How I Make It Work

by Danielle Walsh, MD

December is the time of year when the constant struggle between the needs of work and the commitment to family become most strained. Holiday performances at school, parties for kids sports and other organizations pop up, work-related celebrations occur, and both of my children celebrate birthdays within a week of Christmas Day. After a long day of operating you try and shop online or in crowded stores before heading home to make dinner, ensure homework is done, and then proceed to whatever holiday event is scheduled for that night. It’s exhausting. But I can’t imagine it any other way.

People always ask how to make it all work. Lately, my response is more refined than in the past and it utilizes the tried and true analogy of the full bucket. You have to start with the biggest rocks. My kids’ birthdays, gymnastics meets, the annual AWS conference and a few other events are rocks. They are unmovable, non-negotiable events on my calendar. These are my biggest rocks. My OR days are Monday and Friday. My clinic days are Tuesday afternoon and Thursday morning. They are not movable and are the next size down rocks. I schedule a date night with my husband at least twice a month. Still a rock, but can fit around the other stuff. Then everything else gets filled in order of priority like the AWS, work on a grant, student and resident teaching – gravel, then sand, then water. Most of the time I try to leave pockets in “reserve” – an hour in my schedule for the gym, prayer, or just walking through a store undisturbed (my husband calls this retail therapy, even if I don’t buy anything). Often this is when I can review what the priorities are for that day or week to determine what goes in the bucket.

Sometimes the bucket overflows. I try to do too much at the same time or something unexpected causes the balance to tip. Then I call in the backup buckets – my husband, my parents, my partners, or some hired hand to take on what I can’t handle. Occasionally it means a paper is late (not unlike this blog, which I had hoped to write last week), emails get left in the inbox, and phone messages are not promptly returned. These times never feel good. I hate not being able to do it all on time. Some of the dislike is frustration of leaving others hanging, waiting for me to take action. Some of the issue is realizing that I made an error in taking on so much. But it serves a purpose – a reminder to be patient with others, accept imperfection, and continue trying to do better.

I always schedule at least some vacation time in December when the kids are off. The first day is set aside to clear out all the late assignments from work (like this blog) that will keep me giving my family my full focus. And then I sign out to my partners, turn off the beeper, set up the auto-reply for work email, and be just a mom, wife, and daughter to family for a while. It always feels good.

So as 2013 draws to a close, take a look at your bucket. What are the rocks, the stones, the pebbles, sand, and water? What can fit where and when? Find your time for work, time for family or friends, and time for yourself. May your bucket be full and satisfying.

Peace to all.

Danielle Walsh

P.S. – Didn’t get around to Christmas cards yet. Might still try to do them, but don’t hold it against me if they arrive a little late.

~~~

Dr. Danielle Walsh is an Associate Professor of Surgery at East Carolina University in the Division of Pediatric Surgery. After obtaining her undergraduate degree at Columbia College and her medical degree from the University of South Florida College of Medicine, she trained in general surgery at Massachusetts General Hospital in Boston. She also completed a fellowship in fetal surgery and research at Children’s Hospital of Philadelphia and a fellowship in pediatric surgery at Children’s National Medical Center in Washington, D.C. She practiced in Jacksonville, FL holding faculty appointments at the Mayo Medical Center and University of Florida before moving to her current position in North Carolina. She is the 2013-14 President of the Association of Women Surgeons and mother of 2 children.

Pregnancy during Medical School & Residency

by Callie Thompson, MD

I have read a lot of discussions about “the right time” to have a baby during a career in medicine and most of them come to the conclusion that there is no right time. I don’t think that is really accurate. The more correct answer would be that the right time is entirely dependent on you and your situation. I feel well prepared to write this blog and give this advice because I have been pregnant during both medical school and residency (twice).

In chronological order, I will start with pregnancy during medical school. The first two years of medical school are typically spent listening to a lot of lectures and studying almost all of the time. The third year is usually heavy with clinical work and spending a lot of time in the hospital. And the fourth year is usually a few sub-internships and a lot of light rotations at your home institution. So, where would a pregnancy, birth, and caring for an infant fit in there? Again, it really depends on your situation. You have to weigh the physically demanding state of gravidity with what you will need to be doing at that time. If you are concerned about being on your feet all day, then maybe being pregnant in the first two years would work best for you. You also have to take into account the demands of a newborn/infant. If you need a lot of time to study or are not great at multitasking, then having a newborn prior to taking your USMLE Step 1 might not be the best idea for you. No matter what you decide, you must have a viable option for childcare in mind. I suggest that you do this prior to even becoming pregnant because you will need help.

Regarding taking time away from school, there are no universal rules as to how much time can be taken. This will be school dependent. You just need to make sure that you can fulfill the requirements to earn your degree. Some people choose to take an extra year and make medical school a total of five years to allow them to have their child. I do not think this is necessary for everyone and you are going to know your capabilities best. Don’t let someone push you into a 5th year just because others before you have chosen to do that.

Pregnancy in residency is a bit trickier because of the American Board of Surgery requirements for General Surgery Certification. I had a baby during clinical R3 year and another while I was out in the lab. From a time-off perspective, having a baby during your lab years is much easier. If you are NIH funded through a training grant you can have 6-8 weeks, though some lab work can be done from home so the actual time you get to spend with your newborn can actually be longer than that depending on your research. Having a baby during your clinical years requires a good understanding of “the rules.” The ABS states that:

“To be eligible for ABS certification in general surgery, the following must be completed: At least 48 weeks of full-time clinical activity in each residency year, regardless of the amount of operative experience obtained. The 48 weeks may be averaged over the first three years of residency, for a total of 144 weeks required, and over the last two years, for a total of 96 weeks required."

“For documented medical problems or maternity leave, residents may take an additional two weeks off during the first three years of residency, for a total of 142 weeks required in the first three years of training, and an additional two weeks off during the last two years of residency, for a total of 94 weeks required in the last two years of training.”

Translation: You can average your time over the first three years so, in theory, if you didn't take any other time off for three years, you could have a 14 week maternity leave. Similarly, if you didn't take any time off for vacation during your last two years, you could have a 10 week maternity leave.

In actuality, that isn't possible. For instance, you would have to know that you were going to get pregnant and have a baby during third year so that you could forgo a vacation in your first 2 years. And if you did that, you would surely go insane. So if you did take the regular 3 weeks of vacation a year, you could have an 8 week maternity leave during the year you did have the baby—as long as you don’t take any other vacation that year. A baby during the last two years is even more difficult because of the time constraints. Also, keep in mind that none of this accounts for the possibility of medical problems during the pregnancy and any time off that may need to be taken. None of this is meant to dissuade you from pregnancy during residency (see above where I state I did it twice) but knowledge is power and you have to be prepared to extend your training if you are unable to meet the ABS requirements. This is most important during the last 2 years because they have to be done in succession so if you were to get pregnant, become ill, and need extra time off during your 4th or 5th year, you may be required to start over at year 4.

This blog could end up being very long so the last topic that I will include for today is when/how to tell people when you become pregnant. I advocate telling people when you feel comfortable. For some people that is the minute you find out, for others it is after the first trimester. However, I would not wait much beyond the first trimester because arrangements will need to be made, either to your schedule if you are a student or for coverage from your co-residents if you are a resident. I also would also advise you not to tell anyone else before you tell your Dean or medical school adviser (for students) or your program director (for residents). It is best to give big, personal news yourself, and in person.

~~~ 

Callie is a resident in general surgery at the University of Washington. She completed a two-year research fellowship and is now in her fourth clinical year.  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 under the age of 7.
 

“The Advice Less Given”

by Stephanie Bonne, MD

As a relatively new mother (I have 2 boys, ages 3 and 1), I’m usually anti-advice. I often feel as if each person’s situation is unique and resources and priorities are variable, so it’s hard for anyone to give meaningful advice that fully applies to me. If you have a young family or are contemplating having a family, you have no doubt been inundated with advice from lots of very well-meaning people. Some advice is trivial (“Jen is the best Gymboree instructor!”) and some is not (“if you are going to have more than one, make sure you have them as close together/far apart as possible”), but much of it we hear over and over again. “There is no good time,” “make sure you have lots of help,” “remember to take time for yourself,” are all well-meaning, but tend to be a little vague and can mean vastly different things to different people. However, in recent months, I’ve gotten 3 pieces of parenting advice that were a bit different than the usual advice and pretty adaptable to most woman surgeons, so I thought I’d take the opportunity to share them here.

1. “Learn to let go of some stuff, but not ALL stuff.” This is a comment on balance. As a surgeon, I’m used to being in control of almost everything, but as a parent, I can’t be. This first became apparent to me when my son came home from daycare one day in a mismatched outfit my husband had put him in that morning after I had left for work. I suppressed the urge to say “You let him go to school wearing THAT?!” Having meticulously dressed children is just something I have to let go of, along with the occasional glass of non-organic milk, or extra half hour of cartoons. My first advice to young moms: Throw away the Pottery Barn Kids catalog the minute it enters your house. No four year old boy spends an afternoon quietly reclining in his sailboat-decorated bedroom, reading a Caldecott-winning book while snacking on a perfectly balanced meal from his personalized bento box (seriously, when did preschoolers start carrying bento boxes?). Now, that last statement might sound remarkably reminiscent of some jaded-but-funny suburban parenting blogs. My second bit of advice: unsubscribe from these too. True, there may be humor in highlighting all your first-world failings as a parent, or brazenly point out that your kids are still alive, in spite of your best efforts and constant feelings of failure. These blogs, however, in an attempt to use intellect to deescalate the “Pottery Barn” ideal of a perfect mom, somehow miss the mark and instead validate the very thing they are trying to dismiss. You are a surgeon; you don’t have time to get involved in the mommy wars. This means letting go of the things that don’t matter, but realizing that not everything can be marginalized, and recognizing which things do matter. Your kids need to be fed, clothed, washed, and most of all loved, but that’s just the start – they DO need intellectual stimulation, bedtime stories, play time, social interaction, and swimming lessons. You can’t cast these things off as insignificant in the life of a child, but you also don’t have the time to place too much importance on each of your child’s experiences being perfectly orchestrated to be both stimulating and meaningful. Balance.
2. “Teach your kids, right from the start, about what you do and why it is important.” My experience with this has been short so far, but I do tell my son when I leave for call that I have to go to the hospital to help take care of sick people. Naturally, after a few times, he mustered a fake little cough and said “but I’m sick too.” I think every doctor-parent has a story like this, and yes, it is heartbreaking. But my husband and I reinforce what I do and why it is important and I think my son does understand. He will ask me when I come home the next day if I fixed the hole in someone’s tummy, and burst out an encouraging “great job, mommy!” when I say yes. When I recently went to DC for the AWS and ACS meetings, he asked me if people in Washington DC have holes in their tummies too. I’m sure the day is coming when I will miss a big soccer game or first music recital, but knowing that they understand what I do will help them. Sometimes, reminding myself of the importance of my work helps me too. 
3. “Take time for you and your partner, and do it guilt-free.” This is a variation on the date-night advice, but the key here is doing it guilt-free. This came up last spring after my parents were graciously willing to watch the kids for a few days so my husband and I could have a little getaway. Afterwards, I was recounting our trip on two separate occasions to some older, wiser women when they pointed out that I was making excuses for why we didn’t take the kids on our trip. Both encouraged me to never feel guilty for the time I spend away from the kids, pointing out that having two parents who live together, and furthermore, love each other, is far more important to them than the couple of days spent away from us. I think there is balance here too – we can’t jet away together every weekend, but we can do it within reason and should do it from time to time. For different couples, this will look different – to some, it’s going on long walks or runs together, for others it’s a monthly date night, for others it’s a weekend away once a year. Whatever it is, it’s helping you stay together, so make it a priority, but the real point is - don’t feel bad about it.

Props to the awesome women who gave me this advice – some of you will be reading this, and you know who you are. For the rest of us, take the advice that is given to you gracefully – remember, advice is rarely given in a malicious spirit, and most of your advice-givers really do have your best interest at heart. But take each piece and either toss it later, or process it and make it fit for you, and if it’s really good, pass it on later.

~~~

Stephanie Bonne is an Assistant Professor in Trauma, Acute, and Critical Care Surgery at Washington University in St. Louis. Her husband, Jeremy, is a trademark attorney for Anheuser-Busch. She has two sons, Evan, 3, and Colin, 1.

Family Life

by Jennifer Knight, MD, FACS

I picked this topic because for me, Family Life is a work in progress and sometimes putting thought into something you are working on often allows for enlightenment. As a surgeon, the idea of work life balance is a moving target. I struggle with it most days, but recently a colleague of mine told me that they wished that they could master the work life balance like I had. Master seemed a strong word!  There are things I have mastered; work life balance is not one of them. But I think because I do “try” perhaps that’s as close to mastering, as I will get. I though maybe I’d list a few things that I do as my attempt to try.

1. You need a team. A friend, who is not a surgeon, pointed out to me that I need a team of people in the operating room to ensure that my cases go smoothly and efficiently. Why didn’t I have the same type of team for home? Would a team help my home run smoothly and efficiently as well? So I got a team! I already had a nanny but added someone to clean by house, I signed up for after school play dates, and developed an arrangement with a caterer for parties and functions. 
2. Facebook. Everyone has an opinion about personal pages on Facebook. I find that I can use Facebook to stay involved with friends and relatives. I can post pictures of my family and send birthday wishes to friends. When I am able to meet face to face, I don’t need to “catch up” as much.  And while I am a peripheral user, a select “like” or “comment” lets other people know I am still around and care.
3. Plan ahead. I clearly communicate to everyone that if they want me to participate, I need 3-6 months advance notice. I’ve been able to go on class trips with my son, plan weekend get-away with girlfriends, and make most birthday parties. My friends have commented that planning in advance has helped them be more organized as well.
4. Have a good partner. My husband is also a surgeon and has a high level administrative job in our hospital system. We have to have great communication about each other’s schedules. But he is equal parent. He likes doing laundry and I like yard work. We complement each other’s strengths and weaknesses and both give 100%.
5. Mow the grass. Maybe not literally. But I love mowing the grass. And while I have a “team”, the one job around the house that I love is mowing grass. I put on my headphones and put my John Deere into drive and have great personal quiet time attacking the lawn. The point is, make sure you have alone time and if that alone time contributes to the family in some way, even better.
6. Family-friendly and fun-friendly are two different things.  I have friends and work partners who are single. Make sure that your focus on family life doesn’t trump your friends or work partners needs or plans as well.  

This is not a perfect and complete list but each of these things have helped me. Your family life is YOUR family life. Make it what you want it to be.

What tips do you have that help balance your work life and your family life? 

~~~

Jennifer Knight, MD, FACS is an Assistant Professor of Surgery at West Virginia University. She serves on the AWS Communications Committee. 

Sexism & Surgery

by Amalia Cochran, MD, MA, FACS, FCCM

How many of you saw this great piece from Emily Graslie a couple of weeks ago? 

 

I loved this video for a couple of reasons. One is obvious if you are familiar with her work- Emily’s video series from The Brain Scoop is a terrific, user-friendly approach to science. The other was that I honestly empathized with the comments that Emily included in her video, as I suspect many of us do, and I loved her approach to dealing with sexism and science. She’s no-nonsense about it and addresses the issue head on.

I thought back to my first encounter with sexism in medicine, going back to high school. Our family’s physician, upon being told that I was leaving for college at the end of my junior year under an early admission program with intent of going to medical school, simply commented, “Well, I guess it’s okay for women to be physicians these days.” No, he wasn’t joking. No, he never treated me again (nor my mother). I’ll admit- this was almost 30 years ago, and with the entry of more women into medical school many things have changed. Or have they?

Plenty of research shows that female medical students often experience gender discrimination, and that this occurs most commonly on their surgical clerkships. Women medical students are more likely to experience gender discrimination during their surgical clerkship than are their male counterparts and are more likely to perceive sex discrimination, typically from male attendings and male residents. My own recent work has shown that female surgeons and residents are more concerned about the presence of sex discrimination in the workplace than are their male colleagues, and that they perceive this discrimination as a barrier to advancement in academic surgery. Clearly this problem isn’t just one of the 1980s; it persists in modern-day medicine.

Stories of incidents can be gathered easily enough from many sources; in one night on Twitter I was able to acquire stories ranging from colleagues or patients refusing to address a woman physician as “Doctor” to women being told they are “too nice” to be a surgeon, or being told that they are allowed to do more in the OR because of their looks. While the overt sexism remains, many institutions are starting to consider the role of “implicit bias,” those subtle behaviors and actions that manage to undermine the leadership and credibility of any minority group. Yes, women surgeons are still a minority group.

So back to where we started, with Emily Graslie’s video. We have a problem still, and what we need is a solution. We can start by speaking up when we hear sexist comments- particularly those of us who are a little more senior and have less to lose than our younger colleagues. We can also work within our institutions to increase awareness of implicit bias in hopes that this will have a durable impact. And, as Emily Graslie stated, “We need to make sure we’re making it possible for people of all genders to feel acknowledged for their contributions and not feel held back by something as arbitrary as their genetics or appearance.”

How have you experienced sexism? And, perhaps more importantly, how have you dealt with it when you have either experienced it or witnessed it?

This post was originally published on Dr. Cochran's blog, Life in the Wild West.

 

~~~

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 Vice President of the Association of Women Surgeons. Follow her on Twitter. Visit her blog. 

Interview with Dr. Julie A. Freischlag

by Bharti Jasra, MD

A while back, there once was a little girl in Illinois who impressed everyone with her extraordinary performance at school. Her grandfather told her that when she grew up, people would tell her what she could or couldn't do. "There is nothing that I can't do," her grandfather said. "Is all you need to tell them all."

That little girl grew up to be the great vascular surgeon whom we know as Dr. Julie A. Freischlag. She is an internationally renowned expert in thoracic outlet syndrome. She became the first woman director of the Department of Surgery at Johns Hopkins in its 110 year history. She served as President of the Society of Vascular Surgery from 2012 to 2013. In 2012 she was elected Chair of the Board of Regents of the American College of Surgeons. In addition, she has held leadership positions in many leading surgical societies and serves on the editorial board of several surgical journals. In February 2014 she will join the University of California, Davis as Vice Chancellor for Human Health Sciences and Dean of the UC Davis School of Medicine.

I had the opportunity to interview this great leader and ask a few questions that I thought might benefit our Association of Women Surgeons members.

Q: What role did AWS play in your career?
A: I was one of the first few resident members of AWS. It was really nice at that time to know that there were other women in the surgical community that I could look up to for guidance. Also in early years of my career it helped me as a forum for networking. It was at AWS meetings that I met Dr. Patricia Numann for the first time, and we became good friends in the next 20 years.

Q: Do administrative positions adversely affect clinical duties?
A: I spend 60% of my time in departmental work and whereas only 40% in teaching and clinical duties. As a department chair one has to work for the department and not just for yourself.

Q: Is it essential to have additional degrees like an MBA to hold a leadership position?
A: It is not required to have additional degree but there are several leadership courses offered by ACS and AAMC which could be useful. I myself benefited from the ELAM course and highly recommend it.

Q: Do you think that you had a different set of challenges being a woman?
A: It's quite lonely up there at that level since there are not many of you. Women are underrepresented not just in medical community but in legal and business communities as well. It's easy to get noticed since there are not many of you at that level. At the same time it gives you a unique opportunity to represent interests of an underrepresented class and most effective use of this opportunity is essential.

Q: Do you wish you had more time to spend with your family?
A: I am blessed with a caring husband and loving children. As surgeons we like to stay busy and I have no regrets as I have been able to find time for my family for the most part. I try to go to my son's sporting events and recitals. Also I try to limit my travel for work as much as possible.

Dr. Fresichlag with her son and husband during Parents Day at the University of Maryland

Q: What is the key to happiness?
A: Staying in touch with yourself and your family is the key to happiness.

Q: What do you do to rejuvenate after work?
A: I am a swimmer and use the pool in our backyard. Also I walk try to walk few miles a day.

Q: What is your opinion on infertility among women in surgery?
A: I believe it has been a problem, but we are heading toward better times. My own residents now are having kids during residency, and it’s only going to get better in the future.

Dr. Freischlag with her family at the Ravens-Packers game   

Q: What challenges do you foresee in this new leadership role at UC Davis?

A: I am very excited to learn more about something other than surgery, especially healthcare delivery and medical education among the Hispanic population.

Q: Any message for AWS members?

A: We are very lucky to be surgeons, and we should enjoy every part of it at all levels, whether we are residents or in practice. 

~~~

Bharti Jasra, M.D. is a medical graduate from India finishing up her General Surgery Residency at Saint Louis University Hospital. She is interested in pursuing Breast Surgical Oncology training in the year 2014.

Interview with Susan Pories, MD, FACS, Immediate Past President of the Association of Women Surgeons

by Jane Zhao

Dr. Susan Pories is Co-Director of the Hoffman Breast Center at Mount Auburn Hospital and Associate Professor of Surgery at Harvard Medical School and Beth Israel Deaconess Medical Center. She has been named one of America’s Top Surgeons and is an editor of The Soul of a Doctor: Harvard Medical Students Face Life and Death. She obtained her medical degree from the University of Vermont College of Medicine, where she stayed to continue her general surgery residency. She completed a surgical oncology fellowship at New England Deaconess Hospital. She served as the immediate past president of the Association of Women Surgeons.

Click here to learn more about Dr. Pories from the beginning of her AWS presidency.

In today’s post, Dr. Pories touches upon her involvement with AWS, her work as a breast surgeon, and the grand plans she has moving forward.

Q: You have quite the impressive curriculum vitae! Tell us a little about yourself that readers may not know about just from searching you up on Google.

A: I grew up as an “Air Force brat”. We moved a lot and I always envied people who didn’t have to move so often. I vowed that when I had my own family, I would make sure to stay in one place. However, in retrospect, I realize that the experience of moving taught me to be resilient and now I am grateful for this strength.

Q: Why breast surgery? 

A: I started out as a general surgeon but I was the only woman practicing in Cambridge at the time and women with breast problems naturally gravitated to me. After awhile, I was so busy with breast surgery that I decided to specialize in this exclusively. In addition, my mother was diagnosed with breast cancer in her 40s and underwent bilateral radical mastectomies, which led to my personal interest in this area as well. I have been very happy with this area of practice.

Q: What excites you most about your day-to-day routine?

A: Actually the best thing about my professional life is the variety of things I am involved in. I have the opportunity to participate in research and teaching as well as clinical care and administration. I love the interactions with patients and getting to know them and their families.

Q: How did you become involved with the Association of Women Surgeons?

A: I joined AWS to find a community of other women interested in surgery. I always attended the meetings and dinners but didn’t really get involved actively until Dr. Betsy Tuttle invited me to serve as Vice-Chair of the Grants Committee. This position was a great chance to get more experience with leadership as well as grant review and ultimately opened many doors.

Q: What was your proudest accomplishment during your term as president of the Association of Women Surgeons?

A: While President, I started a Task Force to create the AWS Surgical Career Mentor. This is modeled after the Pocket Mentor for residents, but meant for practicing surgeons. There are over 30 chapters addressing topics such as interview skills, negotiation, research, publishing, teaching, and running a practice. This is nearing completion and should be released sometime this year. I am hoping this will prove to be a useful resource.

Q: What advice do you have for the next generation of surgeons?

A: Surgery is a great field and you are sure to find a niche that will be fulfilling. Try to find an area to focus on and become the expert at this. This will lead to invitations to speak and the most interesting referrals. Align your clinical and research interests so that one informs the other.

Q: What can we expect from you next? 

A: I am the Co-Chair of the Initiative for bringing the arts and humanities into the medical school curriculum and culture at Harvard Medical School. This is a true labor of love – I have met so many interesting people from other specialties and learned so much. We have put on plays, musical events, visited art museums, had poetry readings and more. I am convinced that this effort will enrich and improve the educational experience for students and residents, leading to more balanced practitioners and better patient care.

Thanks for a fantastic year, Dr. Pories! We can’t wait for the AWS Surgical Career Mentor to be published and have absolute faith that your future endeavors will be met with success. 

Readers, what questions do you have for Dr. Pories? Are there any other issues you would like to see addressed—or resources you would like to see be made available—by current and future AWS leadership?

~~~

Jane Zhao is a fourth year medical student at the University of Texas Medical School at Houston. She completed her undergraduate studies in Medicine, Health, & Society at Vanderbilt University. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award. Her interests include healthcare social media, quality improvement, and public health from a surgical perspective. She chairs the AWS blog subcommittee and can be followed on Twitter.

Blogger Q&A: Gratitude

Happy Thanksgiving! Today's post is all about gratitude. Every once in a while, we find it important to pause and reflect about the people and things we hold most dear. Keep reading to find out our responses to the following question:

What are you most thankful for?

Minerva Romero Arenas, MD, MPH:

I am thankful for my family and friends, my health, and my mentors.

Brittany Bankhead-Kendall, MD, MSc:

• The many career and volunteer and family opportunities that come with a career in medicine
• A two-year-old who is healthy, smart, and loves me even when I can't be there for him as much as I want
• The military and their families for keeping our freedom and nation alive
• A job I love
• A husband who is supportive of a surgeon for a wife

Mary Brandt, MD:

I will be thinking of the physicians, in practice and in training, who will sacrifice time with their families this year to take care of others.  To the physicians, nurses, hospital staff, police officers, fire fighters, soldiers, clerks and anyone else who spend this holiday helping others – thank you.  We are grateful.

(cross posted from wellnessrounds.org)

Amalia Cochran, MD, MA:

• My family of rescue animals. They keep me sane and remind me that I am always, always loved.
• The opportunities that I get to teach and mentor. Having found this niche provides me as much or more than those I’m teaching and mentoring.
• My friends, who tolerate my crazy schedule and intermittent unreliability (not my fault- it’s patient care!) and love me in spite of those things

Marie Crandall, MD, MPH:

• My health
• My freedom

Celeste Hollands, MD: 

The privilege of providing surgical care to children and being a part of the lives of those children and their families, the opportunity to teach future surgeons about why my career is awesome, and the love and health of my family: both two- and four-legged members!

Bharti Jasra, MD:

My family and mentors

Sophia Kim McKinley:

Most years, I spent Thanksgiving with my mother and brother in Boston. But this year, thanks to residency interviews, I get to spend Thanksgiving in California not just with my mother and brother but with my aunts, uncles, and grandmother as well! So I am thankful for the chance to spend my favorite holiday with more of my family, and for the privilege of pursuing the career that I love.

Lauren Nosanov:

In the midst of this interview season, I have been very struck by all the pieces that have had to fall into place to enable me to be pursuing a career as a surgeon. I am thankful that I am fortunate enough to live at a time in a place where such opportunities are available to women, standing on the shoulders of those who have come before me. I am thankful that my family placed a great emphasis on education, and constantly reminded me that I could do whatever I wanted in life if I worked hard enough. I am thankful for my husband, who has been a constant source of strength through this entire process - I am certain I would not be here at this juncture without his support. Lastly I am thankful for my son for always being a source of inspiration and drive to be my best every single day. Being here, now, is the most wonderful gift.

Mona Singh:

I'm thankful for the love and support of my family and friends-like-family, all the opportunities to learn and grow, and for this and every moment in life.  

Callie Thompson, MD:

My family and friends and the love and respect we share. My co-residents whom I commiserate and laugh with, whichever is most appropriate at the time. My patients who give me the daily gift of being allowed to care for them.

Danielle Walsh, MD:

I am thankful for three very special men in my life --

• my father, who motivated me to reach higher, work harder, and be more than I ever thought possible
• my husband, who grounds me, picks me up when I fall, and loves me unconditionally
• my son, who reminds me that reading books together is for bonding, wooden swords and shields can bring victory in every battle, and night time "snuggelies" are the best time of the day

Jane Zhao:

• the privilege of being able to spend my adult life living out my childhood dream
• mentors who see my potential and are tough on me for my own good 
• sponsors who see me as a promising investment and enthusiastically open doors for me
• family and friends who have never wavered in their love and support of me
• the kindness of strangers, hearty conversation, and bellyache-inducing laughs

What are YOU most thankful for? Answer in the comments below. To read our Blogger Q&A on advice passed down from our mentors, click here.

There’s Something In the Water

by AWS writer, Denise Harrigan

Often-invisible but highly influential, second-generation gender bias often impedes women’s ascent to top levels of leadership. The Harvard Business Review intends to expose it.

Fifty years after women were first admitted into Harvard’s MBA program, the September 2013 issue of The Harvard Business Review (HBR) examines the status of women in the business world. The cover alone – with a silhouetted female profile and the words “Emotional – Bossy - Too Nice ” -- reveals that women are floundering, not flourishing.

The bottom line is that only four percent of Fortune 500 companies have female CEOs, and 50 of those companies have no female board members. According to Adi Ignatius, editor-in-chief of HBR, women remain “distressingly underrepresented at the top levels of institutions.”

The HBR focus is not on the numbers -- those numbers, in recent years, have been documented to death. The goal, according to Ignatius, is “finding practical new solutions to a seemingly intractable situation. Closing the leadership gap is a formidable challenge. But there’s no excuse for accepting the status quo.”

The issue, part of the Harvard Business School’s global effort to accelerate the advancement of women leaders, features major articles on persistent gender bias and inclusiveness as a mission and moral imperative.

Unfortunate Legacy

The article “Women Rising: The Unseen Barriers,” by Herminia Ibarra, Robin Ely and Deborah Kolb, examines undercurrents that impede women’s progress and identifies second-generation gender bias as a major but rarely acknowledged impediment.

Where first-generation gender bias involved the deliberate exclusion of women, the second generation “erects powerful but often subtle and invisible barriers for women that… inadvertently benefit men while putting women at a disadvantage.”

Insidious

As a result of second-generation gender bias, unspoken cultural perceptions about women often carry more weight than job performance. Perhaps the most insidious belief is that men are natural leaders, and women are followers.

“In most cultures, masculinity and leadership are closely linked,” the authors report. “The ideal leader, like the ideal man, is decisive, assertive and independent. In contrast, women are expected to be nice, caretaking and unselfish.”

Linking leadership with common male behaviors suggests that women are not cut out to be leaders. It can also create a double standard. Assertive men, for example, are admired – and promoted. Assertive women are advised to “soften their sharp elbows.”

As a result, many women waste professional energy trying to project the perfect image -- not too pushy, not too nice. According to the authors, some employ voice coaches, image consultants, and branding experts “to manage the competence-likability trade-off— the seeming choice between being respected and being liked.”

“But the time and energy spent on managing these perceptions can ultimately be self-defeating. Overinvestment in one’s image diminishes the emotional and motivational resources available for larger purposes. People who focus on how others perceive them are less clear about their goals, less open to learning from failure, and less capable of self-regulation.”

Leaders Are Made, Not Born

Leadership is not an innate gift – it’s a skill that requires practice. More often than not, men are given opportunities to practice this skill. The workplace, still predominantly led by men, instinctively grooms men for leadership positions, creating stepping stones where men can practice leadership skills.

According to the authors, “Women have fewer opportunities to develop leadership skills and seem less inclined to create these opportunities for themselves.” By nature or nurture, women often gravitate to behind-the-scenes positions, and their efforts fade into the blur of teamwork.

Internalizing Leadership

“People become leaders by internalizing a leadership identity and developing a sense of purpose,” the authors observe. “Internalizing a sense of oneself as a leader is an iterative process. A person asserts leadership by taking purposeful action—such as convening a meeting to revive a dormant project. Others affirm or resist the action, thus encouraging or discouraging subsequent assertions. These interactions inform the person’s sense of self as a leader.”

In the wake of positive affirmation, “a person’s leadership capabilities grow. Opportunities to demonstrate them expand. High-profile, challenging assignments …. become more likely. Such affirmation gives the person the fortitude to step out-side a comfort zone and experiment with unfamiliar behaviors and new ways of exercising leadership.”

Well-Meaning but Off Center

The authors of “Women Rising” acknowledge that many companies attempt to level the playing field for women. “Many CEOs make gender diversity a priority, set aspirational goals for the proportion of women in leadership roles”…. and invest in building “a more robust pipeline of upwardly mobile women.

“But then, not much happens,” according to the authors. “The solutions to the pipeline problem are very different from what companies currently employ. Mentoring and leadership education programs are necessary but not sufficient.”

Deeply Conflicted Culture

“These approaches don’t address the often fragile process of coming to see oneself, and to be seen by others, as a leader. Integrating leadership into one’s core identity is particularly challenging for women, who must establish credibility in a culture that is deeply conflicted about whether, when, and how they should exercise authority.”

Call It by Name

Since second-generation gender bias “can be subtle, subconscious, assumed but not articulated by both men and women,” the authors recommend that employers begin to address it by simply naming it.

“Second-generation bias does not require an intent to exclude; nor does it necessarily produce direct, immediate harm to any individual. Rather, it creates a context—akin to ‘something in the water’—in which women fail to thrive or reach their full potential.

“Without an understanding of second-generation bias, people are left with stereotypes to explain why women as a group have failed to achieve parity with men: If they can’t reach the top, it’s their own fault for failing to be sufficiently aggressive or committed to the job.”

Alternative Reality

By identifying and addressing second-generation bias, however, companies can finally move toward gender equity – and an executive suite that “doesn’t look or behave like the current generation of senior executives.”

“When women recognize the subtle and pervasive effects of second-generation bias, they feel empowered, not victimized, because they can take action to counter those effects,” the authors promise. “They can put themselves forward for leadership roles when they are qualified but have been overlooked. They can seek out sponsors and others to support and develop them in those roles. They can negotiate for work arrangements that fit both their lives and their organizations’ performance requirements.

“Such understanding,” the authors conclude, “makes it easier for women to ‘lean in.’”

Early Lessons in Leadership

by Sophia K. McKinley

Do you consider yourself a leader?

For most of medical school, I did not consider myself a leader. To me, leaders were people with big personalities and big visions, the kind of individuals who could inspire passion in large crowds or start political movements. I was a quiet-voiced student at the bottom of medicine’s hierarchy – surely not a leader, and in no position to lead.

My perspective on leadership changed dramatically while spending a year as a Zuckerman Fellow at the Center for Public Leadership at the Harvard Kennedy School. Every week I participated in three hours of leadership training in the form of small-group seminars with prominent individuals, workshops on practical skills such as public speaking and negotiating, and personal development sessions. Whenever anyone asks me what I learned over the course of the year-long leadership curriculum, I always identify the same three take-aways:

1. Leaders are made, not born

I used to think some people were leaders and others weren’t. Now, I see leadership as a skill that can be cultivated, practiced, and improved. This shift in attitude has meant that even when I don’t feel as if I am a leader, I still see myself as someone who can learn to become a leader. And, I am now on the lookout for opportunities to practice leading and to gain skills as part of a lifelong process of becoming an increasingly skilled leader.

I expect surgery residency will be full of opportunities to practice leadership skills. Oral presentations will be public speaking practice, and overnight call will serve as an exercise in prioritization and time management. Leaders need excellent interpersonal and teamwork skills even in tense situations—where better to deliberately develop these abilities than the operating room? No one expects newly graduated medical students to show up to intern year as fully formed surgeons. I now know it is just as unrealistic to expect myself to be a fully formed leader.

2. Self-understanding matters

Leadership is about influencing other people. In order to do this better, I realized I first needed to understand myself and my own behaviors. Through a variety of assessments including emotional intelligence evaluation and a 360 feedback process, I gained a greater understanding of how my actions were influencing those around me.

For example, I learned that I often concede what I want in order to avoid negotiation. But in surgery, being a leader often means effectively advocating for patients in difficult situations. Awareness of my tendency not to press my agenda means that in future conflicts, I can reflect on whether I am being assertive enough, or whether I am failing to identify collaborative, “win-win” solutions that satisfy all parties including myself. I now know that a key to my future success as a leader will be improving my negotiation skills. Yet gaining self-understanding isn’t just about identifying weakness—it’s also about understanding strengths. Nearly all of the individuals who provided me with feedback during my 360 evaluation commented on my written communication skills. I know that for me to be the most effective leader possible, I should capitalize on my ability to influence others through writing.

3. Leadership happens at all levels

Finally, I no longer believe that leadership is solely the purview of those at the top. While leadership manifests itself differently at different levels within an organization, individuals at every position in a hierarchy can exhibit leadership. One of the most common definitions of leadership is acting in a way that enlists the support of others towards the accomplishment of a common goal. A title that indicates authority or power is not necessary to engage in leadership of this kind.

Think of a situation during medical school, residency, or beyond in which a group of individuals at the same level were given a task or assignment. Even without adopting formal roles or titles, some individuals functioned as group leaders because their behaviors influenced others towards superior performance in task completion. And probably everyone has been on a medical team in which the individual who did the most to improve group performance was not the team’s most senior member. As I enter intern year and beyond, I hope to be the kind of resident who exhibits leadership by influencing others to better achieve common goals. What I do to exhibit leadership may change as I rise through surgery’s ranks, but no matter what level I am, there will be opportunities to function as a leader, even if that means leading by example to peers and more junior trainees.

Not everyone has the experience of participating in a formal leadership curriculum across a year, but everyone can reflect and seek feedback to gain better self-understanding of leadership strengths and weaknesses. We can all seek opportunities that will develop particular leadership skills, and we can consciously practice leadership in the setting and position we currently work and learn. Hopefully, when asked “Do you consider yourself a leader,” more women surgeons will affirm, as I do now:

“I am a leader.” 

~~~

Sophia is a dual-degree M.D./Ed.M. student at Harvard Medical School and the Harvard Graduate School of Education. She received the 2012 Association of Women Surgeons Patricia Numann Medical Student Award and spent a year as a Zuckerman fellow at the Center for Public Leadership at Harvard Kennedy School. Sophia is passionate about medical education, and she hopes to be an academic surgeon who brings educationally-sound innovations to surgical training. Her clinical interests are gastrointestinal and minimally invasive surgery. Sophia is currently interviewing for general surgery residency during the 2014 Match cycle.

Powerful Tweets

by Lauren Nosanov

Social media have come to play a growing role at national conferences, serving not only as a convenient vehicle for information dissemination, but also as a forum for idea sharing and discourse. This year’s AWS and ACS meetings featured a significantly increased Twitter presence, with tweets from @AmCollSurgeons and @WomenSurgeons as well as several Twitter correspondents and meeting-goers. A review of content tweeted using hashtags #AWS13 and #ACSCC13 offers a wonderful snapshot of ideas discussed and wisdom shared. (For those unfamiliar with Twitter and associated terminology, see our Twitter 101 from Dr. Heather Logghe (@LoggheMD) and consider checking out Twitter’s FAQ section for new users.)

From Dr. Susan Pories on Networking

• Women are often excluded from networks and from conversations that open doors
• Networking: start small and begin with people you know (friends, family, etc)
• Build 3 networks: operational, strategic, developmental
• Don’t be afraid to take risks!
• Smile, ask a question, listen, have a handy business card, make a point to say the person’s name - Dale Carnegie’s five points
• Always be sure to follow up - it confirms that you are someone who can be trusted
• Moral of the story - you never know what will come of the random connections that you make
• “The way of the world is meeting people through other people”
• Key to networking: “building sincere relationships with mutual generosity"

From Dr. Mary Brandt (@drmlb) on Physician Wellness and Avoiding Burnout

• We talk about “quality of life” but not necessary “quality of work”
• Taking care of ourselves is a key part of taking care of our patients
• > 80% of surgeons experience discomfort or pain while operating
• Crucial to pay attention to ergonomics at work, both on the computer and in the OR
• Try to plan exercise every day and do something you really enjoy - focus on rotational core exercise
• When are you eating, are you eating enough, and what exactly are you eating?
• Call nights are similar to jet lag - stay hydrated, eat q3-q4h, repay the deficit
• Human beings heal by telling stories - communicate frequently, sincerely and with intent
• Spend some time every day being still and contemplating awe
• Down time is not wasted time, it’s essential time
• People at the top love to mentor those who are responsive and show potential for success

Dr. Gretchen Purcell Jackson (@pedssurgery) on Planning for Family

• You cannot plan perfectly or be fully prepared (hard for the Type A personality)
• Important to assess values, goal sand priorities prior to starting a family
• One of the few things you can control is your general state of health
• Think about child care options early on
• Know what your institution’s leave policy is and what you need to do to take advantage of it
• Important message from @LeanInOrg - don’t leave before you leave
• It’s okay to have help, and don’t fuss about things you can’t control

Dr. Hilary Sanfey (@hilarysanfey) on Leadership

• Leadership: the process whereby an individual influences a group of individuals to achieve a common goal
• Effective leaders utilize more than one style of leadership
• Watch leaders around you and decide for yourself what style they are using and whether or not it is effective

Joint AWS (@WomenSurgeons) and AAS (@AcademicSurgery) Panel on the Business of Medicine and Professional Development, Moderated by Dr. Carla Pugh (@CarlaPughMDPhD)

• Seek out those who can provide you with objective advice when you find yourself in a difficult situation - Dr. Andrea Hayes-Jordan
• Jobs are not forever - it is ok to change - Dr. Danielle Walsh (@walshds)
• Mentors are a bit like the Easter bunny or unicorns - they can be quite hard to find - Dr. Julie Ann Sosa
• As with all good relationships, mentee-mentor relationships take work to maintain
• You really have to respect your mentor, like them personally and trust them deeply - Dr. Julie Ann Sosa
• Assigned mentors may or may not work out - Dr. Rebecca Sippel
• Good communication is key to effective mentorship - Dr. Julie Ann Sosa
• Mentorship takes effort on the part of the mentee as well. Change mentors as the need arises
• Societies like AWS and AAS place a big emphasis on networking and mentorship - get involved! - Dr. Julie Ann Sosa
• Don’t lose sight of the fact that mentors also stand to gain something from involvement with mentees, it’s a two-way street - Dr. Danielle Walsh
• It’s ok to be a stalker, it’s ok to be a groupie - Dr. Amalia Cochran (@AmaliaCochranMD)
• Mentor opportunities - You give someone a rope and they hang themselves or make macrame - Dr. Mary Brandt (@drmlb)
• When you are asking for something, be sure you’re being realistic about what you need when negotiating - Dr. Andrea Hayes-Jordan
• Know your own value - Dr. Wei Zhou
• Stick to your values during the negotiation process. You will be respected for that. - Dr. Hayes-Jordan and Dr. Wei Zhou
• Write out a description of what you want from your position and get that into your contract - Dr. Joyce Majure
• If you are in a position where you are hiring/firing, work with your HR department to get guidance - Dr. Sandra Wong
• Negotiation is a long dance. Learn the steps. 

A key theme brought up by a number of speakers was the value of advocating for yourself. Whether this is seeking out the mentor that can best meet your needs, prioritizing your own health and well-being or successfully negotiating a competitive salary, conference goers were repeatedly reminded of a crucial point: you cannot expect to get what you need and/or want unless you speak up and ask for it.

Some food for thought:

• What challenges have you faced in advocating for yourself?
• Do you think women surgeons have more difficulty advocating for themselves than their male colleagues?
• Are you on Twitter? Why or why not?
• If so, how has Twitter (or any other form of social media) enhanced your experience of a professional meeting?
• How can the professional use of Twitter enhance your practice as a surgeon? How might it cause harm?

This post can also be found on the blog page of the Association of Academic Surgery.

~~~

Lauren Nosanov is a fourth year medical student at the University of Southern California Keck School of Medicine. She has spent the last year as a Dean’s Research Scholar, dedicating her time to clinical research in the field of Trauma and Critical Care. Having loved surgery from the very beginning, she is excited to embark upon the process of applying to General Surgery residency this fall. She is passionate about issues surrounding surgical education, mentorship and finding a balance between motherhood and medicine. Outside of medicine she enjoys practicing Taekwondo and spending time with her husband and son.

Twitter 101: How to set up a professional Twitter account

by Heather Logghe, M.D.

Since starting my own personal Twitter account, I have mentored numerous peers and faculty on how to get started. I’ve noticed that most surgeons have similar questions and concerns. Below I have detailed the most common questions along with my answers.

Twitter? Isn’t that just a bunch of people talking about what they ate for breakfast? Think again. Twitter is about who you follow. Sure, you can choose to follow celebrities and people who tweet pictures of the donuts they eat for breakfast, but the beauty of Twitter is that you don’t have to. Think of Twitter as millions of people talking at once, and by choosing who you follow, you choose who you want to “listen” to. As an aspiring surgeon, I choose to follow surgical societies, surgical journals, and leading surgeons--literally from all over the world. Through Twitter, I learn about upcoming events, the latest research, and the opinions of surgeons I look up to. I also follow influential non-surgeon physicians and patients who are effecting positive change in medicine. None of the “tweeps” I follow mention what they eat for breakfast. (Well, most of the time anyway.)

But I’m not even on Facebook! Don’t be fooled by the misguided logic that if you didn’t take to Facebook, you’re not going to like Twitter. Twitter actually has a very different flavor and utility. Rather than a purely social network (like Facebook), think of Twitter as more of a “subject” network, where users share information and access it based on common interest. You can take advantage of this endless wealth of information, whether or not you are “friends” with those you are following.

Does Twitter substitute for real, live, face-to-face interaction? No, however it often leads to it. On multiple occasions I have met surgeons and medical students via Twitter whom I then chose to meet in person. Not only did Twitter provide me with these professional connections I would not have otherwise had, it also gave us a common ground to start from, enabling a solid introduction before even meeting. This really allowed us to hit the ground running.

Do I really have to join Twitter to stay “on top” of the field of surgery? Of course not, but you may be missing out on a powerful way to connect with your colleagues and learn from others both inside and outside of medicine.

That sounds nice, but I’m afraid I don’t have the time. I’m not going to tell you that Twitter doesn’t take time. As a surgeon, you know that most endeavors that are worthwhile do have a learning curve and do take time. However you do not have to become a Twitter expert overnight. Tread slowly but confidently. I will lay out some basic steps to get you started.
 
     1. Open a Twitter account at www.Twitter.com. All you need is an email address.

     2. Set up your profile. For your Twitter handle (that “@thing”), I recommend choosing something as close to your real name as possible. Try @FirstLastMD or @DrFirstLast or any variation thereof.


Do I have to log in everyday? Definitely not. Twitter is not something that you have to “keep up” with. You do not need to read every tweet. I repeat: You do not need to read every tweet. It’s like the news. It’s interesting when you feel like tuning into it, but it’s fine if you don’t as well. I like to log into Twitter with a cup of tea. Others might sneak a peek at their Twitter feed while waiting between cases or in line at the grocery store.

I’m not sure I want to use my real name, isn’t it better to be anonymous? No. The days of maintaining an anonymous internet presence are over. Besides, you will only be posting professional tweets, and it’s important you get proper credit for your effort and contributions. Think of it this way--would you attend a conference and introduce yourself as someone else? Would you tell them a fake name just in case you said something silly and didn’t want anyone to remember you? Of course not. Consider your Twitter account an extension of your professional persona. You want it to represent you in a meaningful, memorable way. 

     3. Use a real photo of yourself for your avatar (profile pic).

Can’t I use an image of a scalpel or a picture of my kids or dog? Going back to the conference analogy, picture yourself at a conference with a bag or mask over your head--kind of creepy right? You probably wouldn’t expect people to trust you or take you seriously. The same goes for Twitter. Post a real picture of yourself.

     4. Write your Twitter profile bio, in 160 characters or fewer.

My whole bio in 160 characters? Don’t stress too much about this. The important thing is to put something. You can always edit it later. For ideas, I suggest looking at the bios of other surgeons on Twitter. With the character limit, it will be slightly informal. Add your clinical interests and feel free to include something slightly personal to add character, such as you enjoy cooking or play a mean game of tennis. The goal is professional but personable.

You are now ready to confidently enter the Twitterverse. (Yes, there is a “Twitterese” version of nearly every word in the English language...)

     5. Choose some accounts to follow.

How do I choose who to follow? I recommend following liberally, as it only takes one click to unfollow someone if you do not enjoy their tweets.

For starters, I recommend following the American College of Surgeons: @AmCollSurgeons; the Association of Women Surgeons: @WomenSurgeons; and Mary L. Brandt, MD: @drmlb. Dr. Brandt is a prolific tweeter and an excellent professional example. For general medical commentary you can start by following Kevin Pho, MD: @KevinMD. Through Twitter.com you can also search for the various surgical societies of which you are a member, as well as your own academic or medical institutions.

One simple way to find surgeons on Twitter is to check out the list I have created of over 100 surgeons and surgery-related Twitter accounts. From Twitter.com, you can search “@LoggheMD” and go to my profile page. From there, click on “Lists” on the left and then “Surgery” and “List Members.” You will be presented with numerous surgeons and surgical societies. Simply click “follow” to follow those you find interesting. You will now see their tweets when you log into Twitter.

Finally, I recommend that everyone follow @TweetSmarter. They are an excellent resource for learning the unique etiquette of the Twitterverse. If you read one of their linked articles from time to time, you will become a Twitter expert in no time.

What happens when I follow someone? Do they know I’m following them? When you follow someone, they receive an email notice and have the option to click on your profile and decide whether they want to follow you back. Thus you want to maintain a professional image from the first day you sign up for Twitter.

If I receive an email that someone is following me, is it polite to follow them back? You are never obligated to follow someone back. This is the beauty of Twitter. You choose who you read and learn from. When you receive an email notice that someone is following you, I recommend clicking on their profile link. Often, you can determine whether or not you want to follow them from reading their 160-character bio. If you really want to be thorough, you can also look at their Tweets and see if their tweet content is of interest to you.

Ok. I have a profile, and I’m following a few people--now what? I recommend laying low for a bit. Spend some time skimming your Twitter feed and reading the links that look interesting. There are many unwritten rules to Twitter and it takes some time to understand how it works and how people interact.

I’m nervous about tweeting. Don’t stress about your first tweet. It’s like making an incision--hesitation suggests lack of confidence and clarity. Jump into the conversation. For your first tweet, you can try something like, "Excited to enter the Twitterverse! Eager to learn and share with fellow surgeons and beyond.” This makes it clear that you are joining Twitter to learn and be part of the conversation. This will make other Twitter users more interested in following you.

What if I don’t have anything to say? Don’t worry about having something novel or witty to say. One of the strengths of Twitter is that it fosters sharing of ideas and information. If you are reading an interesting online article and you see the option to tweet it, go for it! If you found it interesting, it’s likely that your followers will as well. Also, for many people, the majority of their tweets early on consist of “retweets.” If you like something someone else shared, retweet it!

Ok. This gives me a basic start, but I know I’m going to have lots of questions. You’re absolutely right. I recommend that everyone find a designated “twentor.” Yes, that’s a twitter mentor. This will likely be someone younger than you, though not necessarily. Find someone you feel comfortable checking in with from time-to-time with your Twitter questions. Ideally, this person will also follow your tweets and can even give you feedback via direct messages (private tweets).

What about the different kind of tweets, and what are those #hashtag things? My next post will detail some of the various types of tweets and how to get started tweeting and engaging other surgeons. In the meantime, I hope you explore the rich links in your Twitter feed. Don’t be afraid to click on the profiles of those who look interesting. You never know who you will meet!

This post was originally published in AWS Connections and on Dr. Logghe's blog, Allies for Health.

~~~

Heather Logghe, M.D. is a general surgery resident at the University of North Carolina. She graduated with her M.D. from the University of California, San Francisco. She has worked on various projects at the intersection of medicine and technology in Silicon Valley and is a tireless advocate for health equity. She blogs and tweets. 

10 Steps to a Successful Residency Interview

by Allison Hoyle, D.O.

Fall is the exciting time in our medical education during which our residency interviews begin. It is important to be prepared for what is to come, as these interviews are different from any you may have ever had before. Here are some tips to help you succeed when you meet your potential future colleagues and mentors!

1. Arrive Early. As you probably know by now, hospital parking can be complicated and with all the additions and renovations hospitals often undergo, it can only work in your favor to arrive at least 15-20 minutes before your scheduled time.

2. Dress to impress! In 2011, Dr. Karen Pine of the Department of Psychology at the University of Hertfordshire conducted research which showed that women wearing skirts are perceived as more successful. If you choose to wear a skirt, however, be sure it is no shorter than 2” above the knee. All in all, wear something flattering that makes you feel comfortable and look professional. Comfortable, professional shoes are also a must. You never know if you will be in a skills lab, a staged patient encounter, or walking the entire hospital!

3. Practice with a friend. You will be asked many questions by your interviewers. They will want to know more about who you are and what your goals in life are. Be prepared to talk about your medical school experience, specific cases you enjoyed, challenging situations, and even your personal life. Here is an excellent resource with sample questions: http://www.med.unc.edu/ome/studentaffairs/residency-and-the-match/files/MedicalResidencyInterviewQuestions.pdf

4. Make a list of questions for your interviewers. For example, “What research opportunities are available?” “Is there a formal didactic curriculum?” “How are residents evaluated?” “What kind of electives are available and how many are there?” “Where do graduates go for fellowship?”

5. Research. Know whom you will be speaking to. Read about the hospital and the program beforehand. As we learned with our clinical rotations, the more you know, the better able you will be to ask thoughtful questions and the more you will get out of your time with those you will meet.

6. Bring a copy of your curriculum vitae, journal articles which you have written, and contact information of your references. Be prepared to discuss your accomplishments as well as any setbacks you may have had, and how you have learned from them.

7. Get plenty of rest the night before, and eat a balanced breakfast before heading out. These interviews can run very long. You will want to keep up your stamina!

8. Take off your watch, turn off your cell phone. Nothing is more important than your interview, so try to minimize the chance that you might offend your interviewer with buzzing, beeping, and glancing at your watch or phone.

9. Smile, Relax, and Be Yourself! Your future colleagues are searching for someone with whom they will be spending a lot of time.

10. Handshake. A firm, confident handshake says a lot about you and makes others feel more comfortable. If you have not yet mastered this technique or if you are not sure, practice with your friends and ask for their honest feedback.

Remember, your fellow residents and mentors will be spending a lot of time with you once you are hired, so they are trying to find someone who fits in well with their group. Likewise, you will be spending a lot of time with them, so you will want to choose a program with people you wish to learn from and residents you enjoy being around. At the end of the day, you are essentially choosing your second family and the program which will shape you into the physician that you will become. This is a very exciting time and I wish you all the best of luck with your interviews and with the match!

~~~

Allison Hoyle, D.O. is a recent graduate of the New York Institute of Technology - College of Osteopathic Medicine. She was a professional pianist living in midtown Manhattan when she decided to return to school to study medicine. While volunteering at St. Luke's-Roosevelt Hospital in New York, NY as a pre-med, Allison discovered her love of surgery. Seven years after observing her first laparoscopic procedure, she was scrubbed in and learning from surgeons at Jersey City Medical Center during what she described as the most exciting time of her life. She was class representative of her school's surgery club, SOSA, during her first year of medical school, and a member of AWS's first ever Student Committee in 2011. Allison has lectured at high schools and colleges in New York and New Jersey about her experiences as a medical student and has been interviewed by NPR and ScienceHouse.com. In her spare time, she enjoys riding and restoring vintage Italian motorscooters, Astronomy, and playing the piano. Allison is in the midst of her residency application process for the 2014 Match. 

I’m going to a BIG professional meeting…now what?!?

by Amalia Cochran, MD, MA, FACS, FCCM

Your first professional meeting, even if it’s a relatively small meeting, is both exhilarating and scary. What are the norms for the group? What do I need to wear? Who do I need to meet-- and who do I need to avoid? Clearly it’s an important opportunity to make an early impression on people who can really impact the rest of your career, and you want to do it right. It’s also a chance to maximize your learning in a unique environment. Here are a few “pro tips” to help you out.

• If you have a trusted senior resident or faculty member who have been to the same meeting before, ask them what sessions might be most important for you to attend. Also-- and this is a “learn from my mistakes” tidbit-- ask about attire for ALL parts of the meeting. I went to the AAST as a senior resident and had no idea that the big dinner was VERY fancy. I ended up passing on the potential networking opportunity and had room service for dinner since I had not packed appropriately.
• Between the advice that you receive and looking for things you are interested in, go into the meeting with a plan. Identify the sessions you want to attend in advance, then use the meeting app (or plain old paper!) to keep track of where you want to be.
• If someone you know will be at the meeting with you, ask them to introduce you to people you need to know. This is an important part of networking when you are a newbie in an organization, and it’s a great way to get connected quickly.
• Should you ask that question or not? If it’s a question you are truly curious about and that is relevant to what has been presented, go for it. Please remember the ground rules: Use the microphone, introduce who you are and where you are from. Over time you’ll get to see people asking questions that seem to be simply an opportunity for them to pontificate-- don’t be “that woman.”
• Mingle, mingle, mingle. Those who know I’m an introvert are laughing as they read that because they know how hard it is for me. The good news is that, as an introvert, I can ask a couple of well-placed questions about someone’s work or interests then just sit back and listen. Please go up to people after sessions and ask them about their work if it was something that piqued your interest. And if you see someone who is a leader in the organization, PLEASE don’t be intimidated and think, “They’re too busy and too important.” Most of us in leadership roles are eager to meet new members-- you are our future!
• Be prepared with an elevator speech. You want to be able to give anyone who asks a succinct response to what you’re working on at any given time. What’s exciting you in your research? That’s always a great place to start.
• If you’re attending a meeting of an organization that will be part of your career in the long term, see if there’s a way to get more involved. Some organizations have open committee structures (the AWS is one!); others are always looking for project volunteers. If you show up and fulfill your responsibilities, it’s a wonderful way to become a leader over time and to get to know some truly terrific people. Remember, though, that over-committing and not getting the work done also earns you a reputation, and it’s not one that you want to have.
• Wear comfortable shoes. For some of you who are younger and biomechanically better suited than I am, a long day of walking around in 3-inch heels is nothing. I personally am a big fan of Cole-Haan, AGL, Thierry Rabotin, Ron White, and Anyi Lu for their fun flats and low heels. All let me be fashionable without being miserable.
• Last, but not least-- Have Fun! While meetings at this stage of my career almost invariably have some work attached to them, I always come home rejuvenated and recommitted to the work that I am doing. It’s amazing how seeing your friends from other institutions can help you remember that you’re not in this alone and that your work really does make a difference.

Readers who have been to meetings before, what piece of advice would you offer to a newbie? What do you wish someone had told YOU before your first professional meeting?

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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 the Secretary for the Association of Women Surgeons. Follow her on Twitter.