Friday, March 28, 2014

"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.

Thursday, March 27, 2014

Changing Gender Paradigms

Original blog post by Dr. Paula Ferrada (February 22, 2014) can be found on OnSurg's blog
While reading an innocuous post regarding dating female doctors, I came across a comment that immediately unleashed a visceral response: an MD implying that medical education is wasted on women.

His argument is as follows: Medical education is expensive and supported by federal and state tax money, both at the university level and at teaching hospitals, and apparently more women than men choose to work part time. In this doctor’s view, women who work full time are part-time wives and mothers, and women who work part-time are a waste of money and education.

How not to have a visceral reaction to a statement like this…. I am a foreign graduate, and it took a lot of clinical and academic effort to find and hold a position in surgical training. Following that, I finished two fellowships and I still work full time (trauma surgeons’ hours). I have a four-year-old child, and I am married. I LOVE my job, I love being a mother and a wife, and not for a second of my life have I ever considered that I am doing anything part time.

This is not only about the terrible discrimination and stereotypical definition of roles; the core of the problem runs deeper.
Parenting is not the unique responsibility of females, neither is being a good partner in any relationship (wife, husband, friend, sister, etc.). For some reason, the “ideal family picture still contains a woman dressed in pink, holding the complete responsibility of managing a house, cooking and raising children, while the guy works late hours, earns the bacon, and is completely unaware of his children’s education and family’s emotional needs; it is not only NOT ideal, but not compatible with the reality of gender roles in 2014.

Until ALL of usmales and females, recognize the change in gender paradigms, we will not see a change in our culture. The best advice that a mentor once gave me, “be excellent.” I took it to heart: in my world, that translates into being an excellent mother, wife, friend, surgeon, teacher, partner… just being excellent. To become our best selves, we need infrastructures that understand and support our need for growth, not only as doctors, but as humans. Male and female residents, fellows and faculty, need more support to fulfill their obligations at home, while maintaining a full clinical workload.

Until each hospital/training program makes an effort to provide working parents with child care that can be open at “surgeon friendly” hours; until husbands and wives understand that building a home is a partnership that requires equal distribution of work; until both men AND women find a way of supporting each other, rather than pressurizing one another into thinking that working full time means being an incompetent parent, until then, there will be women “quitting their day jobs,” and as the poisonous blogger who inspired this option stated, “wasting tax payers dollars.”

It is encouraging to see a new generation of women and men, progressive thinkers who know that we can do anything, and sometimes even everything. So it is up to us. Unless there are people like us who purposely want to make a difference, nothing will change. It just won’t.
Dr. Paula Ferrada is an Assistant Professor of Surgery at Virginia Commonwealth University and the incoming president of the Virginia Chapter of AWS. 

Tuesday, March 25, 2014

Green Solutions for the Operating Room: Remanufacturing of Single Use Devices

In 2013, the Association of Women Surgeons sponsored its second Green Solutions for the Operating Room Contest in a partnership with Practice Greenhealth.  We received many innovative and creative approaches to reducing the environmental impact of the operating room.  Today we are featuring a submission from Titi Adegboyega, a 4th year medical student at Gundersen Health System in La Crosse, WI.  Congratulations, Titi!

Green Solutions for the Operating Room: 
Remanufacturing of Single Use Devices
Gundersen Health System, La Crosse, WI

By Titi Adegboyega

My interest in medicine has been deeply rooted in my passion for global health. As I go through my training, I always ask myself what obstacles I would face if I plan to execute the same treatment plan I just provided a patient in Wisconsin to a similar patient in a rural town in Nigeria. Specifically, I consider how performing surgery here in the United States can be very different from doing surgery in a developing country. The limited resources in these areas sometimes preclude the use of laparoscopy and expensive devices like staplers and vessel sealing devices. In addition to the cost of securing these instruments, the one-time use makes them a deterrent to in light of limited funds. Innovations to recycle these devices are one way to make these expensive devices cost effective.

Single Use devices (SUD) are commonly used in the operating room. With growing number of minimally invasive procedures, the use of SUD such as laparoscopic trocars has also grown. Likewise, there has been a surge in use of the LigaSure and Harmonic, both SUDs utilized in many surgical procedures for vessel sealing and dissection. For over ten years, Gundersen Health System (GHS) has been participating in remanufacturing of single use devices. The list of the most common devices remanufactured a listed in table 1. In other to reduce waste, GHS recycles 95% of SUD although only about 2% is actually remanufactured and packaged for reuse based on the Food and Drug Administration guidelines. The recycled products are diverted away from the regulated medical waste stream which results in ‘waste savings’.
The process of recycling involves placing items for recycling in clearly labeled teal Stryker containers in each operating room. These items are sent to one of the two processing plants in the US (Arizona and Florida). Items are then sorted for recycling versus remanufacturing. There is no additional cost of recycling to GHS and no additional personnel required as SUD are placed in the recycle bins immediately after surgery by the OR staff.

The safety of utilization of SUD is a potential concern for both patients and healthcare organizations. The department of infection control and infectious diseases is engaged in the remanufacturing process and each remanufactured device is inspected multiple times in the cleaning, sterilization and repackaging process to insure quality and safety.

The average cost of medical waste disposal is $0.50 per pound. In 2013 alone, GHS has recycled 7,843 pounds, resulting in a waste savings of $3,924. GHS has also saved $161, 360 this year alone from reusing of SUD (figure 1).

The cost savings attained from recycling SUD makes it more suitable for low resource environments and is one of many innovative ways to bridge the difference in surgical care globally.  I hope to incorporate this in my career in global surgery to maximize the limited resources available to care for patients.

Table 1: Remanufactured OR products
Arthroscopic Shavers / Burs
Burrs / Bits / Blades
Cardiac Stabilization
Compression Device - Pairs
EP Catheters & Cables
Endoscopic Trocars
External Fixation
Opened & Unused / Expired
Suture Passers
Tourniquet Cuffs
Ultrasonic Scalpels

Figure 1: 2013 Monthly savings on utilization of remanufactured Single Use Devices


Titi Adegbboyega is a fourth year surgery resident at Gundersen Health System in La Crosse, WI. She completed medical school at the University of Minnesota and is interested in global surgery.

Friday, March 21, 2014

What it's like to be a visiting professor.

The AWS Kim Ephgrave Visiting Professor Program provides medical schools with the opportunity to request top women surgeons as speakers and receive funding from the AWS Foundation. Opportunities to lecture heighten the visibility of women surgeons while encouraging women medical students to pursue similar careers. In addition, the program promotes dialogue between practicing surgeons and the academic community. The program was recently named in memory of Dr. Kim Ephgrave (1956-2012), who served in the AWS Leadership from 1997 - 2002 and as AWS President in 2000/2001.

Kim Ephgrave Visiting Professors have an opportunity to share professional and personal experiences with Department Chairs, Faculty, Residents and Students through grand rounds, walk rounds, lecture and research presentations and other arranged opportunities.

Medical Centers provide the platform for the experience by hosting the Kim Ephgrave Visiting Professor at a breakfast, luncheon and/or dinner meetings and arranging for clinical experiences.

The following is from one of the 2014 Visiting Professors: Dr. Betsy Tuttle Newhall who visited Cleveland Clinic. 

It was my honor and pleasure to represent the Association of Women Surgeons as the Kim Ephgrave Visiting Professor this year at the Cleveland Clinic Foundation (CCF). I had a wonderful time and gave two talks, one to the Women’s Physician Professional Association and the other at the Digestive Disease Grand Rounds. I interacted with physicians, surgeons, residents and students. Dr. Jane Wey and Dr. Walsh were outstanding hosts and I am grateful for their time and effort. I would also like to thank the transplant team, who spent the morning with me presenting incredibly challenging cases – the sort all transplant surgeons care for, and in some circumstances, dread. I am grateful to Dr. Charlie Miller and his team for their incredible attention. Finally, to Dr. Dympna Kelly who gave me the most outstanding introduction. (I kept looking behind me to see to whom she was really referring.) I have known Dr. Kelly for some time and was happy to see that she is happy and fulfilled in her role at the CCF. Thanks to all of you for this great honor.

In speaking to the Professional Women’s Association Tuesday night, I had the honor of reflecting on my now twenty years of practice and being a woman in Academic Surgery. I had the luxury of recently writing a chapter for the Surgical Career Guide for AWS with Dr. Leigh Neumayer regarding leadership and was able to put that together with my experiential advice based on the context of that project. It is hard to believe that I am now fifty years of age, with a teenager, a son who will soon be a teenager, and married for twenty-three years. Life moves quickly both professionally and personally. I believe that the life unexamined, while worth living (my apologies to Socrates), is not becoming of an intellectual woman. I have found fifty to be a freeing birthday and less a birthday based in fear.

The next blog post is a summary of my talk to the outstanding women physicians, surgeons and their trainees at the CCF. Read Challengesfor Women in Academic Medicine and the Question of Leadership

Dr. Betsy Tuttle Newhall 
Professor of Surgery, and Urology
Division Chief of Abdominal Transplantation
Surgical Director for UNOS, Kidney and Kidney Pancreas Program
Saint Louis University

Challenges for Women in Academic Medicine and the Question of Leadership

“The world will be saved by a Western Woman.” - His Holiness, the 14th Dalai Lama at the Vancouver Peace Summit, 2010

His holiness stated this on stage with three Nobel peace laureates: Mairead Maguire, Jody Williams and Betty Williams. Also at the table was Mary Robinson, most beloved of all Irish presidents and a tireless human rights activist. Susan Davis was there too. Her humanitarian work has impacted the lives of millions in Haiti, Bangladesh, Afghanistan and several African countries.

Women, it is well known in the developing world, are less a credit risk and take monies made in a small business and invest in their families, their communities and their countries. Women do not start wars (with the exception of Catherine the Great and Margaret Thatcher). Women, in the Dalai Lama’s opinion, have more compassion and care for those who suffer. That is why he believes that Western Women, highly educated and motivated for change, will save the world. In this era of healthcare, I believe that Women, have a unique role to play in caring for our patients, our trainees and our colleagues as the environment changes. I believe that we have a very unique opportunity to steward our profession during “these “uncertain and changing times.

In academics, how does one start a “traditional academic career?” You go to the “right” medical school, then the “right” residency, followed by the prestigious fellowship. At some point along the journey, you obtain a mentor in the focus of your field of study – clinical, scientific, or academic. As a woman, your mentor doesn’t have to be gender specific. In fact, my first (and current) mentor is Dr. Jesse Meredith at Wake Forest University – not to be confused with his son, J. Wayne Meredith, MD, the Chair of Surgery at Wake Forest. Dr. Meredith Sr. is one of the surgeons who trained and performed surgeries in the day of portal hypertension decompressive surgeries. When TIPS (transjugular intrahepatic portal caval shunts) do not work or are not possible, those with “open” surgical experience in those types of surgeries are few and far between.  Sometimes, in my line of work, I need someone to talk to about these types of problems. He has always been there for me with advice, before I was a transplant surgeon and afterwards. He is who set the tone for my career: patient first.

The mentor can certainly help direct your career, and the relationship with the mentor certainly does not have to be formal. I believe that we are always training and there are always lessons to learn from whoever is around you if you are aware and take the time to notice.

Having said that, where does one go from formal training? First: job, grants, clinical experience, promotion, tenure, and then perhaps, leadership? This is where the “glass ceiling,” or perhaps lack of opportunity, becomes a reality for most mid-level to senior women, not only in surgery, but medicine.

When you review the 2012 AAMC report Women in US AcademicMedicine and Science: Statistics and Benchmarking Report, it is clear that despite women being greater than 50% of all medical school students, we have not progressed in numbers statistically equivalent in progression in academic rank or leadership positions. Currently, there are only three sitting chairs of surgery that are women in the United States, with the departure of Dr. Julie Freischlag and Dr. Nancy Ascher from their respective chairs.

Why have women not progressed in similar achievements in the academic hierarchy in similar numbers occurs for many reasons. I am certainly no sociologist, and a full discussion of the many pressures that women face in academics is beyond my talk, however, I can only speak from my own experiences and observations over the past twenty years in academic surgery.

Medicine as we know it is undergoing a significant number of changes with the Accountable Care Act and the call for “value” in healthcare from patients, payers and CMS, as well as many other changes in the fundamental way we as healthcare providers perform the business of Medicine. For-profit healthcare, loss of private practices, hospital ownership of physician’s time and effort, vertically integrated healthcare systems, are all new and frightening for medical leaders on all levels. I believe that the instability in the current healthcare environment leads Healthcare Leadership to choose leaders with whom they are “comfortable “ and “ familiar” with, as opposed to leaders who don’t look like them and perhaps possess demographic characteristics they have never worked with in an executive environment.

I know that there are other factors in these choices: variations in experience, additional training, women not understanding the “language of leadership”, opportunities, and mentorship, and frankly, women’s choices. Leadership in academic medicine is different than leadership as defined by business, in my opinion. Whether it is the day-to-day operations of caring for patients, the pressures of working for organizations that often have conflicting agendas (research, patient care, teaching, administration and making enough money to support the missions), the politics of being in academic medicine – leadership, as defined in business, is different than that observed and defined in medicine. I do not believe that this should be the case, and leadership should be just that- Leadership.

“True leadership is less of a title or a position, it is more of a state of “being.” It is about courage and risk taking and not so much about politics and walking a “safe” line. Leadership is about standing up for what is important to you – patients, trainees, your research or science, mentorship and having the vision to bring your Department/Division/group of partners along with you.  It is about sacrificing your career for the forward motion of your organizations and its members – the concept of “servant leadership.” It is eventually about your legacy and the legacy of the organization under your direction. Not empire building and certainly not about money.

So, if this is a track you want to pursue, the first thing one needs to do is to assess what you have available to you to make this happen and what you need to acquire. What resources do you have? What skills do you have and potentially need? What are your challenges? First, you must learn the language of leadership and have a vision for what you want to achieve. Think globally not locally.

There are resources available to you for your leadership training and development. 35% of AAMC accredited medical schools have monetary support for the standard Group on Women in Medicine and Science (GWIMS). These monies are intended for women faculty promotion and provide development opportunities for those selected faculty members. Departments and Divisions often have funds set aside for faculty training and development. If there are no monies available at your institution at that level, the Dean’s office or Hospital may possess funds available for leadership training. See the table below for some options and costs for those training opportunities.

Other options for leadership development include formal mentorship opportunities (if not available for you locally) in national societies such as the American College of Surgeons and the Association of Women Surgeons. A searchable mentor database has been developed for AWS members.  

I have found personal coaching and assessment very valuable and now have a relationship with a psychologist who specializes in helping women find their way to leadership. Personal coaching is an expensive option. However, it is about you – your skills, your challenges and your issues and allows you to have an objective ear for your concerns. I have found this assessment and support, invaluable.

I would suggest that now is the right time to pursue leadership opportunities. The challenges that Healthcare Reform presents allows us that opportunity and the business literature is full of articles and assessments regarding women as leaders. While it is unfair to all of us to stereotype a “typical” woman leader, Forbes Magazine at a conference in 2012, published an article regarding women’s leadership characteristics including: empathy, curiosity, collaboration – as well as – an open, information sharing style vs. hording of knowledge. Women are also described as highly adaptable leaders. The perfect skills to have in the changing health care environment.

While you are preparing for whatever leadership role you desire (section, division, department chief or dean role or even a chief medical officer in industry), here are a few suggestions from lessons I have learned along the way (mostly from mistakes).

1. First, always lead yourself.

Have a routine for basic self-care (exercise, diet, meditation, yoga, religion, etc.). Practice finding that work/life balance – whatever that looks like for you. Be extremely mindful of the resource that is you. Don’t waste your energy on people, issues or activities that do not “feed you” and only drain you. People depend on you – family, patients, and colleagues. Preserve yourself for what matters to you. Become the leader you would like to be. Have unquestionable integrity, and fairness. Lead by example. Be on time for the OR, keep your charts up to date, and be on time for clinic. Have a sense of humor, and remember most of the time, “it” isn’t all that important usually. We, as surgeons, know what is really important. Never hold a grudge – easier said than done, but work at it. Be the best surgeon you can be.

2. Have peer credibility.

Possess and practice the four A’s of Surgery – accountability, availability, affability and ability (usually in that order of priority). If you are friendly and available, you will go a long way with garnering the support and, if not admiration, the respect of your colleagues. Remember, it is your colleagues that you are hoping to lead in some fashion as you move forward.  Be supportive to the people who work for you: nursing staff, administrative support staff, and especially trainees. Never be demeaning, hold people accountable but communicate and educate.

3. Most importantly, fine tune your inter-personal and communication skills.

Moving forward in academics is about relationship building. Note, I did not say politics. Learn people’s names and listen to staff (you usually can find out the “real” story about any one issue by listening.) Work on building your reputation of being friendly, approachable and most importantly, effective. Never lose your temper and if you do, do not say anything that could be repeated out of context that makes you look worse.

I have observed over the years, that women in the operating room (for example); do not enjoy the same level of understanding from the staff when tempers are lost. There is no room for immaturity or lack of insight into how a tiff in the OR could potentially ruin or significantly delay your potential promotion into a leadership position until you have been judged to be “mature.” Most importantly, never single out an individual with your tirade. It has to be about the issues.

4.  Have a constructive way to resolve conflict on any level.

Always start your resolution process with a clear mind and a calm heart (as hard as that might be). Remember it is about the issue, not the person, even if it has to do with the person’s behavior. It is about being disruptive, for example. Always resolve issues face-to-face and refrain from the immediate email reflex. A short meeting with a published agenda and planned follow up is critical. Ignore the urge to call someone’s boss. Be deliberate, be about the issue and follow through.

5.       Set your priorities.

Refer back to #1. Preserve the resource that is you for the things and efforts that you think are important. Other people will have an idea of what they want for you, but you have to be very clear in your own direction and avoid busy work (i.e. committee that are not important, and do not accomplish anything for example). Avoid being the token appointment to any committee or organization unless you feel it is something that you think is worthy of your time and effort. Be extremely organized using whatever tools work for you. The personal coach for me has been extremely useful in this particular issue. Prioritize your office, and time – clinical administrative and teaching. If research is important to you, set aside protected time for your efforts. This of course, may require negotiation and follow through. You cannot do research and have a clinic the same day.

6.       Disarm the tenure clock and collaborate.

In order to progress in the hierarchy of Medicine, one must be productive in a research area and/or publish. Not all of us should be, or can be, an NIH funded basic science researcher. However, that doesn’t mean that all of us in academic medicine cannot be productive.

One of the issues in retaining women faculty is the issue to promotion and tenure. Certainly, some institutions have more rigorous promotion and tenure requirements than others. However, all academic programs have some minimum requirement for contribution to the literature and some have a time limit for application for promotion and tenure.

If and when you make the decision to have a child, and you are in the academic setting, know your own institution’s maternity policy. Apply for leave, in anticipation of your leave, in an early and timely fashion and do not leave this application to anyone else. I have had Division Chief’s lose these types of applications on their desks – never reaching their intended destinations. If you are planning a child or you are a very busy clinical surgeon, it is critical for your academic success to collaborate with academically productive people. You as a clinician can contribute much needed clinical expertise to (as my example) an Outcomes Research group. By collaborating, instead of being on your own, your work can continue when you do take leave, or you become very busy.

7.       Hone your administrative skill set.

Currently, I am in the throes of a Corporate Finance class as part of a Master’s in Health Administration Program. Why? As a Division Chief and as the former interim Chair of Anesthesia at my institution, I was responsible for budgets to the Dean, determining salaries based on productivity, bonuses and contract negotiations with Hospital organizations for services provided. I was blessed with a wonderful business manager; however, I felt that I needed more precise information about what I was doing, hence my return back to school for the MHA.

It is imperative if you are to be a leader in academic medicine especially in the current environment that you understand the finances of what it is that you do. You need to know diagnostic codes, reimbursements, documentation requirements and your own regulatory environment. You must have a trustworthy business manager but they are often hard to find and may have been “institutionalized” meaning they may not be open to new ideas about how to do your business. You often have to mentor them as much as your partners and trainees. If you cannot read the P & L statement or an income statement, take the time to talk to your business people and learn about how overhead is allocated and what the lines on your P & L statement mean. It is important. Profitable divisions and departments have the ability to grow and develop. If you are not comfortable with any of this perhaps you too will find yourself back in school for an MBA or an MHA. It isn’t surgery, after all.

In conclusion, I hope my hard learned lessons have been useful. I have learned over the years, that keeping one’s own CV is important, make sure you know what you are doing (i.e. do an executive summary) and look at yourself and your career annually to make sure you are on the track you want to be. Use your friends to help you on your way.

I would never be where I am, or more importantly who I am and how I am, without the Association of Women Surgeons and my mentors there. To be the 2014 Kim Ephgrave Visiting Professor is one of the highlights of my career. Thank you again for this honor.

“I learned all kinds of things from AWS members and staff about challenges in our various family and professional situations, and AWS gave meaning to my own hard learned lessons as a vehicle for sharing them with others.” - Kim Ephgrave, MD

A few references for your perusal:

 Dr. Betsy Tuttle Newhall 
Professor of Surgery, and Urology
Division Chief of Abdominal Transplantation
Surgical Director for UNOS, Kidney and Kidney Pancreas Program
Saint Louis University

Thursday, March 20, 2014

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

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.

Thursday, March 13, 2014

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.



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. <>. 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.

Wednesday, March 12, 2014

Interview with Dr. Diana L. Farmer

by Lauren B. Nosanov

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

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

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

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

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

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

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

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

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

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


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

Wednesday, March 5, 2014

Why I Started Tweeting and Blogging

by Sophia K. McKinley

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

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

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

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

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

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


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