A place of our own

by Amalia Cochran, MD

Apparently there are a number of men who, upon hearing about a women surgeon’s activity will state, “We don’t get to have a men in surgery group!”

This statement is both true and untrue.

While it would probably be considered politically incorrect to have a formal “men in surgery organization”, it can easily be argued that academic surgery remains the “men in surgery” club. Between 2001 and 2011, the number of women in surgery residencies increased from 24% to 37% of trainees, breaking that 33% number often associated with achieving “critical mass” for any non-majority group. However, in the ranks of academic surgery in 2012, women constituted 21% of surgery faculty, and women are apparently stalled as 9% of full professors in surgery. This paucity of women in academic surgery does matter, both in terms of availability of role models for our residents and students, and in terms of how women are seen and perceived in academic surgery. If you were to ask most (if not all) of my male colleagues if they have walked into a room at a surgical meeting and felt out of place, the vast majority would tell you no, and many would look at you like you were crazy for asking. In contrast, I know experientially from speaking to many of my female colleagues that we’ve walked into any number of surgical settings and felt fairly certain we didn’t belong there. My first experience of this nature came during my fourth year of medical school while on the interview trail- I was one of 40 interviewees at a program that shall remain unnamed on a given date, and I was the only woman in the interview group. While I knew I deserved the interview, I inferred that being a resident there had the potential for me to have to fight lots of battles that involved being judged not on my work, but on my gender. I didn’t have an interest in that. I still occasionally make jokes about it when I find myself seated in a room of surgeons in which I am the only woman- and yes, this does still happen in 2014.

My support for and involvement in organizations like the Association of Women Surgeons, is predicated on this idea that as women we do need a place where we are exclusively looked at for our body of work and where we aren’t judged for being any of the stereotypes associated with single/ married/ divorced/ childless/ childed women surgeons. For me, and for many others, it’s been a “safe” environment to expand our leadership skills and to experiment with authentic engagement with colleagues. My experience in a social sorority in college was similar, in terms of it being a place where my leadership skills were cultivated and I learned to collaborate with people who were very different from I. While I recognize that many horror stories exist about the collegiate Greek system, I remain passionate about the benefits of sorority life when it’s done “right.”

Would I have the leadership and team skills that I have today without Alpha Delta Pi and without the Association of Women Surgeons? Maybe. Would I be where I am in my career without the support of some wonderful men who focused on who I was as a student, then as a surgeon? Absolutely not. Did opportunities in these women’s-only organizations change my life for the better? No doubt, and I am absolutely certain that they helped make me into who I am today. For me, and for many women leaders in varied professions (particularly historically male professions), this idea of having a “place of our own” is critical to our professional and personal development.

This post originally appeared March 11, 2014 on Dr. Cochran's blog Life in the Wild West

~~~

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

"You've matched to a Preliminary position."

by Brittany Bankhead-Kendall, M.D, M.Sc.

Every medical student looks forward to "Match Day." Even non-medical people know what this "match day" is . . . . they hear about it from us, read it on our Facebook posts, and see our blogs about it. We're obsessed with it. What happens, though, when "match day" isn't all you hoped and dreamed it would be?

As I've written before, my husband and I tried to couple's match our fourth year in medical school and were unsuccessful. He obtained a residency position outside the match, and I matched to a preliminary position.

To any hopeful medical student, matching a preliminary position is bittersweet. It's devastating that no one "wanted" you long term. It's frustrating because you will, quite literally, be starting the match all over again in a few months time. And mostly, for me, you will go for another year of your life in a large amount of debt, after thousands of hours of very hard work, with an insane amount of knowledge... and no career to show for it. None. Nothing. Just a degree that says "M.D." but that you could never actually DO anything with. I, too, was devastated.

But instead of drowning in my devastation, I chose joy: Joy that I matched at all. Thousands of hopeful medical students don't match each year and are forced into non-clinical jobs that they did not really aspire to. I also found joy in matching to a preliminary position in my field of choice; I was very happy to be a surgical preliminary resident.

I chose to use my preliminary year as a gift to see if surgery was really what I wanted to do for the rest of my life. What an amazing thing! How many of our colleagues actually get to "try out" their chosen profession for a year, with no strings attached, to see if it is something that they really like? As a medical student, you have 6-12 weeks of watching residents do what you THINK you want to do, and deciding to make a career of it. I was able to walk the walk and talk the talk (and work the work :) ) to decide if this was really what I wanted to do.

When I matched to a preliminary position I communicated to my new chief residents that I wanted to be thrown into the very most difficult rotations (busiest, hardest, longest hours, however they wanted to take that request) at the beginning of my year- in July and August. This would give me an up front, real time, on the front lines view of General Surgery, as well as expose me to the most intense months that I would be encountering. For me, these months were very busy and very overwhelming at first, but I was absolutely positive at the end of it that I was supposed to be here, and I was supposed to be doing surgery.

Letters of recommendation are very important in your preliminary year, they are basically the only thing that will have changed between last year and this year's application. You should have the maturity and the responsibility to seek these early and form relationships with faculty that allow them to easily communicate how dedicated and just how good you actually are at what you do. I love my job, and that was evident to my attendings. Also important: having an answer to "So what happened last year?" I was asked this on almost every interview I went on. Be prepared for being offered about half the number of interviews you were intially offered your fourth year of medical school. Save up money on your small resident's salary for interviews. Talk to your program director early about expectations for vacation time to be able to travel for interviews. Be nice to your co-interns because they will have to cover your call now while you travel. You are no longer enjoying a lax 4th year as you travel, you are in the thick of intern year and you will be tired. I can almost guarantee that at one point during interview season, you will walk off a night call and walk straight on to a plane. The next day you will need to look as fresh and excited as those chilled out fourth years who are interviewing around you.

The absolute best part about interviewing for a categorical position as a preliminary intern: I knew my stuff.  I know what to do, and am not frazzled, when a trauma comes in to the Emergency Department and starts decompensating right in front of me... because I've done it. I walked into every interview with complete confidence that this was going to be my career, 100%, and I was going to be VERY good at it... because it's been my job for a year now. I discussed the parts of being a surgical resident that I love that medical students don't have a clue about yet... because I'm here when everyone else goes home.

Match Day 2014 was a success for me. I matched to a categorical position. I've got a career. I'm so, so happy.

If you matched to a preliminary position this year, keep your head up. Keep your eyes on the prize. View it as an opportunity to try out a field in medicine or surgery for a year. Take the high road. Work your butt off.

You'll have a career soon, too. And it will be everything you'd hoped it would be.

~~~

Brittany Bankhead-Kendall, M.D, M.Sc. is a PGY1 preliminary general surgery resident at Methodist Dallas Medical Center in Dallas, Texas and will be a categorical resident at St. Joseph Mercy Oakland in Pontiac, Michigan this summer. She obtained her M.D. from Ross University School of Medicine, M.Sc. from Barry University in Biomedical Science, and studied Biomedical Science and Spanish at Texas A&M University. She enjoys being a surgical intern and mentoring medical students. In her personal time she enjoys spending time with her husband and son, interior design, international travel, and Texas Aggie football.

A Recipe for Success: One Surgeon's Story

 by Minerva Romero Arenas, MD, MPH

 

There are two questions that students frequently ask me about becoming a doctor. One is, “What did you do to become a doctor?” and “How did you stay motivated?” I often tell students attending the Tour 4 Diversity in Medicine (T4D) that becoming a doctor is like running a marathon. The pathway to medicine is long and challenging; I jumped through a lot of “hoops” (prerequisite courses, examinations, extracurricular activities, letters of recommendation, interviewing, etc.) just to get to medical school. At this point, I swear if their eyes get any wider they will come out of their socket. Then I tell them about the time I have spent in residency, research, and fellowships – and overwhelming is probably a gross understatement.

There are many factors that contribute to a person’s success – especially the success of a doctor. In my own personal path, I credit my success to at least four essential factors.

My family has been one of the main sources of strength and motivation. Like many immigrant families, we moved to the United States to pursue the American Dream. I was 8 years old when we moved, but since that young age I knew that my family (yes, I mean my parents, tías and tíos and abuelita) wanted better opportunities for our family. While my family never pushed me to be anything in particular, they always supported and encouraged me to pursue higher education – an opportunity they did not have. When a situation challenges me, I think back to how fortunate I am to have a loving and supportive family and any doubt is erased from my mind.

I also credit my mentors – yes, more than one – with a large part of helping me succeed. Some of them were professors who helped me stay on track and grow academically. Others were instrumental in helping me develop leadership and life skills. Yet others were research mentors or clinical mentors who helped figure out my interest in these fields. Even now as I am in my surgical training, I continue to keep in touch with some of these mentors and have even gained new mentors who are helping me grow and develop as a surgeon-in-training and future leader in healthcare.

I also found motivation in programs that helped me remember why I wanted to be a doctor. In college it was when I worked in certain clinics or doctors. In medical school, student-run clinics, organizations that connected me with other students and doctors who shared similar backgrounds or interests such as ending health disparities. In fact, even now that I have become a doctor and am completing my surgical training I still find it refreshing to remember why I chose this career in the first place. This is part of the reason I joined Tour 4 Diversity in Medicine. Talking to students about my love of surgery, or helping patients, or my research – it always help make me feel more
motivated.

Lastly, I tell students the most important factor in achieving success is the one that nobody else can help you with: hard work. There have been many people who have provided guidance, support, and opportunities that helped me achieve my dream of becoming a doctor. However, I know that my own effort helped me earn the respect and time of my mentors and make the most of the opportunities that were provided. Most importantly it has given me a source of pride and confidence that will continue to make me a successful person and surgeon.

This article was originally posted on February 5, 2014 on the Tour 4 Diversity website under the title "#T4DWest Day 2: A Recipe for Success – One Surgeon’s Story"

~~~

 

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.

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.

Finding Strength in Setbacks

by Jane Zhao

Two months ago, I read a great book, and I’ve been raving about it ever since to whoever will listen. David and Goliath: Underdogs, Misfits, and the Art of Battling Giants by Malcolm Gladwell is a book that stays true to form to Gladwell’s other works. In it, Gladwell challenges readers to look beyond conventional wisdom to reevaluate the way we look at setbacks.

The nonfiction book begins with a vignette from the biblical passage of David and Goliath. Historically, David has always been painted as the underdog and Goliath the giant. But based on what criterion? The fact that David is of significantly smaller stature? Pfft. According to Gladwell, David wasn’t such a weakling. In fact, he had numerous other qualities that made him just as formidable (if not more so) than Goliath.

Gladwell writes early on in the book:

“There is a set of advantages that have to do with material resources, and there is a set that have to do with the absence of material resources—and the reason underdogs win as often as they do is that the latter is sometimes every bit the equal of the former.

“For some reason, this is a very difficult lesson for us to learn. We have, I think, a very rigid and limited definition of what an advantage is. We think of things as helpful that actually aren’t and think of other things as unhelpful that in reality leave us stronger and wiser.”

As I read, I thought bemusedly how his words could be applied to setbacks faced by women in surgery. How often have I heard of the challenges faced by my predecessors described as blessings in disguise? Based on his writing, Gladwell probably wouldn't think of that analogy as far-fetched at all.

So I came up with some examples of surgeons whose pasts as underdogs and misfits shaped them into amazing role models.

• In the 1970s, women were discriminated against from receiving credit in their own name at banks, and if these women were married, they were told to use their husband’s name on the checking account. Finally, in response to the refusal of service, a number of women banded together and formed the first ever women’s bank. Dr. Anita Figueredo was one of them. During the creation of the bank, these women received derision and dismissal from many of their peers. But after the bank’s successful launch, banks all around (even the ones that had previously refused them service) began to open up "women’s departments" and "women's divisions." Lessons learned: when these women didn’t feel welcome, they decided that instead of trying to fit in, they’d start from scratch elsewhere. As a result, they each became successful entrepreneurs with leverage of their own right in the banking community.
• Dr. Frances Conley never really considered herself the victim of sexual harassment. Anytime an off-color joke was directed her way, she’d fire off a snappy retort, and that’d be the end of that. She built an incredibly successful career as a neurosurgeon at one of the most prominent academic institutions in the country. She kept her head down and didn't rock the boat. But then came an incident of misogyny that she simply couldn’t ignore, and she publicly resigned from her tenured position in protest. Her office and lab were ransacked; she was vilified by the media and many of her peers. Thanks to her efforts, numerous medical schools, universities, hospitals, and research labs created or updated their policies regarding sexual harassment. When she finally performed the unsavory deed of “rocking the boat” that she’d spent so long trying to avoid, she became recognized and respected as a leader brave enough to speak the unspeakable.
• Dr. Linda Brodsky serendipitously discovered in 1997 during a residency program review that a recently hired male faculty member in her department with lesser qualifications, responsibilities, and seniority was being compensated by her university at twice her state salary. Upon further investigation, she discovered that this was not an isolated incident. After more than two years of trying to resolve her gender and pay concerns internally, she resorted to filing charges of discrimination by her two employers. As a consequence, she lost her job. She’s since spoken publicly about the innumerable times she became wracked with guilt over putting her family through the tortuous process. Often, she’d lose sight of the light at the end of the tunnel and question whether she’d made the right choice by filing a lawsuit. After ten long years, the lawsuits were finally settled. Because of that grueling period in her life, she is significantly wiser about the laws regarding fair gender compensation, and she has become a fearless leader in the global community by advocating for others who are now in similar situations. 
• And lastly, an orthopedic surgeon I know was teased and called “Token” by her co-residents all throughout residency because she was the token woman their program had taken in that year to meet its quota for diversity and inclusion. Being called by a nickname she hated irked her to no end, but that experience made her aware of just how damaging and alienating such taunts, however slight, can be over time. As a result, she is an infinitely more sensitive caretaker and teacher than she would have been otherwise.

The incidents suffered by these women were awful. They faced difficulties because they were different. The silver lining to all of this is that we wouldn’t know about any of these women and their heroic contributions to society if they hadn’t been pushed to the brink and been forced by their situations to find the inner courage to implement change when change was needed.

Globally, women and underrepresented minorities still have a ways to go before full equality is met. It’s a new year though, and with that as reason enough to celebrate, I’d like to raise a toast to the tremendous progress we’ve made as a society, all thanks to the efforts of underdogs and misfits who saw setbacks not as obstacles that blocked their paths but as walls to be climbed over.

Happy 2014.

Oh, and make sure to read David and Goliath: Underdogs, Misfits, and the Art of Battling Giants by Malcolm Gladwell. It’s a good book.

Do you have an experience where being an outsider made you a stronger individual? Share your story with us in the comments below.

~~~

Jane Zhao is a fourth year medical student at the University of Texas Medical School at Houston. She completed her undergraduate studies in Medicine, Health, & Society at Vanderbilt University. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award. Her interests include healthcare social media, quality improvement, and public health from a surgical perspective. She chairs the AWS blog subcommittee and can be followed on Twitter. She is in the process of interviewing for General Surgery residency for the 2014 Match.

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.

~~~  

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.

 

Lean In: Book Review & Discussion (Part Two)

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

Chapter 4: It’s a Jungle Gym, not a Ladder (Sophia)

Sandberg reveals that she did not have a master plan at the outset or her career. Instead, she took opportunities as they arose or created her own opportunities. Again, business is a different context than surgery, in which the progression up the totem pole happens in a very particular and prescribed order. Still, there are elements of uncertainty, risk, and surprise when making decisions about a career in medicine.

Even as a 4th year medical student, I can describe junctions and branch points in my medical career where, instead of taking the safe or planned route, I pursued something else and wound up in a wonderful situation. I entered a lottery to be one of a dozen students in a novel, integrated third year and found myself having yearlong relationships with patients. It was there that I abandoned my plan of becoming a dermatologist in the operating room of a surgeon who would become one of my greatest mentors. And because of the effect of this new rotation system, I developed an interest in surgical education and ended up taking a year off to complete a Master of Education. It’s easy to look at someone successful or admirable and imagine him or her climbing a ladder straight to that position. Long-term goal setting and planning are critical to achieving ambition dreams, but Sandberg reminds her readers that there is likely more to the story, including a willingness to pursue unanticipated opportunities because of the potential for growth, whether that be taking a job in a new part of the country, starting a new research project, or taking on additional responsibilities in one’s current practice setting.

Have you taken alternative routes in your career?

Chapter 5: Are you my mentor? (Minerva)

“It should be a badge of honor for men to sponsor women.”

This chapter is full of practical advice that can easily be applied into any field, and in my opinion, can help both the mentee and the mentor. Through anecdotes of Sandberg’s own mentors and the people she has mentored herself (whether officially or not), her message becomes clear: mentoring relationships have to develop naturally and grow. As such, having ground rules for these relationships is important.

Things to consider:

1. Be mindful of the mentor’s time – mentees cannot expect to spend hours of a mentor’s time each week. As Sandberg points out “That’s not a mentor – that’s a therapist.” In my personal experience, setting up short meetings of 15-20 minutes with focused questions or goals are more effective for both the mentor and mentee. On a similar note, Sandberg suggests avoiding complaining “excessively” to a mentor and instead, ask for specific advice about how to move forward.
2. Strangers can be mentors – Just do not seek a mentor by asking a stranger cold-turkey “Can you be my mentor?” Successful mentees have approached Sandberg in a different form – a simple introduction with a well-thought out question. These individuals sparked her interest through their own success and she eventually filled that mentor role.
3. “Excel and you will get a mentor” – In surgery, strangers are frequently referred to each other by a common colleague or friend. This is how I landed with my current research mentor. The key is engaging potential mentors so they may take an interest in you and your success (via your CV or a strong referral) and following through afterwards with hard work (the mentoring relationship will naturally develop through your hard work).

In my own experience, it is important to have more than one mentor, something Sandberg alludes to through various anecdotes. For example, I have surgical mentors to whom I can turn to for various aspects of my career: my clinical concerns, career advice, and even task or situation-specific guidance. I have mentors to whom I can turn to for support and life advice. I also have some informal mentors with whom I interact on a less frequent basis (often by email or occasional text messages or calls).

The importance of mentors in surgery (as in other fields) is obvious and many employers and medical organizations, including AWS, have launched their own mentorship programs. Interestingly, Sandberg points out that “official mentorship programs are not sufficient by themselves and work best when combined with other kinds of development and training.”

What has your own mentorship experience been like? Have you been a part of an organized mentorship program?

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.

Chapter 6: Seek and speak your truth (Minerva)

In closing the chapter, Sandberg writes one of the sentences that made me think a lot about my own experience in surgery- “And maybe the compassion and sensitivity that have historically held some women back will make them more natural leaders in the future.”

What I took away from this chapter really was a lesson in effective communication and leadership. By this point in the book it is no doubt that Sandberg has research to back up the inescapable fact that gender strongly influences others’ perceptions of a person. In fact, gender strongly influences our own perceptions of ourselves. Sandberg laments that women hesitate to provide honest feedback, lest they be labeled as whiners or avoid discussing their children at work lest their priorities be questioned. Instead she advocates for honesty and a shift in leadership that strives for “authenticity over perfection.”

I have seen both types of leaders and struggled with the qualities I want to emulate. Slowly I have realized that some situations will call for a different kind of leader in order to be effective. For example, I know a leader who is generally regarded as someone who has high expectations, demands perfection, and may not be the easiest person to please. While this style may aggravate colleagues and subordinates in many situations, in surgery this type of leadership is essential when dealing with decisions that carry serious consequences such as life or death. Ultimately, more diversity in the workforce will translate to changes in leadership and eventually, I hope more equitable roles in the workforce.

Have you ever felt like you could not voice concerns out of fear that you may be labeled as a complainer or not a team-player?

Chapter 7: Don't leave before you leave (Minerva)

Sandberg points out that many women start to end their career before even getting out of the workforce. In an extreme example, Sandberg notes a young employee who worried about raising children before even being in a relationship, pregnant, or anywhere near having to worry about career-personal life balance. She raises a valid point that instead of holding themselves back from success due to being unable to meet demands later – women should aim for success and adjust or scale back as needed later when their success will lend them much more flexibility.

When I read this chapter I immediately thought of one surgery mentor. Having seen many intelligent, bright, and technically gifted female residents quit surgery for their families, he would frequently warn me not to quit surgery “because you want to have kids.” Most of the time I thought he was kidding with me, but in retrospect I feel lucky that someone saw enough promise in me and cared enough to open up a sincerely dialogue with me about career planning.

I must admit that I am guilty of nearly doing this to myself. While I had mentally prepared to make sacrifices for my career, during medical school I realistically started to consider how much of my life I would let my career consume. After my clinical rotations I was convinced in my heart that I wanted to do surgery, but all the warning alarms in my mind were going off. I am thankful that I had the sense to call one of my mentors (and a voice of reason) to help me think through this seemingly enormous decision. “Why not?” she asked during that call –I had no answer –and with that simple question she helped me realized that only I could hold myself back from a fulfilling career in surgery.

Do women really leave before they leave?

We value your opinion. Chime in on the comments below, and be sure to check back tomorrow as we continue our discussion in Part Three. Yesterday's discussion can be found here.

~~~

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.

Lean In: Book Review & Discussion (Part One)

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

Introduction

Lean In: Women, Work, and the Will to Lead.

Sheryl Sandberg published this book less than one year ago – and caused quite a stir. Some praise her for exploring the question of why there are so few women in the top ranks of corporate America. Others criticize a perceived failure to represent the needs of the non-elite women who are not in positions to pursue C-suite offices.

We share our impression of her book – a chapter at a time– eyes of individual women in surgery. Not necessarily a book review, we try to draw out any parallels or lessons that the book offers to women who are also operating within a traditionally male-dominated discipline.

We hope you will join in our discussion – even if you have not read the book!

Chapter 1: The Leadership Ambition Gap (Sophia)

Sandberg writes from the perspective of a woman in business, but I found that many of her observations and points apply just as well to medicine, in particular surgery. She describes that, for a number of reasons, a smaller proportion of women aspire to the top leadership positions in their organizations or their fields. I wonder if a poll of general surgery applicants would also reveal that fewer of the women hope to become Department Chair or President of prominent surgical associations. Is there a leadership ambition gap in surgery?

Reading this chapter, I reflected on my own ambitions. How often had I envisioned myself ultimately becoming Full Professor or Chair or President? The answer was telling—exactly zero. Since then, I’ve committed to ignoring the thought “I could never be XYZ” and follow it with “Why not me?” And I’m going to encourage my female friends to do the same. Instead of dwelling on the difficulties of juggling multiple personal and professional identities, I’ll encourage them, as Sandberg does, “not to be afraid” of ambition. There are many valid reasons a female physician might not embrace the pursuit of being at the top of a strongly hierarchical field, but fear and cultural distaste for a woman’s ambition should not be among them.

Have you noticed a difference in ambition?

Chapter 2: Sit at the Table (Callie)

In this chapter Sandberg discusses how women often feel fraudulent when they are praised because they feel their recognition is undeserved and how she personally felt like an imposter, moments away from the inevitable embarrassment of failure. This is an easy chapter to apply to surgery because the author actually does it for me. She highlights a study that looked at students on a surgery rotation that found female students gave themselves lower scores than the male students despite the fact that the faculty evaluations showed the women were outperforming the men. I am certain that this does not stop when these ladies graduate medical school. Some of them will go onto surgical residency where they will continue to underestimate their abilities despite feedback to the contrary. I see it every day.

The most salient part of this chapter is the inherent differences between men and women when it comes to what each will credit their success to, and more importantly, what they credit their failures to. Anecdotally, I have seen my male and female colleagues deal with complications in vastly different ways--specifically with my female co-residents being quick to take responsibility for a patient’s complication but much less quick to compliment themselves when an outcome is favorable. The fact of the matter is, the data show that women are less likely to credit her success to her abilities and more likely to contribute her failures to them. In another excellent book entitled Mindset, Carol Dweck describes how this thought pattern is something that becomes ingrained in us during our upbringing and requires great focus and attention to our inner monologue to overcome it.

Do you agree that women do not sit at the table enough? Are there differences in our upbringing that make us more submissive perhaps subconsciously? 

Chapter 3: Success and Likeability (Sophia)

Sandberg begins this chapter with a reference to Harvard Business School’s Heidi/Howard study, in which students rated a case protagonist far more likeable when the only change to the case was changing the name “Heidi” to “Howard.” She asserts that a woman’s desire to be liked can be an impediment to success because success and likeability for women, unlike men, are often at odds.

I am not convinced this is as true in surgery as it is in business. Surgery is patient-focused work, and the operating room requires a great deal of teamwork and communication between many different individuals. Even research projects are far more successful when one is well-regarded by collaborators. So when I see a highly successful female surgeon, I assume that she must excel in working with others because success in this field depends so much on interpersonal skills. This is the same assumption I make for men. But perhaps relevant take-always for women in surgery are Sandberg’s points about taking ownership of one’s success and the importance of negotiation. She encourages women not to mute their accomplishments for fear of being perceived as likeable, especially within the context of negotiating for themselves.

Do men and women perceive leaders the same way? Are female leaders at an unfair disadvantage?
  
We value your opinion. Chime in on the comments below, and be sure to check back tomorrow as we continue our discussion in Part Two.

~~~ 

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 is 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.

Unconventional: Our Couple's Match Story

by Brittany Bankhead-Kendall, M.D., M.Sc.

Match Day 2012 was supposed to be the best day of our lives. Or one of them, at least. But it was so, so not. Monday morning my husband and I left our respective rotations around 11:45am and hopped into our SUV in the hospital parking lot in anticipation of the noon email saying we had matched. We wanted to celebrate that together. My email came: "Congratulations! You have matched to a one year preliminary position." I was devastated. But it got worse. My husband's email came: "We're sorry, you have not matched to any positions."

Can that happen? Did that just happen? I didn't think that was possible. Our numbers were right. We had plenty of interviews. We were matching Emergency Medicine (him) and Surgery (me). A difficult match, but not an impossible one. Right?

He was the better candidate, but we thought Surgery was the harder match. So at match choice #18, after all of our same city match choices, we listed a match-no match option. The thought was that in this certain city we chose, surely he could find something to do for a year. A big city, close to my family, lots of options. We assumed he would at the very least be able to find a preliminary surgery spot at one of the four hospitals in the area. Prelim surgery spots aren't hard to find, right?

We drove straight from the hospital parking lot to a McDonalds and hooked up the laptop and filled out his SOAP application. He applied to all the Surgery Prelim spots in my city (the NRMP will tell a couple, in a match-no match situation, the city of your match). Tuesday, Wednesday, and Thursday came; no interviews, no offers. Match Day came and went, we "celebrated" at home with our baby boy and my parents, and occasional tears.

Then we looked for research positions for the year for him. And... Nothing. We tried, we weren't even picky. But he was over or under qualified for anything we found.

Then one day, out of the blue, he got an email inviting him to interview across the country for a position in Emergency Medicine. He got the position. And yet we struggled with it. Was this a temptation that he should pass on? Was this a blessing? Was it great for his career at the expense of our family? Would we be able to survive without each other? Could I be a surgery intern, with our BABY, without him?

Ultimately, he took the position. We're tough. Yes, he and I are tough. But what I also mean is that we women physicians are tough. We're a different breed, I think. No one can tell us no. No one can put anything in our path too great to achieve our goals. No one can tell us we can't love our job and love our child. No one can tell us we can't do it without certain features of our home life lined up. We can do it.

It's hard every day. That I won't deny. It's hard being away from my best friend and confidante; the person I want to vent to and hug and go on dates with and share in our son's new milestones and that he finally says "Mama." It's hard being a "single" parent. It's hard knowing my son is not with his mom or his dad 24-7. It's hard when your child reaches for their grandmother for comfort when they fall and you are both standing there. And oh yeah- it's hard being a surgical intern, period.

But I'm blessed. We're blessed. Training looks different for everyone (we went to a school where our basic sciences were in the Caribbean; more on that another day). Life looks different for everyone. Just because it's different doesn't make it wrong or weird or not doable. We've learned a lot along the way, and talk about it a lot (when our shifts don't overlap, that is). I'll sum it up for you, in case it would help anyone else along the way . . .

1. Don't be too proud to apply to different locations if you're couple's matching. You'd rather be a doctor in a different geographical location than not-a-doctor in the same location.

2. Surgical preliminary spots aren't as easy to get into as you might think. I think that's the going rate for almost any residency these days.

3. There's lots of spots outside the match that you don't hear about unless you look for them in the right places. Look on your specialty's program director website (a good place to start) to see if there are open positions outside the match.

4. Don't panic if things don't go how you saw them. Where there's a will, there's a way. Don't let anyone tell you something isn't possible.

5. Family comes first, but deciding to be apart doesn't mean they don't still come first. Don't feel bad for choosing it. It doesn't mean you ranked them of less importance. It just means your story looks different.

6. Speaking of stories: Life looks different for everyone. You can use yucky situations for learning and growing, or for being miserable. It's a choice.

7. When you rank programs, go where you love. The rest will fall into place.

Of note- at the time of publication of this blog, my husband has an interview for an open PGY1 EM position that came available in late July right down the street at a phenomenal academic center.

Either way, we know what we've learned through all this.

Either way, we're good.

What obstacles have you overcome to achieve success? Do you have any words of advice for surgeons or aspiring surgeons who are going through a difficult time? Please share your thoughts in the comments below.

~~~

Brittany Bankhead-Kendall, M.D, M.Sc. is a PGY1 general surgery resident at Methodist Dallas Medical Center. She obtained her M.D. from Ross University School of Medicine, M.Sc. from Barry University in Biomedical Science, and studied Biomedical Science and Spanish at Texas A&M University. She enjoys being a surgical intern and mentoring medical students. In her personal time she enjoys spending time with her husband and son, interior design, international travel, and Texas Aggie football.

Solidarity

by Minerva Romero Arenas, MD, MPH

Since medical school, I had an interest in oncology. Our professors frequently invited patients and families to come and share with our class how they were personally affected by disease. I remember meeting a survivor of glioblastoma multiforme despite having been initially given a poor prognosis. Another family shared the heartache after losing a child to neuroblastoma and their efforts in raising his siblings. I was inspired to do something to show support for patients like the ones who shared their stories with us - the patients whom I one day hoped to treat. Being on a limited student budget, I had to think outside the box since I could not afford to make "significant" monetary donations. One day I decided I would donate my hair so someone else could have a wig.

Having had long tresses for decades, I must admit I was hesitant to go for a short bob. The fear quickly faded, as the stylist transformed my ponytails into "locks of love." The selflessness I felt, as I placed those long ponytails in the mail, let me know that it was one of the best ways I could contribute outside of my dedication to the medical field. I first donated to Locks of Love, though I have since switched to the Beautiful Lengths program.

Since that time, I have donated my thick, brown locks again. However, the next time became a lot more personal. During my first week of surgery residency, one of my surgery attendings made me burst out in tears after a teaching conference. Now, there is an unspoken rule that there's no crying in surgery! (just like in baseball). But my tears were not the result of a terrible pimping session or getting chewed out for making any mistake-- I had just learned that this surgeon, my professor, had terminal cancer. Having been given less than six months, she already had beat the odds a few years from initial diagnosis. Over the next year and half, she became a mentor and had a great influence on my early development as a young surgeon. I did not think twice about donating my hair again when she faced a debulking surgery for a recurrence. During our last conversation, she smiled when I told her about the donation.

My hair grew long again; it had been more than two years since the last donation. What a perfect metaphor for my progression in residency, and the adage that a tincture of time is sometimes the best medicine. Then I found out a colleague was facing a cancer recurrence. I prepared to visit my favorite hairdresser. He gets the most length by separating the hair into at least two ponytails. That day I mailed two ponytails, 12 inches each, of solidarity. Priceless.

~~~

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.