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

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

Standardizing Resident Hand-offs to Improve Hand-off Quality

by Nicole Tapia, MD

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

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

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

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

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

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

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

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

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

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

The Changing Face of Medicine

by Minerva A. Romero Arenas

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

– Malala Yousafzai

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Resources

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

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

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

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

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

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

Image Credit

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

A bit of kindness

by Amalia Cochran, MD

The following is an excerpt from an email I recently received from a mentee:

“I love, love, love surgery, but even as someone who has thrived in this environment, I now acknowledge that there are some aspects of the culture of surgery/academics/surgical and medical education that I am deeply unsettled by and wish very much to change. I see fellow students, residents, fellows, young faculty transform from being full of zeal and goodwill into angry, bitter, jaded people, and it’s absolutely disheartening to see. What’s more infuriating (to me because of the wrongness of it all and because I’m such a fixer) is that those who have been negatively affected and are the very ones capable of enacting positive change because they’ve “been there” sadly become the very ones who perpetuate the indignities of the broken culture, and they don’t even recognize that they’re doing so.”

Her important question that she asked me, and one that I found incredibly wise, was, “Did you ever struggle with this during your training or see this among your colleagues? Or even now?”

I asked her if I could answer this on the blog, and she graciously said yes. It was important for me to do so because I feel obliged to make some confessions related to her concerns.

The biggest one? I had many days during my residency when I was so tired, so broken, so frustrated that I wasn’t a nice person. While I was able to focus on doing the right thing for my patients, I could be and often was impatient with students who needed nurturing and staff who were still learning too. I was so Hell-bent on my own survival, on not making mistakes, on not showing any shred of evidence that I might not be able to succeed as a surgeon that I had no qualms about running over people. I nearly quit surgical residency during my PGY2 year because I didn’t like what I was my self becoming (then was nurtured by some VERY kind mentors who managed to help me hang in there).

I attribute a significant portion of my behaviors when they weren’t outstanding to sleep deprivation and not having a functional set of skills for coping with my chronic exhaustion. I also attribute some of my less-than-ideal behaviors to the surgical culture in which we were supposed to prove that we’re tough and don’t have flaws. Reality check: I may be resilient- I far prefer that word to “tough”- but I do have flaws. Sometime around my 40th birthday, I became okay with that.

• I want to believe I was asked about this topic because I’m seen as someone who is generally patient and supportive. A few key lessons have helped me get back to this place, one in which I think I existed prior to my 7 years of complete exhaustion and chronic stress.
• We’re all struggling. Every one of us is, in one way or another. That’s not a source of shame, it’s a source of humanity.
• If those moments in which your lesser self shows up are rare, people believe you when you apologize for your behavior.
• We are all learning, ever hour of every day. That’s what we’re here to do in a teaching environment.
• As someone in a position of leadership, my team and those around my team rely on me to set a tone. I don’t want that tone to be one of nastiness, blaming, and negativity because I want/ need a high-achieving team. Therefore, it’s up to me to be supportive, to be patient, to take a deep breath before reacting, even when my gut wants to say, “WHAT were you thinking?!?”
• When people are intimidated, their ability to think critically is impaired. Working in an ICU, I need everyone around me to be a critical thinker. Kindness does much more towards that end than bullying.
• If all else fails, go for a walk with the dog. Dogs are masters of this moment being the very best moment ever and that influence is contagious- particularly on a snowy day if one has a Siberian Husky in their life (as I do).

If nothing else I wrote tonight resonates with you, it’s my hope that a picture of an incredibly happy husky will help you pause and be a bit kinder.

This post originally appeared March 24, 2014 on Dr. Cochran's website Life in the Wild West

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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. 

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"

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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.

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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.

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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.

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.

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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.

Respect

by Erin W. Gilbert, MD 

“Your job gives you authority. Your behavior gives you respect.”
—Irwin Federman, general partner at U.S. Venture Partners

Throughout my surgical training I blindly accepted that having grey hair (and experience) equaled garnering respect as a surgeon. Now that I am junior faculty at an academic institution (and beginning to grey myself), I’m wondering if there is more to the story. There is a noticeable difference in how residents treat me as compared to how they treat the Department Chair- which is of course OK by me, but I have begun wondering how can I ensure that I will achieve and more importantly maintain the same level of respect?

As a medical student at LSU in New Orleans, we followed a very hierarchical system where the intern was the boss of the students, the junior was the boss of the intern and so on. It seemed to me in this system that the doctor’s role dictated the level of respect they earned from the team, but just because you follow someone’s orders does not mean you respect them. Other misconceptions I have had include believing respect comes from being a good dresser, having large muscles or simply being intimidating in some way. Now that I have matured a bit I am learning that people may admire good looks, muscles, or a power suit, but this does not translate into respect.

Federman’s quote alludes to the real heart of the story. Think about people in your life you respect; who you would follow into battle without question, who you try to emulate… they are kind, generous, caring, and fair. They treat all of those around them with respect - from the hospital CEO to housekeeping staff - without question and without needing a reason to show respect. They value others’ efforts and acknowledge them; they listen, and they are always sincere. I may just be figuring this out for myself now, but thanks to my upbringing, I know that treating all people with respect is the expectation not the exception- I just didn’t realize how much it could influence how others treat me.

Readers, think back to the role models in your life. What behaviors of theirs did you respect? Share with us in the comments below. 
 

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Erin Gilbert is an Assistant Professor at Oregon Health & Sciences University in Portland where she is a member of the Knight Cancer Institute. She received her medical degree from LSU in New Orleans and completed her general surgery residency at the University of Washington in Seattle. She was fellowship trained in Minimally Invasive Surgery at OHSU and specializes in the surgical management of pancreatic disease.

Sexism & Surgery

by Amalia Cochran, MD, MA, FACS, FCCM

How many of you saw this great piece from Emily Graslie a couple of weeks ago? 

 

I loved this video for a couple of reasons. One is obvious if you are familiar with her work- Emily’s video series from The Brain Scoop is a terrific, user-friendly approach to science. The other was that I honestly empathized with the comments that Emily included in her video, as I suspect many of us do, and I loved her approach to dealing with sexism and science. She’s no-nonsense about it and addresses the issue head on.

I thought back to my first encounter with sexism in medicine, going back to high school. Our family’s physician, upon being told that I was leaving for college at the end of my junior year under an early admission program with intent of going to medical school, simply commented, “Well, I guess it’s okay for women to be physicians these days.” No, he wasn’t joking. No, he never treated me again (nor my mother). I’ll admit- this was almost 30 years ago, and with the entry of more women into medical school many things have changed. Or have they?

Plenty of research shows that female medical students often experience gender discrimination, and that this occurs most commonly on their surgical clerkships. Women medical students are more likely to experience gender discrimination during their surgical clerkship than are their male counterparts and are more likely to perceive sex discrimination, typically from male attendings and male residents. My own recent work has shown that female surgeons and residents are more concerned about the presence of sex discrimination in the workplace than are their male colleagues, and that they perceive this discrimination as a barrier to advancement in academic surgery. Clearly this problem isn’t just one of the 1980s; it persists in modern-day medicine.

Stories of incidents can be gathered easily enough from many sources; in one night on Twitter I was able to acquire stories ranging from colleagues or patients refusing to address a woman physician as “Doctor” to women being told they are “too nice” to be a surgeon, or being told that they are allowed to do more in the OR because of their looks. While the overt sexism remains, many institutions are starting to consider the role of “implicit bias,” those subtle behaviors and actions that manage to undermine the leadership and credibility of any minority group. Yes, women surgeons are still a minority group.

So back to where we started, with Emily Graslie’s video. We have a problem still, and what we need is a solution. We can start by speaking up when we hear sexist comments- particularly those of us who are a little more senior and have less to lose than our younger colleagues. We can also work within our institutions to increase awareness of implicit bias in hopes that this will have a durable impact. And, as Emily Graslie stated, “We need to make sure we’re making it possible for people of all genders to feel acknowledged for their contributions and not feel held back by something as arbitrary as their genetics or appearance.”

How have you experienced sexism? And, perhaps more importantly, how have you dealt with it when you have either experienced it or witnessed it?

This post was originally published on Dr. Cochran's blog, Life in the Wild West.

 

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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 Vice President of the Association of Women Surgeons. Follow her on Twitter. Visit her blog. 

Interview with Dr. Julie A. Freischlag

by Bharti Jasra, MD

A while back, there once was a little girl in Illinois who impressed everyone with her extraordinary performance at school. Her grandfather told her that when she grew up, people would tell her what she could or couldn't do. "There is nothing that I can't do," her grandfather said. "Is all you need to tell them all."

That little girl grew up to be the great vascular surgeon whom we know as Dr. Julie A. Freischlag. She is an internationally renowned expert in thoracic outlet syndrome. She became the first woman director of the Department of Surgery at Johns Hopkins in its 110 year history. She served as President of the Society of Vascular Surgery from 2012 to 2013. In 2012 she was elected Chair of the Board of Regents of the American College of Surgeons. In addition, she has held leadership positions in many leading surgical societies and serves on the editorial board of several surgical journals. In February 2014 she will join the University of California, Davis as Vice Chancellor for Human Health Sciences and Dean of the UC Davis School of Medicine.

I had the opportunity to interview this great leader and ask a few questions that I thought might benefit our Association of Women Surgeons members.

Q: What role did AWS play in your career?
A: I was one of the first few resident members of AWS. It was really nice at that time to know that there were other women in the surgical community that I could look up to for guidance. Also in early years of my career it helped me as a forum for networking. It was at AWS meetings that I met Dr. Patricia Numann for the first time, and we became good friends in the next 20 years.

Q: Do administrative positions adversely affect clinical duties?
A: I spend 60% of my time in departmental work and whereas only 40% in teaching and clinical duties. As a department chair one has to work for the department and not just for yourself.

Q: Is it essential to have additional degrees like an MBA to hold a leadership position?
A: It is not required to have additional degree but there are several leadership courses offered by ACS and AAMC which could be useful. I myself benefited from the ELAM course and highly recommend it.

Q: Do you think that you had a different set of challenges being a woman?
A: It's quite lonely up there at that level since there are not many of you. Women are underrepresented not just in medical community but in legal and business communities as well. It's easy to get noticed since there are not many of you at that level. At the same time it gives you a unique opportunity to represent interests of an underrepresented class and most effective use of this opportunity is essential.

Q: Do you wish you had more time to spend with your family?
A: I am blessed with a caring husband and loving children. As surgeons we like to stay busy and I have no regrets as I have been able to find time for my family for the most part. I try to go to my son's sporting events and recitals. Also I try to limit my travel for work as much as possible.

Dr. Fresichlag with her son and husband during Parents Day at the University of Maryland

Q: What is the key to happiness?
A: Staying in touch with yourself and your family is the key to happiness.

Q: What do you do to rejuvenate after work?
A: I am a swimmer and use the pool in our backyard. Also I walk try to walk few miles a day.

Q: What is your opinion on infertility among women in surgery?
A: I believe it has been a problem, but we are heading toward better times. My own residents now are having kids during residency, and it’s only going to get better in the future.

Dr. Freischlag with her family at the Ravens-Packers game   

Q: What challenges do you foresee in this new leadership role at UC Davis?

A: I am very excited to learn more about something other than surgery, especially healthcare delivery and medical education among the Hispanic population.

Q: Any message for AWS members?

A: We are very lucky to be surgeons, and we should enjoy every part of it at all levels, whether we are residents or in practice. 

~~~

Bharti Jasra, M.D. is a medical graduate from India finishing up her General Surgery Residency at Saint Louis University Hospital. She is interested in pursuing Breast Surgical Oncology training in the year 2014.

Interview with Susan Pories, MD, FACS, Immediate Past President of the Association of Women Surgeons

by Jane Zhao

Dr. Susan Pories is Co-Director of the Hoffman Breast Center at Mount Auburn Hospital and Associate Professor of Surgery at Harvard Medical School and Beth Israel Deaconess Medical Center. She has been named one of America’s Top Surgeons and is an editor of The Soul of a Doctor: Harvard Medical Students Face Life and Death. She obtained her medical degree from the University of Vermont College of Medicine, where she stayed to continue her general surgery residency. She completed a surgical oncology fellowship at New England Deaconess Hospital. She served as the immediate past president of the Association of Women Surgeons.

Click here to learn more about Dr. Pories from the beginning of her AWS presidency.

In today’s post, Dr. Pories touches upon her involvement with AWS, her work as a breast surgeon, and the grand plans she has moving forward.

Q: You have quite the impressive curriculum vitae! Tell us a little about yourself that readers may not know about just from searching you up on Google.

A: I grew up as an “Air Force brat”. We moved a lot and I always envied people who didn’t have to move so often. I vowed that when I had my own family, I would make sure to stay in one place. However, in retrospect, I realize that the experience of moving taught me to be resilient and now I am grateful for this strength.

Q: Why breast surgery? 

A: I started out as a general surgeon but I was the only woman practicing in Cambridge at the time and women with breast problems naturally gravitated to me. After awhile, I was so busy with breast surgery that I decided to specialize in this exclusively. In addition, my mother was diagnosed with breast cancer in her 40s and underwent bilateral radical mastectomies, which led to my personal interest in this area as well. I have been very happy with this area of practice.

Q: What excites you most about your day-to-day routine?

A: Actually the best thing about my professional life is the variety of things I am involved in. I have the opportunity to participate in research and teaching as well as clinical care and administration. I love the interactions with patients and getting to know them and their families.

Q: How did you become involved with the Association of Women Surgeons?

A: I joined AWS to find a community of other women interested in surgery. I always attended the meetings and dinners but didn’t really get involved actively until Dr. Betsy Tuttle invited me to serve as Vice-Chair of the Grants Committee. This position was a great chance to get more experience with leadership as well as grant review and ultimately opened many doors.

Q: What was your proudest accomplishment during your term as president of the Association of Women Surgeons?

A: While President, I started a Task Force to create the AWS Surgical Career Mentor. This is modeled after the Pocket Mentor for residents, but meant for practicing surgeons. There are over 30 chapters addressing topics such as interview skills, negotiation, research, publishing, teaching, and running a practice. This is nearing completion and should be released sometime this year. I am hoping this will prove to be a useful resource.

Q: What advice do you have for the next generation of surgeons?

A: Surgery is a great field and you are sure to find a niche that will be fulfilling. Try to find an area to focus on and become the expert at this. This will lead to invitations to speak and the most interesting referrals. Align your clinical and research interests so that one informs the other.

Q: What can we expect from you next? 

A: I am the Co-Chair of the Initiative for bringing the arts and humanities into the medical school curriculum and culture at Harvard Medical School. This is a true labor of love – I have met so many interesting people from other specialties and learned so much. We have put on plays, musical events, visited art museums, had poetry readings and more. I am convinced that this effort will enrich and improve the educational experience for students and residents, leading to more balanced practitioners and better patient care.

Thanks for a fantastic year, Dr. Pories! We can’t wait for the AWS Surgical Career Mentor to be published and have absolute faith that your future endeavors will be met with success. 

Readers, what questions do you have for Dr. Pories? Are there any other issues you would like to see addressed—or resources you would like to see be made available—by current and future AWS leadership?

~~~

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.

There’s Something In the Water

by AWS writer, Denise Harrigan

Often-invisible but highly influential, second-generation gender bias often impedes women’s ascent to top levels of leadership. The Harvard Business Review intends to expose it.

Fifty years after women were first admitted into Harvard’s MBA program, the September 2013 issue of The Harvard Business Review (HBR) examines the status of women in the business world. The cover alone – with a silhouetted female profile and the words “Emotional – Bossy - Too Nice ” -- reveals that women are floundering, not flourishing.

The bottom line is that only four percent of Fortune 500 companies have female CEOs, and 50 of those companies have no female board members. According to Adi Ignatius, editor-in-chief of HBR, women remain “distressingly underrepresented at the top levels of institutions.”

The HBR focus is not on the numbers -- those numbers, in recent years, have been documented to death. The goal, according to Ignatius, is “finding practical new solutions to a seemingly intractable situation. Closing the leadership gap is a formidable challenge. But there’s no excuse for accepting the status quo.”

The issue, part of the Harvard Business School’s global effort to accelerate the advancement of women leaders, features major articles on persistent gender bias and inclusiveness as a mission and moral imperative.

Unfortunate Legacy

The article “Women Rising: The Unseen Barriers,” by Herminia Ibarra, Robin Ely and Deborah Kolb, examines undercurrents that impede women’s progress and identifies second-generation gender bias as a major but rarely acknowledged impediment.

Where first-generation gender bias involved the deliberate exclusion of women, the second generation “erects powerful but often subtle and invisible barriers for women that… inadvertently benefit men while putting women at a disadvantage.”

Insidious

As a result of second-generation gender bias, unspoken cultural perceptions about women often carry more weight than job performance. Perhaps the most insidious belief is that men are natural leaders, and women are followers.

“In most cultures, masculinity and leadership are closely linked,” the authors report. “The ideal leader, like the ideal man, is decisive, assertive and independent. In contrast, women are expected to be nice, caretaking and unselfish.”

Linking leadership with common male behaviors suggests that women are not cut out to be leaders. It can also create a double standard. Assertive men, for example, are admired – and promoted. Assertive women are advised to “soften their sharp elbows.”

As a result, many women waste professional energy trying to project the perfect image -- not too pushy, not too nice. According to the authors, some employ voice coaches, image consultants, and branding experts “to manage the competence-likability trade-off— the seeming choice between being respected and being liked.”

“But the time and energy spent on managing these perceptions can ultimately be self-defeating. Overinvestment in one’s image diminishes the emotional and motivational resources available for larger purposes. People who focus on how others perceive them are less clear about their goals, less open to learning from failure, and less capable of self-regulation.”

Leaders Are Made, Not Born

Leadership is not an innate gift – it’s a skill that requires practice. More often than not, men are given opportunities to practice this skill. The workplace, still predominantly led by men, instinctively grooms men for leadership positions, creating stepping stones where men can practice leadership skills.

According to the authors, “Women have fewer opportunities to develop leadership skills and seem less inclined to create these opportunities for themselves.” By nature or nurture, women often gravitate to behind-the-scenes positions, and their efforts fade into the blur of teamwork.

Internalizing Leadership

“People become leaders by internalizing a leadership identity and developing a sense of purpose,” the authors observe. “Internalizing a sense of oneself as a leader is an iterative process. A person asserts leadership by taking purposeful action—such as convening a meeting to revive a dormant project. Others affirm or resist the action, thus encouraging or discouraging subsequent assertions. These interactions inform the person’s sense of self as a leader.”

In the wake of positive affirmation, “a person’s leadership capabilities grow. Opportunities to demonstrate them expand. High-profile, challenging assignments …. become more likely. Such affirmation gives the person the fortitude to step out-side a comfort zone and experiment with unfamiliar behaviors and new ways of exercising leadership.”

Well-Meaning but Off Center

The authors of “Women Rising” acknowledge that many companies attempt to level the playing field for women. “Many CEOs make gender diversity a priority, set aspirational goals for the proportion of women in leadership roles”…. and invest in building “a more robust pipeline of upwardly mobile women.

“But then, not much happens,” according to the authors. “The solutions to the pipeline problem are very different from what companies currently employ. Mentoring and leadership education programs are necessary but not sufficient.”

Deeply Conflicted Culture

“These approaches don’t address the often fragile process of coming to see oneself, and to be seen by others, as a leader. Integrating leadership into one’s core identity is particularly challenging for women, who must establish credibility in a culture that is deeply conflicted about whether, when, and how they should exercise authority.”

Call It by Name

Since second-generation gender bias “can be subtle, subconscious, assumed but not articulated by both men and women,” the authors recommend that employers begin to address it by simply naming it.

“Second-generation bias does not require an intent to exclude; nor does it necessarily produce direct, immediate harm to any individual. Rather, it creates a context—akin to ‘something in the water’—in which women fail to thrive or reach their full potential.

“Without an understanding of second-generation bias, people are left with stereotypes to explain why women as a group have failed to achieve parity with men: If they can’t reach the top, it’s their own fault for failing to be sufficiently aggressive or committed to the job.”

Alternative Reality

By identifying and addressing second-generation bias, however, companies can finally move toward gender equity – and an executive suite that “doesn’t look or behave like the current generation of senior executives.”

“When women recognize the subtle and pervasive effects of second-generation bias, they feel empowered, not victimized, because they can take action to counter those effects,” the authors promise. “They can put themselves forward for leadership roles when they are qualified but have been overlooked. They can seek out sponsors and others to support and develop them in those roles. They can negotiate for work arrangements that fit both their lives and their organizations’ performance requirements.

“Such understanding,” the authors conclude, “makes it easier for women to ‘lean in.’”

Early Lessons in Leadership

by Sophia K. McKinley

Do you consider yourself a leader?

For most of medical school, I did not consider myself a leader. To me, leaders were people with big personalities and big visions, the kind of individuals who could inspire passion in large crowds or start political movements. I was a quiet-voiced student at the bottom of medicine’s hierarchy – surely not a leader, and in no position to lead.

My perspective on leadership changed dramatically while spending a year as a Zuckerman Fellow at the Center for Public Leadership at the Harvard Kennedy School. Every week I participated in three hours of leadership training in the form of small-group seminars with prominent individuals, workshops on practical skills such as public speaking and negotiating, and personal development sessions. Whenever anyone asks me what I learned over the course of the year-long leadership curriculum, I always identify the same three take-aways:

1. Leaders are made, not born

I used to think some people were leaders and others weren’t. Now, I see leadership as a skill that can be cultivated, practiced, and improved. This shift in attitude has meant that even when I don’t feel as if I am a leader, I still see myself as someone who can learn to become a leader. And, I am now on the lookout for opportunities to practice leading and to gain skills as part of a lifelong process of becoming an increasingly skilled leader.

I expect surgery residency will be full of opportunities to practice leadership skills. Oral presentations will be public speaking practice, and overnight call will serve as an exercise in prioritization and time management. Leaders need excellent interpersonal and teamwork skills even in tense situations—where better to deliberately develop these abilities than the operating room? No one expects newly graduated medical students to show up to intern year as fully formed surgeons. I now know it is just as unrealistic to expect myself to be a fully formed leader.

2. Self-understanding matters

Leadership is about influencing other people. In order to do this better, I realized I first needed to understand myself and my own behaviors. Through a variety of assessments including emotional intelligence evaluation and a 360 feedback process, I gained a greater understanding of how my actions were influencing those around me.

For example, I learned that I often concede what I want in order to avoid negotiation. But in surgery, being a leader often means effectively advocating for patients in difficult situations. Awareness of my tendency not to press my agenda means that in future conflicts, I can reflect on whether I am being assertive enough, or whether I am failing to identify collaborative, “win-win” solutions that satisfy all parties including myself. I now know that a key to my future success as a leader will be improving my negotiation skills. Yet gaining self-understanding isn’t just about identifying weakness—it’s also about understanding strengths. Nearly all of the individuals who provided me with feedback during my 360 evaluation commented on my written communication skills. I know that for me to be the most effective leader possible, I should capitalize on my ability to influence others through writing.

3. Leadership happens at all levels

Finally, I no longer believe that leadership is solely the purview of those at the top. While leadership manifests itself differently at different levels within an organization, individuals at every position in a hierarchy can exhibit leadership. One of the most common definitions of leadership is acting in a way that enlists the support of others towards the accomplishment of a common goal. A title that indicates authority or power is not necessary to engage in leadership of this kind.

Think of a situation during medical school, residency, or beyond in which a group of individuals at the same level were given a task or assignment. Even without adopting formal roles or titles, some individuals functioned as group leaders because their behaviors influenced others towards superior performance in task completion. And probably everyone has been on a medical team in which the individual who did the most to improve group performance was not the team’s most senior member. As I enter intern year and beyond, I hope to be the kind of resident who exhibits leadership by influencing others to better achieve common goals. What I do to exhibit leadership may change as I rise through surgery’s ranks, but no matter what level I am, there will be opportunities to function as a leader, even if that means leading by example to peers and more junior trainees.

Not everyone has the experience of participating in a formal leadership curriculum across a year, but everyone can reflect and seek feedback to gain better self-understanding of leadership strengths and weaknesses. We can all seek opportunities that will develop particular leadership skills, and we can consciously practice leadership in the setting and position we currently work and learn. Hopefully, when asked “Do you consider yourself a leader,” more women surgeons will affirm, as I do now:

“I am a leader.” 

~~~

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 currently interviewing for general surgery residency during the 2014 Match cycle.

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.