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!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Minerva Romero Arenas, MD, MPH
Resident
What holiday do you celebrate and what is the special meaning of this
holiday to you?
We celebrate Christmas Eve because in the Catholic faith it is the celebration of the birth of Jesus Christ. My family traditionally gave us kids gifts on Día de Los Reyes Magos (The 3 Wise Men), which correlates to the gifts presented to Jesus. In addition to reflecting on the spiritual meaning of the Christmas holidays, I also like to take time to think about the previous and upcoming years and to remind my family and friends how special they are to me.
What are some family traditions you have related to this holiday?
Being Mexican in the US means my family celebrates both cultures. We still celebrate primarily on Christmas Eve, we pray and sing carols, and have a Posada. Dinner varies - traditionally turkey is on the menu for this day- but we change it up according to what everyone wants to eat. One of my favorite memories was when my grandmother showed my cousins and I how to make tamales. Other years we have enjoyed catered Chinese or Indian food. After having lived in the US many years we adopted the tradition of exchanging presents on Christmas morning. On January 6th, we try to continue the tradition of eating King's cake.
Do you have a good memory of patient care during a time you worked during
the holiday?
I've had several years in residency that I could not travel back home for the holidays. I am thankful for technology like FaceTime, which enabled me to share some special moments with my family while away. Nonetheless, during the holidays the patients who are in the hospital are usually very sick & grateful to have us around helping keep an eye on them in their recovery from surgery or trauma injuries. I have to admit that some of my favorite memories are sharing food with nursing, our mid-level providers, attendings & OR staff. In particular, I am thankful for having co-workers and mentors who have invited me to join them for dinner.
Showing posts with label training. Show all posts
Showing posts with label training. Show all posts
Sunday, December 28, 2014
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!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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.
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!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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.
Thursday, July 17, 2014
Sub-internship Success: A How-to Guide
by Callie Thompson, MD and Jane Zhao, MD
For those who are not familiar: A sub-internship is a rotation that a medical student does, in their fourth (and last) year, in which they are expected to function as an intern. We lovingly refer to such a person as a sub-I, sub-intern, or acting intern. Usually, at least one of these rotations is done at an outside institution. And typically, this is considered a month long job interview.
What follows are our tips/suggestions for a successful rotation.
Keep in mind that these are general guidelines, and that each medical school will have slightly different expectations of their surgical sub-interns.
Away rotations: Only do a sub-internship at a place that you might want to train at for residency if you are ready to work, work, work. This is your chance to knock the socks off the people you are working with. You need to show them how good you are and they need to come away from it thinking "we want her/him in our program." Because of these odds, many attendings and residents will tell you that the underwhelming returns of matching at a program where you have completed an away rotation are not worth the amount of money and effort you pitch in.
On the other hand, do an away rotation if you want to take advantage of the opportunity to gain some perspective on how residency programs may differ and which characteristics of a program you absolutely need and which you may be willing to sacrifice when push comes to shove, e.g. location, demographics, prestige. Furthermore, obtaining a letter of recommendation from an away rotation is a great way to gain invitations to programs that typically only interview regional applicants. This holds especially true for those who stayed in one location from undergraduate and medical school and have a desire to move elsewhere for residency.
Another word on away rotations: Do not ever turn down an away rotation you applied for at a hospital where you would like to interview for residency. Turning down the opportunity to visit a program for a month after you have taken the time to apply for it and after the program has taken the time to approve you is the single quickest way to blacklist yourself from the program when interview season rolls around.
Scheduling and letters of recommendation: Generally speaking, the earlier you schedule your sub-internship the better because most students take advantage of this time to also ask for letters of recommendation from faculty members they work with. Make sure the faculty member knows you, make sure they are going to say something good about you, and give them enough notice so that they aren’t rushing to meet a 48 hour deadline. Thus, July, August, and September are prime months. Keep in mind that if you schedule your rotation in the midst of interview season, you may have to request numerous absences, which will detract from your experience and even possibly reflect negatively on you. Scheduling a sub-internship earlier in the school year also provides faculty who have worked with you a greater level of comfort to advocate strongly for you if programs use a democratic process to create their rank list. This comes in handy if you absolutely need to match to a particular program or city.
Choosing the site of your rotation: Numerous programs request a letter from either your medical school’s chair of surgery or program director. If you haven’t had the chance to meet with either of them during other occasions, you may want to figure out which service they belong to, and try to rotate through there.
Given that a good surgeon should also have a firm understanding of medicine, a strong letter from a respected attending from a different department such as internal medicine can also go a long way in making your application shine, so if you have enough time, it certainly would behoove you to attempt a sub-internship in medicine.
A sub-internship is also a great chance to try out a particular surgical subspecialty you might be interested in pursuing further down the road, e.g. colorectal, trauma and critical care, or pediatrics. If you end up falling in love with it, you now have a stronger incentive to match to certain programs, or if you end up hating it with a passion, you have saved yourself from years of potential misery.
Set yourself up well: This starts by developing a full understanding of the dynamics of the system setup and the people on the service you will work with. Will you be working on a high-volume service with fast turnover? Will you be working on one where the norm is one to two elective cases every other day? Are the attendings known for their Socratic style of teaching? Do the residents go out of their way to include students in the work up of patients? Play to your strengths, particularly if you are trying to obtain a letter. Some sub-interns’ strengths come out in chaotic situations, when their reliability and collected composure are a sweet breath of relief to ragged residents working in a hectic environment. Some sub-interns love being pimped and shine best when being grilled with question after question while their classmates stare gape-mouthed and hopeless. Do you rock at presenting and working up patients? Are you better with procedures? Figure out how your strengths will complement the needs of the service you are joining, and make sure you choose and prepare accordingly. For better or worse, your performance will be evaluated subjectively, and it doesn’t take much for a poor impression to be wrongly formed of a usually wonderful sub-intern or a positive one of an otherwise average sub-intern.
Eliminate distractions: This is your opportunity to take on the responsibilities of an intern. Help manage the list. Know every patient. Unlike your third year clerkship, you do not have assignments or a shelf exam to worry about during your acting internship (disclaimer: this is not true at every medical school). Plan out your year to avoid having to work on your personal statement, ERAS application, away rotations, scheduling interviews, or study for the USMLE Step 2 during this time. You can take full advantage of the freed up time to play an active role on the team and gain more hands on patient care experience.
Presentation: If you are expected to give a presentation (many rotations require them), get started on it early, and identify both a resident and a faculty member to advise you. Be sure that you already have an idea in mind before you speak to them and get your presentation done early enough that they can help you make improvements if need be.
Prioritizing: A real intern probably spends more time on the wards than in the operating rooms, while a third year medical student gets the best possible snapshot of what it’s like to be a surgeon by being in the operating room whenever possible. What’s a sub-intern to do? As a fourth year medical student, you are somehow expected to find the happy medium between both.
Some pearls:
You need to be able to function like an intern which means you need to have a good idea of how to manage your time and balance multiple patients at a time. You aren't a third year student anymore, so you need to carry more than two to three patients at a time. Ideally, you should know the entire service, just like the intern does. Even if there is a third year medical student on your service, you should know everything about their patients too without stepping on their toes.
In the mornings, do your best to help the third year medical students and interns collect vitals and pre-round on patients. Chat with the nurses and ancillary staff for events that occurred overnight.
For rounds, you will most likely follow steps for success that won’t have deviated much from your third year clerkship: Carry marking pens, suture removal kits, gauze, tape, and consent forms in your pockets. Split up patients with the other medical students on your team, and take down dressings on all patients who are postop day two. Have a penlight at the ready to shine on the incision for your resident to have better visualization. Propose alternative treatments for patients who appear to quickly be running out of conventional options. And so on.
Go into the patient’s room with the senior resident or fellow, and gain a sense of what the plan for that day will be. You have no idea how helpful you can end up being when you run the list with the other junior residents later or when you spare the time to follow up on labs and imaging while the rest of the team is occupied handling tasks that only they can do with the MD or DO behind their name.
The intern may not be able to make time to be in the operating room, but you do. Since you are a sub-intern and not an actual intern, your priority is to get the most of your undergraduate medical education. However, you should be demonstrating your ability to be an intern in less than a year so don’t ignore the floor work. Also, not helping the intern and going to the OR the entire time will be noticed and not in a positive way since that isn’t really the function of a sub-I.
When you do go to the operating rooms, first (as always) you must know the patient you are operating on. Help roll the patients into and out of the rooms. Retract. Answer questions about anatomy, pathophysiology, ethics, or whatever else the attending or resident wants you to answer. Drive the camera. Again, this part won’t be much different from when you were a third year medical student. Let third year medical students have opportunities to scrub into cases you have seen before. If you desperately want to be involved in a case, and there are two students, ask the attending if both of you can scrub. Teach the third year medical student basic skills, and share opportunities to do procedures in the operating rooms and by the bedside with them. You had great residents and sub-interns when you rotated through that made surgery rock your world. Now it’s your turn to pay the favor forward.
If the team is short-staffed, your priority is to take care of the floor patients or clinic patients depending on where your are assigned. If you are done with your tasks on the floor, then make your way to clinic (even if you weren’t assigned), and see patients and present to the attendings. Come up with plans for the patients. Look out for your third year medical students and have them present to you before they present to the resident/attending, and help them polish their presentation.
Be proactive rather than reactive, and let your residents know what you are up to, especially once you have completed a task. If you ask if you can do anything to help, they will invariably reply, “No thanks. You really don’t have to. Seriously.” So if you see that they have a million and one tasks to complete, take the initiative to tackle a task within your ability that doesn’t put patients at risk, and provide your upper level with the completed result. That is the difference between a stellar, unforgettable sub-intern and one who is great.
Ask for help when you are unsure, and take advantage of this time to ask questions that may seem silly or dumb. Now is the time. While it sometimes may not seem to be the case, you shouldn’t be expected to know everything about surgery. Residency is after all a training process. It’s better to clarify what you don’t know now, rather than wait later when you have actual responsibility over patients.
Remember, not always knowing the answer is forgivable. What’s important is being reliable and teachable. Surgery is one of the most exhausting specialties out there, and not everyone has the physical or emotional fortitude to pursue the field. This has led to a phenomenon where even 80 hours per week are sometimes perceived as not enough. Thus, we don’t think we’re remiss in stating that a honest hard worker of above average intelligence is often preferred over a genius who can’t be relied on, a statement true for most walks of life but one that sub-interns should particularly take to heart.
Read: Just because you don’t have a shelf exam to prepare for anymore doesn’t mean you should stop studying. Read up on your patients. Find relevant articles. Create treatment algorithms and cheat sheets.
There are some folks who function well on three hours of sleep. If you are not that type of individual, give yourself permission to crash when you return home in the evening. Instead, set aside time early in the morning to jot down notes about the patients who will be operated on for the day. Be smart about it. If there are too many cases for you to scrub into, and you’re pressed for time, then concentrate on those whom you know for sure you will be operating on. For those patients, know the following:
o pertinent details from patient’s history, labs, and imaging
o indications for the operation
o crucial anatomy and steps of the operation
o possible short-term and long-term complications
o important details of perioperative management
Hopefully, if you have read up about each patient prior to their operation, then as the rotation goes on, you will be able to anticipate the general management and time course of all the patients on the service during their post-operative stay in the hospital.
Share what you have learned with the other medical students on your service. It helps guide their studying and cements the knowledge further in your mind. Remember the big picture. By helping others, you indirectly improve the care of those patients who will be one day be treated by other members of your team.
Pay it forward. Take the third year medical students under your wing. Teach them how to tie surgical knots. Share with them stories of your own frustrations and triumphs from your time as a third year. Remind them to eat. Buy them coffee, or share a granola bar. Help them with their presentations. Let them know when it is okay to text the upper level and ask, “is there anything else I can do to help?” which we all know is universal student code speak for “may I please leave?”
Lastly, if you really want to stand out, give the sub-intern and third year medical students who will trade you out for the next month a heads up about what to expect once they come onto service. This will make not only their lives easier but also relieve a weight off the shoulders of your upper levels. Your patients may even benefit from safer care.
You will impress everyone if you show them how helpful and kind you are to others, even when it doesn't directly benefit you.
In conclusion: what does it take to succeed as a sub-intern? If you can in anyway make the service run as smoothly as possible and life better for the residents then you can be rest assured that you’ve done a good job.
Did we miss anything? Let us know your own suggestions for sub-internship success in the comments below.
Medical students, click here for more information on how to succeed on your third year medical student surgical clerkship.
Surgical interns, click here for advice on how to build the foundation for future success by starting off intern year the right way.
Callie Thompson is a chief resident in general surgery at the University of Washington. 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 ages 1, 3, and 7.
Jane Zhao is a general surgery resident at the University at Buffalo, State University of New York. She obtained her medical degree with a scholarly concentration in Clinical Quality, Safety, and Evidence-based Medicine from the University of Texas Medical School at Houston and completed her undergraduate studies in Medicine, Health, & Society at Vanderbilt University. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award and chaired the AWS Blog Subcommittee from 2013 to 2014. Her interests include healthcare social media, quality improvement, and public health. She can be followed on Twitter.
For those who are not familiar: A sub-internship is a rotation that a medical student does, in their fourth (and last) year, in which they are expected to function as an intern. We lovingly refer to such a person as a sub-I, sub-intern, or acting intern. Usually, at least one of these rotations is done at an outside institution. And typically, this is considered a month long job interview.
What follows are our tips/suggestions for a successful rotation.
Keep in mind that these are general guidelines, and that each medical school will have slightly different expectations of their surgical sub-interns.
Away rotations: Only do a sub-internship at a place that you might want to train at for residency if you are ready to work, work, work. This is your chance to knock the socks off the people you are working with. You need to show them how good you are and they need to come away from it thinking "we want her/him in our program." Because of these odds, many attendings and residents will tell you that the underwhelming returns of matching at a program where you have completed an away rotation are not worth the amount of money and effort you pitch in.
On the other hand, do an away rotation if you want to take advantage of the opportunity to gain some perspective on how residency programs may differ and which characteristics of a program you absolutely need and which you may be willing to sacrifice when push comes to shove, e.g. location, demographics, prestige. Furthermore, obtaining a letter of recommendation from an away rotation is a great way to gain invitations to programs that typically only interview regional applicants. This holds especially true for those who stayed in one location from undergraduate and medical school and have a desire to move elsewhere for residency.
Another word on away rotations: Do not ever turn down an away rotation you applied for at a hospital where you would like to interview for residency. Turning down the opportunity to visit a program for a month after you have taken the time to apply for it and after the program has taken the time to approve you is the single quickest way to blacklist yourself from the program when interview season rolls around.
Scheduling and letters of recommendation: Generally speaking, the earlier you schedule your sub-internship the better because most students take advantage of this time to also ask for letters of recommendation from faculty members they work with. Make sure the faculty member knows you, make sure they are going to say something good about you, and give them enough notice so that they aren’t rushing to meet a 48 hour deadline. Thus, July, August, and September are prime months. Keep in mind that if you schedule your rotation in the midst of interview season, you may have to request numerous absences, which will detract from your experience and even possibly reflect negatively on you. Scheduling a sub-internship earlier in the school year also provides faculty who have worked with you a greater level of comfort to advocate strongly for you if programs use a democratic process to create their rank list. This comes in handy if you absolutely need to match to a particular program or city.
Choosing the site of your rotation: Numerous programs request a letter from either your medical school’s chair of surgery or program director. If you haven’t had the chance to meet with either of them during other occasions, you may want to figure out which service they belong to, and try to rotate through there.
Given that a good surgeon should also have a firm understanding of medicine, a strong letter from a respected attending from a different department such as internal medicine can also go a long way in making your application shine, so if you have enough time, it certainly would behoove you to attempt a sub-internship in medicine.
A sub-internship is also a great chance to try out a particular surgical subspecialty you might be interested in pursuing further down the road, e.g. colorectal, trauma and critical care, or pediatrics. If you end up falling in love with it, you now have a stronger incentive to match to certain programs, or if you end up hating it with a passion, you have saved yourself from years of potential misery.
Set yourself up well: This starts by developing a full understanding of the dynamics of the system setup and the people on the service you will work with. Will you be working on a high-volume service with fast turnover? Will you be working on one where the norm is one to two elective cases every other day? Are the attendings known for their Socratic style of teaching? Do the residents go out of their way to include students in the work up of patients? Play to your strengths, particularly if you are trying to obtain a letter. Some sub-interns’ strengths come out in chaotic situations, when their reliability and collected composure are a sweet breath of relief to ragged residents working in a hectic environment. Some sub-interns love being pimped and shine best when being grilled with question after question while their classmates stare gape-mouthed and hopeless. Do you rock at presenting and working up patients? Are you better with procedures? Figure out how your strengths will complement the needs of the service you are joining, and make sure you choose and prepare accordingly. For better or worse, your performance will be evaluated subjectively, and it doesn’t take much for a poor impression to be wrongly formed of a usually wonderful sub-intern or a positive one of an otherwise average sub-intern.
Eliminate distractions: This is your opportunity to take on the responsibilities of an intern. Help manage the list. Know every patient. Unlike your third year clerkship, you do not have assignments or a shelf exam to worry about during your acting internship (disclaimer: this is not true at every medical school). Plan out your year to avoid having to work on your personal statement, ERAS application, away rotations, scheduling interviews, or study for the USMLE Step 2 during this time. You can take full advantage of the freed up time to play an active role on the team and gain more hands on patient care experience.
Presentation: If you are expected to give a presentation (many rotations require them), get started on it early, and identify both a resident and a faculty member to advise you. Be sure that you already have an idea in mind before you speak to them and get your presentation done early enough that they can help you make improvements if need be.
Prioritizing: A real intern probably spends more time on the wards than in the operating rooms, while a third year medical student gets the best possible snapshot of what it’s like to be a surgeon by being in the operating room whenever possible. What’s a sub-intern to do? As a fourth year medical student, you are somehow expected to find the happy medium between both.
Some pearls:
You need to be able to function like an intern which means you need to have a good idea of how to manage your time and balance multiple patients at a time. You aren't a third year student anymore, so you need to carry more than two to three patients at a time. Ideally, you should know the entire service, just like the intern does. Even if there is a third year medical student on your service, you should know everything about their patients too without stepping on their toes.
In the mornings, do your best to help the third year medical students and interns collect vitals and pre-round on patients. Chat with the nurses and ancillary staff for events that occurred overnight.
For rounds, you will most likely follow steps for success that won’t have deviated much from your third year clerkship: Carry marking pens, suture removal kits, gauze, tape, and consent forms in your pockets. Split up patients with the other medical students on your team, and take down dressings on all patients who are postop day two. Have a penlight at the ready to shine on the incision for your resident to have better visualization. Propose alternative treatments for patients who appear to quickly be running out of conventional options. And so on.
Go into the patient’s room with the senior resident or fellow, and gain a sense of what the plan for that day will be. You have no idea how helpful you can end up being when you run the list with the other junior residents later or when you spare the time to follow up on labs and imaging while the rest of the team is occupied handling tasks that only they can do with the MD or DO behind their name.
The intern may not be able to make time to be in the operating room, but you do. Since you are a sub-intern and not an actual intern, your priority is to get the most of your undergraduate medical education. However, you should be demonstrating your ability to be an intern in less than a year so don’t ignore the floor work. Also, not helping the intern and going to the OR the entire time will be noticed and not in a positive way since that isn’t really the function of a sub-I.
When you do go to the operating rooms, first (as always) you must know the patient you are operating on. Help roll the patients into and out of the rooms. Retract. Answer questions about anatomy, pathophysiology, ethics, or whatever else the attending or resident wants you to answer. Drive the camera. Again, this part won’t be much different from when you were a third year medical student. Let third year medical students have opportunities to scrub into cases you have seen before. If you desperately want to be involved in a case, and there are two students, ask the attending if both of you can scrub. Teach the third year medical student basic skills, and share opportunities to do procedures in the operating rooms and by the bedside with them. You had great residents and sub-interns when you rotated through that made surgery rock your world. Now it’s your turn to pay the favor forward.
If the team is short-staffed, your priority is to take care of the floor patients or clinic patients depending on where your are assigned. If you are done with your tasks on the floor, then make your way to clinic (even if you weren’t assigned), and see patients and present to the attendings. Come up with plans for the patients. Look out for your third year medical students and have them present to you before they present to the resident/attending, and help them polish their presentation.
Be proactive rather than reactive, and let your residents know what you are up to, especially once you have completed a task. If you ask if you can do anything to help, they will invariably reply, “No thanks. You really don’t have to. Seriously.” So if you see that they have a million and one tasks to complete, take the initiative to tackle a task within your ability that doesn’t put patients at risk, and provide your upper level with the completed result. That is the difference between a stellar, unforgettable sub-intern and one who is great.
Ask for help when you are unsure, and take advantage of this time to ask questions that may seem silly or dumb. Now is the time. While it sometimes may not seem to be the case, you shouldn’t be expected to know everything about surgery. Residency is after all a training process. It’s better to clarify what you don’t know now, rather than wait later when you have actual responsibility over patients.
Remember, not always knowing the answer is forgivable. What’s important is being reliable and teachable. Surgery is one of the most exhausting specialties out there, and not everyone has the physical or emotional fortitude to pursue the field. This has led to a phenomenon where even 80 hours per week are sometimes perceived as not enough. Thus, we don’t think we’re remiss in stating that a honest hard worker of above average intelligence is often preferred over a genius who can’t be relied on, a statement true for most walks of life but one that sub-interns should particularly take to heart.
Read: Just because you don’t have a shelf exam to prepare for anymore doesn’t mean you should stop studying. Read up on your patients. Find relevant articles. Create treatment algorithms and cheat sheets.
There are some folks who function well on three hours of sleep. If you are not that type of individual, give yourself permission to crash when you return home in the evening. Instead, set aside time early in the morning to jot down notes about the patients who will be operated on for the day. Be smart about it. If there are too many cases for you to scrub into, and you’re pressed for time, then concentrate on those whom you know for sure you will be operating on. For those patients, know the following:
o pertinent details from patient’s history, labs, and imaging
o indications for the operation
o crucial anatomy and steps of the operation
o possible short-term and long-term complications
o important details of perioperative management
Hopefully, if you have read up about each patient prior to their operation, then as the rotation goes on, you will be able to anticipate the general management and time course of all the patients on the service during their post-operative stay in the hospital.
Share what you have learned with the other medical students on your service. It helps guide their studying and cements the knowledge further in your mind. Remember the big picture. By helping others, you indirectly improve the care of those patients who will be one day be treated by other members of your team.
Pay it forward. Take the third year medical students under your wing. Teach them how to tie surgical knots. Share with them stories of your own frustrations and triumphs from your time as a third year. Remind them to eat. Buy them coffee, or share a granola bar. Help them with their presentations. Let them know when it is okay to text the upper level and ask, “is there anything else I can do to help?” which we all know is universal student code speak for “may I please leave?”
Lastly, if you really want to stand out, give the sub-intern and third year medical students who will trade you out for the next month a heads up about what to expect once they come onto service. This will make not only their lives easier but also relieve a weight off the shoulders of your upper levels. Your patients may even benefit from safer care.
You will impress everyone if you show them how helpful and kind you are to others, even when it doesn't directly benefit you.
In conclusion: what does it take to succeed as a sub-intern? If you can in anyway make the service run as smoothly as possible and life better for the residents then you can be rest assured that you’ve done a good job.
Did we miss anything? Let us know your own suggestions for sub-internship success in the comments below.
~~~
Medical students, click here for more information on how to succeed on your third year medical student surgical clerkship.
Surgical interns, click here for advice on how to build the foundation for future success by starting off intern year the right way.
~~~
Callie Thompson is a chief resident in general surgery at the University of Washington. 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 ages 1, 3, and 7.Jane Zhao is a general surgery resident at the University at Buffalo, State University of New York. She obtained her medical degree with a scholarly concentration in Clinical Quality, Safety, and Evidence-based Medicine from the University of Texas Medical School at Houston and completed her undergraduate studies in Medicine, Health, & Society at Vanderbilt University. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award and chaired the AWS Blog Subcommittee from 2013 to 2014. Her interests include healthcare social media, quality improvement, and public health. She can be followed on Twitter.
~~~
Wednesday, July 9, 2014
My International Surgery Elective
by Jane Zhao, MD
In April 2014 I spent a month with the Department of Surgery at the Affiliated Hospital of Qingdao University – Huangdao Branch. It was a marvelous experience, and I was asked to share a snapshot of my time there.
Qingdao, which means Green Island, is a major coastal city of approximately three million people in the Shandong province of China. The city boasts the world’s longest sea bridge, Tsingtao Brewery, and Lao Mountain. Reminders of its time period under German colonization in the 1800s remain visible in Qingdao’s wide streets and architecture.
The Field Hospital of Germany first opened its doors on the shore of the Yellow Sea in 1898. As Qingdao modernized and grew, the Field Hospital transformed into the Affiliated Hospital of Qingdao University. Today, there are three hospital branches that provide patient care to all of Qingdao and its surrounding areas. The vast majority of my time was spent at Huangdao Hospital, the newest branch, located a 40 minute drive outside the heart of Qingdao.
I learned an incredible amount during my month in China. I was given multiple opportunities to see surgery practiced differently, more cost-efficiently, and most importantly, without detriment to the patient, which made me pause, take mental notes, and ask why on a frequent basis. Take laparoscopic appendectomies for example. In the US, the cost of appendectomies including hospital stay, conservatively speaking, can quickly add up to a bill of $30K. In China, the cost is approximately 3200 RMB, which if converted to US dollars would be less than $1K. Same disease process, same step-by-step operation, but a drastic reduction in cost.
There were plenty of other differences that I found intriguing. One of them was the observation that the hospital did not stock scrub brushes by the sinks. Instead, faculty and staff prior to each case will rinse once with a chlorhexidine solution, dry off with nonsterile paper napkins, and then Avagard. The rationale for eliminating scrub brushes is that the constant scrubbing leads to skin abrasion, increasing the risk of bacterial growth. On the other hand, if the epidermis stays smooth and intact, anything other than normal skin flora is unlikely to grow. The hospital infection control team has been swabbing the hands of random operating room personnel monthly and growing the samples for culture, but so far nothing beyond typical skin flora has grown.
Another observation led to the realization that I have been spoiled by the scrub nurses back at home. In the operating rooms at Huangdao Hospital, everyone with the exception of the attending was expected to gown and glove themselves. Also, every effort was made to conserve and reuse. Gowns, needles, and even the laps used to soak up the betadine solution used to prep the patient were recycled through the system for future use. Face masks and caps are rationed out to those entering the operating rooms by a nurse who stood guard outside the locker rooms.
An additional fascinating discovery was in learning which types of cases were considered too risky for residents to perform independently and which were not. Residents were given exceptional autonomy in performing upper gastrointestinal and colorectal cases, but if a patient needed a gallbladder out due to symptomatic cholelithiasis or choledocholithiasis, attendings and chief residents were the only ones allowed to manipulate the biliary tract during laparoscopic cholecystectomies. The most action junior residents could hope for was to drive the camera. They were shocked when I gave them examples of the types of cases US residents at their similar level were allowed to perform.
Catching a close-up glimpse of a different training structure gave me some added perspective into what mine would soon be in the US. Given the controversy in the states regarding how work hour restrictions have led to an increase in hand-off errors, it was of particular interest to me as a soon-to-be intern to see what life without work hour restrictions looked like. The residents lived in or around the hospital--most unmarried or living separately from their partners and children. Their attention was channeled 100% into become better surgeons each and every day, which showed. The residents in Huangdao were technical wizards in the operating room. They were able to dissect their way into the correct plane in seconds, without a single wasted movement. No bleeder or atypical anatomy fazed them. They knew all the patients front-to-back. Many of my mentors in the US have spoken to me of what surgery was like in the good ol' days without work-hour restrictions. Being in China gave me a glimpse into their past, and it was awe-inducing.
The thing is, the past is almost always seen through rose-colored lenses, and after the initial rosiness died down a bit, I started to better understand the rationale for why residency training in the US has undergone such tremendous changes, even if the changes have resulted in their own challenges. The residents at Huangdao Hospital had little time to stay up-to-date with the literature, spend time strengthening family ties, or maintain interest in meaningful outside hobbies. It was not unusual for residents with families to take the bus into the city to visit wife and child for half a day, spend the other six days of the week in the hospital, and then send as much of their income as possible home to help pay the bills. The residents were at the beck and call of the hospital and their department around the clock. It was only by their good fortune that they had a Chair known throughout the hospital for his fairness and kindness.
I spent a significant amount of time with the Chair of Surgery
discussing the differences I noted between residency training in the US
and at Huangdao Hospital. He was particularly interested in the way training was standardized from program to program, so I told him that, in US teaching hospitals, each specialty is usually represented by one or more services, each composed of a mix of junior and senior residents and headed by an attending. During rounds, the senior
resident comes up with a plan for each patient based on the clinical presentation, touches base with the attending for any changes he or she wants to make, and then the junior residents see to it that the final versions of the plan are carried out. By having residents rotate through different services, each with a
standardized hierarchy, the residents can gain similar
opportunities for graded responsibility throughout their training. By the time residents graduate, they are expected to have received comparable training, regardless of where they completed their residency. Another upside to the US model of training, I told the Chair, was that by minimizing the micro-managing, attendings can devote more of their nonclinical time to research, teaching, or other
administrative tasks. The Chair of Surgery was so enthusiastic about
what I shared with him that within days he had morning rounds changed,
and as far as I know, they are still being conducted via the revised approach.
My conversations with the Chair of Surgery were rewarding. I was able to pick his brain on how to become a better leader based on his own his triumphs and tribulations, and he had an opportunity to learn new methods by which he could try to improve the quality of his residents' training. Our conversations were numerous, but one particularly meaningful impact I made didn't require me to make any fancy speeches. My mere presence was enough because it caused people to talk. By April, I had already found out that I would be at the University at Buffalo, the State University of New York for my next half decade of general surgery training. Women pursuing surgery in China is a once in a blue moon phenomenon—essentially unheard of. They were shocked and impressed to find out that I was one of multiple women in my class at the University of Texas Medical School at Houston who matched into a surgical specialty for residency. One circulating nurse rushed home that evening to share the news with her daughter. It was mind-boggling to see the people around me attempt to grasp the concept of a woman not only pursuing surgery but also having that accepted as normal within society. I could see the beginnings of a paradigm shift taking place in many of their minds.
There are so many more remarks I can make about my experience abroad. The 60-70% 5-year survival rate for patients diagnosed with resectable gastric adenocarcinoma at Huangdao Hospital compared to the dismal 30% in the US. The occasional traveler or expatriate who spoke English. The sick patient who still appreciated whatever counseling I provided in my broken Mandarin. The Chinese government's firewall of social media platforms like Blogger, Wordpress, Facebook, Youtube, and Twitter that allow real-time communication to take place, now so heartily embraced by our surgical community. The pay-for-service approach. The paternalism. The around-the-clock walk-in clinic. The heavy reliance on radiographic imaging. The lack of tort reform or Good Samaritan laws. The lateral rigidity in career transfer. The integral role played by family in the perioperative management of patients. There are some aspects of surgery in China that have my utmost admiration, others nothing but frustration. But that goes for most things in life.
My observations are all anecdotal and limited by my experience being predominantly at only one hospital. I can hardly say if the hospital where I rotated is representative of other hospitals in China or even Asia. That being so, I have had such an expansion of my worldview that I would not have had otherwise, and my undergraduate medical education has benefited tremendously.
I would never have had this opportunity without the mentorship and sponsorship of Dr. Anil Kulkarni, whose recommendation of me to his friend and former colleague paved the way for me to establish my own special project to rotate in China. Dr. Yun Lu, the Chair of Surgery at the Affiliated Hospital of Qingdao University, Huangdao Branch has invited me to return, and I definitely plan to take him up on his offer. Eventually I would like to bring other students along with me to show them how amazing of a profession surgery is, and what a comfort it is to know how quickly and easily it can be for a surgeon or aspiring surgeon to feel at home in any country simply by walking into an operating room.
Have you ever completed a surgical rotation in a country different from your own? If so, what was that experience like? Share in the comments below.
Jane Zhao is a general surgery resident at the University at Buffalo, the
State University of New York. She obtained her medical degree with a
scholarly concentration in Clinical Quality, Safety, and Evidence-based
Medicine from the University of Texas Medical School at Houston and
completed her undergraduate studies in Medicine, Health, & Society
at Vanderbilt University. She was the 2012 recipient of the Shohrae
Hajibashi Memorial Leadership Award and chaired the AWS Blog
Subcommittee from 2013 to 2014. Her interests include healthcare social
media, quality improvement, and public health. She can be followed on Twitter.
In April 2014 I spent a month with the Department of Surgery at the Affiliated Hospital of Qingdao University – Huangdao Branch. It was a marvelous experience, and I was asked to share a snapshot of my time there.
Qingdao, which means Green Island, is a major coastal city of approximately three million people in the Shandong province of China. The city boasts the world’s longest sea bridge, Tsingtao Brewery, and Lao Mountain. Reminders of its time period under German colonization in the 1800s remain visible in Qingdao’s wide streets and architecture.
 | |||||
| View from Lao Mountain |
 |
| German Governor's Mansion, a prime example of Qingdao's colonial architecture. The construction was said to be so extravagant that the Kaiser fired the governor once he received the bill. |
 |
| The outpatient entrance of the Affiliated Hospital of Qingdao University, Huangdao Branch which formally opened its doors in 2011 (picture source) |
During the week, my mornings started with morning report at seven
o'clock, with rounds following shortly after. The rest of the day would
be spent in the operating theatre. Cases usually began around nine
o’clock, with the occasional earlier start time. Rooms turned over
quickly, and it was not unusual for the team to schedule multiple
gastrectomys and low anterior resections each day (the department of
general surgery was colorectal heavy). Elective cases took place through
the weekend, but I used my Saturdays and Sundays to attend local
conferences, visit a community health clinic, and observe other
services, such as emergency medicine, critical care, neonatology,
pediatric surgery, and hepatobiliary surgery.
 |
| Outside the Huangdao Community Health Service Center, where patients can receive preventative care or chronic care management |
 |
| An infographic that breaks down the typical appendectomy bill generated from a US hospital (picture source) |
Another observation led to the realization that I have been spoiled by the scrub nurses back at home. In the operating rooms at Huangdao Hospital, everyone with the exception of the attending was expected to gown and glove themselves. Also, every effort was made to conserve and reuse. Gowns, needles, and even the laps used to soak up the betadine solution used to prep the patient were recycled through the system for future use. Face masks and caps are rationed out to those entering the operating rooms by a nurse who stood guard outside the locker rooms.
An additional fascinating discovery was in learning which types of cases were considered too risky for residents to perform independently and which were not. Residents were given exceptional autonomy in performing upper gastrointestinal and colorectal cases, but if a patient needed a gallbladder out due to symptomatic cholelithiasis or choledocholithiasis, attendings and chief residents were the only ones allowed to manipulate the biliary tract during laparoscopic cholecystectomies. The most action junior residents could hope for was to drive the camera. They were shocked when I gave them examples of the types of cases US residents at their similar level were allowed to perform.
Catching a close-up glimpse of a different training structure gave me some added perspective into what mine would soon be in the US. Given the controversy in the states regarding how work hour restrictions have led to an increase in hand-off errors, it was of particular interest to me as a soon-to-be intern to see what life without work hour restrictions looked like. The residents lived in or around the hospital--most unmarried or living separately from their partners and children. Their attention was channeled 100% into become better surgeons each and every day, which showed. The residents in Huangdao were technical wizards in the operating room. They were able to dissect their way into the correct plane in seconds, without a single wasted movement. No bleeder or atypical anatomy fazed them. They knew all the patients front-to-back. Many of my mentors in the US have spoken to me of what surgery was like in the good ol' days without work-hour restrictions. Being in China gave me a glimpse into their past, and it was awe-inducing.
The thing is, the past is almost always seen through rose-colored lenses, and after the initial rosiness died down a bit, I started to better understand the rationale for why residency training in the US has undergone such tremendous changes, even if the changes have resulted in their own challenges. The residents at Huangdao Hospital had little time to stay up-to-date with the literature, spend time strengthening family ties, or maintain interest in meaningful outside hobbies. It was not unusual for residents with families to take the bus into the city to visit wife and child for half a day, spend the other six days of the week in the hospital, and then send as much of their income as possible home to help pay the bills. The residents were at the beck and call of the hospital and their department around the clock. It was only by their good fortune that they had a Chair known throughout the hospital for his fairness and kindness.
 |
| My classmate from UTHealth Amy Wang and I with the Chairs of Surgery from each of the three hospital branches affiliated with Qingdao University. Dr. Yun Lu on the far left of the screen, next to Amy, was the Chair of Surgery and our faculty mentor at the Affiliated Hospital of Qingdao University, Huangdao Branch. |
My conversations with the Chair of Surgery were rewarding. I was able to pick his brain on how to become a better leader based on his own his triumphs and tribulations, and he had an opportunity to learn new methods by which he could try to improve the quality of his residents' training. Our conversations were numerous, but one particularly meaningful impact I made didn't require me to make any fancy speeches. My mere presence was enough because it caused people to talk. By April, I had already found out that I would be at the University at Buffalo, the State University of New York for my next half decade of general surgery training. Women pursuing surgery in China is a once in a blue moon phenomenon—essentially unheard of. They were shocked and impressed to find out that I was one of multiple women in my class at the University of Texas Medical School at Houston who matched into a surgical specialty for residency. One circulating nurse rushed home that evening to share the news with her daughter. It was mind-boggling to see the people around me attempt to grasp the concept of a woman not only pursuing surgery but also having that accepted as normal within society. I could see the beginnings of a paradigm shift taking place in many of their minds.
There are so many more remarks I can make about my experience abroad. The 60-70% 5-year survival rate for patients diagnosed with resectable gastric adenocarcinoma at Huangdao Hospital compared to the dismal 30% in the US. The occasional traveler or expatriate who spoke English. The sick patient who still appreciated whatever counseling I provided in my broken Mandarin. The Chinese government's firewall of social media platforms like Blogger, Wordpress, Facebook, Youtube, and Twitter that allow real-time communication to take place, now so heartily embraced by our surgical community. The pay-for-service approach. The paternalism. The around-the-clock walk-in clinic. The heavy reliance on radiographic imaging. The lack of tort reform or Good Samaritan laws. The lateral rigidity in career transfer. The integral role played by family in the perioperative management of patients. There are some aspects of surgery in China that have my utmost admiration, others nothing but frustration. But that goes for most things in life.
 |
| Here I am checking up on my patient. No identifying features of the patient are shown out of respect for the patient’s privacy |
I would never have had this opportunity without the mentorship and sponsorship of Dr. Anil Kulkarni, whose recommendation of me to his friend and former colleague paved the way for me to establish my own special project to rotate in China. Dr. Yun Lu, the Chair of Surgery at the Affiliated Hospital of Qingdao University, Huangdao Branch has invited me to return, and I definitely plan to take him up on his offer. Eventually I would like to bring other students along with me to show them how amazing of a profession surgery is, and what a comfort it is to know how quickly and easily it can be for a surgeon or aspiring surgeon to feel at home in any country simply by walking into an operating room.
 | |||
| An aerial view of Qingdao (picture source) |
Have you ever completed a surgical rotation in a country different from your own? If so, what was that experience like? Share in the comments below.
~~~
Tuesday, April 8, 2014
Failure
by Mary Brandt, MD
Dear Dr. Brandt,
I enjoy your blog very much. As a second year medical student, I know that my peers and I all struggle with what we view as ‘failure’ at some point or another. I imagine this problem doesn’t stop (…ever), especially since medicine seems to attract people who hold themselves to extremely high, if not impossible, standards. If you’re looking for topics, I wonder if you might have some insight to offer on how to deal with the downfalls along the way.
Dear Colleague,
It is part of our profession that we will never stop trying to be perfect and – just as true – that we will always fall short. As a student, it tends to be about the tests you are taking and the feeling that you will never study enough. As a resident, it’s the feeling that you don’t know enough to make the decisions you are being asked to make. As a practicing physician, you will at times stay awake at night worrying about your decisions, even when you know you did the best you could. All of this sounds like a huge downside to the profession we’ve chosen, but it’s actually a blessing. One of the core personality traits of physicians is that they care. In a way, all of the stress about not doing well enough happens only because you have empathy and compassion for your patients.
Although it’s hard to believe at the beginning, with time you will realize that the feeling of having “failed” is actually a gift. You’ll discover that “mistakes” and, more importantly, “near misses” become your most valuable teachers. What’s important is that you grasp the opportunity to learn from falling short, rather than beating yourself up. “Failing” at a task (or test) is different than being a “failure.” When you have moments you feel you could have done better, use it as motivation to study a little more, go back to the textbook, look up one more article, or review all the facts again. William Osler, in his famous book to medical students (Osler’s Aequanimitas) talked about keeping a journal of mistakes: “Begin early to make a threefold category – clear cases, doubtful cases, mistakes. And learn to play the game fair, no self-deception, no shrinking from the truth… It is only by getting your cases grouped in this way that you can make any real progress in your post-collegiate education; only in this way can you gain wisdom with experience. “
So, to answer your question about how to deal with the downfalls along the way - Start by revisiting your motivation. Remember why you started down this path in the first place. If you are trying your best to do the right thing, and are humble about the fact that you are human (and will therefore fall short) you can end every day with satisfaction and a sense of accomplishment. That being said, make sure that you work with focus – that when you study or work it is with dedication to the patients and families who are trusting you with some of the most precious decisions of their life. When you fall short, use it as motivation to learn. But, in this process, make sure you are taking care of yourself by taking time for good nutrition, exercise, social interactions and spiritual growth. The worst thing you can do when you feel inadequate is to just work more and more. This leads inevitably to compassion fatigue, which makes you less effective (and will make you suffer). Compassion fatigue is a common diagnosis for care-givers; it happens to every medical student, resident or physician at some point in time. Just like any other diagnosis, the next step is treatment. In a nutshell, the treatment is self-care. Here are few sites that can help you with tips to prevent and treat compassion fatigue:
Top 12 Self-Care tips
Preventing Compassion Fatigue
Do’s and Don’ts of Compassion fatigue
This post originally appeared November 13, 2010 on Dr. Brandt's website Wellness Rounds
Dear Dr. Brandt,
I enjoy your blog very much. As a second year medical student, I know that my peers and I all struggle with what we view as ‘failure’ at some point or another. I imagine this problem doesn’t stop (…ever), especially since medicine seems to attract people who hold themselves to extremely high, if not impossible, standards. If you’re looking for topics, I wonder if you might have some insight to offer on how to deal with the downfalls along the way.
Dear Colleague,
It is part of our profession that we will never stop trying to be perfect and – just as true – that we will always fall short. As a student, it tends to be about the tests you are taking and the feeling that you will never study enough. As a resident, it’s the feeling that you don’t know enough to make the decisions you are being asked to make. As a practicing physician, you will at times stay awake at night worrying about your decisions, even when you know you did the best you could. All of this sounds like a huge downside to the profession we’ve chosen, but it’s actually a blessing. One of the core personality traits of physicians is that they care. In a way, all of the stress about not doing well enough happens only because you have empathy and compassion for your patients.
Although it’s hard to believe at the beginning, with time you will realize that the feeling of having “failed” is actually a gift. You’ll discover that “mistakes” and, more importantly, “near misses” become your most valuable teachers. What’s important is that you grasp the opportunity to learn from falling short, rather than beating yourself up. “Failing” at a task (or test) is different than being a “failure.” When you have moments you feel you could have done better, use it as motivation to study a little more, go back to the textbook, look up one more article, or review all the facts again. William Osler, in his famous book to medical students (Osler’s Aequanimitas) talked about keeping a journal of mistakes: “Begin early to make a threefold category – clear cases, doubtful cases, mistakes. And learn to play the game fair, no self-deception, no shrinking from the truth… It is only by getting your cases grouped in this way that you can make any real progress in your post-collegiate education; only in this way can you gain wisdom with experience. “
So, to answer your question about how to deal with the downfalls along the way - Start by revisiting your motivation. Remember why you started down this path in the first place. If you are trying your best to do the right thing, and are humble about the fact that you are human (and will therefore fall short) you can end every day with satisfaction and a sense of accomplishment. That being said, make sure that you work with focus – that when you study or work it is with dedication to the patients and families who are trusting you with some of the most precious decisions of their life. When you fall short, use it as motivation to learn. But, in this process, make sure you are taking care of yourself by taking time for good nutrition, exercise, social interactions and spiritual growth. The worst thing you can do when you feel inadequate is to just work more and more. This leads inevitably to compassion fatigue, which makes you less effective (and will make you suffer). Compassion fatigue is a common diagnosis for care-givers; it happens to every medical student, resident or physician at some point in time. Just like any other diagnosis, the next step is treatment. In a nutshell, the treatment is self-care. Here are few sites that can help you with tips to prevent and treat compassion fatigue:
Top 12 Self-Care tips
Preventing Compassion Fatigue
Do’s and Don’ts of Compassion fatigue
This post originally appeared November 13, 2010 on Dr. Brandt's website Wellness Rounds
~~~
Mary L. Brandt, M.D. is a professor of Surgery, Pediatrics, and
Medical Ethics at Baylor College of Medicine and a practicing pediatric
surgeon at Texas Children’s Hospital. She is involved in education on a
day-to-day basis in her clinical work. She also thinks about medical
education on a bigger scale through her work as Vice Chair of Education
of the Michael E. DeBakey Department of Surgery and Associate Dean of
Student Affairs at Baylor College of Medicine. She actively blogs and tweets.
Friday, March 28, 2014
"You've matched to a Preliminary position."
by Brittany Bankhead-Kendall, M.D, M.Sc.
Every medical student looks forward to "Match Day." Even non-medical people know what this "match day" is . . . . they hear about it from us, read it on our Facebook posts, and see our blogs about it. We're obsessed with it. What happens, though, when "match day" isn't all you hoped and dreamed it would be?
As I've written before, my husband and I tried to couple's match our fourth year in medical school and were unsuccessful. He obtained a residency position outside the match, and I matched to a preliminary position.
To any hopeful medical student, matching a preliminary position is bittersweet. It's devastating that no one "wanted" you long term. It's frustrating because you will, quite literally, be starting the match all over again in a few months time. And mostly, for me, you will go for another year of your life in a large amount of debt, after thousands of hours of very hard work, with an insane amount of knowledge... and no career to show for it. None. Nothing. Just a degree that says "M.D." but that you could never actually DO anything with. I, too, was devastated.
But instead of drowning in my devastation, I chose joy:
Joy that I matched at all. Thousands of hopeful medical students don't
match each year and are forced into non-clinical jobs that they did not
really aspire to. I also found joy in matching to a preliminary position
in my field of choice; I was very happy to be a surgical preliminary
resident.
I chose to use my preliminary year as a gift to see if
surgery was really what I wanted to do for the rest of my life. What an
amazing thing! How many of our colleagues actually get to "try out"
their chosen profession for a year, with no strings attached, to see if
it is something that they really like? As a medical student, you have
6-12 weeks of watching residents do what you THINK you want to do, and
deciding to make a career of it. I was able to walk the walk and talk
the talk (and work the work :) ) to decide if this was really what I
wanted to do.
When I matched to a preliminary position I communicated
to my new chief residents that I wanted to be thrown into the very most
difficult rotations (busiest, hardest, longest hours, however they
wanted to take that request) at the beginning of my year- in July and
August. This would give me an up front, real time, on the front lines
view of General Surgery, as well as expose me to the most intense months
that I would be encountering. For me, these months were very busy and
very overwhelming at first, but I was absolutely positive at the end of
it that I was supposed to be here, and I was supposed to be doing
surgery.
Letters of recommendation are very important in your
preliminary year, they are basically the only thing that will have
changed between last year and this year's application. You should have
the maturity and the responsibility to seek these early and form
relationships with faculty that allow them to easily communicate how
dedicated and just how good you actually are at what you do. I love my
job, and that was evident to my attendings. Also important: having an
answer to "So what happened last year?" I was asked this on almost every
interview I went on. Be prepared for being offered about half the
number of interviews you were intially offered your fourth year of
medical school. Save up money on your small resident's salary for
interviews. Talk to your program director early about expectations for
vacation time to be able to travel for interviews. Be nice to your
co-interns because they will have to cover your call now while you
travel. You are no longer enjoying a lax 4th year as you travel, you are
in the thick of intern year and you will be tired. I can almost
guarantee that at one point during interview season, you will walk off a
night call and walk straight on to a plane. The next day you will need
to look as fresh and excited as those chilled out fourth years who are
interviewing around you.
The absolute best part about interviewing for a
categorical position as a preliminary intern: I knew my stuff. I know
what to do, and am not frazzled, when a trauma comes in to the Emergency
Department and starts decompensating right in front of me... because
I've done it. I walked into every interview with complete confidence
that this was going to be my career, 100%, and I was going to be VERY
good at it... because it's been my job for a year now. I discussed the
parts of being a surgical resident that I love that medical students
don't have a clue about yet... because I'm here when everyone else goes
home.
Match Day 2014 was a success for me. I matched to a categorical position. I've got a career. I'm so, so happy.
If
you matched to a preliminary position this year, keep your head up.
Keep your eyes on the prize. View it as an opportunity to try out a
field in medicine or surgery for a year. Take the high road. Work your
butt off.
You'll have a career soon, too. And it will be everything you'd hoped it would be.
~~~
Brittany Bankhead-Kendall, M.D, M.Sc. is
a PGY1 preliminary general
surgery resident at Methodist Dallas Medical Center in Dallas, Texas and
will be a categorical resident at St. Joseph Mercy Oakland in Pontiac,
Michigan this summer. She obtained her M.D. from
Ross University School of Medicine, M.Sc. from Barry University in
Biomedical
Science, and studied Biomedical Science and Spanish at Texas A&M
University.
She enjoys being a surgical intern and mentoring medical students. In
her
personal time she enjoys spending time with her husband and son,
interior
design, international travel, and Texas Aggie football.
Thursday, March 20, 2014
A Recipe for Success: One Surgeon's Story
by Minerva Romero Arenas, MD, MPH
There are two questions that students frequently ask me about becoming a doctor. One is, “What did you do to become a doctor?” and “How did you stay motivated?” I often tell students attending the Tour 4 Diversity in Medicine (T4D) that becoming a doctor is like running a marathon. The pathway to medicine is long and challenging; I jumped through a lot of “hoops” (prerequisite courses, examinations, extracurricular activities, letters of recommendation, interviewing, etc.) just to get to medical school. At this point, I swear if their eyes get any wider they will come out of their socket. Then I tell them about the time I have spent in residency, research, and fellowships – and overwhelming is probably a gross understatement.
There are many factors that contribute to a person’s success – especially the success of a doctor. In my own personal path, I credit my success to at least four essential factors.
My family has been one of the main sources of strength and motivation. Like many immigrant families, we moved to the United States to pursue the American Dream. I was 8 years old when we moved, but since that young age I knew that my family (yes, I mean my parents, tías and tíos and abuelita) wanted better opportunities for our family. While my family never pushed me to be anything in particular, they always supported and encouraged me to pursue higher education – an opportunity they did not have. When a situation challenges me, I think back to how fortunate I am to have a loving and supportive family and any doubt is erased from my mind.
I also credit my mentors – yes, more than one – with a large part of helping me succeed. Some of them were professors who helped me stay on track and grow academically. Others were instrumental in helping me develop leadership and life skills. Yet others were research mentors or clinical mentors who helped figure out my interest in these fields. Even now as I am in my surgical training, I continue to keep in touch with some of these mentors and have even gained new mentors who are helping me grow and develop as a surgeon-in-training and future leader in healthcare.
I also found motivation in programs that helped me remember why I wanted to be a doctor. In college it was when I worked in certain clinics or doctors. In medical school, student-run clinics, organizations that connected me with other students and doctors who shared similar backgrounds or interests such as ending health disparities. In fact, even now that I have become a doctor and am completing my surgical training I still find it refreshing to remember why I chose this career in the first place. This is part of the reason I joined Tour 4 Diversity in Medicine. Talking to students about my love of surgery, or helping patients, or my research – it always help make me feel more
motivated.
Lastly, I tell students the most important factor in achieving success is the one that nobody else can help you with: hard work. There have been many people who have provided guidance, support, and opportunities that helped me achieve my dream of becoming a doctor. However, I know that my own effort helped me earn the respect and time of my mentors and make the most of the opportunities that were provided. Most importantly it has given me a source of pride and confidence that will continue to make me a successful person and surgeon.
This article was originally posted on February 5, 2014 on the Tour 4 Diversity website under the title "#T4DWest Day 2: A Recipe for Success – One Surgeon’s Story"
There are two questions that students frequently ask me about becoming a doctor. One is, “What did you do to become a doctor?” and “How did you stay motivated?” I often tell students attending the Tour 4 Diversity in Medicine (T4D) that becoming a doctor is like running a marathon. The pathway to medicine is long and challenging; I jumped through a lot of “hoops” (prerequisite courses, examinations, extracurricular activities, letters of recommendation, interviewing, etc.) just to get to medical school. At this point, I swear if their eyes get any wider they will come out of their socket. Then I tell them about the time I have spent in residency, research, and fellowships – and overwhelming is probably a gross understatement.There are many factors that contribute to a person’s success – especially the success of a doctor. In my own personal path, I credit my success to at least four essential factors.
My family has been one of the main sources of strength and motivation. Like many immigrant families, we moved to the United States to pursue the American Dream. I was 8 years old when we moved, but since that young age I knew that my family (yes, I mean my parents, tías and tíos and abuelita) wanted better opportunities for our family. While my family never pushed me to be anything in particular, they always supported and encouraged me to pursue higher education – an opportunity they did not have. When a situation challenges me, I think back to how fortunate I am to have a loving and supportive family and any doubt is erased from my mind.
I also credit my mentors – yes, more than one – with a large part of helping me succeed. Some of them were professors who helped me stay on track and grow academically. Others were instrumental in helping me develop leadership and life skills. Yet others were research mentors or clinical mentors who helped figure out my interest in these fields. Even now as I am in my surgical training, I continue to keep in touch with some of these mentors and have even gained new mentors who are helping me grow and develop as a surgeon-in-training and future leader in healthcare.
I also found motivation in programs that helped me remember why I wanted to be a doctor. In college it was when I worked in certain clinics or doctors. In medical school, student-run clinics, organizations that connected me with other students and doctors who shared similar backgrounds or interests such as ending health disparities. In fact, even now that I have become a doctor and am completing my surgical training I still find it refreshing to remember why I chose this career in the first place. This is part of the reason I joined Tour 4 Diversity in Medicine. Talking to students about my love of surgery, or helping patients, or my research – it always help make me feel more
motivated. Lastly, I tell students the most important factor in achieving success is the one that nobody else can help you with: hard work. There have been many people who have provided guidance, support, and opportunities that helped me achieve my dream of becoming a doctor. However, I know that my own effort helped me earn the respect and time of my mentors and make the most of the opportunities that were provided. Most importantly it has given me a source of pride and confidence that will continue to make me a successful person and surgeon.
This article was originally posted on February 5, 2014 on the Tour 4 Diversity website under the title "#T4DWest Day 2: A Recipe for Success – One Surgeon’s Story"
~~~
Dr. Minerva Romero Arenas is a general surgery resident at Sinai Hospital of
Baltimore and is completing a research fellowship at The University of Texas MD
Anderson Cancer Center in Houston, TX. She obtained her MD and MPH from The
University of Arizona, and studied Cellular Biology & French at Arizona
State University. She is also involved in mentoring and public policy. On her
personal time she enjoys spending time with friends and family, especially when
it involves good food.
Thursday, 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.
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.”
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.
~~~
Monday, December 2, 2013
Interview with Dr. Julie A. Freischlag
by Bharti Jasra, MD
That little girl grew up to be the great vascular surgeon whom we know as Dr. Julie A. Freischlag. She is an internationally renowned expert in thoracic outlet syndrome. She became the first woman director of the Department of Surgery at Johns Hopkins in its 110 year history. She served as President of the Society of Vascular Surgery from 2012 to 2013. In 2012 she was elected Chair of the Board of Regents of the American College of Surgeons. In addition, she has held leadership positions in many leading surgical societies and serves on the editorial board of several surgical journals. In February 2014 she will join the University of California, Davis as Vice Chancellor for Human Health Sciences and Dean of the UC Davis School of Medicine.
I had the opportunity to interview this great leader and ask a few questions that I thought might benefit our Association of Women Surgeons members.
Q: What role did AWS play in your career?
A: I was one of the first few resident members of AWS. It was really nice at that time to know that there were other women in the surgical community that I could look up to for guidance. Also in early years of my career it helped me as a forum for networking. It was at AWS meetings that I met Dr. Patricia Numann for the first time, and we became good friends in the next 20 years.
Q: Do administrative positions adversely affect clinical duties?
A: I spend 60% of my time in departmental work and whereas only 40% in teaching and clinical duties. As a department chair one has to work for the department and not just for yourself.
Q: Is it essential to have additional degrees like an MBA to hold a leadership position?
A: It is not required to have additional degree but there are several leadership courses offered by ACS and AAMC which could be useful. I myself benefited from the ELAM course and highly recommend it.
Q: Do you think that you had a different set of challenges being a woman?
A: It's quite lonely up there at that level since there are not many of you. Women are underrepresented not just in medical community but in legal and business communities as well. It's easy to get noticed since there are not many of you at that level. At the same time it gives you a unique opportunity to represent interests of an underrepresented class and most effective use of this opportunity is essential.
Q: Do you wish you had more time to spend with your family?
A: I am blessed with a caring husband and loving children. As surgeons we like to stay busy and I have no regrets as I have been able to find time for my family for the most part. I try to go to my son's sporting events and recitals. Also I try to limit my travel for work as much as possible.
Dr. Fresichlag with her son and husband during Parents Day at the University of Maryland
Q: What is the key to happiness?
A: Staying in touch with yourself and your family is the key to happiness.
Q: What do you do to rejuvenate after work?
A: I am a swimmer and use the pool in our backyard. Also I walk try to walk few miles a day.
Q: What is your opinion on infertility among women in surgery?
A: I believe it has been a problem, but we are heading toward better times. My own residents now are having kids during residency, and it’s only going to get better in the future.
Dr. Freischlag with her family at the Ravens-Packers game
Q: What challenges do you foresee in this new leadership role at UC Davis?
A: I am very excited to learn more about something other than surgery, especially healthcare delivery and medical education among the Hispanic population.
Q: Any message for AWS members?
A: We are very lucky to be surgeons, and we should enjoy every part of it at all levels, whether we are residents or in practice.
~~~
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!
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.
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.
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.
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