Association of Women Surgeons: Inspiring and Encouraging Women Surgeons Since 1981: residency

Showing posts with label residency. Show all posts

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!
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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.

Monday, May 12, 2014

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?

~~~

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.

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.

Wednesday, November 20, 2013

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.

Thursday, October 17, 2013

10 Steps to a Successful Residency Interview

by Allison Hoyle, D.O.

Fall is the exciting time in our medical education during which our residency interviews begin. It is important to be prepared for what is to come, as these interviews are different from any you may have ever had before. Here are some tips to help you succeed when you meet your potential future colleagues and mentors!

1. Arrive Early. As you probably know by now, hospital parking can be complicated and with all the additions and renovations hospitals often undergo, it can only work in your favor to arrive at least 15-20 minutes before your scheduled time.

2. Dress to impress! In 2011, Dr. Karen Pine of the Department of Psychology at the University of Hertfordshire conducted research which showed that women wearing skirts are perceived as more successful. If you choose to wear a skirt, however, be sure it is no shorter than 2” above the knee. All in all, wear something flattering that makes you feel comfortable and look professional. Comfortable, professional shoes are also a must. You never know if you will be in a skills lab, a staged patient encounter, or walking the entire hospital!

3. Practice with a friend. You will be asked many questions by your interviewers. They will want to know more about who you are and what your goals in life are. Be prepared to talk about your medical school experience, specific cases you enjoyed, challenging situations, and even your personal life. Here is an excellent resource with sample questions: http://www.med.unc.edu/ome/studentaffairs/residency-and-the-match/files/MedicalResidencyInterviewQuestions.pdf

4. Make a list of questions for your interviewers. For example, “What research opportunities are available?” “Is there a formal didactic curriculum?” “How are residents evaluated?” “What kind of electives are available and how many are there?” “Where do graduates go for fellowship?”

5. Research. Know whom you will be speaking to. Read about the hospital and the program beforehand. As we learned with our clinical rotations, the more you know, the better able you will be to ask thoughtful questions and the more you will get out of your time with those you will meet.

6. Bring a copy of your curriculum vitae, journal articles which you have written, and contact information of your references. Be prepared to discuss your accomplishments as well as any setbacks you may have had, and how you have learned from them.

7. Get plenty of rest the night before, and eat a balanced breakfast before heading out. These interviews can run very long. You will want to keep up your stamina!

8. Take off your watch, turn off your cell phone. Nothing is more important than your interview, so try to minimize the chance that you might offend your interviewer with buzzing, beeping, and glancing at your watch or phone.

9. Smile, Relax, and Be Yourself! Your future colleagues are searching for someone with whom they will be spending a lot of time.

10. Handshake. A firm, confident handshake says a lot about you and makes others feel more comfortable. If you have not yet mastered this technique or if you are not sure, practice with your friends and ask for their honest feedback.

Remember, your fellow residents and mentors will be spending a lot of time with you once you are hired, so they are trying to find someone who fits in well with their group. Likewise, you will be spending a lot of time with them, so you will want to choose a program with people you wish to learn from and residents you enjoy being around. At the end of the day, you are essentially choosing your second family and the program which will shape you into the physician that you will become. This is a very exciting time and I wish you all the best of luck with your interviews and with the match!

~~~

Allison Hoyle, D.O. is a recent graduate of the New York Institute of Technology - College of Osteopathic Medicine. She was a professional pianist living in midtown Manhattan when she decided to return to school to study medicine. While volunteering at St. Luke's-Roosevelt Hospital in New York, NY as a pre-med, Allison discovered her love of surgery. Seven years after observing her first laparoscopic procedure, she was scrubbed in and learning from surgeons at Jersey City Medical Center during what she described as the most exciting time of her life. She was class representative of her school's surgery club, SOSA, during her first year of medical school, and a member of AWS's first ever Student Committee in 2011. Allison has lectured at high schools and colleges in New York and New Jersey about her experiences as a medical student and has been interviewed by NPR and ScienceHouse.com. In her spare time, she enjoys riding and restoring vintage Italian motorscooters, Astronomy, and playing the piano. Allison is in the midst of her residency application process for the 2014 Match.

Tuesday, September 17, 2013

Unconventional: Our Couple's Match Story

by Brittany Bankhead-Kendall, M.D., M.Sc.

Match Day 2012 was supposed to be the best day of our lives. Or one of them, at least. But it was so, so not. Monday morning my husband and I left our respective rotations around 11:45am and hopped into our SUV in the hospital parking lot in anticipation of the noon email saying we had matched. We wanted to celebrate that together. My email came: "Congratulations! You have matched to a one year preliminary position." I was devastated. But it got worse. My husband's email came: "We're sorry, you have not matched to any positions."

Can that happen? Did that just happen? I didn't think that was possible. Our numbers were right. We had plenty of interviews. We were matching Emergency Medicine (him) and Surgery (me). A difficult match, but not an impossible one. Right?

He was the better candidate, but we thought Surgery was the harder match. So at match choice #18, after all of our same city match choices, we listed a match-no match option. The thought was that in this certain city we chose, surely he could find something to do for a year. A big city, close to my family, lots of options. We assumed he would at the very least be able to find a preliminary surgery spot at one of the four hospitals in the area. Prelim surgery spots aren't hard to find, right?

We drove straight from the hospital parking lot to a McDonalds and hooked up the laptop and filled out his SOAP application. He applied to all the Surgery Prelim spots in my city (the NRMP will tell a couple, in a match-no match situation, the city of your match). Tuesday, Wednesday, and Thursday came; no interviews, no offers. Match Day came and went, we "celebrated" at home with our baby boy and my parents, and occasional tears.

Then we looked for research positions for the year for him. And... Nothing. We tried, we weren't even picky. But he was over or under qualified for anything we found.

Then one day, out of the blue, he got an email inviting him to interview across the country for a position in Emergency Medicine. He got the position. And yet we struggled with it. Was this a temptation that he should pass on? Was this a blessing? Was it great for his career at the expense of our family? Would we be able to survive without each other? Could I be a surgery intern, with our BABY, without him?

Ultimately, he took the position. We're tough. Yes, he and I are tough. But what I also mean is that we women physicians are tough. We're a different breed, I think. No one can tell us no. No one can put anything in our path too great to achieve our goals. No one can tell us we can't love our job and love our child. No one can tell us we can't do it without certain features of our home life lined up. We can do it.

It's hard every day. That I won't deny. It's hard being away from my best friend and confidante; the person I want to vent to and hug and go on dates with and share in our son's new milestones and that he finally says "Mama." It's hard being a "single" parent. It's hard knowing my son is not with his mom or his dad 24-7. It's hard when your child reaches for their grandmother for comfort when they fall and you are both standing there. And oh yeah- it's hard being a surgical intern, period.

But I'm blessed. We're blessed. Training looks different for everyone (we went to a school where our basic sciences were in the Caribbean; more on that another day). Life looks different for everyone. Just because it's different doesn't make it wrong or weird or not doable. We've learned a lot along the way, and talk about it a lot (when our shifts don't overlap, that is). I'll sum it up for you, in case it would help anyone else along the way . . .

1. Don't be too proud to apply to different locations if you're couple's matching. You'd rather be a doctor in a different geographical location than not-a-doctor in the same location.

2. Surgical preliminary spots aren't as easy to get into as you might think. I think that's the going rate for almost any residency these days.

3. There's lots of spots outside the match that you don't hear about unless you look for them in the right places. Look on your specialty's program director website (a good place to start) to see if there are open positions outside the match.

4. Don't panic if things don't go how you saw them. Where there's a will, there's a way. Don't let anyone tell you something isn't possible.

5. Family comes first, but deciding to be apart doesn't mean they don't still come first. Don't feel bad for choosing it. It doesn't mean you ranked them of less importance. It just means your story looks different.

6. Speaking of stories: Life looks different for everyone. You can use yucky situations for learning and growing, or for being miserable. It's a choice.

7. When you rank programs, go where you love. The rest will fall into place.

Of note- at the time of publication of this blog, my husband has an interview for an open PGY1 EM position that came available in late July right down the street at a phenomenal academic center.

Either way, we know what we've learned through all this.

Either way, we're good.

What obstacles have you overcome to achieve success? Do you have any words of advice for surgeons or aspiring surgeons who are going through a difficult time? Please share your thoughts in the comments below.

~~~

Brittany Bankhead-Kendall, M.D, M.Sc. is a PGY1 general surgery resident at Methodist Dallas Medical Center. She obtained her M.D. from Ross University School of Medicine, M.Sc. from Barry University in Biomedical Science, and studied Biomedical Science and Spanish at Texas A&M University. She enjoys being a surgical intern and mentoring medical students. In her personal time she enjoys spending time with her husband and son, interior design, international travel, and Texas Aggie football.

Wednesday, August 14, 2013

Solidarity

by Minerva Romero Arenas, MD, MPH

Since medical school, I had an interest in oncology. Our professors frequently invited patients and families to come and share with our class how they were personally affected by disease. I remember meeting a survivor of glioblastoma multiforme despite having been initially given a poor prognosis. Another family shared the heartache after losing a child to neuroblastoma and their efforts in raising his siblings. I was inspired to do something to show support for patients like the ones who shared their stories with us - the patients whom I one day hoped to treat. Being on a limited student budget, I had to think outside the box since I could not afford to make "significant" monetary donations. One day I decided I would donate my hair so someone else could have a wig.

Having had long tresses for decades, I must admit I was hesitant to go for a short bob. The fear quickly faded, as the stylist transformed my ponytails into "locks of love." The selflessness I felt, as I placed those long ponytails in the mail, let me know that it was one of the best ways I could contribute outside of my dedication to the medical field. I first donated to Locks of Love, though I have since switched to the Beautiful Lengths program.

Since that time, I have donated my thick, brown locks again. However, the next time became a lot more personal. During my first week of surgery residency, one of my surgery attendings made me burst out in tears after a teaching conference. Now, there is an unspoken rule that there's no crying in surgery! (just like in baseball). But my tears were not the result of a terrible pimping session or getting chewed out for making any mistake-- I had just learned that this surgeon, my professor, had terminal cancer. Having been given less than six months, she already had beat the odds a few years from initial diagnosis. Over the next year and half, she became a mentor and had a great influence on my early development as a young surgeon. I did not think twice about donating my hair again when she faced a debulking surgery for a recurrence. During our last conversation, she smiled when I told her about the donation.

My hair grew long again; it had been more than two years since the last donation. What a perfect metaphor for my progression in residency, and the adage that a tincture of time is sometimes the best medicine. Then I found out a colleague was facing a cancer recurrence. I prepared to visit my favorite hairdresser. He gets the most length by separating the hair into at least two ponytails. That day I mailed two ponytails, 12 inches each, of solidarity. Priceless.

~~~

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.

Friday, June 21, 2013

Internship: Ready, Set, Go!

by Callie Thompson, M.D.

Congratulations to all of you newly minted Doctors of Medicine! It is almost time to start your internships! You are probably trying to imagine what it will be like, and you are probably excited, nervous, scared, and maybe even a little nauseous.

This transition from medical student to doctor will be a big adjustment. But don't worry, you really can (and will) do this. I will start with a few general tips for how to succeed in your internship and then finish with some more specific tips that you will hopefully find helpful.

1. The patient comes first. Always. They are your North Star. When you lose your way, ask yourself "What is best for my patient?" and do that.

2. Be the doctor. I know, this one seems obvious, but you just graduated 3 weeks ago and now someone is calling you "Dr. So-and-so" and you feel both scared and like a total fraud almost all of the time. However, your patients and your team still depend on you. You are their "Dr. So-and-so" and you need to act like it. Have assessments, have plans and be willing and able to explain your reasoning for them.

And don't forget to introduce yourself as "Dr. (YOUR LAST NAME HERE)"--you earned it.

3. Always worry, but never worry alone. If you load that proverbial boat early, at least you won't sink alone. If someone on the floor is going south, assess them and then let your senior resident know. Immediately. No one expects you to be perfect; you will be learning and improving for the rest of your life, but we do expect that you will not keep secrets from us.

4. Never lie. Not to your seniors, not to your attending, and not to the patient. I know that these people will be looking at you and wanting to hear "good news" but your only job is to be honest, to tell them the truth. Trust is what your relationships with these people is built on; lying, even once, can permanently damage that relationship and worst of all, put the patient at risk.

5. Utilize the nurses, but don't let them use you. The nurses can and will be your best friends. They have experience, and they can teach you infinite amounts. If they call and tell you someone is sick, listen to them. Don't let your ego get in the way. Everyone is on the patient's team. The flip side of this is that some people will take advantage of your "newness" and they will ask you to do things that seem wrong to you. If that is the case, don't do it. Politely tell them that you need to check with your senior, and check with your senior. No one should get offended by that, as long as you remain polite and respectful.

6. Ask your senior residents and attendings for their expectations of you. There is nothing worse than finding out that you are falling short of expectations that you didn't know existed. Asking for expectations up front will lessen their potential frustrations, and yours.

7. Ask for feedback from your seniors and attendings. Don't wait for the end of a rotation to get an evaluation. That leaves you no opportunity to fix things and get better. Ask for feedback in the middle of your rotation (a great time for this is when you are finishing up a case) and then they will know that you were interested in improvement, and they will be able to recognize when you have improved.

And for the interns who are parents:

8. Set goals for yourself and your family. Make promises to yourself and your family about when you will study and prepare for your patients and when you will just be present for them. This is going to be an especially big period of adjustment for you, your partner, and your child(ren), but you'll get through it. Have patience with yourself and with them.

Now for a few specifics...

Must-use Websites & Apps:

1. NCCN Guidelines. The absolute best resource for guidelines for treatment of cancers. This site will help you immensely in clinic--and they have an app.

2. Up-to-date. Obviously.

3. Epocrates. Again, obviously.

4. ACGME case log mobile app. Immediately enter all of your cases after you complete them. Seriously, don't let them stack up. I had to enter an entire year's worth at one point, and it was obnoxious. Open the ACGME case log site on your iPhone (if you know how to do this on a non-Apple product please weigh-in in the comments below), click the rectangle with an arrow icon on the bottom of the page, and then click "add to home screen."

5. Twitter. Join twitter, follow people and organizations that you are interested in, and just watch. I have read more journal articles in the two months since joining twitter than I have in the prior two years. I recommend the Association of Women Surgeons, American College of Surgeons, Journal of Trauma, Annals of Surgery, NEJM, JAMA, and Journal of Burn Care and Research, but there are many more.

6. DrawMD apps. A perfect way to explain an operation to a patient.

7. Other useful (but potentially costly) resources include the SCORE curriculum (this will be an institutional license, so your program may not have it), the Gray's anatomy app, and SESAP 14.

8. Useful books (I like e-books because they are easier to carry around): Greenfield's Surgery, Zollinger's Atlas of Surgical Operations, and Operative Dictations in General and Vascular Surgery.

Organizing Your Day:

Pre-rounding, rounding, clinic, OR, afternoon rounding, sign-out. The schedule probably hasn't changed too much from medical school, except that you will be the one in charge of getting things done while still being in clinic and in the OR. Multi-tasking and triaging will be vitally important, but they can't really be taught. They are best observed and then applied in a trial and error manner until you find a method that works for you. I will give you this tip: discharge your patients before doing anything else (unless the something else is urgent). With computerized order entry, a lot of the discharge orders can be done the night before. This is also true for the discharge summary.
The big question is, what should you do when you get home from work? You should NOT start working again immediately. You should NOT study or read for the next day's cases. You SHOULD sit down and relax. Take a few moments for yourself. Eat some dinner. Maybe have a glass of wine. If you have a significant other or kids, spend time with them--see above. If you don't, make some plans with friends (co-residents make great friends) or give your family a call. Then, set a time (maybe 1-2 hours after you get home) to study, prepare for the next day, and/or check in on your patients.

What You Should Know for Every Case/Procedure You Do:

Prior to scrubbing in to a case or performing a procedure you need to know...

1. Your patient's history (including being familiar with their imaging)

2. The indications for the operation

3. The steps of the operation (including the anatomy)

4. The pitfalls for those steps

5. The general perioperative management

You may not be asked anything during the case but you should know these things all the same.
If you have a question or can't see during the case, ask politely if it would be a good time to ask a question or for you to take a closer look. Be okay if the answer is no because the patient comes first.
At the end of every case, talk with the senior resident and attending about the perioperative plan for the patient. You should know the plan for every drain/line, diet, pain management, and wound care. You should also know the criteria for discharge. (Hint: if you do this, you will almost always have an acceptable plan for the patient on morning rounds.)

Best of luck to all of you and congratulations, again!

For those of you who have already completed internship or at the tail-end of your intern year, do you have any additional tips or advice? What helped you out most during your first year as a new surgeon-in-training? Let us know in the comments below!

~~~

Callie is a resident in general surgery at the University of Washington. She will be entering her fourth clinical year at the end of June 2013 after completing a two year research fellowship. 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.