Happy Holidays from the AWS!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays.

Please enjoy these delightful stories from fellow AWS members -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
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Kandace P. McGuire, MD, FACS
Assistant Professor of Surgery
Director Breast Surgical Oncology Fellowship & Premenopausal Breast Services
Magee Womens Hospital of UPMC


What holiday do you celebrate and what is the special meaning of this
holiday to you?
My family and I celebrate Christmas. We have celebrated many ways on many days and on multiple continents over the years! To me, Christmas is about family and giving. I love reconnecting with those I have lost touch with and being able to give to them and others during the holiday season.

What are some family traditions you have related to this holiday?
We have many family traditions, but my favorite is our annual trip to NYC. We take our son to see the tree in Rockefeller Center and to FAO Schwartz. We also take him to a restaurant that wouldn’t normally be “kid-friendly”. Last year we went to Le Cirque. He was such a little gentleman; they invited him into the kitchen to make his own dessert with the pastry chef! The 80 year old owner stopped us on the way out and complimented us on our well-behaved child. Pretty special!

We also have a tradition of giving to a child in need every year. I try to choose a boy who is about the same age as my son, so that he can pick out gifts that he would like and then give them away. Every Christmas morning we try to remember how special this Christmas must be for the little boy to whom we gave.

Do you have a good memory of patient care during a time you worked during
the holiday?
I was on trauma call for Christmas Eve my second year of residency. A funny story is a family of four who came in after a minor motor vehicle collision. They were spread out throughout the trauma bay: mother, father, two boys. Unfortunately, Dad was driving without a license and when the cops came to talk to him, you could hear one of the boys from around the corner yell, “Is Dad getting arrested AGAIN?!?”
Luckily, the cops gave him a summons and let him go home to enjoy Christmas with his family.

A nice memory is later that night, going across the street from the hospital to the only restaurant open, a diner that served the hospital and the local Philly old-timers. The entire trauma team crowded into a booth, ordered black and white milkshakes and burgers and traded war stories. We were blessed by no major traumas that night and no sad endings. It was one of my most memorable nights on call during my residency.

Happy Holidays from the AWS!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays.

Please enjoy these delightful stories from members of the Association of Women Surgeons -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Amalia Cochran, MD, FACS, FCCM
Blog: amaliacochranmd.com
Twitter: @amaliacochranmd

One of my favorite traditions during residency grew up from a tradition back home in Texas. I’ve long believed that tamales are Christmas food, and when I moved to Utah for residency, I started the tradition of a tamale dinner at my house on Christmas night for my co-residents, friends…anyone who wanted to drop by.

At first, quite a few of them thought it was an intriguing and strange tradition, but it was always a fun evening. By Christmas of our PGY-6 year, one of my classmates looked at me as she was eating her tamales and confessed, “I’m going to miss this next year when I’m in Minnesota.” While I got to have my Christmas tamales with my Mom the next year- and was back in Texas for my fellowship - it definitely wasn’t the same.
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Brittany Bankhead-Kendall, MD, MSc
Resident

This Christmas my family and I will be navigating the waters that the "Match" has bestowed upon us- living on separate sides of the country. My surgery residency is in Michigan, and my husband's emergency medicine residency is in Texas. He and my son decorated our tree while we "FaceTimed." No parent likes to be away from their children, especially during holidays. But I think Christmas is about traditions, making traditions, and yet sometimes breaking them to remember what's really important.

Happy Holidays from the AWS!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays – both at home and work.

Please enjoy these delightful stories from members of the Association of Women Surgeons -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Stephanie Bonne, MD, FACS
Assistant Professor
Trauma, Acute, and Critical Care Surgery
Washington University in St. Louis

What holiday do you celebrate and what is the special meaning of this
holiday to you?
We celebrate Christmas - I was raised Catholic and that's just the way it is!

What are some family traditions you have related to this holiday?
My mother's family is Polish, so we have a very traditional dinner on Christmas Eve with mushroom soup, fish, pierogi and picked Herring.

Do you have a good memory of patient care during a time you worked during
the holiday?
For the past several years, I've worked 6pm-6am over Christmas in the ICU. I kind of like it - there is a ton of food to eat, everyone is kind of cozy and happy. We watch NORAD tracks Santa at the nurses' station. The patient's families are usually in in the evenings and you can walk around and say hello to everyone.

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Callie Thompson, MD
Resident

What holiday do you celebrate and what is the special meaning of this
holiday to you?
We celebrate Christmas. For me, the holiday is a time of new beginnings and hope. I love spending this time of year with my family and seeing my children enjoy the same traditions that I loved as a kid.

What are some family traditions you have related to this holiday?
My family is very big on tradition so we try to do the same thing every year. We start by going to church on Christmas Eve and this year, my two oldest children are both in the Christmas play so I am really looking forward to that. On Christmas morning we open stockings and then have to have breakfast before we move to the presents from Santa. We are open-one-at-a-time-while-everyone-watches people.

Do you have a good memory of patient care during a time you worked during
the holiday?
My favorite holiday memory in the hospital would be from Christmas day my R2 year in the cardiothoracic ICU. All of the patients were critically ill but the nursing staff decorated and had a potluck that they invited the families to participate in. I just love the memory of the atmosphere in the unit that day.

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

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

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

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

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

I was pleasantly surprised to see how much her patients admire her for her care and compassion. One can also see that most of her family and friends either work or volunteer at her practice. Of all the people, her husband Mr Reed and son Kasim Reed Mayor of Atlanta, are one of the biggest supporters of her mission. With pure good intentions, she has not only earned loyalty of her patients but devotion of her family for a cause that is dear to her. She has proved that all it takes is one dedicated woman community surgeon to change the way care is provided to vast section of the community underserved or uninsured.

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Bharti Jasra is a Breast Surgical Oncology Fellow at UTSW 2014-2015. She completed General Surgery residency at Saint Louis University Hospital in June 2014.

The Importance of Mentoring

Last month, the Healthcare Leadership Tweet Chat (#HCLDR) invited me to participate as guest moderator to discuss The Changing Face of Medicine. You can read the accompanying blog post here. 

The weekly Tuesday evening #HCLDR chat engages a diverse community made up of patients, medical students, doctors, surgeons, residents, nurses, healthcare executives, and many others with a shared interest in healthcare leadership. Some international colleagues also joined from Europe, the Philippines, and Australia.

For many Tweeters, it was also the first time joining the #HCLDR Tweet chat. We were very proud to have the support of the American Medical Women’s Association (AMWA) and the Association of Women Surgeons (AWS).

The #HCLDR platform resulted in an engaging conversation on the importance of diversity in medicine. One question we discussed was how can we encourage women and other minorities to pursue careers in medicine/surgery or any non-traditional field?

Among the many excellent responses, a common theme emerged of the importance of mentoring.

Another important factor is to expose students to careers in medicine and surgery early. "Building the pipeline" can be achieved through personal interactions and through support of outreach programs and organizations. One of our AWS members recently wrote on her experience in showing young students what she does daily as a surgeon on The Power of a Stitch.

Demonstrating that diversity is important to the organization and showing students that doctors are also people they can relate to are other important aspects of mentoring. 

 

How do you find mentors? We previously tackled the topic of finding a Mentor in our Lean In Book Review, which you can find here.  A quick recap on working with mentors: 

1.            Be mindful of the mentor’s time

2.            Strangers can be mentors. Don’t be afraid to seek out someone no matter how much you admire them.

3.            “Excel and you will get a mentor”

4.            Have more than one mentor.

What has your own mentorship experience been like? Have you been a part of an organized mentorship program? How can mentoring be fruitful endeavor for faculty?

If you have not downloaded the AWS Pocket Mentor you may do so here. You can also read our AWS blog post for good advice passed down from our mentors.

Featuring 2013 ACS Surgical Forum Excellence in Research Award Recipient: Nicole Tapia, MD

General Surgery Resident Nicole Tapia, MD was honored a Surgical Forum Excellence in Research Award at the 2013 American College of Surgeons Clinical Congress held in Washington, D.C. Her work entitled "PACT Project: Standardized Resident Hand-off Implementation Improves Hand-off Quality" was also chosen as one of the top three resident presentations at the American College of Surgeons South Texas Chapter Meeting held in Austin, Texas during February 2014. The Association of Women Surgeons is proud to present Dr. Tapia’s work—in her own words—on the blog.

Standardizing Resident Hand-offs to Improve Hand-off Quality

by Nicole Tapia, MD

Morbidity and mortality conferences allow us to review our complications and ask ourselves if it was preventable, how it happened, and what we could have done differently to achieve an alternate outcome. There is usually a lesson to be learned during discussion of the adverse patient event, and a new best practice can develop as a result of such dialogue.

I have come to believe that the question of “what could I have done differently” is applicable to many realms of surgical life – struggling in the operating room with a new task, juggling management of a surgical team as a senior resident with both junior resident and attending expectations, and even balancing home and resident life. Recently, my institution offered an Advancing Clinical Excellence (ACE) in Health Care research grant which challenged residents to propose a study to improve health care delivery. They asked us to approach health care with a unique resident perspective and hypothesize and test our ideas.

Brainstorming with another research colleague and my research mentor, we agreed that a current hot topic which is omnipresent in resident work-life is the unintended consequences of the ACGME work hour requirements. In particular, our residents and staff have noted challenges that come with increased patient handoffs as we transitioned to a night-float system. We all agreed that anecdotally, we thought quality of patient care was likely worsened by this change.

Our research group determined that to test and study our hypothesis and improve handoffs, we needed to focus on verbal communication of patient information, as we work at several hospitals with varied electronic medical records and wanted our approach to be independent of a computer system. We set out to improve patient handoffs using a three-pronged approach: (1) determine current limitations and shortcomings of patient handoffs, (2) develop an ideal handoff, and (3) test the new handoff comparing subjective and objective quality measures.

Utilizing a focus group of residents and surgical staff to determine current limitations as well as the ideal handoff, everyone agreed that patients should be discussed based on acuity -- communication of events and plans of the sickest patients should occur first. This should be followed by in-depth discussion of the newest admissions, then changes to the current patients. Finally, a task review for the on-coming shift would be reviewed in top-down fashion. We developed a mnemonic, PACT (Priority, Admissions, Changes, Task review), to help our residents remember this discussion based on acuity.

Measuring pre- and post-PACT implementation, we found that with PACT implementation, residents had lower incidence of incomplete tasks and lack of patient knowledge on morning rounds, decreased discrepancy between junior and senior handoffs, and senior residents reported junior residents were better able to handle emergencies.

We were encouraged by our findings, but in true reflective fashion, thought we could further improve our handoffs. One limitation we found was that there were considerable interruptions during the handoff process. Additionally, we found that although residents were discussing the PACT content, they preferred to discuss patients based on list order – organized by patient location – rather than true acuity. Achieving complete buy-in to the new process has not been without resistance, even though our outcomes were excellent with improved handoff practices. As a result, we developed a second iteration of the handoff process (PACT 2.0) to address these limitations, and we are testing it head-to-head with our current PACT system, in a randomized controlled trial. We are currently analyzing the results and hope to report soon on our outcomes.

As a previous research resident and now third-year clinical resident, I have witnessed the junior residents transfer care of their patients with improved communication and feel confident that the night float residents have better knowledge of the patients on their census as a result of the work we have done so far. We introduced the PACT handoff system to our interns at orientation this past year and intend to do so again when they show up in late June. I feel privileged that through a unique grant opportunity at my institution, we were able to review our handoff process and ask ourselves not only what we could do differently, but also, were able to institute change.

Our experience has made me curious: How does your program do handoffs? Do you do handoff training?

~~~

Nicole Tapia, MD, is a general surgery resident in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, currently in her third clinical year. She recently completed two years of research, focusing on trauma and resident education. Nicole hopes to be a trauma surgeon at an affiliated academic center, where she can work with residents and medical students.

The Changing Face of Medicine

by Minerva A. Romero Arenas

We cannot all succeed if half of us are held back.

– Malala Yousafzai

Elizabeth Blackwell, a teacher and immigrant to the U.S., turned to medicine after a friend confided on her deathbed that she would have been spared much suffering had her physician been a woman. She went on to become the first woman to earn the Medical Doctorate in the U.S. She was admitted as a prank by the all-male students on the faculty – who allowed the students to vote on Elizabeth’s admission never thinking they would allow a woman to become their peer. The face of medicine has changed significantly in the 160+ years since Dr. Blackwell graduated from Geneva Medical College (now Hobart and William Smith College/SUNY).

Women are pursuing medical careers in record-breaking numbers. Female applicants to medical schools went from less than 10% in 1965, to approximately 50% in 2005. In 2013, 48 schools had a female majority of the class.

The changes seen in medical schools, however, are not representative of the currently active physician workforce. Women make up less than one-third of all physicians, and only 15% of general surgeons, and 4-6% of neurosurgeons, urologists, and orthopedic surgeons. Data of gender representation in residency reflect similar trends. In 2011, nearly half of female residents were training in primary care (pediatrics, internal medicine, family medicine) and less than 10% in surgical specialties.

Why are women doctors more often choosing primary care than surgical fields?

About 5 years ago, I was talking on the phone with one of my lifelong mentors when she asked me, “Minerva, why not?” I was unable to come up with an answer. I was nervous about a realization I had just a few weeks before: I loved surgery. I had just spent 2 months working long hours with excellent residents and surgeons. They had a great work ethic, were cool in the face of chaos, showed compassion toward their patients, and had a passion for their work that I had not seen in any other field. What should have been an exciting moment actually terrified me. Did I have what it takes to be a surgeon? And would it be worth making the sacrifices it would take for possibly 5-10 years of training?

Just days away from starting what we call “audition rotations” in the fourth year, switching to surgery was also a scheduling nightmare. I personally called the clerkship directors to apologize for a late cancellation. Thankfully, they were graceful and encouraged me to “figure it out,” even offering to allow me back later in the year if I ultimately decided against surgery.

It was not surprising that they were perhaps a bit skeptical of this decision. Surgery had crossed my mind during college, but fell off my list at some point in my first two years of medical school. I had planned to pursue a residency in internal medicine and eventually subspecialize in a field like medical oncology or infectious disease. These fields were friendly to women, and most importantly, I thought would help me merge my love of medicine and public health. Many of the mentors and role models I met were primary care physicians.

When I announced my interest in surgery, nobody hesitated at trying to save me/tell me why it was so hard – after all, surgery programs have one of the highest percentages of residents quitting training. “You won’t have a personal life.” “Do you want to have children?” “What does surgery have to do with public health?” The issue of lifestyle differences for surgeons is serious. In a 2009 study (the year I graduated medical school), women surgeons were less likely to have children and more likely to have their first child later in life. Male surgeons were more likely have a spouse who was the child’s primary caretaker. Reassuringly, 82% of women in that study would choose their profession again.

If I had a nickel, for every time I heard “but I never met a woman surgeon” maybe I would have paid off my student loans by now.

As a member of two key underrepresented groups in medicine (woman and Latina/Hispanic), I have felt the need to share my story with students who may have similar doubts about pursuing careers in medicine and surgery. I am involved in mentoring & leadership through several organizations (National Hispanic Medical Association, Latino Medical Student Association, Alliance in Mentorship, Tour for Diversity in Medicine, and Association of Women Surgeons). Many of the premedical and medical students I meet at mentoring events are surprised to meet a 1) surgeon, 2) woman surgeon, or 3) Latina surgeon. I was too when I met them in medical school.

In fact, many of my patients are too. When making rounds at the hospital, I have frequently heard patients tell someone on the phone, “Let me call you back, the nurse just walked in the room.” I have the utmost respect for my colleagues in nursing and do not take offense to these innocent remarks – after all, since 9 out of 10 nurses are female it is more likely that a patient will encounter a woman who is a nurse than a woman who is a doctor.

As I continue my training to become a general surgeon, I have come up with a couple of answers that I was so worried about years ago. More than halfway through my training, I can confidently say, Yes, I do have what it takes to be a surgeon. And it IS worth all the sacrifices.

Please join me on Tuesday May 13, 2014 at 8:30pm Eastern (for your local time click here) as I guest moderate the weekly #hcldr tweetchat.

• T1: How important/beneficial is diversity in health care (e.g., gender, age, ethnicity, background, etc.)?
• T2: How can we encourage women and other underrepresented minorities to pursue careers in medicine/surgery, or any non-traditional field?
• T3: What can we, as healthcare leaders, do to stop discriminatory comments or behaviors in healthcare, esp. to women doctors, minorities?
• CT: What’s one thing you learned tonight that you can use to help a patient tomorrow?

This article was originally posted on the Healthcare Leadership Blog on May 7, 2014. 

  ~~~

Minerva A. Romero Arenas, MD, MPH is completing a research fellowship in the Dept. of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, TX. She is a General Surgery Resident at Sinai Hospital of Baltimore. She received her MD and her MPH from The University of Arizona College of Medicine and the Zuckerman College of Public Health in 2009. She studied Cell Biology and French at Arizona State University as an undergraduate. 

Her interests include surgical oncology & endocrinology, global health, health disparities, quality improvement, and genomics. A native of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting the next generation of surgeons and is involved in mentoring through various organizations.

She enjoys fine arts, films, gastronomy, and sports. She enjoys jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas treasures spending time with her family and loved ones.

Resources

National Library of Medicine. Dr. Elizabeth Blackwell Biography on “Changing the face of Medicine.” Accessed April 2014. www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_35.html

American Association of Medical Colleges. Women in Academic Medicine Statistics and Medical School Benchmarking, 2011-2012. 2012. https://www.aamc.org/members/gwims/statistics/

American Association of Medical Colleges. Table 1: U.S. Medical School Applications and Matriculants by School, State of Legal Residence, and Sex, 2013 www.aamc.org/data/facts

American College of Surgeons Health Policy Research Institute. The Surgical Workforce in the United States: Profile and Recent Trends. http://www.acshpri.org/documents/ACSHPRI_Surgical_Workforce_in_US_apr2010.pdf

Troppmann KM, et al. Women surgeons in the new millennium. Arch Surg. 2009 Jul;144(7):635-42. doi: 10.1001/archsurg.2009.120.

Health Resources and Services Administration. The U.S. Nursing Workforce: Trends in Supply and Education. 2013. http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/nursingworkforcefullreport.pdf

Image Credit

https://www.nlm.nih.gov/hmd/about/exhibition/changingthefaceofmedicine.html