Association of Women Surgeons: Inspiring and Encouraging Women Surgeons Since 1981: medical students

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Tuesday, December 30, 2014

Cold hands, bright eyes, and tuberculosis… Happy New Year!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays.

Please enjoy these delightful stories from fellow AWS members -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
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Lauren Poindexter
MD Candidate, Class of 2015
Virginia Tech Carilion School of Medicine

Nearly every child lining the Pasadena Tournament of Roses Parade route on New Year’s Day in Southern California is bundled up to their noses in oversized parkas, gripping onto their parents hands tightly so as not to get lost in the excitable mass of humanity. Long before the start of the parade at 8:00am, bright-eyed children pull adults this way and that in attempts to touch the vibrant flowers, seeds, and grasses of the floats, stare at the huge costumed parade horses, and say hello to the perfectly-positioned musicians of the marching bands. Fascination and wonder predominates. Families are honored, a community gathers, rival football fans cheer, the nation celebrates a new year. Since the first Rose Parade in 1890 and the first Rose Bowl Game in 1902, the scene has only grown larger and more fantastic. New Year’s Day is my favorite holiday!

However lighthearted the modern festivities appear, few know of the original purpose of the Rose Parade and its roots in medical history: it was a nineteenth century small-town public relations stunt to entice the families of tuberculosis patients to relocate to Pasadena. Their target audience was East Coast citizens trapped in frigid, blustery winters.

The founder of Pasadena’s exclusive society, the Valley Hunt Club, was, himself, an East Coast transplant, former “consumptive,” and mastermind of the first Rose Parade. He established his club in 1888, the same decade when Prussian scientist Robert Koch identified the Mycobacterium tuberculosis organism, and at a time when physician specialists in America espoused the healing benefits of “climatic therapeutics” for tuberculosis sufferers.

Physicians in those days recommended their patients receive modern tuberculosis treatment and rest in temperate locales – ideally ones offering drier climes, mild winters, and warm temperature ranges. Through the late 1800’s and early 1900’s, international medical journals, textbooks, and newspaper articles included the Greater Los Angeles Area in their purported list of ideal regions. The Valley Hunt Club’s goal was to capitalize on this movement.

The 1890 Rose Parade featured a festival atmosphere of many athletic competitions and a parade of floral-bedecked horse-drawn carriages held under a sunny blue sky in the “dead of winter.” Vivid roses draped over horses necks and bundles of bright juicy citrus fruits wowed the 8,000 attendees. Foot races were run, children rode ponies, and visitors gushed in letters to their families.

Amidst the sprawling citrus groves and well-established ranches, newly constructed mansions sprouted in Pasadena. A residential spectacle dubbed “Millionaire’s Row” consisted of an impressive line of winter retreats commissioned by Eastern magnates desperate for a seasonal escape. Famous residents included the Wrigleys of chewing gum fame and the Gamble family of Proctor & Gamble. Average citizens also sought treatment for tuberculosis in this region. Pasadena’s “Ballard Pulmonary Sanitorium” was well-known for its excellent outcomes and its success was complimented by donations of dollars and volunteer time from members of local women’s clubs. By 1910, Pasadena was one of the fastest growing cities in the US.

When the Valley Hunt Club could no longer financially sustain the wild success of the Rose Parade, the non-profit Pasadena Tournament of Roses was created, eventually choosing William Wrigley’s winter mansion as its home base. Today, the parade progresses down the original “Millionaire’s Row” (now Orange Grove Boulevard) and past the Wrigley Estate. As a young child, I, too, was overwhelmed by the fantastic experience of the Rose Parade and fondly remember the years when we would spend New Year’s Eve at my grandfather’s townhouse across from the Wrigley Estate. He had ventured to Southern California as a young man to start his family in this beautiful region and was a strong supporter of the Tournament’s community involvement.

Though I’ve since migrated back east for medical school, and my grandfather has passed away, I look forward to every opportunity to head home to Pasadena for this annual celebration. Spending time with my family on a crisp January morning watching scores of floats, marching bands, and equestrian units, plus a raucous college football competition, is my favorite way to start a new year. Now I know to credit this event to the Valley Hunt Club… and tuberculosis!

* Tradition dictates that no parade will be held on a Sunday, therefore January 2nd is an alternate date.

Sunday, December 28, 2014

Happy Holidays from the AWS!

Thursday, December 25, 2014

Happy Holidays from the AWS!

Wednesday, December 24, 2014

Happy Holidays from the AWS!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays.

Please enjoy these delightful stories from members of the Association of Women Surgeons -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Amalia Cochran, MD, FACS, FCCM
Blog: amaliacochranmd.com
Twitter: @amaliacochranmd

One of my favorite traditions during residency grew up from a tradition back home in Texas. I’ve long believed that tamales are Christmas food, and when I moved to Utah for residency, I started the tradition of a tamale dinner at my house on Christmas night for my co-residents, friends…anyone who wanted to drop by.

At first, quite a few of them thought it was an intriguing and strange tradition, but it was always a fun evening. By Christmas of our PGY-6 year, one of my classmates looked at me as she was eating her tamales and confessed, “I’m going to miss this next year when I’m in Minnesota.” While I got to have my Christmas tamales with my Mom the next year- and was back in Texas for my fellowship - it definitely wasn’t the same.
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Brittany Bankhead-Kendall, MD, MSc
Resident

This Christmas my family and I will be navigating the waters that the "Match" has bestowed upon us- living on separate sides of the country. My surgery residency is in Michigan, and my husband's emergency medicine residency is in Texas. He and my son decorated our tree while we "FaceTimed." No parent likes to be away from their children, especially during holidays. But I think Christmas is about traditions, making traditions, and yet sometimes breaking them to remember what's really important.

Tuesday, December 23, 2014

Happy Holidays from the AWS!

We asked our Women Surgeons to share with us their Holiday traditions and some of their favorite memories of the holidays – both at home and work.

Please enjoy these delightful stories from members of the Association of Women Surgeons -- and feel free to share your own in the Comments.

Happy Holidays from all of us on the Blog team and the AWS!
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Stephanie Bonne, MD, FACS
Assistant Professor
Trauma, Acute, and Critical Care Surgery
Washington University in St. Louis

What holiday do you celebrate and what is the special meaning of this
holiday to you?
We celebrate Christmas - I was raised Catholic and that's just the way it is!

What are some family traditions you have related to this holiday?
My mother's family is Polish, so we have a very traditional dinner on Christmas Eve with mushroom soup, fish, pierogi and picked Herring.

Do you have a good memory of patient care during a time you worked during
the holiday?
For the past several years, I've worked 6pm-6am over Christmas in the ICU. I kind of like it - there is a ton of food to eat, everyone is kind of cozy and happy. We watch NORAD tracks Santa at the nurses' station. The patient's families are usually in in the evenings and you can walk around and say hello to everyone.

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Callie Thompson, MD
Resident

What holiday do you celebrate and what is the special meaning of this
holiday to you?
We celebrate Christmas. For me, the holiday is a time of new beginnings and hope. I love spending this time of year with my family and seeing my children enjoy the same traditions that I loved as a kid.

What are some family traditions you have related to this holiday?
My family is very big on tradition so we try to do the same thing every year. We start by going to church on Christmas Eve and this year, my two oldest children are both in the Christmas play so I am really looking forward to that. On Christmas morning we open stockings and then have to have breakfast before we move to the presents from Santa. We are open-one-at-a-time-while-everyone-watches people.

Do you have a good memory of patient care during a time you worked during
the holiday?
My favorite holiday memory in the hospital would be from Christmas day my R2 year in the cardiothoracic ICU. All of the patients were critically ill but the nursing staff decorated and had a potluck that they invited the families to participate in. I just love the memory of the atmosphere in the unit that day.

Tuesday, October 28, 2014

The Art and Science of Touch

Recently one of our own Women Surgeons, Dr. Carla Pugh, was an invited speaker at the popular TEDMED 2014 event. In the session “Play is not a waste of time,” Dr. Pugh discussed Haptic Learning – the Art and Science of Touch – and her own experience with integrating this concept in surgical education.

Dr. Pugh started her talk with a powerful recollection of a difficult procedure in the emergency room – a thoracotomy. Dr. Pugh noted something made her seriously worried: the resident working with her seemed to have missed a critical finding while leading the thoracotomy, cardiac massage, and evaluation of the patient.

“As a surgical educator I am worried why my resident missed the blood clot around the heart, and things were moving so quickly that there was no time to discuss this great learning opportunity.”

I had the opportunity to interview Dr. Pugh to discuss her TEDMED talk and more.

In regards to the education opportunity that was missed with the resident, Dr. Pugh notes that providing feedback to residents is not built into the system. “The goal is to take care of patients & make money... Nobody gets paid to teach. Feedback is not built into the system... People who enjoy teaching do it, but it is not well-integrated. How do you teach residents how to be assertive? How to learn points of the operation? This is something that happens every day in medicine."

Unfortunately, Dr. Pugh has noted that this is something that has not changed since even her days in surgical residency. Despite high expectations, she notes that it is rare for people to provide direct detailed information/feedback.

This is how she got into Haptics.

Dr. Pugh holds a patent to a sensorized clinical exam model. She landed her first patent in 1998 during her postgraduate studies at Stanford University. The models can sense aspects of the physical exam such as tactile technique. One exciting finding to be published soon, was a model adapted for the clinical breast exam (CBE).

Dr. Pugh’s team was collecting data on CBE from experienced clinicians to help identify which technique was most sensitive to detect a mass in the breast. The data was supposed to help teach medical students the appropriate technique for CBE. A surprise finding was that 10-15% of clinicians were missing the mass in the model! Upon review of the data from her sensorized model, it was found that a specific examination technique was associated with being more likely to miss the mass.

Dr. Pugh notes, "We must go beyond the paper and pencil test." The technology is now available to help assess clinical exam and surgical skills. Incorporating this type of feedback into medical education and continuing medical education will likely make a big difference for patients.

Dr. Pugh grew up in Berkeley, California, and has long been interested in science and medicine. At 5 years old she received her first stethoscope and "was listening to people's ankles at the grocery store." As a child she had her first run-in with the power of touch “I was always taking things apart,” she notes. It was during one of these play sessions in the living room, she was electrocuted at 5 years old. “My hand was stiff!”

How do I get involved?

Dr. Pugh has an active research lab, which usually consists of engineering students. She has had two residents working in her lab. In addition to traditional surgical meetings, Dr. Pugh attends conferences usually dominated by engineers, like NEXTMED where Medicine Meets Virtual Reality.

Thank you, Dr. Pugh, for reminding us to dream big and never forget the art and science of touch.

Minerva A. Romero Arenas, MD, MPH is a General Surgery Resident at Sinai Hospital of Baltimore. She recently completed a research fellowship in the Dept. of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, TX. 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.

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.

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.

Thursday, December 19, 2013

Pregnancy during Medical School & Residency

by Callie Thompson, MD

I have read a lot of discussions about “the right time” to have a baby during a career in medicine and most of them come to the conclusion that there is no right time. I don’t think that is really accurate. The more correct answer would be that the right time is entirely dependent on you and your situation. I feel well prepared to write this blog and give this advice because I have been pregnant during both medical school and residency (twice).

In chronological order, I will start with pregnancy during medical school. The first two years of medical school are typically spent listening to a lot of lectures and studying almost all of the time. The third year is usually heavy with clinical work and spending a lot of time in the hospital. And the fourth year is usually a few sub-internships and a lot of light rotations at your home institution. So, where would a pregnancy, birth, and caring for an infant fit in there? Again, it really depends on your situation. You have to weigh the physically demanding state of gravidity with what you will need to be doing at that time. If you are concerned about being on your feet all day, then maybe being pregnant in the first two years would work best for you. You also have to take into account the demands of a newborn/infant. If you need a lot of time to study or are not great at multitasking, then having a newborn prior to taking your USMLE Step 1 might not be the best idea for you. No matter what you decide, you must have a viable option for childcare in mind. I suggest that you do this prior to even becoming pregnant because you will need help.

Regarding taking time away from school, there are no universal rules as to how much time can be taken. This will be school dependent. You just need to make sure that you can fulfill the requirements to earn your degree. Some people choose to take an extra year and make medical school a total of five years to allow them to have their child. I do not think this is necessary for everyone and you are going to know your capabilities best. Don’t let someone push you into a 5th year just because others before you have chosen to do that.

Pregnancy in residency is a bit trickier because of the American Board of Surgery requirements for General Surgery Certification. I had a baby during clinical R3 year and another while I was out in the lab. From a time-off perspective, having a baby during your lab years is much easier. If you are NIH funded through a training grant you can have 6-8 weeks, though some lab work can be done from home so the actual time you get to spend with your newborn can actually be longer than that depending on your research. Having a baby during your clinical years requires a good understanding of “the rules.” The ABS states that:

“To be eligible for ABS certification in general surgery, the following must be completed: At least 48 weeks of full-time clinical activity in each residency year, regardless of the amount of operative experience obtained. The 48 weeks may be averaged over the first three years of residency, for a total of 144 weeks required, and over the last two years, for a total of 96 weeks required."

“For documented medical problems or maternity leave, residents may take an additional two weeks off during the first three years of residency, for a total of 142 weeks required in the first three years of training, and an additional two weeks off during the last two years of residency, for a total of 94 weeks required in the last two years of training.”

Translation: You can average your time over the first three years so, in theory, if you didn't take any other time off for three years, you could have a 14 week maternity leave. Similarly, if you didn't take any time off for vacation during your last two years, you could have a 10 week maternity leave.

In actuality, that isn't possible. For instance, you would have to know that you were going to get pregnant and have a baby during third year so that you could forgo a vacation in your first 2 years. And if you did that, you would surely go insane. So if you did take the regular 3 weeks of vacation a year, you could have an 8 week maternity leave during the year you did have the baby—as long as you don’t take any other vacation that year. A baby during the last two years is even more difficult because of the time constraints. Also, keep in mind that none of this accounts for the possibility of medical problems during the pregnancy and any time off that may need to be taken. None of this is meant to dissuade you from pregnancy during residency (see above where I state I did it twice) but knowledge is power and you have to be prepared to extend your training if you are unable to meet the ABS requirements. This is most important during the last 2 years because they have to be done in succession so if you were to get pregnant, become ill, and need extra time off during your 4th or 5th year, you may be required to start over at year 4.

This blog could end up being very long so the last topic that I will include for today is when/how to tell people when you become pregnant. I advocate telling people when you feel comfortable. For some people that is the minute you find out, for others it is after the first trimester. However, I would not wait much beyond the first trimester because arrangements will need to be made, either to your schedule if you are a student or for coverage from your co-residents if you are a resident. I also would also advise you not to tell anyone else before you tell your Dean or medical school adviser (for students) or your program director (for residents). It is best to give big, personal news yourself, and in person.

~~~

Callie is a resident in general surgery at the University of Washington. She 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.

Friday, May 31, 2013

Five Reasons I loved my Longitudinal Integrated Surgery Clerkship

by Sophia Kim McKinley

“I don’t understand.”

This is the most common response when I tell people that during my third year of medical school, I did all of my core rotations simultaneously for a year. As a student in the Cambridge Integrated Clerkship, I was paired with an attending physician in each discipline for 12 months and juggled clinic sessions, operating room days, inpatient weeks, and didactics for seven different fields. While most medical students participate in traditional block rotations, I was learning the fundamentals of clinical medicine in a longitudinal, integrated model. “Longitudinal” refers to the fact that my experience in each field stretched across a year, “integrated” refers to the opportunity to follow individual patients across multiple disciplines.

An example of one of my most memorable days was when I had radiology teaching rounds followed by a pediatrics clinic in the morning and internal medicine in the afternoon. In the early evening, I conducted a home visit on one of my geriatrics patients. Then, I was paged to labor and delivery because a prenatal patient had presented with regular contractions. At 2 A.M. when the fetal monitor suggested distress, I scrubbed into her C-section. Within 24 hours, I had been a student in radiology, pediatrics, internal medicine, and ob-gyn.

What the longitudinal, integrated model meant for my surgery rotation is that I had half a day of clinic per week in addition to one day in the OR. Four weeks of time on the resident-led inpatient team was distributed across the year, but most of my rotation was spent learning from my preceptor, who was the surgical chair. Many surgeons have expressed some skepticism about this introduction to surgery, but here are 5 reasons I loved my longitudinal integrated surgery clerkship.

Continuity of Care – I was able to follow individual surgical patients across an entire year. For example, I met a woman with newly diagnosed colon cancer in June and continued to participate in her care until the following May. I was present at her pre-op cardiology clearance all the way to her first follow-up CT scan. Six months after I finished my third year, she called me to ask if I could be present for her ventral incisional hernia repair.
Continuity of mentorship – My surgical attending taught me for months in a row. He became very familiar with my strengths and weaknesses both inside and outside the OR, and I was constantly challenged based precisely on my learning needs. When he was on call, he would send me text messages and I would go to the hospital to assist on urgent and emergent cases.
OR privileges for a year – need I say more? I spent all my free time for the entirety of my third year going to the OR and scrubbing cases. The OR staff became like a second family, the attending surgeons all got to know me very well, and I had the chance to practice technical skills regularly for 12 months straight.
Side-by-side comparison – Because I was doing all seven disciplines at once, it was easy to figure out which field attracted my interest the most. I always looked forward to Mondays, because those were my days to go to the OR. I lamented Monday holidays because there wouldn’t be elective cases scheduled. I couldn’t stay away from the OR. The other fields were great, but it was clear my future was in general surgery.
View into the life of an attending surgeon – While my classmates in the traditional block rotations may have finished third year with a better understanding of the life of a house officer, I certainly had an excellent perspective on life after residency. Because my primary teacher was an attending physician, my surgical rotation reflected the workflow of an attending surgeon from how he spent his time to the kinds of relationships he had with patients. I still had some insight into life as a resident during my 4 weeks of dedicated inpatient time, and my fourth year surgical subinternships were another way to expose myself to what life during surgical residency might be like. I’m happy to have had both types of experiences during medical school.

A longitudinal integrated surgery rotation isn’t available at every medical school, but they are becoming more common. Here are a few links and papers to read about this model of third year clerkships:

NYTimes Well Blog (http://well.blogs.nytimes.com/2012/04/19/reinventing-the-third-year-medical-student/)
American Medical News (http://www.amednews.com/article/20111226/profession/312269951/2/)
Teaching medical students about cancer impact through a longitudinal surgical experience: a case study. (2012) (http://www.ncbi.nlm.nih.gov/pubmed/22490098)
Educational outcomes of the Harvard Medical School-Cambridge integrated clerkship: a way forward for medical education. (2012) (http://www.ncbi.nlm.nih.gov/pubmed/22450189)

What are your thoughts on the longitudinal integrated surgery clerkship? What are surgical rotations like where you train(ed)? Given the option, which type of clerkship model would you prefer?

~~~

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 will be applying for general surgery residency during the 2014 Match cycle.

Monday, May 20, 2013

Welcome to the New AWS Blog & Tips for Surviving Your Surgery Clerkship

We're proud to share the launch of the AWS blog with you, and hope that this will provide a new resource for you. We'll be posting at least once a week, trying to spark a conversation with you--usually about a topic that relates directly to being a woman surgeon, but also about things that relate to life in the modern day. Mostly, we do want this to be a place for conversation, for thought, for discussion, and we look forward to getting to know you better through that dialogue. If you have a topic of interest you would like to see us address, please let us know. Those of us writing for the blog and the leadership of the AWS are interested in creating a community space, and to do that, we need to hear your voice.

Welcome!

Amalia Cochran, MD, FACS, FCCM
Secretary, Association of Women Surgeons

Surviving Your Surgery Clerkship

by Lauren B. Nosanov

I was asked to help compile some words of advice for students entering their third year of medical school, specifically addressing tips for surviving the surgery clerkship. Surgery was my first rotation of my third year, and by far my favorite. That said, I know that many students do not enjoy it nearly as much, and experience a great deal of anxiety thinking about it. As such, I have decided to share here those pointers which I thought would be universally applicable.

General Pointers

Be excited about the OR!

Surgeons love the OR and they want you to also, even though they accept that most rotating students will not end up applying to a surgical field. Don't shirk your duties outside of the OR, but do your best to spend as much time observing and participating in operations as you can.

Learn the basics of the OR:

how to scrub (you will be taught this at the beginning of the clerkship - pay attention, sterile technique is important!)
how to not accidentally scrub yourself out (few things raise the ire of an attending / resident as much as a med student who scratches their nose and then contaminates the surgical field!)
what is sterile in the OR and therefore should be avoided when not scrubbed (pretty much everything draped in blue is a good rule of thumb)
where to stand and observe to have a good view but not be in the way (when in doubt, ask)

Anatomy, anatomy, anatomy.

This is 90% of what you will be pimped on, and good knowledge of relevant anatomy makes it much easier to figure out what is going on in the OR. Go back and review the relevant parts of your notes from first and second year lectures and labs. Make sure you know what cases your team will be doing if at all possible and study up the night before.

Learn to tie and to suture ASAP.
Students who can demonstrate these abilities are more likely to be allowed to do things in the OR other than retract. Take advantage of the surgical skill center and the amazing people who work there and practice, practice, practice.
Be confident.
Surgeons tend to be straightforward and sometimes even a bit impatient. When you present, speak up, speak clearly and most importantly, speak concisely. This will earn you respect, and in turn you are more likely to receive more teaching, more opportunities to see and do cool procedures, and (of course) a better grade.
Help your team by becoming a walking cabinet - you will be thanked endlessly time saved and hassle avoided. At a minimum, consider carrying (in white coat pockets or a bag):

radiology order forms
sliding scale forms
trauma forms
suture removal kits
staplers
suture
sterile gloves in your size and your resident's size
sterile saline
syringes
marking pens
kerlix
4x4s
tape
extra copies of the team's patient list

Be gracious when you are allowed to close at the end of a case. This educational opportunity comes at a cost to everyone else (mostly in the form of time, as you are inevitably slower than your resident closing or stapling). Your appreciation to the OR support staff and your residents will not go unnoticed, and you will likely find that you are given opportunities to close more often.
When on call, don't forget to pack:

lots of healthy snacks you can carry in your white coat pocket (think string cheese, ziplocs with nuts, granola bars, bananas, PBJ) - eat when you can to keep your energy up!
deodorant, toothbrush and toothpaste, washcloth, extra glasses / contact lenses - anything that will help you stay feeling clean and refreshed
cell phone charger (nothing worse than being 20 hours in to your shift and realizing your phone is dead)
books / study materials for potential down time

Don't tolerate abuse and mistreatment, but try to have a thick skin. Remember that surgery is stressful, and that the well-being of the patient comes before your feelings. That said, if you feel your are being mistreated, speak to whoever is in charge of your clerkship and report - keeping your mouth shut won't help you or your fellow students.

Study Resources

NMS Surgery Casebook: great for learning how to assess and manage surgical patients
NMS Surgery: fantastic, concise bullet-pointed information about common surgical conditions; helpful for reading up on your patients' diagnoses each night
Pestana Review: case-based review, this is the Surgery equivalent of Goljan Path (very valuable!)
Surgical Recall: nice coverage of basics of surviving a surgical clerkship; best resource for commonly asked pimping questions (and answers!)
Surgery Blueprints: Clinical Cases; a lot like Case Files but more true to the types of questions asked on the Shelf
Access Surgery: great website for reviewing basics of surgical cases and conditions - load on the computers in the OR immediately prior to a case for last-minute review; requires a subscription (many medical schools provide students with access)
As with all clerkships, Pretest, First Aid and Case Files may come in handy depending on student preference

Cross-posted on November 1, 2012 at metamorphosistomd.blogspot.com

What resources did YOU use to prepare for your surgery clerkship? What other general pointers do you have for students who wish to excel during their third year?

Share your thoughts in the comments! Let us know what else you would like to see featured on the blog!

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Lauren Nosanov is a fourth year medical student at the University of Southern California Keck School of Medicine. She has spent the last year 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 embark upon the process of applying to General Surgery residency this fall. 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 son.