Wednesday, April 22, 2015

Having it all means having good physical, mental and spiritual health, too!

by: Marie-Christine Wright, JD

“I’m discovering that women can have it all, just not all at the same time.” If we can’t have it all at the same time, is there always room for wellness, and what does being well really mean? There is the obvious answer: physical health. But in addition, we must nurture our mental and spiritual health. A surgical career requires nurturing, but so does a human being: how do we do both, without compromising either? 

First we must view our life’s path in two timelines: the daily minutiae and the long-term. We want to exercise and eat well on a daily basis, which seems impossible when one has all but 10 minutes to shove hospital cafeteria food in one’s mouth, spends 12 or more hours on her feet rounding or in the OR, and has to keep up with her field by reading after work. When are you supposed to exercise if you are in the hospital by 5:30 am and home after 8 pm? While you may not have time for a gym session, you can execute a simple routine at home, whether it’s a brisk jog, yoga, or stretching. Take the stairs at work. Invest in healthy snacks that you can bring to work to prevent cafeteria binging, and spend the extra money to buy healthy prepared meals that are easy to warm up at home, rather than getting take out. Or, just prepare large batches of healthy fare once a week (if you’re like me and easily get bored eating the same thing, freeze single portions of several large dishes so that you can defrost something different each night). 

Admittedly, as a student, fitting in exercise and preparing one’s meals is much more doable. An hour of exercise can actually help break up a marathon study session and refresh the mind. And better eating translates to better thinking. Beyond exercise and eating well, spiritual nurturing comes in the form of community service. I always feel lighter and more fulfilled after spending time helping the community, whether I am assessing inpatients at the local drug abuse recovery shelter, or working on art projects with children. Your community service can, but does not have to, be medical in nature, especially if you have outside interests (side note, having outside interests makes you more interesting as well!).

Long-term, mission trips are important humanitarian work that not only benefit the community you are servicing, but help fill the well of your soul, too. One of the members of the AWS Medical Student Committee, National Chair Carla Valenzuela, recently traveled to Kenya to assist with a Head and Neck surgical mission.  She described her experience as life-changing: “I would recommend a mission trip to anyone in medicine—it opens your eyes to health disparities and how much you can accomplish with patience, thinking resourcefully, and working as hard as possible to improve patient outcomes in a place where there are limited surgical subspecialists.” 

Medical schools are generally supportive of such trips, and students should not be afraid to ask for excused absences and flexibility to accommodate such essential experiences. Residents, too, will find their institutions supportive in planning around mission trips; you just have to know how to formulate your request. If you need to get away and recharge your batteries, take advantage of vacation days. Ultimately, being healthy requires that one set boundaries to protect life outside of work. From a resident’s perspective, “A lot of us lose some of our outside selves to medicine, and we are doing okay, but we could be doing so much better. We shouldn’t just accept ‘okay.’”

Marie-Christine Wright, JD is a medical student at Tulane and the National Vice-Chair of the AWS Medical Student Committee. A nontraditional second year student, Marie-Christine founded a financial firm in Switzerland and obtained her law degree before attending medical school. She has long been interested in pediatric neurosurgery and looks forward to empowering women to pursue careers in surgery.

Interview on Mentoring with Dr. Angela Neville

by: Dr. Angela Neville, MD and Medical Student Katherine Jeffress, MA, MPH

How have mentors positively impacted your career?

Mentors have probably most impacted my career by being examples - good examples.  :)  I feel that my mentors have helped and continue to help shape my career (and sometimes personal) path.  
Originally, my mentors helped me choose a career in medicine and subsequently in a surgical specialty. By finding people that I could identify with and learn from, I was able to begin molding myself to "be like them." My career mentors were initially all men, because there were no women on my immediate teaching faculty.  My junior chief year, my residency finally hired a woman who was wholeheartedly part of our residency.  It was life changing to have a woman to aspire to be like. It was life changing to see male residents respect and feel that a woman could teach them something!! That being said, I feel that women can certainly have both men and/or women mentors.

Ultimately, my mentors continue to impact my career by being there and caring about me as a person. If I have a question about a career decision, I know that my mentors will "have my back" and advise me in a positive way.

What have you learned through your mentoring experience?

I have learned that we all have insecurities and vulnerabilities, but that we are all just trying to be the best we can be. This is true for both men and women. Even the most outwardly accomplished person has their struggles about something and needs to be given the space to ask that question or explore their self doubt.
The majority of the students / residents that have sought out my advice or opinion tend to be women, but I think that is because women tend to look outside of themselves and try and figure things out. I have perhaps been most touched when one of our male residents comes to me asking about how to handle a difficult emotional situation or what operation he should do. It reminds me that being open, approachable, and demonstrating sound judgment makes people feel comfortable asking for help when they need it. This is a huge part of being a good mentor.

What has surprised you about being a mentor?

Maybe, how important this role is to me. Sometimes, when I have thought about leaving academic medicine, the one thing that holds me back is the concept that I can be a role model of strength, competency, and compassion to both men and women and students and residents alike.  
As I mentioned before, there was a single woman surgeon at my teaching institution. Since that time, obviously, more and more women have joined teaching faculties across the country, but things are far from equal and there are still many stereotypes about women in surgery. I can remember when one of my female fellows (when I was a resident) told me she would rather be operated on by a man... Really!?! Men can be good and women can be good, just as men can be crappy and women can be crappy. I am compelled to see that we are evaluated (both in our hospitals and in the community) on merit more than gender. 

How do I get the most out of mentoring?

Keep your eyes open, find the right mentor(s), and learn something from everyone.  
Every surgeon that I encountered during my training taught me something. Sometimes, it was by watching them interact with nursing staff or how they carried themselves in the OR during a crisis. Other times it was by seeing how they discussed a complication with a patient's family member. When I saw something from that person that resonated with me and the surgeon I wished to become I tried to align myself with that person. This concept can work both professionally and personally. Conversely, I think there are also some "anti-mentors" out there -- people who you really want NOT to be like!!  Like I said, learn something from everyone.  

What should a mentee look for in a mentor?

I would advise finding a mentor who you truly feel has your best interest at heart. Sometimes, this relationship takes a bit of time to develop, and you may need to put out a few feelers, but it is worth it in the end. Find a person who you trust so that you can be vulnerable without feeling uncomfortable or that your trust will be violated. Several mentors may be needed to fulfill different needs.  For example, maybe you have really identified with a faculty member about how to achieve in the realm of research / academic medicine, but you seek a different direction in your personal life. Another mentor could be particularly useful here. The bottom line is that a good mentor will care about you.

Why do you believe mentoring is so important?

A career in medicine is not 'normal' in many ways. Doctors choose a different way of life. While many people out there have several careers in their lifetime, many of us chose medicine in our 20s and have not looked back. We went to school for years and accumulated significant debt. Maybe we delayed marriage or children for our career. Maybe we have neglected family and friends. More over, a surgical career can be exceptionally demanding and requires a constant giving of self.  

I feel like mentoring is incredibly important because it helps normalize this unique career path and offer advice that we cannot seek from people outside of this realm. My parents to this day do not understand what happens when I am on-call. "You mean you are spending the night in the hospital?" Mentors can provide insight about all aspects of life as a surgeon. Just the other day, I had one of our most accomplished (and intimidating) orthopedic surgeons give me sage advice about how to balance a busy life in surgery with a young child at home (my first and only son is 16 months old). I was amazed that he wanted to take a moment to pass on his experience to me, and it was particularly valuable. He is certainly someone that I felt it worthwhile to listen to, and his words have made me reevaluate my current actions. Mentoring can often help one work through all sorts of on the job struggles (am I doing the correct operation, should I look for a new job, how many days will I need for maternity leave, etc).  

What advice do you have for future mentors?

My biggest piece of advice is to NOT advise, but to allow the mentee the freedom to make the decision they want to make. People know what they want. They know what is important to them. For some, it is to be the next president of the ACS.  For others, it is to be closer to their family and work shorter hours. Both of these options are OK!! I feel like good mentors ask the mentees the right questions so that the mentee can come to their own truth. Often it involves giving the mentee the confidence to make their own decisions!!  

I can recall several students in my office in tears because faculty had told them they should really pick a certain specialty but they didn't want to do that and were afraid of disappointing people. Or a resident in serious angst because somebody told them to rank a certain fellowship first, but they really didn't want to go there. For the love of Pete!! It is their life. And we are more influential than we think. Those students or residents (and their family and friends) are the only ones that are going to have to live with their decision when they are long gone from our training institutions. How dare we put our personal biases on their life decisions?  

I guess I am just saying, be careful when you are mentoring. Mentors can be very influential, and I think it is extremely important that we are guiding our mentees in a direction that they truly want to go and not in a way that simply will be pleasing to us.

What do you think are the characteristics that make a good mentee?

This is a really hard question for me because there are so many types of mentoring relationships. I feel I have had many transient interactions with students or residents that came and went, but hopefully in that moment, I was a good mentor. So for those interactions, being a good mentee meant having the courage to come forward and ask the important question for one’s self at that time. 

In some of my more lasting mentoring relationships, often the mentees had some similar qualities to me and we were able to truly get to know one another. In this way, I knew what drove them both professionally and personally, so I was able to help guide decisions in the correct way. Thus, I am not sure there is a characteristic that makes one a "good mentee," but feel that the relationship you have with your mentor should come naturally with the right person.

I guess my one plea is patience with the mentor. (For example, it has taken me longer than I expected to do this blog. :/)  We are all insanely busy, so respect that when you approach a mentor for advice you need to make sure you try and give them the time and space to help you. I will always put my work down for a few minutes to help my mentees, but I may need to reschedule to really get down to the nitty gritty of the problem. I have always been incredibly grateful when my mentors have made time for me, but I try and make sure I make this exchange convenient for them. 

Final thoughts...

At the end of the day mentoring helps develop relationships in surgery that can last a lifetime.  These relationships are rewarding to the mentee through their successes and the mentor who can watch with a smile as their mentee achieves. Mentoring humbles us as we help people through crisis and comforts us when our time of need arises. For me, mentoring is often a friendship that develops with another in a different life phase, but once established can certainly outlive the confines of that original setting.  A special thank you to those who have and continue to mentor me and to my mentees who continue to enrich my life. Thank you to my student, Katherine Jeffress, who asked me to do this post. And thank you for reading. Best wishes for a healthy, happy life.

Dr. Angela L. Neville, MD is a practicing surgeon in the Division of Trauma, Acute Care Surgery, and Surgical Critical Care at Harbor-UCLA Medical Center. She is also the Interim Program Director, General Surgery Residency at Harbor-UCLA Medical Center, and an Associate Clinical Professor of Surgery at David Geffen School of Medicine at UCLA.


A Different Kind of Mentor

by: Kathryn Hughes, MD, FACS

Mentorship in medicine and surgery was not always formally acknowledged and promoted. Today not only is it acknowledged and promoted, but also the importance of mentorship for professional development through the arc of a career is stressed. However, for many women, the one-to-one relationship of the classic mentor-protégé remains elusive, complicated by gender and generational differences. This has been especially true for the groundbreaking women before me, and for some remains true even today. In a very real and tangible way, the Association of Women Surgeons has been a mentor to me, and perhaps to other women surgeons as well. The mission of the Association of Women Surgeons is "to inspire, encourage and enable women surgeons to realize their professional and personal goals." This sounds a lot like the description of a mentor. (The AWS even publishes a book entitled ThePocket Mentor).

So that begs the question, can an organization itself be a mentor? I would assert that it can be.

Mentorship and the mentoring relationship overlap and encompass many other roles. One can have more than one mentor, each for different activities or components of work and career, or just one mentor to help with the big picture. Role model, professor or teacher, advocate, coach all come to mind, and mentors may be any or all of these to some degree. A mentor provides encouragement and support, advocacy and sponsorship; they guide and educate. The relationship between a mentor and protégée is notable for longevity over time.

These sorts of professional relationships formed in the past as they do now, but they were spontaneous and organic, as junior- and senior-level individuals naturally gravitated together, bonding over shared interests or goals. However, mentorship was not well defined or delineated, not identified beyond one of its component functions of advisor, teacher, proctor or coach. The mentoring relationship retains that spontaneous and organic nature; it can't be forced or assigned. Unlike then, however, there is encouragement to go and look for mentors. You will never find these relationships if you don't look.

I certainly had role models and champions along the way as I moved through the stages of my education. Teachers and professors and coaches, residents and attendings who took an interest in, supported and encouraged me. To them I am thankful and grateful. But there is an important part of the definition of mentorship, the concept of developing and nurturing the relationship and the guidance over time that differs from these relationships. Mentorship as I understand it is different, and it is more.

Women in surgery remain a minority, more striking as one advances through the ranks, just as striking in community practice as in academia. Whether academic rank or leadership in societies and organizations, the farther up the ladder you go, the fewer women you see. This is mirrored in community and in private practice, where there may be no women at all, or maybe just one. I am hard-pressed to think of many practices outside of breast surgery with more than one woman. A surgical practice may strive to have a woman, but rarely more than one. In fact, often if a community has more than one woman surgeon on staff, these women will usually be found in different specialties.

This is very isolating. Although we have much in common with our female colleagues in other specialties and other professions, there is much about surgery that remains unique and uniquely challenging. We seek mentors to help us navigate the day-to-day challenges as well as to help guide the trajectory our career. Many of us have had meaningful guidance and mentorship from men, but since it's a given that our male colleagues can't truly understand the challenges unique to being both women and surgeons, their help can only go so far.

This is the void that the Association of Women Surgeons fills. Into this place the organization steps in, as a surrogate for an individual mentor.

As a group, the AWS makes good on the promise of its mission statement, taking the form of conferences, lectures, networking, committee work, and publications. Since the AWS first came together, the organization has been there for all women in surgery, at all levels. Along with other similar groups, the AWS has deconstructed the dynamics of the "good old boys network," identifying and promoting both theory and practice of networking. Indeed, I believe by shining the light on mentorship, we now pay attention to it. Mentorship is deconstructed, defined, and promoted. Our students and trainees seek mentors. I don't think this is a coincidence that the attention to mentors and mentorship has paralleled the activity and growth of women (and their organizations) in medicine and surgery. This benefits not just the young women in medical school and residency, but all physicians in all levels and stages of career, male and female.

Today there are opportunities for women in surgery to find each other and connect, especially with the expansion of social media. Organizations like the AWS catalyze this. The challenges going forward are to harness the power of technology and social media to continue to connect, to network, to support, and to form mentoring relationships. To increase involvement and engagement in the core constituency of general surgery (as the meeting piggybacks on the American College of Surgeons annual Clinical Congress), and meaningfully include women in all of the surgical specialties, including GYN surgery, where a parallel organization such as ours does not exist.

Our numbers will continue to grow, so will our influence. The fellowship and support of the Association of Women surgeons is the surrogate mentor for all of us as we continue to chip away at the glass ceiling, and provides the structure for those who do break through to send a ladder back down to offer other colleagues a rung to stand on and a way up.

Dr. Kathryn A. (Kathy) Hughes, FACS is a General Surgeon, practicing breast and general surgery.  She has spent the majority of her career in private practice in community hospitals, where she has had leadership roles as Chief of Surgery and most recently Vice-President of the Medical Staff.  In addition to the ACS and AWS,  she is a member of the American Society of Breast Surgeons, the AMA, and the Massachusetts Medical Society, where she represents the North Essex District in the House of Delegates, and serves on the Committee on Women in Medicine. 

She currently resides and practices in Massachusetts. She has ventured out into social media and is on Twitter as @DrKathyHughes, you can find her on Facebook as DrKathy Hughes and on her page Behind the Mask. She blogs from Behind the Mask on Wordpress.

Tuesday, March 31, 2015

Advocacy for Our Patients and Ourselves

by: Amalia Cochran, MD, MA, FACS, FCCM

How many of you have written a letter or sent an email to your member of Congress about an issue?

How many of you have called your member of Congress’ office?

How many of you have visited your member of Congress office, either in the home district or in DC?

How many of you aren’t sure this stuff matters?  Does it really make a difference when you call or write or visit to discuss the SGR or the zero-day global or ongoing support for trauma systems?

I’m here to tell you that it does matter.  Our Senators and our Representatives are listening- maybe not they themselves directly, but they are using their staff members as their eyes and ears to review those emails and letters and calls.  They are interested in what you, as a constituent, have to say.  When you are able to develop a longer-term relationship with a staffer, you can even become a content expert for them so that when issues they know are within your scope of practice come up, they’ll contact you for support and further information.  So, yes, your engagement on these things matters, and can even bring your Representative along to become a co-sponsor of meaningful legislation or to vote “Yay” or “Nay” in a way that helps our patients and helps the profession of surgery.

I recently crowdsourced on Twitter, and immediately realized that the biggest gap for most people with advocacy is that they simply have no idea where to start.    Here’s a helpful visual for you, recognizing that you want to start at the broad base of the pyramid:

The great news is that the American College of Surgeons has developed a resource in the form of ; once you log in to the site using your ACS member number, it provides you with a roadmap for advocacy, especially if you go to the Action Alerts.  They set you up to seamlessly send an email to your member of Congress in two minutes or less.

If you are interested in becoming a bit more engaged, the next step would be to set up an in-district meeting with your member of Congress and/or their staff.  I strongly recommend that the first time that you do this, take someone with experience with you.  It will make it less intimidating and more fun- and it’s an opportunity to participate in some peer mentoring.  In-district meetings are easy to set up, and you can do it simply by making a phone call to their local office.

Finally, a shameless plug.  Please come to Washington, DC, in April for the ACS Leadership andAdvocacy Conference. It’s a wonderful opportunity to rub elbows with College leadership, you get trained in the process for doing Hill visits, and your appointments all get made for you.  Most importantly, someone from your state will usually have done this before, so you have that experienced peer mentor who I alluded to above.

So, get involved.  Send a letter, make a call, set up a meeting…go to DC for the leadership and advocacy.  Your voice matters.

Monday, March 30, 2015

Visiting Professor at Washington University

by: Amalia Cochran, MD, MA, FACS, FCCM

On a cold and snowy February 17 & 18, I had the privilege of visiting Washington University in St. Louis as the Ephgrave professor.  Dr. Stephanie Bonne was an amazing host, organizing a trip that provided perfect exposure of the medical students, residents, and faculty.  I had the opportunity to tour many of the surgical areas at Barnes- Jewish Hospital, including participation in their Trauma QI/M&M meeting and rounds with both the Trauma team and the Surgical ICU team.  I very much enjoyed and appreciated some dedicated time with Stephanie, who is a developing leader in the AWS, and with Kathy Raman, a vascular surgeon who shares my interest in telemedicine.  I also had some focused time with John Kirby, the medical student clerkship director, and Paul Wise, the residency program director, to compare notes on challenges our institutions face in the education of the next generation.

I delivered Grand Rounds on Tuesday evening with my talk entitled, “Bullies Throwing Tantrums:  Disruptive Surgeon Behavior in the Perioperative Environment.”  Professionalism and disruptive behavior is a particular interest of Dr. Tim Eberlein, the Department chair, and he specifically asked that I share my research in this area.  Grand Rounds was followed by a wonderful dinner at a local restaurant that included women faculty, women chief residents, and Adrienne Davis, who is a Vice Provost and member of the University’s law faculty.

My area of clinical expertise is in burn care, and Wednesday morning began with me teaching about the complexities of burn physiology for the weekly resident’s conference.  An innovative way in which the residency program at Wash U capitalizes on the experience of visiting professors is by having a “fireside chat” at the conclusion of Wednesday conference, giving residents an opportunity to discuss issues about education, academic surgery, and life as a surgeon in a more casual environment.  After the fireside chat, Elspeth Hill (a plastic surgery intern) shared her PhD dissertation about women in surgery with me; her eye-opening qualitative work was done about the system in the UK, but has some interesting implications that are also relevant in the US.  After a visit to see the weekly skills lab activities for the residents, I had lunch with the AWS Student Chapter Leadership.  Best wishes to Grace and Amelia in the upcoming match, and thanks to Lindsey and Ema for spending time with me as well.  After an interesting case presentation from the Surgical ICU team, it was time for me to head home from my great St. Louis adventure.

Special thanks to the AWS for sponsoring me as the Ephgrave visiting professor this year, to Tim Eberlein for his enthusiasm for my work, and to Stephanie Bonne for doing some “heavy lifting” to make my visit go seamlessly.  It was an honor to be your guest, and the hospitality was without parallel.

Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah.  She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah.  Her research interests lie in surgical education and in clinical outcomes in burns.  She is completing her term as Vice President for the Association of Women Surgeons.