Changing the paradigm

by Robert Swendiman

Whether I am at Grand Rounds, a department meeting, or the American College of Surgeons Clinical Congress, it is often like looking into a mirror. I cannot help noticing the abundance of white men – especially at “the top.” While I meet numerous female and minority surgical residents and junior faculty, most of the chairs, program directors, and full professors are men.

Outside of the medical profession, surgery has an “old boys club” reputation. But I come from a school of leadership where difference and diversity are more than just opportunities for social progress – they are requirements. So I was disappointed when I perceived the stereotype affirmed. The more I look around, the more men I see.

Constant inquiry (or “quality assessment and quality improvement” in medical terminology) is an important component of leadership. Without it, we fail to analyze, understand, and improve the systems in which we are a part. Thus, I began my investigation, and what I found was shocking. Despite the increasing number of women entering general surgery residency programs – from 10% in 1980 to 36% in 2011 – as of last year, women only represent 9% of all full professors, 17% of associate professors, and 25% of assistant professors in surgery. 1, 2 While these numbers are obviously disproportionate, what is perhaps more concerning is that they also remain stagnate. In the last 15 years, these percentages have not changed. 3

Despite the fact that men and women enter academic medicine at equal rates, the rate promotion is uneven. 4-6 Though men and women start at similar ages, the mean age of attaining “Professor” status in approximately five years younger for men. 4 “Even after adjusting for number of publications, amount of grant support, tenure versus other career track, number of hours worked, and specialty, women [remain] substantially less likely than men to be promoted.” 4

Thus, female surgeons remain impressively underrepresented in the ranks of surgical faculty at 21% of the workforce (the average across all medical departments is 37%). 2 Of all academic departments in the basic and clinical sciences, surgery ranks second to last in percentage of total female faculty members (orthopedics, 15%). 2 However, in other specialties, women hold more than half of all faculty positions (obstetrics and gynecology, pediatrics, and public health and preventive medicine). 2

The famous surgeon, Dr. William Halsted, once quipped that the issue with surgeons taking call every other night was that residents would miss half of the cases. In the same manner, when we exclude 51% of the population from top leadership positions, we are missing out on half of the talent. If fewer than 10% of professors of surgery are women – and that figure has not changed in more than a decade – I wonder, “Is our academic community really moving surgery forward?”

Fellow colleague, Sophia McKinley, wrote about her own early lessons in leadership. She states, “Individuals at every position in a hierarchy can exhibit leadership.” I agree, and I see this lack of diversity as an urgent opportunity for real-time leadership at every level. As a white male, I think it is my job to participate in changing this paradigm – chipping away at the explicit and implicit barriers that male surgeons still espouse in surgery, advocating for and leveraging diversity, and staying curious about surgery’s present and future challenges. As an inspiring academic surgeon, this also meant research, which is why I joined a multi-institutional team from UNC, Harvard, and Stanford to better understand how we can change the status quo. I know it’s not enough, and change will not happen overnight, but doing nothing is not a viable option.

I was often asked on the interview trail, “Can an intern or a medical student really be a leader?”

This is the answer I give them.

~~~

References

1. Cochran A, Freischlag JA, Numann P. Women, surgery, and leadership: where we have been, where we are, where we are going. JAMA Surg 2013;148(4):312-3.

2. Association of American Medical Colleges. “Women in Academic Medicine and Science: Statistics and Benchmarking Report 2011-2012.” Table 3: Distribution of full-time faculty by department, rank, and gender, 2012. < https://members.aamc.org/eweb/upload/Women%20in%20U%20S%20%20Academic%20Medicine%20Statistics%20and%20Benchmarking%20Report%202011-20123.pdf>. Accessed November 6, 2013.

3. Sexton KW, Hocking KM, Wise E, et al. Women in academic surgery: the pipeline is busted. J Surg Educ 2012;69(1):84-90.

4. Zhuge Y, Kaufman J, Simeone DM et al. Is there still a glass ceiling for women in academic surgery? Ann Surg 2011;253:637–643.

5. Schroen AT, Brownstein MR, Sheldon GF. Women in academic general surgery. Acad Med 2004;79:310

6. Buckley LM, Sanders K, Shih M, et al. Obstacles to promotion? Values of women faculty about career success and recognition. Acad Med 2000;75:283-8.

~~~

Robert Swendiman is a dual-degree M.D./M.P.P student at UNC School of Medicine and the Harvard Kennedy School of Government. He spent his time at Harvard as a Dubin Fellow for Emerging Leaders at the Center for Public Leadership, researching how leadership principles can be applied to medical education. Robert is participating in the 2014 Match cycle, and is interested in pediatric surgery.

Interview with Dr. Diana L. Farmer

by Lauren B. Nosanov

Dr. Diana L. Farmer, an internationally renowned fetal and neonatal surgeon, is Chair of the Department of Surgery at UC Davis Health System, where she oversees more than 250 faculty, volunteer clinical faculty, post-doctoral fellows, residents, students, and staff who provide highly skilled, specialty services in bariatric, burn, cardiothoracic, gastrointestinal, plastic and reconstructive, oncology, transplant, trauma and vascular surgery. A recognized leader in pediatric surgery, Dr. Farmer is known for her skilled surgical treatment of congenital anomalies and for her expertise in cancer, airway, and intestinal surgeries in newborns and for her investigations on the safety and effectiveness of providing spina bifida treatments before birth.

At a recent American College of Surgeons Chapter meeting, I was fortunate enough to attend a Women in Surgery luncheon featuring Dr. Farmer. Among the topics she discussed was the journey she took from the beginning of her career to her current position as Chair of Surgery at UC Davis. She had a great deal of wisdom and advice to offer for surgeons at all points in their professional life. Below she shares some of these insights.

Q: You have taken what some would consider an unusual path through your career. What do you consider to be the most crucial turning points that have brought you to where you currently are?

A: Following my husband to match our careers allowed (forced) me to spend three years in the Lab. My resident surgical oncology lab time (two decades ago) working on adoptive cellular immune therapy for cancer, has proven to be unexpectedly valuable in my career as a pediatric surgeon now working on stem cell therapies for children’s surgical diseases.

Q: What roles have mentorship and networking played throughout your career development? 

A: In the early days, mentorship and networking were less formal, and I would define it as functioning more by observing people who served more as role models than mentors.

Q: Does being a woman affect the way in which you approach your position as Chair of Surgery? If so, how?

A: I don’t think that being a woman affects my approach to the Chair job. It’s a very maternal/paternal kind of job in a very big family!

Q: What advice can you provide to our younger members looking to have a successful career in academic surgery?

A: Follow your passion, “lean in,” don’t be afraid to try things and fail.

~~~

Lauren Nosanov is a fourth year medical student at the University of Southern California Keck School of Medicine. She spent a year before her last year of medical school 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 start her General Surgery residency in a couple of months. 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 children.

Why I Started Tweeting and Blogging

by Sophia K. McKinley

For years, I limited my participation in social media: my tendency is to untag all photos of myself on Facebook, and as recently as six months ago I had never visited Twitter.com. I do have some experience writing personal travel blogs, but the main purpose of those online posts was to communicate to an audience of one (Hi, Mom) that I was safe and sound despite being thousands of miles away from home. If you had asked me a year ago why I wasn’t more engaged with the online community, I would have responded that I was too introverted and private, or that I had nothing worth sharing with other people.

Today, I have a Twitter account and have written blog posts for both the Association of Women Surgeons and the Association of Academic Surgeons. I’ve even explored options for launching a personal website, though instead of describing which remote destination I’ve visited, this website will outline my research interests and link to my Twitter feed.

It sounds implausible, but I began to overcome my hesitation to develop an online presence through an old-fashioned essay writing course. The instructor, Nancy Sommers, embraces a philosophy that everyone has a story to tell and that the world is better off when those stories are shared. The essays my classmates wrote were fascinating not because they were perfectly polished, but because they were genuine and authentic. Their stories were interesting and full of meaning, and I found myself thinking this might also be true of my own life. I was forced to reconsider my assumption that I had nothing to contribute to a larger conversation.

The next experience that pushed me to become more active in social media was hearing a talk by Dr. Mary L. Brandt at the Women in Surgery Career Symposium in San Francisco. Dr. Brandt provided an outline for creating an online presence and reviewed useful applications for tweeting and blogging, but the most important thing I learned was that the online world is still dominated by written language. Previously, I thought that the kinds of individuals who shared frequently online would be extroverts who easily navigate cocktail parties and always have a snappy verbal reply at the ready. I’m most confident when communicating through writing, so viewing tweeting and blogging as forms of writing made these activities less daunting.

There continue to be moments when I cringe at the thought of other people reading my tweets and blog entries. Sometimes I wonder if I am oversharing, or if I’ve only added noise to an already crowded internet. What keeps me stepping outside my comfort zone and hitting that “tweet” button one more time is the overwhelmingly positive feedback on what I have already transmitted into cyberspace. Just a few tweets and blog posts have led to productive face-to-face networking opportunities with other medical students, surgical residents, and even leading surgeons.

I may never stop untagging photos on Facebook, but I now consider Twitter and the blogosphere as additional writing venues within my professional life. Whatever hesitations you may have about establishing an online presence, I’d urge you to be courageous and dip a toe into the social media waters. Not as warm as a Balinese beach, but that’s a post for a totally different blog.

~~~

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 in the process of applying for general surgery residency for the 2014 Match cycle.

I sought professional help.

By Stephanie Bonne, MD

When I finished my training, my husband and I were overwhelmed by decisions - student loans, college planning, life insurance, oh my! So, we decided to seek the help of a financial advisor. It's definitely been one of the better decisions we have made.  To address financial planning this month, I decided to interview my financial advisor, Robert Balice of Bridgewater Asset Management, and the answers to my questions are below.

Q: Many people say, “I'm finishing training, so I’ll just quickly pay down my student loans and max out my 401k.  What do I need a financial advisor for?”

A:  Some people don't need one, but I cannot think of a case when an advisor would not provide significant benefit to someone, particularly someone just starting out. When you are starting out, you need to have some perspective of where you are going.  Set goals, then focus on what you do well (surgery), while having an advisor guide you through the rest can help you take advantage of the opportunities available to you, and help you miss some of the pitfalls on the way.  Even simply establishing an investment strategy for your 401(k) is fraught with pitfalls. 

Q: Okay, so I think I need an advisor. How do financial advisors get paid?

A: Good advice is not free, but it is important to understand how an advisor is compensated to make a choice that fits your situation.  There are 2 predominant ways:

1. Commissions – The advisor makes a commission on the products they sell you (insurance policies or investments).  This can work if you don’t need long term advice, like managing a one-time inheritance.  However, beware of implication that you don't pay anything for the investments they place you in simply because you don’t “see” the charge.  There may be up front, ongoing or back end sales charges. It may appear that you are not paying anything, but the advisor is definitely making something by recommending a certain investment or insurance product.

2. Advisory fees - for the vast majority of people, you want your advisor to be compensated in a way that he/she is motivated to keep your interests first, and stay engaged over the long term.  A fee-based advisor is not getting transactional compensation up front by selling products, they make money on your business over time, so it is in the interest of the advisor to keep you as a long term client and make sure you continue to get advice on your investments. 

Either one can be right for any individual.  A fee-based advisor is a true consultant and not a salesperson.

Q: What’s the best way to address my student loans?

A:  There are a few strategies that apply to everyone.  Consolidate your loans to get lower interest rates, and try to get fixed rate loans in case interest rates rise.  Next, consider what you can make in your investments versus the interest on your loans to decide what to pay off. If you are paying 2.5% on your loans, don't rush to pay those off and forego savings where you can earn 5% and build an investment account.  Remember you can always liquidate your savings to pay the loan off in the future for some other reason. To contrast, if your student loan rates are 8% annually, you should pay those down, because it's hard to expect that your investments will make 8% annually after tax.

Q: I have little kids at home.  How much is college going to cost for them?

A: Most children of educated parents, certainly doctors, would expect that their children are going to attend college. You can pay for college by either saving for it with discounted dollars, or pay for it afterwards with loans that have additional interest costs.  I suggest that you not plan for financial aid.  The best way to plan is to start early, and save for a good 4 year university, either private or public.  A child born today will need about $200,000 for a 4-year degree at a public school, or up to 3 times that for private school.  To achieve this, you need to save $400-$1000 per child per month from your child's birth. It's hard to imagine that private schools will cost over half a million dollars, but that's just the reality.  However, college inflation was previously 6-7% annually, but has recently slowed.  Still, I'd plan for the worst and hope for the best.  

Q: Taxes are always a concern for those in higher income brackets.  How do I avoid taxes?

A: Start by taking full advantage of employer matching contributions through your qualified plan (401k, 403b). Today, many companies offer traditional pre-tax savings or after-tax investment savings as in a Roth 401(k).  If you are still in residency, you tend to be in a lower tax bracket, and at that point, you are better off using Roth 401k or Roth IRAs, because the taxes today are not as large as the taxes you will pay when you take that money out.  If you are out of residency and in a higher tax bracket, then you definitely want to use the pre-tax options so you get the tax benefit today.  You can control your taxes better in retirement by choosing how much income you are going to take, whereas you have less control now, as your income is decided by your employer. If you have outside income due to speaking engagements or consulting, you should consider opening a personal qualified plan for that income.  The tax code allows you to have multiple qualified plans as long as there is no common ownership with your employer.

After your retirement accounts, your tax deductions dwindle quickly.  If you are saving for your child's education, some 529 plans offer state income tax deductibility.  

After that, try minimizing taxes on the savings that you are making on an after-tax basis. These generate taxable income and capital gains.  Variable annuities or variable universal life policies can accomplish this, but consider all the pros and cons of these vehicles and the tax implications of such products.  Bottom line is: you can lose up to 1/3 of your investment earnings if you don’t pay attention to the tax treatment of your investments. .  Not all investments make sense for everyone - this is why you need a qualified advisor.

Q: I am concerned about an injury that causes a loss of my ability to do surgery.  How do I plan for this?

A: You’re right; statistically, you have a 40% chance of being disabled for 90 days or more before age 65. Your first line of protection is your employer’s group long term disability plan. However, be aware that it typically does not cover all your compensation; specifically, it may not cover your bonuses and will not cover any outside income. You may want a personal disability policy that overlaps the group coverage.  If you purchase options for future coverage, that guarantees your insurability as your income continues to go up.  If you plan on having your own practice, and therefore not working for an employer, then a personal disability policy is essential to do at a young age when you are healthy and costs are lower.  

Q:  Long term care insurance (LTCI) is getting more expensive and is of greater necessity for women than men.  How should we be prepared?

A: Because women statistically live longer than men, insurance companies have struggled to fully assess LTCI.  As a result, some states have recently taken away unisex rates for LTCI, resulting in up to 300% increases in rates for women, who use LTCI more and live longer.  Not all states have moved away from unisex rates, but they probably will at some time.  If you have any genetic conditions that would result in long term care needs (Parkinson’s, Alzheimer’s); then early coverage is essential.  

Q: What if I still live in a state with unisex rates?

A: If you are in a state that still has unisex rates, you should take advantage of some sort of coverage.  The premiums are not guaranteed, and all rates will go up as the demand for long term care increases. But, if you are in a unisex state, you would probably get a much better premium if you get a policy before your state changes. If your state changes later, your rate will probably be more than the unisex rate, but less than the female rate.

Q: Does long term care insurance follow you if you move?

A: Some employers have group long term care which are portable if you leave employment.  But, these tend to have limitations in coverage for things like in-home care. In that case, a personal long term care usually will provide more comprehensive coverage, and is portable if you change jobs. The timing of when you should acquire LTCI is based on many individual factors such as age and health.

Q:  Women typically have longer life spans.  What does this mean for financial planning?

A: We already addressed long term care.  The other challenge is to accumulate retirement assets.  If you live into your 90s, you may need to draw 30 years of income from your investments.  Longevity translates to a more aggressive savings strategy now. This does not necessary mean taking on more risk, but would require higher accumulation to meet their retirement needs. The advantage women have due to longevity is cheaper life insurance rates because insurance companies are less likely to have to pay your death benefit early.  What that means in terms of financial planning is that we can consider insurance-oriented products to provide sources of retirement income with relatively low insurance costs.

Q: I hear a lot about the debt accrual by the US Government, what does this mean to me?

A: This isn't meant to be political, but the fact is, the government has a lot of debt.   In the intermediate and long term, having so much debt is likely to translate to higher inflation and higher taxes.  This requires your retirement savings to outpace inflation, in particular.  In the short term, interest rates will likely need to increase. This means you should be aware of the impact of rising interest rates, in particular to fixed income investments.

~~~

Robert Balice is a full-service financial advisor at Bridgewater Asset Management in Chesterfield, MO.   He completed his undergraduate education at Lawrence Technological Institute in Michigan, and has an MBA from Washington University in St. Louis.  He has over 20 year experience in financial planning. www.bwam.net

 Stephanie Bonne is an assistant professor in trauma, acute and critical care surgery at Washington University in St. Louis. 

Respect

by Erin W. Gilbert, MD 

“Your job gives you authority. Your behavior gives you respect.”
—Irwin Federman, general partner at U.S. Venture Partners

Throughout my surgical training I blindly accepted that having grey hair (and experience) equaled garnering respect as a surgeon. Now that I am junior faculty at an academic institution (and beginning to grey myself), I’m wondering if there is more to the story. There is a noticeable difference in how residents treat me as compared to how they treat the Department Chair- which is of course OK by me, but I have begun wondering how can I ensure that I will achieve and more importantly maintain the same level of respect?

As a medical student at LSU in New Orleans, we followed a very hierarchical system where the intern was the boss of the students, the junior was the boss of the intern and so on. It seemed to me in this system that the doctor’s role dictated the level of respect they earned from the team, but just because you follow someone’s orders does not mean you respect them. Other misconceptions I have had include believing respect comes from being a good dresser, having large muscles or simply being intimidating in some way. Now that I have matured a bit I am learning that people may admire good looks, muscles, or a power suit, but this does not translate into respect.

Federman’s quote alludes to the real heart of the story. Think about people in your life you respect; who you would follow into battle without question, who you try to emulate… they are kind, generous, caring, and fair. They treat all of those around them with respect - from the hospital CEO to housekeeping staff - without question and without needing a reason to show respect. They value others’ efforts and acknowledge them; they listen, and they are always sincere. I may just be figuring this out for myself now, but thanks to my upbringing, I know that treating all people with respect is the expectation not the exception- I just didn’t realize how much it could influence how others treat me.

Readers, think back to the role models in your life. What behaviors of theirs did you respect? Share with us in the comments below. 
 

~~~

Erin Gilbert is an Assistant Professor at Oregon Health & Sciences University in Portland where she is a member of the Knight Cancer Institute. She received her medical degree from LSU in New Orleans and completed her general surgery residency at the University of Washington in Seattle. She was fellowship trained in Minimally Invasive Surgery at OHSU and specializes in the surgical management of pancreatic disease.

Creating your own academic timeline

by Christina Cellini, MD, FACS, FASCRS

This topic came to me during a grand rounds given by a well-known surgeon in his mid-career - henceforth will be referred to as “WKS”. I had just returned from my second three-month maternity leave in two years and was looking forward to hearing about what advice he had to give.

That morning WKS gave a talk about how he advanced academically starting from residency to his early attending years that eventually led to his promotion to associate professor. His talk was very informative, and he made a really big deal about being present for your family while trying to achieve your goals. All in all it was a thoughtful presentation. However a few things caught my attention and highlighted how everyone’s situation is unique.

One piece of advice given was that one should constantly “be writing papers” and even to “get up at 4 am before work” to write in order to fulfill that goal.

4am??? I thought back to what I was doing at four A.M. that morning. Oh right… I was nursing an infant. I’m certain that’s not something that ever stood in his way of writing papers. Oh well, no time for paper writing this morning. Maybe tomorrow.

His next piece of advice was to take advantage of all the wonderful scholarships and traveling opportunities that are catered towards young attendings under the age of 45 . He showed lovely pictures of him and his family frolicking around a foreign country that was many time zones away.

I thought- wow! I didn’t know about these awards. I should think of putting something together. Then I thought of the logistics- I don’t think I’ll be able to leave my tiny children away for that amount of time. And since these days I need to plan about an hour in advance to take both kids out to a trip to Target…. maybe in about 5-7 more years. But then I’ll be too old for these scholarships!

Finally he mentioned being involved in society meetings and to bring family along so that you can take advantages of the opportunities there while your spouse and kids go and do fun things in the area. See- you can work and spend time with your family as well! I thought- that might be doable. I did have to skip the last 2 of my society meetings because I was either too pregnant to fly safely or did not have the resources to travel with an infant. Let me ask my husband how he’d feel about watching the girls in a strange place for a week while I do my surgery thing. I texted him- I got back “absolutely not”. Apparently dealing with two cranky, nap-less, off schedule children by himself while I do my own thing most of the day was not my husband’s idea of “family fun”. He encouraged me to go alone. Now don’t get me wrong- my husband is awesome and takes care of the lion’s share of child rearing and is supportive of my career- but I couldn’t blame him for not wanting to sign up for that.

WKS had a number of great ideas that worked for him to achieve academic success so quickly in his career. I am certain there are many young surgeons - both men and women- who can achieve that as well. However, WKS had a personal situation that allowed him to flourish early on. He was able to follow the typical academic timeline that usually consists of publishing 2-3 papers/year, obtaining some sort of early career development grant or funding in the first 5 years as a means for future funding, active involvement in the ACS and specialty societies - all in addition to growing one’s clinical practice at the expected pace. With this timeline one can usually expect promotion to associate professor within five years or so. I know that I will not be able to keep up with that timeline. My path to promotion will likely take a few (or more) years longer than others. Occasionally I get antsy about it when I perceive that my peers are advancing faster than me or that I am in some way “behind”. However, I have been lucky to have colleagues and mentors that understand my need to slow down for my family and are supportive of an “extended” academic timeline to academic advancement.

Now, if you can breastfeed and write scientific papers at the same time go for it! If not, I suggest the following:

1) Take some time to really think about what your future academic goals are. Make them very discrete, not ambiguous. Also, take the time to write them down.

2) Prioritize the goals and create a timeline to go with them. Give some real thought as to how you might go about achieving these goals. Again, the more specific you are, the more likely you are to realize them.

3) Share your academic timeline with a more senior colleague or mentor. Doing so may help you identify potential opportunities or pitfalls in your strategy that you may not have considered. As always AWS members are available to help- and have likely been in your shoes at one time or another!

4) Periodically look back on what you have written and adjust as necessary. Do not feel bad or guilty if it takes longer than you thought. Try not to fall into the “keeping up with the Jones’s” trap that can be prevalent in surgery (I know I have on more than one occasion). Take the time to write down and reflect on everything that you have accomplished up to that point. Remember no accomplishment is too small! As long as you remember what’s important to you and keep your eye on the prize you will no doubt be able to balance your personal and professional life and accomplish what you have set out to do.

Readers, how have you adjusted your own professional timeline to achieve both personal and professional goals in a reasonable manner? Share your thoughts below.
 

~~~

 

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

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.
 

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. 

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?

~~~

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.

Lean In: Book Review & Discussion (Part Three)

 by Sophia Kim McKinley, Callie Thompson, MD, and Minerva Romero Arenas, MD, MPH

Chapter 8: Make your partner a real partner (Callie)

By nature, women are charged with carrying the child, birthing the child, and feeding the child (if one so chooses), resulting in an uneven distribution of work between a couple from conception. This chapter discusses some of the author’s personal struggles with being a new parent and the division of labor and responsibility in her relationship. Data show that in heterosexual couples, when both work outside the home, the women does 30-40% more of the childcare and housework, and as recently as 2009, only 9% of dual-earner marriages said they split the work evenly.

As a surgeon, I would suggest that this needs to be acknowledged and discussed prior to starting a family with a spouse/significant other. When a couple is discussing having children, there can be a lot of debate and negotiations about the vision for that child with regard to religion, discipline, schooling, extracurricular activities, and on and on. One thing should not be a negotiation; both parents must contribute equally to the care and development of the child, and if that is not okay with your partner, I strongly suggest reconsidering him for that role. This does not mean that each task needs to be done by each parent equally, just that the division of labor overall needs to be as close to 50/50 as possible. If you feed the child, your partner can bathe the child, and if you clean the dishes after dinner, your partner can vacuum the floor, etc . . . .

If that was it, things would be easy, but you also have to deal with society. You have to realize that society is going to set out to make your male partner feel emasculated because he is sharing household and child-rearing tasks with you. Believe it or not, even in 2013, men are still harassed for staying at home with their kids. Lighthearted comments and snide remarks can be hurtful to our male partners. The easiest way to counteract those actions is to let them know how appreciated they are, not because they are doing things FOR you but because they are doing them WITH you. Society will also try to make you feel badly for working outside of the home. People will tell you how wonderful it is or how lucky you are that your husband “watches” your kids for you. When this takes place, you should feel free to inform these people that the father of your children is fathering them. Nothing more, nothing less. But overall, my best advice is to ignore, ignore, ignore. If it works for you and your family, the rest does not really matter.

Do you have a family? Is your partner in medicine or surgery? Are couples in similar fields more likely to succeed or fail?

Chapter 9: The myth of doing it all (Callie)

In this chapter, “having it all” is called “the greatest trap ever set for women,” “antiquated rhetoric,” “a myth,” and a “recipe for disappointment.” I think we can all agree that this phrase should leave the vocabulary of our society and never return. Sandberg quotes some amazing women in this chapter: Gloria Steinem, Nora Ephron, Tina Fey. All of it is to say that being a working parent is hard work, and it doesn’t always (read: almost never) go according to plan, but the best way to manage is to cut yourself some slack, be willing to compromise, be honest with yourself about your own goals/desires, and be willing to change the plan. Admittedly, some of these things are much easier to do in other lines of work and at different points in our surgical careers. For instance, it would be great to be able to work the hours that worked best for my family, but those aren’t the hours that are best for my patients, my attendings, my co-residents, or my hospital system, so as a resident, I work the hours I work, and when it comes time to choose a job, I may want to take that into consideration in my choice.

Another important point is that we need to manage our guilt. This is a hard one because, no matter how many times you hear people say that your kid(s) will be okay even though you don’t stay home with them, the one time someone insinuates the opposite, it will stick with you and that one thought can fester and cause a lot of damage to your psyche. However, as lovers of science and evidence-based practice, we should rely on the data. As the author points out, data show that kids who are cared for by their mom vs. those also cared for by others develop the same, build the same relationships, and still bond with their moms. Also, having an involved dad, a mom who gives you independence, and parents with emotional intimacy are much more influential on a child’s development than having their mom care for them exclusively.

Full disclosure: despite this data, I still feel guilty quite frequently. I was irrationally crushed just last week when we missed my son’s 12 -month check-up because my husband and I both forgot. Other than reminding myself that the kid is fine, the appointment was rescheduled, and nothing bad actually happened because of this. Conclusion? I do not have a good solution to these thoughts.

How do you “do it all?” Is it really a myth?

Chapter 10: Let’s Start Talking About It (Sophia)

Sandberg encourages a conversation about the influence of gender in the workplace—the whole point of her book is to start talking about it. I’ve heard from more senior women in surgery that the attitude in the past has been one of “play along to get along.” That is, you don’t bring up the fact that you are a woman because you don’t want to bring any more attention to your obvious minority identity. While “play along to get along” may be useful for an individual to minimize any associated penalty for being a woman, Sandberg would challenge this strategy as one that would win in the long run. She encourages naming hidden biases and the micro-aggressions against women as a way to move forward toward gender equality.

Once, when I told a faculty member that I was going into general surgery, the first thing she said was “Are you planning on having children?” I highly doubt she would have asked the same question to a male medical student, which means that my gender was a strong determinant in her attitude toward my chosen career. I shared her comments with other faculty as a way to shed light on the ways in which women who pursue surgery continue to be treated differently, even by other women. Knowing precisely how and when to raise the topic of gender requires thoughtfulness and discretion, but I am hoping that forums such as the AWS Blog will continue the conversation about gender and surgery in a way that is rigorous yet respectful.

Have you encountered gender discrimination in or out of surgery? How have you addressed it? 

Chapter 11: Working together towards equality (Callie)

“Today, despite all of the gains we have made, neither men nor women have real choice. Until women have supportive employers and colleagues as well as partners who share family responsibilities, they don’t have real choice.” This is where the AWS and each of us at our institutions across the country can make a big impact. We can be those colleagues and mentors. We can encourage our fellow women surgeons to make their partners real partners. We can speak out when we see or hear a male medical student or resident praised for their outgoing spirit while a female who behaves the same is chastised for her aggressiveness. If we do not point out the inequities of such thoughts and perceptions, they will never end.

As Deborah Gruenfeld is quoted to have said, “Working together, we are fifty percent of the population and therefore have real power.”

How can we move toward equality? How can we engage the men in these initiatives?

Let’s Keep Talking

We have truly enjoyed reading and discussing our thoughts on this book and the parallels drawn in the surgical world. Please join our discussion below and share your input on how we can improve personally, as a discipline, and as leaders.

Part One of the discussion can be found here. Part Two, here.

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Sophia Kim McKinley 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 will be applying for general surgery residency during the 2014 Match cycle.  

Dr. Callie Thompson is a resident in general surgery at the University of Washington. She recently 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.

Dr. Minerva Romero Arenas is a general surgery resident at Sinai Hospital of Baltimore and is completing a research fellowship at The University of Texas MD Anderson Cancer Center in Houston, TX. She obtained her MD and MPH from The University of Arizona, and studied Cellular Biology & French at Arizona State University. She is also involved in mentoring and public policy. On her personal time she enjoys spending time with friends and family, especially when it involves good food.