her second book, 50 Studies Every Surgeon Should Know, will be released in 2015 by Oxford University Press and describes seminal research in the surgical field.  Dr. Kuy is an assistant professor of surgery at Louisiana State University and the Overton Brooks Veterans Affairs Medical Center.    



[1] Hamel M, Ingelfinger J, Phimister E, Solomon C.  Women in Academic Medicine – Progress and Challenges.  NEJM. 2006;355:310-312.
[2] Nonnemaker L.  Women Physicians in Academic Medicine: New Insights from Cohort Studies.  NEJM. 2000;342:399-405.
[3] Nattinger A.  Promoting the Career Development of Women in Academic Medicine.  Arch Intern Med.  2007;167:323-324.
[4] Bickel J, Wara D, Atkinson B, Cohen L, Dunn M, Hostler S, Johnson T, Morahan P, Rubenstein A, Sheldon G, Stokes E.  AAMC Paper:  Increasing Women’s Leadership in Academic Medicine: Report of the AAMC Project Implementation Committee.  Acad Med.  2002;77(10):1043-1058.
[5] Allen I.  Women doctors and their careers: what now?  BMJ. 2005;331:569-572.
[6] Valentine H, Sandborg C.  Changing the Culture of Academic Medicine to Eliminate the Gender Leadership Gap: 50/50 by 2020. Acad Med. 2013;88(10):1411-1413.
[7] Fried L, Francomano C, MacDonald S, Wagner E, Stokes E, Carbone K, Bias W, Newman M, Stobo J.  Career Development for Women in Academic Medicine.  JAMA.  1996;276:898-905.
[8] Morahan P, Rosen S, Richman R, Gleason K.  The Leadership Continuum: A Framework for Organizational and Individual Assessment Relative to the Advancement of Women Physicians and Scientists.  Journal of Women’s Halth.  2011;20(3):1-10.
[9] Westring A, Speck R, Sammel M, Scott P, Tuton L, Grisso J, Abbuhl S.  A Culture Conducive to Women’s Academic Success: Development of a Measure.  Acad Med. 2012;87(11):1622-1631.
[10] Association of Women Surgeons.  https://www.womensurgeons.org/CDR/AJSprofdevleadershiparticle.pdf.  Accessed 6/10/2014.
[11] Sonnino R.  Professional development and leadership training opportunities for healthcare professionals.  The American Journal of Surgery.  2013;206:727-731.
[12] Richman R, Morahan P, Cohen D, McDade S.  Advancing Women and Closing the Leadership Gap:  The Executive Leadership in Academic Medicine (ELAM) Program Experience.  Journal of Women’s Health & Gender Based Medicine.  2001;10(3):271-277.
[13] Dannels S, Yamagata H, McDade S, Chuang Y, Gleason K, McLaughlin J, Richman R, Morahan P.  Evaluating a Leadership Program: A Comparative, Longitudinal Study to Assess the Impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women.  Acad Med. 2008;83:488-495.
[14] Kiesewetter J, Schmidt-Humber M, Netzel J, Krohn A, Angstwurm M, Fischer M.  Training of Leadership Skills in Medical Education.  GMS.  2013;30(4).
[15] American College of Surgeons.  Residents as Teachers and Leaders Course.  http://www.facs.org/education/residentsasteachersandleaders.html.  Accessed 6/10/2014.
[16] American College of Surgeons.  Surgeons as Leaders: From Operating Room to Boardroom.  http://www.facs.org/education/surgeonsasleaders.html.  Accessed 6/10/2014.  


Thursday, July 24, 2014

Running a Multi-Disciplinary Breast Center

by: Holly Mason, MD FACS

One of the great challenges and great accomplishments of my career has been the oversight of the Baystate Breast & Wellness Center. Under one roof, patients can undergo breast imaging, breast surgery consultation, plastic surgery consultation and high risk assessment. Patients with cancer are transitioned to medical and radiation oncology at the Cancer Center at the appropriate time. The sum of all of this is that coordination of care is needed between multiple specialties, providers and staff all while respecting the patients emotional needs and desires. The presence of nurse navigators significantly improves this coordination of care and lowers the anxiety of the patient as they now have a guide to lead them through the care process. Finesse and patience is required when dealing with the specialties; I am a surgeon and may not understand why a specialist has to do things in a certain way or why the process takes a certain amount of time. I simply want things done (that is the surgeon in me). As a surgeon in a leadership position, I need to temper the surgeon part of my personality to give the collaborative part of me a chance to succeed.

We live in a time of change and our practice needs to keep up with that change. The purpose of our clinical steering committee is to delve into the processes of the Breast Center to sort out those that work both for the patient and the institution and those that do not. Our leadership team regularly looks at metrics to ensure that our access rates are appropriate and that our imaging meets or surpasses national standards. It is necessary to look at the financial impact of the choices we make and the tests that we order. No other specialty highlights this challenge quite like breast cancer care. We have advanced technology to evaluate patients but it is necessary to choose wisely what is indicated medically and what is not to keep costs under control. We can’t order a test just because we can. We have the surgical skills to treat the breast in the form of the patients choosing, but, as recent data shows, there is significant cost both to the patient (increased complication rates for patients undergoing bilateral mastectomy and reconstruction, for example) and to the health care system. Most of my hour-long visit with a breast cancer patient is spent trying to find the correct balance for the individual patient that optimizes cancer care and minimizes risk.

I am fortunate to work with providers as passionate about breast cancer as I am. Our multidisciplinary team meets regularly to review protocols and practices to ensure that we are keeping up with the rapidly changing world that is breast cancer care. Together, we strive to provide high quality efficient care that can work in a changing cost-control environment. As a surgeon in a leadership position, I balance the need to keep a “big picture” view of the impact of our patient care choices with the maintenance of an active clinical practice.  I wouldn’t have it any other way.


Dr. Holly Mason is the Director of Breast Surgical Services at Baystate Medical Center in Springfield, MA.  She is also the Co-Medical Director of the Baystate Breast & Wellness Center.  Besides her specialized work in breast surgery, she enjoys time with her husband and two daughters and tries to remind herself to take a deep breath every now and then to enjoy the world around her.

Wednesday, July 23, 2014

Sisters by choice: A community Woman surgeon leading charity since 1989








A native Georgian, Dr. Rogsbert F. Phillips-Reed is a general surgeon specialized in breast surgery. I had the pleasure to meet her last week and was inspired to write about her great work.When I first mentioned Association of Woman Surgeons (AWS), she smiled mischievously and recalled as being one of the first few AWS resident members.

She graduated from Columbia University School of Physicians and Surgeons in 1977 and in 1982 became the second woman and first African-American woman to successfully complete Emory University's surgical Program. When she started her general surgery practice, majority of her referral was Breast related. She welcomed all patients alike and gave best care possible. Over a period of time she was successful in building a  very broad based general surgery practice. Her caseload ranged from Hernias to Whipple. All that only inspired her to learn more, do better and keep up with new innovations in surgery. While midway in her practice, she trained herself to do complex laparoscopic as well as oncoplastic procedures. Forapproximately 30 years she has practiced medicine in metropolitan Atlanta area, serving a diverse patient population. Today she heads Metro Surgical Associates, a community-based surgical practice with offices in downtown Atlanta and Lithonia.

Georgia ranks 10th in population among the fifty states, but 40th  in physician supply per 100,000 population. In fact, latest figures tell us that 15% of Georgia's population is medically underserved for primary care. Access to more specialized services is even worse. Since majority of  Dr Rogsbert-Phillips's practice was breast related she soon realized the need for programs that would not only increase public awareness of breast cancer but also bridge the gap in care. So, in 1989 she founded Sisters By Choice (SBC). Initially formed as a support group for women diagnosed with breast cancer and their families, SBC has evolved into a multi-faceted organization serving women in Georgia.SBC provides over 800 free mammograms and breast exams to uninsured, unemployed and homeless women each year as well as free educational seminars, workshops, and health fairs to promote breast cancer awareness.

Realizing that there are health care disparities surrounding access to quality breast care in rural Georgia; Dr. Phillips-Reed has started an initiative to address this disparity by developing a Mobile Breast Clinic. This unique mobile breast clinic will facilitate remote screening and diagnostic services. It will provide screenings, diagnostic services, treatment referrals, education and access to clinical trials to medically underserved men and women in rural and urban Georgia. This complete diagnostic care will make this clinic historic. It will be the first of its kind in Georgia, and among the first in the nation.

I was pleasantly surprised to see how much her patients admire her for her care and compassion. One can also see that most of her family and friends either work or volunteer at her practice. Of all the people, her husband Mr Reed and son Kasim Reed Mayor of Atlanta, are one of the biggest supporters of her mission. With pure good intentions, she has not only earned loyalty of her patients but devotion of her family for a cause that is dear to her. She has proved that all it takes is one dedicated woman community surgeon to change the way care is provided to vast section of the community underserved or uninsured.
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Bharti Jasra is a Breast Surgical Oncology Fellow at UTSW 2014-2015. She completed General Surgery residency at Saint Louis University Hospital in June 2014.

Tuesday, July 22, 2014

Adding a Business Degree to Your Repertoire

By: Christina Cellini, MD, FACS, FASCRS

We’ve all heard it before – “medicine is a business.”  While it sounds distasteful to some, there is no denying that this is true to a large degree - more so today than ever before.  “Accountable Care Act,” “Value-based purchasing,” “Accountable Care Organizations,” “Pay-for Performance,” the list goes on. 

How many of you truly understand these terms?  How well do you understand that monthly profit/loss statement you receive from your department administrators? Many hospital systems are merging- how well do you understand the implications of this on your practice?

I, like many, started my career out of fellowship assuming that all I needed to understand was how to care for patients and not worry about all that other “stuff.” In my opinion, other people were hired to focus on the “business stuff.”  However, I slowly came to the realization that it is crucial to understand the organizational structure of my institution in order to be able to mold my career into what I want it to be and continue to provide my services in a manner that is most beneficial to my patients as well as to myself.

First, I had to understand the “language of business.” Much like how we are all fluent in medical speak, hospital administrators have a completely different way of analyzing and relaying information. I was fortunate that my university offered a part-time Masters in Medical Management – somewhat like a Masters of Business Administration but geared towards examples in the medical field. The program was 18 months long – a year of night and (long) weekend classes plus a 5-6 month team project culminating in a presentation to hospital administration. The program also offered the opportunity to use the credits towards a full MBA later. Courses included health care marketing, managerial accounting, finance, economics, health care operations and organizational theory and design.

My experience being back in school with a new family and career was interesting to say the least. It definitely helps to have a hands-on spouse who is already used to long hours of work and time away from home. I was also quite nervous about obtaining passing grades having only been immersed in science courses during my educational years without having ever taken a business or finance course. However, I was able to acclimate quickly especially with the help of my classmates who were also employed in various health-care related fields. The experience was invaluable. I learned a new “language” and understanding of organizational processes that affect us daily. This in itself makes me unique as someone who can translate for other colleagues. In addition, the business school model works via a team structure where all assignments and projects are prepared and graded in 4-6 person teams.  While this clashes with our traditional medical training in which tests are graded and performances are evaluated on an individual basis, it gave me the opportunity to work with different personalities and learn to manage diverse teams to produce excellent results.  

I highly recommend looking into your institutions or nearby universities for similar programs. The American College of Physician Executives is a great resource for programs, either live or online.

There is a considerable time commitment with obtaining a Masters degree but the long term benefits are huge whether it’s just to be able to understand and contribute to administrative meetings/conversations or if your goal is to become a physician executive.



Dr. Christina Cellini is an Assistant Professor of Surgery and Oncology at the University of Rochester Medical Center in the Division of Colorectal Surgery. After obtaining her undergraduate and medical school degrees at Cornell University she trained in general surgery at the NewYork Presbyterian Hospital-Weill Cornell Medical Center. Following residency, she completed a fellowship in Colorectal Surgery at Washington University in St. Louis. She recently completed a Masters in Medical Management at the Simon School of Business at the University of Rochester. She lives in Webster, NY with her husband and 2 children and enjoys running and snowshoeing in her free time. Dr. Cellini serves on the AWS communication committee.  

Thursday, July 17, 2014

Sub-internship Success: A How-to Guide

by Callie Thompson, MD and Jane Zhao, MD

For those who are not familiar: A sub-internship is a rotation that a medical student does, in their fourth (and last) year, in which they are expected to function as an intern. We lovingly refer to such a person as a sub-I, sub-intern, or acting intern. Usually, at least one of these rotations is done at an outside institution. And typically, this is considered a month long job interview.

What follows are our tips/suggestions for a successful rotation.

Keep in mind that these are general guidelines, and that each medical school will have slightly different expectations of their surgical sub-interns.


Away rotations: Only do a sub-internship at a place that you might want to train at for residency if you are ready to work, work, work. This is your chance to knock the socks off the people you are working with. You need to show them how good you are and they need to come away from it thinking "we want her/him in our program." Because of these odds, many attendings and residents will tell you that the underwhelming returns of matching at a program where you have completed an away rotation are not worth the amount of money and effort you pitch in.

On the other hand, do an away rotation if you want to take advantage of the opportunity to gain some perspective on how residency programs may differ and which characteristics of a program you absolutely need and which you may be willing to sacrifice when push comes to shove, e.g. location, demographics, prestige. Furthermore, obtaining a letter of recommendation from an away rotation is a great way to gain invitations to programs that typically only interview regional applicants. This holds especially true for those who stayed in one location from undergraduate and medical school and have a desire to move elsewhere for residency.

Another word on away rotations: Do not ever turn down an away rotation you applied for at a hospital where you would like to interview for residency. Turning down the opportunity to visit a program for a month after you have taken the time to apply for it and after the program has taken the time to approve you is the single quickest way to blacklist yourself from the program when interview season rolls around.

Scheduling and letters of recommendation: Generally speaking, the earlier you schedule your sub-internship the better because most students take advantage of this time to also ask for letters of recommendation from faculty members they work with. Make sure the faculty member knows you, make sure they are going to say something good about you, and give them enough notice so that they aren’t rushing to meet a 48 hour deadline. Thus, July, August, and September are prime months. Keep in mind that if you schedule your rotation in the midst of interview season, you may have to request numerous absences, which will detract from your experience and even possibly reflect negatively on you. Scheduling a sub-internship earlier in the school year also provides faculty who have worked with you a greater level of comfort to advocate strongly for you if programs use a democratic process to create their rank list. This comes in handy if you absolutely need to match to a particular program or city.

Choosing the site of your rotation: Numerous programs request a letter from either your medical school’s chair of surgery or program director. If you haven’t had the chance to meet with either of them during other occasions, you may want to figure out which service they belong to, and try to rotate through there.

Given that a good surgeon should also have a firm understanding of medicine, a strong letter from a respected attending from a different department such as internal medicine can also go a long way in making your application shine, so if you have enough time, it certainly would behoove you to attempt a sub-internship in medicine.

A sub-internship is also a great chance to try out a particular surgical subspecialty you might be interested in pursuing further down the road, e.g. colorectal, trauma and critical care, or pediatrics. If you end up falling in love with it, you now have a stronger incentive to match to certain programs, or if you end up hating it with a passion, you have saved yourself from years of potential misery.

Set yourself up well: This starts by developing a full understanding of the dynamics of the system setup and the people on the service you will work with. Will you be working on a high-volume service with fast turnover? Will you be working on one where the norm is one to two elective cases every other day? Are the attendings known for their Socratic style of teaching? Do the residents go out of their way to include students in the work up of patients? Play to your strengths, particularly if you are trying to obtain a letter. Some sub-interns’ strengths come out in chaotic situations, when their reliability and collected composure are a sweet breath of relief to ragged residents working in a hectic environment. Some sub-interns love being pimped and shine best when being grilled with question after question while their classmates stare gape-mouthed and hopeless. Do you rock at presenting and working up patients? Are you better with procedures? Figure out how your strengths will complement the needs of the service you are joining, and make sure you choose and prepare accordingly. For better or worse, your performance will be evaluated subjectively, and it doesn’t take much for a poor impression to be wrongly formed of a usually wonderful sub-intern or a positive one of an otherwise average sub-intern.

Eliminate distractions: This is your opportunity to take on the responsibilities of an intern. Help manage the list. Know every patient. Unlike your third year clerkship, you do not have assignments or a shelf exam to worry about during your acting internship (disclaimer: this is not true at every medical school). Plan out your year to avoid having to work on your personal statement, ERAS application, away rotations, scheduling interviews, or study for the USMLE Step 2 during this time. You can take full advantage of the freed up time to play an active role on the team and gain more hands on patient care experience.

Presentation: If you are expected to give a presentation (many rotations require them), get started on it early, and identify both a resident and a faculty member to advise you. Be sure that you already have an idea in mind before you speak to them and get your presentation done early enough that they can help you make improvements if need be.

Prioritizing: A real intern probably spends more time on the wards than in the operating rooms, while a third year medical student gets the best possible snapshot of what it’s like to be a surgeon by being in the operating room whenever possible. What’s a sub-intern to do? As a fourth year medical student, you are somehow expected to find the happy medium between both.

Some pearls:

You need to be able to function like an intern which means you need to have a good idea of how to manage your time and balance multiple patients at a time. You aren't a third year student anymore, so you need to carry more than two to three patients at a time. Ideally, you should know the entire service, just like the intern does. Even if there is a third year medical student on your service, you should know everything about their patients too without stepping on their toes.

In the mornings, do your best to help the third year medical students and interns collect vitals and pre-round on patients. Chat with the nurses and ancillary staff for events that occurred overnight.

For rounds, you will most likely follow steps for success that won’t have deviated much from your third year clerkship: Carry marking pens, suture removal kits, gauze, tape, and consent forms in your pockets. Split up patients with the other medical students on your team, and take down dressings on all patients who are postop day two. Have a penlight at the ready to shine on the incision for your resident to have better visualization. Propose alternative treatments for patients who appear to quickly be running out of conventional options. And so on.

Go into the patient’s room with the senior resident or fellow, and gain a sense of what the plan for that day will be. You have no idea how helpful you can end up being when you run the list with the other junior residents later or when you spare the time to follow up on labs and imaging while the rest of the team is occupied handling tasks that only they can do with the MD or DO behind their name.

The intern may not be able to make time to be in the operating room, but you do. Since you are a sub-intern and not an actual intern, your priority is to get the most of your undergraduate medical education. However, you should be demonstrating your ability to be an intern in less than a year so don’t ignore the floor work. Also, not helping the intern and going to the OR the entire time will be noticed and not in a positive way since that isn’t really the function of a sub-I.

When you do go to the operating rooms, first (as always) you must know the patient you are operating on. Help roll the patients into and out of the rooms. Retract. Answer questions about anatomy, pathophysiology, ethics, or whatever else the attending or resident wants you to answer. Drive the camera. Again, this part won’t be much different from when you were a third year medical student. Let third year medical students have opportunities to scrub into cases you have seen before. If you desperately want to be involved in a case, and there are two students, ask the attending if both of you can scrub. Teach the third year medical student basic skills, and share opportunities to do procedures in the operating rooms and by the bedside with them. You had great residents and sub-interns when you rotated through that made surgery rock your world. Now it’s your turn to pay the favor forward.

If the team is short-staffed, your priority is to take care of the floor patients or clinic patients depending on where your are assigned. If you are done with your tasks on the floor, then make your way to clinic (even if you weren’t assigned), and see patients and present to the attendings. Come up with plans for the patients. Look out for your third year medical students and have them present to you before they present to the resident/attending, and help them polish their presentation.

Be proactive rather than reactive, and let your residents know what you are up to, especially once you have completed a task. If you ask if you can do anything to help, they will invariably reply, “No thanks. You really don’t have to. Seriously.” So if you see that they have a million and one tasks to complete, take the initiative to tackle a task within your ability that doesn’t put patients at risk, and provide your upper level with the completed result. That is the difference between a stellar, unforgettable sub-intern and one who is great.

Ask for help when you are unsure, and take advantage of this time to ask questions that may seem silly or dumb. Now is the time. While it sometimes may not seem to be the case, you shouldn’t be expected to know everything about surgery. Residency is after all a training process. It’s better to clarify what you don’t know now, rather than wait later when you have actual responsibility over patients.

Remember, not always knowing the answer is forgivable. What’s important is being reliable and teachable. Surgery is one of the most exhausting specialties out there, and not everyone has the physical or emotional fortitude to pursue the field. This has led to a phenomenon where even 80 hours per week are sometimes perceived as not enough. Thus, we don’t think we’re remiss in stating that a honest hard worker of above average intelligence is often preferred over a genius who can’t be relied on, a statement true for most walks of life but one that sub-interns should particularly take to heart.

Read: Just because you don’t have a shelf exam to prepare for anymore doesn’t mean you should stop studying. Read up on your patients. Find relevant articles. Create treatment algorithms and cheat sheets.

There are some folks who function well on three hours of sleep. If you are not that type of individual, give yourself permission to crash when you return home in the evening. Instead, set aside time early in the morning to jot down notes about the patients who will be operated on for the day. Be smart about it. If there are too many cases for you to scrub into, and you’re pressed for time, then concentrate on those whom you know for sure you will be operating on. For those patients, know the following:

o pertinent details from patient’s history, labs, and imaging

o indications for the operation

o crucial anatomy and steps of the operation

o possible short-term and long-term complications

o important details of perioperative management

Hopefully, if you have read up about each patient prior to their operation, then as the rotation goes on, you will be able to anticipate the general management and time course of all the patients on the service during their post-operative stay in the hospital.

Share what you have learned with the other medical students on your service. It helps guide their studying and cements the knowledge further in your mind. Remember the big picture. By helping others, you indirectly improve the care of those patients who will be one day be treated by other members of your team.

Pay it forward. Take the third year medical students under your wing. Teach them how to tie surgical knots. Share with them stories of your own frustrations and triumphs from your time as a third year. Remind them to eat. Buy them coffee, or share a granola bar. Help them with their presentations. Let them know when it is okay to text the upper level and ask, “is there anything else I can do to help?” which we all know is universal student code speak for “may I please leave?”

Lastly, if you really want to stand out, give the sub-intern and third year medical students who will trade you out for the next month a heads up about what to expect once they come onto service. This will make not only their lives easier but also relieve a weight off the shoulders of your upper levels. Your patients may even benefit from safer care.

You will impress everyone if you show them how helpful and kind you are to others, even when it doesn't directly benefit you.

In conclusion:
what does it take to succeed as a sub-intern? If you can in anyway make the service run as smoothly as possible and life better for the residents then you can be rest assured that you’ve done a good job.

Did we miss anything? Let us know your own suggestions for sub-internship success in the comments below.

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Medical students, click here for more information on how to succeed on your third year medical student surgical clerkship.

Surgical interns, click here for advice on how to build the foundation for future success by starting off intern year the right way.


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Callie Thompson is a chief resident in general surgery at the University of Washington. Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children ages 1, 3, and 7.

 








Jane Zhao is a general surgery resident at the University at Buffalo, State University of New York. She obtained her medical degree with a scholarly concentration in Clinical Quality, Safety, and Evidence-based Medicine from the University of Texas Medical School at Houston and completed her undergraduate studies in Medicine, Health, & Society at Vanderbilt University. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award and chaired the AWS Blog Subcommittee from 2013 to 2014. Her interests include healthcare social media, quality improvement, and public health. She can be followed on Twitter.



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Thursday, July 10, 2014

Mentorship

By: Shilpa S. Murthy, MD, MPH

Socrates mentorship of Plato lead to advancements in philosophy and science. William Halstead’s mentorship style, based on Socrates’ teaching methods, lead to Harvey Cushing’s success in creating the field of neurosurgery.1For centuries, mentorship of surgical trainees has been critical to progressing the field of surgery. Strong mentorship and devoted development of a surgical trainee can lead to advancement and innovation in the field.  As a medical student, one may not anticipate the crucial role a mentor plays through transitions in their career. A trainee goes through three transitions where guidance is critical to the development of a skilled surgeon:  the transition from medical student to surgical resident, surgical resident to surgical researcher, and resident to surgical attending.  All three transitions come with their own challenges as well as rewards.  During these phases, it is important to gain direction from knowledgeable individuals who already experienced these transitions. They will guide trainees through un-anticipated challenges. Similarities in personality and background are important in mentorship interactions but common goals and values create a successful relationship.  I was fortunate to meet three mentors whose life’s work aligned with my own goals of training the next generation of physicians and reducing the inequalities in health care.

In 1998 the percentage of female surgeons was 21.8% and in 2008 that number increased to 32.3%.2In a field where the female voice is sparse and still growing, strong female mentorship can be fruitful for young women surgeons.  In medical school I was fortunate to have a female mentor who was a dean and pediatrician who shared a passion for medical education. Few women in science have been able to reach the prominent academic position she holds.  As a professional woman, she experienced the unique challenges that women face as they continue to advance professionally in the medical field. With her female voice, guidance, and insight borne from years in the profession, I have been better able to navigate my career as a surgeon. The female perspective is important for women in medicine, but excellent mentorship comes from both genders.

During my research years as a surgical resident, I am pursuing oncology projects in Rwanda in global surgery. Making waves to define a new academic field, global surgery, can be rewarding but extremely challenging. It is complex since there are numerous cultural and ethical issues. I am privileged to be mentored by a surgeon who is a pioneer in the nascent field of global surgery. Modeling his cross cultural interpersonal communication skills and sharing our passion for equity in surgery, I have been able to successfully develop a breast disease training course with my Rwandan colleagues. But even with this success, the field is severely underfunded and due to funding challenges our projects almost fell through. However, his guidance and experience on how to navigate philanthropic meetings and administrative hurdles ultimately led to successful outcomes. His kindness, altruism, and passion towards reducing inequities in surgical care globally is to be modeled and commended.

During surgical residency, a trainee also needs a mentor who is invested in developing their technical and cognitive surgical skills. In my clinical residency program, I met a hepatobiliary surgeon who has pushed me to strive harder. His engagement and experience in my development has been un-wavering through professional and personal hurdles. I always trust his advice because I know it is coming from someone who truly cares about me.

Although each mentor has a slightly different background than my own, pieces of their personality, experiences, and backgrounds resonate with me as an individual. Their trust and belief in me has led to fruitful relationships and they are like family. My mentors have been crucial in my transition from medical student to surgical resident and as a surgical researcher. Their un-wavering support during hurdles I didn’t anticipate have strengthened our bonds. Recognizing my passions for surgery, education, and equitable care for impoverished populations they are guiding me towards concrete goals that will hopefully make a lasting contribution to society. While the line of Socrates mentorship continued in Plato and eventually worked its way to William Halsted and Harvey Cushing, so too will the teachings of my mentors. I hope to pass on our shared values, goals, and their kindness to those I mentor in the future.

References
1.) Assael, Leon. Every Surgeon Needs Mentors: A Halsteadian/Socratic Model in the Modern Age. J Oral Maxillofac Surg. 68:1217-1218, 2010.
2.) Association of American Medical Colleges Accessed June 6, 2014 https://www.aamc.org/download/53502/data/wimstatisticsreport2009.pdf


Dr. Shilpa S. Murthy is currently a second year research fellow at the Center for Surgery and Public Health, Brigham and Women's Hospital in Boston, Massachusetts. She recently completed her MPH at Harvard School of Public Health and has interests in global surgical oncology, surgical disparities, and medical education. She is a general surgery resident at Indiana University.