education
The Dickey Amendment: Low-Hanging Fruit
In the wake of the mass shooting at Marjory Stoneman Douglas High School in February, the national discussion about gun violence has been reignited as evidenced by the subsequent student-led protests and recent March for Our Lives last week. While mass shootings are dreadful and headline-grabbing, they are responsible for just a tiny fraction of the 39,000 firearm fatalities that occur annually in this country. As surgeons we are all too familiar with the endemic nature of gun-related injuries and deaths -- suicides, homicides attempted in the name of gang warfare or drug turf battles, “drive-by” shootings, domestic violence, as well as all manner of accidental shootings -- are all dispiritingly prevalent in our trauma centers. A number of surgeons are taking a hard look at what can be done to stem the epidemic of gun violence in our communities and across the country. Thoughtful people honestly disagree as to...
Difficult Conversations
I’m a trauma and critical care surgeon. I deliver bad news. It’s not one of the perks of the job, but it’s one of the very important parts of my job. I have seen it all. The full spectrum of emotions: shock, sadness, terror, fear, rage. You name it, I’ve seen it. I say this because I thought I understood it….the emotions, the feelings my patients’ family members have when I deliver bad news. I’ve been less than gracious in my mind when I see families “falling out” at the shock and horror of losing a loved one. Everything changed September 2, 2011. I will never forget the phone call from my brother-in-law. As I raced to the hospital across town from mine, I cried. Something was seriously wrong with my sister. My car literally ran out of gas before I could park in the emergency lot (yes, I’m one...
A Surgeon’s Scope of Practice
For the 18th year, March has been dedicated to Colorectal Cancer Awareness. Since the mid-2000’s, we have seen a rapid decline in the incidence of colorectal cancer, mainly due to the early detection and removal of polyps during colonoscopy, and an increase in screening. However, the disease will still affect 1 in 22 males, and 1 in 24 females during their lifetime. At a time when colorectal screening is of utmost importance, there remains competition for which providers perform the endoscopy: the surgeon or gastroenterologist? As a General Surgeon, endoscopy is an integral part of my practice. Endoscopy is a field that was developed by surgeons. I believe we possess an advantage over other endoscopists since we routinely visualize the colon anatomy during surgery. During abdominal surgery, we are allowed the opportunity to see variations in anatomy, like colon length, redundancy of the sigmoid or transverse colon, the angles of...
Defining the Resident Role in the Operating Room
In recent years, expectations and requirements for attending supervision of residents in the operating room has increased. This has led to ambiguity for both residents and attendings as to how and when operative autonomy is earned, appropriate, and safe. Another area of uncertainty is when, how, and by whom the resident’s role should be described and explained to the patient. Research in thoracic surgery by Meyerson et al. showed that while trainees’ and attendings’ expectations of resident autonomy did not differ, both groups expected higher levels of autonomy than were observed. The January #AWSchat will explore these issues through facilitated questions led by three distinguished moderators: Dr. Shari Meyerson (@lungteacher), thoracic surgeon and Program Director for the General and Thoracic Surgery Residency Programs at Northwestern, Feinberg School of Medicine Dr. Nell Maloney Patel (@MaloneyNell), AWS member, colorectal surgeon, and General Surgery Residency Program Director at Rutgers Robert Wood Johnson Medical...
Thyroid Cancer Awareness
In my training as a surgical oncologist, I certainly performed my share of thyroidectomies and node excisions for thyroid cancer. My practice quickly focused on breast cancer once in academic practice, given the demand in the community. Yet, my patients will report thyroid cancer frequently enough that I felt I should revisit this topic, to fill in the details of our growing knowledge. We should all be aware of this cancer. Not only is it the fifth most common cancer, it affects three times as many women as men! Only 2% of the cases will occur in children or adolescents. In adulthood, women present usually in their 40’s or 50’s, whereas men will present later, in their 60’s or 70’s. There can be a hereditary component; RET gene mutations are associated with the development of medullary cancer of the thyroid, which may be part of familial medullary thyroid cancer (FMTC)...
Clean Hands Deserve Two Thumbs Up
The Hungarian obstetrician and a father of modern antiseptic techniques, Ignaz Semmelweis, risked his reputation when he took to stage at the Vienna Medical Society’s meeting on May 15, 1850. He was beseeching his colleagues to participate in a simple but a provably effective method of diminishing disease transmission: hand washing. The rates of puerperal fevers on wards covered by medical students, whose morning autopsies on women who died from the fever preceded examinations on the day's laboring women, far outnumbered the rates on wards monitored by midwives, whose responsibilities did not include autopsies. Semmelweis attributed rates of the former group to poor hand hygiene. Ever the scientist-at-heart, he implemented a protocol whereby students and physicians washed their hands with a chlorinated lime solution after dissection. The results were groundbreaking: mortality rates of mothers seen on those wards covered by students and junior physicians plunged. Despite the evidence, Semmelweis’s conclusions...
Prioritizing Palliative Care in Surgical Management
During my third year rotation, I experienced the terror of an anastomotic leak. This patient had previously had a resection of his colon cancer and had undergone chemotherapy. Three weeks later, he was coming in with respiratory distress and was urgently taken to the operating room for an anastomotic leak. The surgery was done in two parts. The edematous bowel, of which some was resected, did not allow for a complete closure of his abdomen. Having never seen a Bogota bag before, I watched in amazement as we took him back to the ICU, sedated. The next day, the procedure was completed, his abdomen closed. He remained in the surgical ICU for weeks, receiving treatment for complications that seemed to change every day. He remained on the service after I left my rotation, and months later, I saw that he had passed. Throughout his postoperative recovery, I had gotten to...
The Ideal Team Player
By Jean Miner, MD In all aspects of our lives, we are members of a “team”. We are members of our family “team” first and then head to school at a young age and are paired off on the playground. Many of us joined teams throughout our lives for sports, debate, math, dance, etc… As we get older, we start to value the importance of teamwork to accomplish goals or projects. Think about the college chemistry lab partners or the members of a committee who helped (or hindered) meet deadlines or complete tasks. As surgeons, we are always members of a team- in the operating room, clinic, and patient wards. Ultimately, in life we belong to numerous teams.Recently, the members of the AWS Clinical Practice Committee (CPC) held a book club discussion using The Ideal Team Player by Patrick Lencioni. Our lively discussion quickly turned into a focus on leadership...
Implicit Bias
By Doreen Agnese, MD As the deadline approaches for this blog, I again wonder what topic will be interesting to discuss. I try to gather inspiration from prior blog posts, and as I scroll through the list of recent blogs, the one thing that I notice most acutely is how much older I am than all of the other contributors. Maybe this blogging is a young person’s game….but as I sit here thinking about what to say, I see a reminder about surgical grand rounds this week. The topic this week is “Unconscious Bias in Healthcare—A Primer and Strategies to Reduce the Impact of Unconscious Bias.” Included in the announcement is a link to the implicit association test, a well-validated web-based test to determine unconscious associations or preferences (https://implicit.harvard.edu/implicit/). I realize that we have come a long way with respect to explicit bias since I was a trainee, but women...
So you want to be a Surgeon in the United States? 6 Tips to Succeed as an International Medical Graduate (IMG)
By Sristi Sharma Congratulations! Your ambition of becoming a surgeon in the United States has finally brought you to this country. You have left your family, your life and everything behind to train in an environment that is completely new to you. You know that you have a steep learning curve ahead of you-be it clinical, personal or social. So how do you navigate this new phase of your career? There are unique challenges that come with being an IMG in the States. Here are 6 tips that will help you become the best surgical trainee you can be: Be good…no excellent…at what you do! Know your subject inside out and practice your surgical skills . Challenge yourself to learn more everyday. There is no substitute for hard work, and as a foreign medical graduate you will have to work even harder to prove yourself everyday. Learn the system: Do...
