Monday, September 30, 2013

Lean In: Book Review & Discussion (Part One)

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


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.

Tuesday, September 17, 2013

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.

Thursday, September 5, 2013

A Word with Amalia Cochran, MD, MA, FACS, FCCM about Twitter

by Heather Logghe, M.D.

Dr. Amalia Cochran serves as Secretary for the Association of Women Surgeons and is a member of the American College of Surgeons Professional Association Political Action Committee Board of Directors. She chairs the Education Committee of the American Burn Association, is Vice Chair of the Undergraduate Medical Education Committee of the Society for Critical Care Medicine, and is a member of the Association of Academic Surgery Education Committee. She is also the Chair of the Multi-institutional Education Research Group of the Association for Surgical Education. 

Her research interests lie in the areas of education and clinical outcomes, and she has been the recipient of numerous teaching awards. Dr. Cochran is a burn surgeon at the University of Utah School of Medicine.

In addition to all of Dr. Cochran's accomplishments, she serves as a leading voice in health care social media. In today's post, Dr. Cochran discusses her growing use of Twitter.
Q: What has surprised you most about your Twitter experience?

A: I have been most surprised by the amount of material I am able to access quickly from links in Twitter. I have a strong interest in mentoring and professionalism in surgery, and Twitter has given me a community to engage in meaningful discussions with people at other institutions about those things.  It's good to both find like minds AND to be challenged in your ideas in a collegial manner.

Q: Does Twitter help you stay current? If so, how?

A: Yes, more than I expected.  Many surgical and medical journals have begun to tweet links to abstracts of key articles they have published, and they are sometimes things I would have otherwise missed.  Also, now that I have a fairly robust group of people I follow, I'm often impressed at the links that they will provide that lead me to something fascinating and new.

Q: Do you engage patients via Twitter, and have patients approached you?

A: So far, no to both, but I could see this happening.  I tend to be very cautious about giving medical advice to anyone who isn't my patient, so while I might not be willing to use it to give advice, I would happily use it to help connect patients to resources.

Q: What are your thoughts on the future of Twitter for surgeons?

A: I am optimistic that we'll see growing engagement with Twitter in the surgical community, and that as we do, it will become a more robust clinical and educational resource for us.  The Twitter session at #ACSCC12 was certainly a great start, and I recently participated as part of a Twitter "team" for the Academic Surgical Congress (#ASC13) and the American Burn Association (#ABA13) meetings this past Spring.  I know that it was a great way to stay engaged-- and keep track of places that you couldn't be simultaneously-- during the Clinical Congress.

Q: What are your thoughts on Twitter for:

Medical Education: I see limitless potential here for asynchronous learning.  While I have been looking into ways to use Twitter for CME, I'm simultaneously brainstorming how I could effectively use it for medical student education. There may be an experiment coming up during our Transitions course for our 4th year medical students in April! I'm also appreciative of the networks that I have become part of by virtue of being active on Twitter.

Patient Education: This is an angle that I haven't looked at much within my own specialty-- yet-- but that I see the value of with the wonderful #bcsm chats hosted by Dr. Deanna Attai every week. She hosts a robust forum with a scheduled topic, and often includes topic-specific guests.  I think she's setting a great bar for the rest of us!

Advocacy: Having made it through an election cycle, and having witnessed the Komen/ Planned Parenthood debacle of February, 2012, it is clear to me that Twitter has amazing potential as an advocacy tool.  Also, my own experience tells me that most people don't want big bites of advocacy information given to them, so 140 characters may just be the perfect way to help educate people on key issues and teach them how to be involved.

Readers, what are your thoughts regarding Twitter and its use in the surgical community? Share your comments below.