Tuesday, June 30, 2015

Research and Career Development

By Christine Laronga, MD, FACS

As I reflect on my academic career spanning 15 years and 2 institutions, several items emerge as key steps in my journey from Assistant Professor to Professor. First is identifying that you wanted to make the trip in the first place and then setting a realistic goal for this accomplishment. For example, I envisioned 5 years would be needed to go from Assistant to Associate Professor and another 5 years to rise to Professor. Set your own pace though. Now that you have established your long term goals, you need to break it down into yearly achievable goals to keep you on track. To do this, you need to know early what the requirements are for promotion at your institution. The requirements may fall into categories, such as research, teaching, service and clinical leadership, but they all go hand in hand. Each component will help your research and career development.

Clinical leadership entails building a practice and being recognized by one’s peers as an expert in your field. Building a practice usually takes a year or two during which time you are busy introducing yourself to the other departments (referrals). Offer to teach a didactic lecture or give grand rounds. This fulfills requirements for teaching on your CV but also gets your name out there.  Make several generic talks –The Surgeons Role in Breast Cancer etc.  This way you can be ready on short notice to give the talk and you can update it as new information /technologies become available. I had 3 ready to go my first month in practice. Usually the first month or so is slower as you are awaiting insurance coverage to see patients; so take advantage of this time to do meet-and-greet sessions with the community doctors (again a great way to get referrals). Most institutions have someone that can arrange these contacts and even go with you. Some hospitals will also have a monthly conference / tumor board for their doctors and you can offer to give a talk (good thing you have 3 talks ready). These sessions would go on your CV under invited talks (teaching) but also can be applied to service (local / community). Speaking of community, one of your talks should be created for the public. Many churches, schools, hospitals,  or organizations host community events to raise awareness. Check out your local community newspaper to find some of these. Reach out and offer your services. This helps build your practice and gets you service credit. To complete your service requirement as an Assistant Professor, volunteer to be on a hospital committee that isn’t too time demanding, until you get settled. You want a continuous item such as cancer committee because the commitment should span years. Your goal as an Assistant professor is to establish yourself in the local/regional area as a clinical expert and educator. Your reach will extend nationally / internationally as you progress from Associate to Professor.

Research development requires awareness of your ultimate goals. If you want to be a basic science / translational researcher, as a surgeon you will need great collaboration with your basic colleagues. You will need start up funds and need to bang out preliminary results to apply for grant funding. Shoot for mentored research grants. A grant awardee needs to show expertise in the arena of their studies.  Your studies will take years to come to fruition. So you need to start off with review articles and retrospective chart reviews at your institution. Publish these results. Present these results regionally and nationally. Most institutions have a minimum number of publications required for promotion, of which a proportion are expected to be as first author. Review articles and retrospective chart reviews are perfect for you to be a first author and they hone your knowledge base about your future research endeavors. For example, if your institution wants 5 publications with 1 as first author, you may want to target 1 a year. Don’t cram in the last year. A key to my success was building databases the minute I arrived at my first job.  I created an IRB protocol encompassing an extensive amount of data from demographics, presentation, pathology, to surgery, adjuvant treatment, and complications about one disease entity such as ductal carcinoma in situ. (Yes by now you have figured out that I am a breast surgical oncologist).  Then you make datasheets that are easily filled out by circling items on a piece of paper or ipad, such as Race. You get the tumor registry data in this example and you do your chart review. The following year you add follow-up data and additional patients accrued in your first year of practice. Each year you create an abstract based off that database – what margin width is acceptable, does every lumpectomy patient need radiation or tamoxifen, predictors of upstaging to invasive cancer, the role of sentinel lymph node biopsy, etc. The list of possibilities is endless. Keep building on the database and eventually you will have long-term follow-up on a portion of the database.  Create abstracts for local, regional and then national meetings. Over time as you involve trainees to assist with the database, you transition to senior author and the abstracts move to national and international platforms. Try to convert every abstract presentation, regardless of oral or poster into a manuscript, even if you have to combine two smaller projects into one paper. Also initially you may need to target lower impact journals until your data matures or has large numbers. Just get published. Papers provide expertise and preliminary results that are used for grant applications and your CV for promotions. They are also great ways to collaborate and create networks for your future success.

So in summary, build a strong foundation early on in your job (canned talks, community awareness talks, meet-and-greets, didactic lectures for trainees and the community physicians, build databases and establish a research network for collaboration of projects – both within and external to your department, and engage in service activities at your hospital and in the community). Think local regional and then extend national as you transition from Assistant Professor to Associate Professor to Professor.   A Professor is expected to have a national reputation and be involved in leadership roles on a national level. They must show continued productivity with teaching and research. Their service is on a more national level. Set yearly short-term goals and expectations and monitor on your progress. Finally read “Navigating Your Surgical Career – An AWS Resource Guide to Success” recently published and available on our website or the Harvard bookstore.
All the best in your success.

Dr. Laronga is board-certified in general surgery. Her clinical and research interests are diseases of the breast from bench to bedside (genomics/proteomics, nipple sparing mastectomy, quality of life, and quality indicators). She recently served as treasurer of the Association of Women Surgeons 2012-2014. Currently she is the Florida representative (Board of Governors) for the American College of Surgeons, The Florida State Chair for the Commission on Cancer, and on the Florida Division Board of the American Cancer Society. She serves on several national societal committees, such as the Society of Surgical Oncology and the Society of University Surgeons.

AWS Foundation

By Hilary Sanfey MB. BCh. MHPE. FACS. FRCSI

Chair, AWS Foundation Board 

I have been approached on a number of occasions by young surgeons who begin a conversation with “You won’t remember me BUT…… I was your medical student / resident, and because of you I decided to become a surgeon”. These are the most fulfilling moments of my career. Nothing gives me more pleasure than knowing I did or said something to help another person achieve success. After all, this is the AWS mission; to inspire, encourage, and enable women surgeons to realize their professional and personal goals. A considerable number of the women surgeons who have achieved significant leadership positions are AWS members, and owe their success in part to the mentorship, support, and collegiality offered by other AWS members. For example:

Did you know that 9 of the 10 women surgeons who were successful in becoming chairs of academic departments of surgery are AWS members?

The AWS Foundation relies on the generous financial support of AWS members and friends like you to deliver meaningful educational opportunities for medical students, residents, and women surgeon members and thus continue our work. You have the opportunity to recognize the person that helped you develop the skills and confidence you needed on your path to becoming a great surgeon. Your mentor will receive a special tribute letter recognizing your gift in his / her honor and your gift will be acknowledged on the AWS website.

Donations will go to support AWS Foundation programs. These include:

  • The Kim Ephgrave Visiting Professor Program - provides medical schools with opportunities to heighten the visibility of women surgeons while encouraging women medical students to pursue similar careers.  In addition, the Visiting Professorship Program promotes dialogue between practicing surgeons, surgeons in training and the academic community.

  • AWS Foundation Awards Program – honors outstanding female medical students, residents and AWS Members and provides opportunities for career advancement through exposure to successful women surgeons and potential mentors.  Includes the Nina Starr Braunwald Award, Olga Jonasson Distinguished Member Award, the Past Presidents’ Honorary Member Award, Hilary Sanfey Outstanding Woman Resident Award and the Patricia Numann Medical Student Award. 
Click here to make your donation. Select “Legacy Fund” in the drop down menu under “Donation Type.” Following the amount of donation, click the “In Honor Of” box that will provide you with a drop down to enter your mentor’s name and contact information.

Thank you for honoring your mentor with a tribute gift today!

Dr. Hilary Sanfey is Professor of Surgery and Vice-chair for Educational Affairs at Southern Illinois University, and the current Chair of the AWS Foundation Board. She was previously a Professor of Surgery in the Transplant Division of the Department of Surgery at the University of Virginia (UVA), where she was a member of the university Senate, and of the UVA Academy of Distinguished Educators.

Monday, June 1, 2015

Book Announcement: Being a Woman Surgeon

by Jane Zhao, MD

Preeti John, MBBS, MPH, FACS, is the editor of Being a Woman Surgeon: Sixty Women Share Their Stories, an anthology of stories and poetry from 60 women surgeons around the country. The anthology will be the first of its kind. It was created after Dr. John found herself being asked by one female medical student after another about her personal pursuit into surgery. It was then that she realized what a dearth there was of first hand accounts from women about life as a women surgeon. In retrospect, this is not entirely surprising. Despite the numerous strides made toward gender equality in the 21st century, women still comprise little more than 20% of the surgical workforce. As a result, many women take heart when they can connect with other women surgeons. Now, thanks to this anthology, the tradition of passing on stories from one woman to another—as well as our male counterparts—is easier than ever.

The authors of this anthology include but are most definitely not limited to the following surgeons: Nia D. Banks, Patricia J. Numann, Susan E. Pories, Kathleen Yaremchuk, Martha A. Zeiger, Joan Huffman, and Sylvia Marina Ramos.

Compiling this anthology has been a labor of love for Dr. John over the last couple of years. I remember as a medical student receiving e-mails about this up-and-coming anthology. It is an honor for me to now as a resident be the one to introduce this anthology by Dr. John on the Association of Women Surgeons blog.

Here are what some of my favorite role model physician authors have to say about the anthology:

"Dr. John has carefully collected an illuminating anthology of experiential writings from women surgeons. Her contributors vary in surgical specialty, years of experience, and personal situation. This rich and literate collection will prove fascinating reading for anyone interested in the world of medicine." - Carol Scott-Conner, MD, PhD, MBA, FACS, author of A Few Small Moments.

"An extraordinary collection of essays written by an even more extraordinary group of women, this book offers an unparalleled view of what it is like to be a woman surgeon. It is the book that I wish I had as a medical student and that even now I find inspiring." - Pauline Chen, MD, FACS, New York Times columnist; author of Final Exam: A Surgeon's Reflections on Mortality.

"This is a poignant and moving narrative collection from women who each in their own way were pioneers in their field of surgery. The story of the courage, physical strength, stamina and, most of all, the mental fortitude required to complete surgical training is beautifully conveyed here. This collection will hopefully both inspire and make the path easier for the next generation of surgeons, both women and men." - Abraham Verghese, MD, author of Cutting for Stone, The Tennis Partner, and My Own Country.

"This book is an enthralling read. It is all too rare to hear the stories of surgeons, and even rarer to hear those of women surgeons. Yet here they are, told straight out, fearlessly, by residents and retirees alike. The stories are by turns funny, heartbreaking, flabbergasting, infuriating, inspiring-and at times all of these at once. Each voice here is singular and fascinating. But the collective effect is overwhelmingly moving. You want to hear more." - Atul Gawande, MD, MPH, FACS, staff writer for The New Yorker, author of Complications, The Checklist Manifesto, and Better.

"An inspiring compendium of stories that challenged a generation and defined an era. Being a Woman Surgeon will be the archival account of the women who dared to radically advance the world's greatest profession." - Marty Makary, MD, MPH, FACS, author of Unaccountable.

To listen to an audio from Dr. John and some of the contributing authors, click here.

Being a Woman Surgeon: Sixty Women Share Their Stories will be published June 1, 2015 by Gordian Knot Books. It will be 337 pages and sold for $29.

Dr. Preeti R. John is a critical care surgeon who works at the VA Hospital in Baltimore, Maryland. She is also faculty at the University of Maryland. She is triple board certified in General Surgery, Surgical Critical Care, and Hospice and Palliative Medicine.


Jane Zhao is a general surgery resident at the University at Buffalo, the State University of New York. She obtained her medical degree with a scholarly concentration in Clinical Quality, Safety, and Evidence-based Medicine from the University of Texas Medical School at Houston and completed her undergraduate studies in Medicine, Health, & Society at Vanderbilt University. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award and chaired the AWS Blog Subcommittee from 2013 to 2014. Her interests include healthcare social media, quality improvement, and public health. She can be followed on Twitter.